___________________________________________________________ Asthma: Diagnosis and Management
Outdoor Pollution The verdict regarding the effects of outdoor pollution on the condition of asthma remains controversial. Consider two main types of outdoor pollution: industrial smog (such as sulfur dioxide) and photochemical smog (a combination of ozone and nitrogen oxides). Physicians and scientists are cautious about implicating these and other environmental pollutants as asthma triggers. But the findings of several studies confirm a relationship between pollutants and asthma, particularly when nitrogen oxide, acid aerosols, and ozone are involved [8; 47; 48]. Air pollution plays a variety of roles in asthma and allergy. Some pollutants irritate the nose, airways, and/or skin, mak- ing them more sensitive to allergens. Specifically, ozone can increase the effects of allergens and may take 4 to 24 hours to produce its effects on the lungs and airways. Such pollutants can worsen existing asthma symptoms and may even promote development of allergies and/or asthma, particularly in chil- dren, whose airway membranes are more permeable. Other chemical pollutants may affect the immune system directly, which would tend to increase any existing tendency to allergic reactions [8; 47; 48]. In many regions, air quality is also reported. A government- backed program, AIRNow, is available online to monitor the air quality in various areas around the United States [49]. This information can be used to determine when indoor activities should be encouraged. Local air quality monitoring services may also be available. Tobacco Smoke One of the worst irritants in indoor air, and perhaps the most obvious, is tobacco smoke. Cigarette, cigar, or pipe smoke can trigger asthma attacks in the short term and generally worsen asthma symptoms in the long term. Passive, or second-hand, smoking may also adversely affect the immune system. Smok- ing should not be permitted around a patient with asthma or in rooms an individual with asthma uses. Patients who smoke should be advised to stop smoking. Patients should also be advised of the many techniques available to assist in smoking cessation, including the various nicotine replacement agents [8; 47; 48]. Smoking during pregnancy significantly increases the risk of the infant developing allergies and asthma. In addition, research also reveals that, for those who had asthma as children for whom symptoms have resolved, cigarette smoking greatly increases the chance of the asthma returning. Generally, pediatric patients with asthma who have one or more parents who smoke indoors tend to have more severe and frequent asthma symptoms. It has been found that teenagers can be just as affected by passive smoking as young children [8; 50]. Smoking has many distressing effects on patient health, and smoking cessation should be integrated into all care plans and general assessments.
Irritants are nonspecific; in fact, irritants affect every person, if sufficiently concentrated, causing bronchospasm and aggra- vating the airway lining. These irritants include, but are not limited to smoke, some industrial fumes, ozone, sulfur dioxide, insecticides, air freshener, perfumes, and other aerosols. At levels usually encountered, irritants do not adversely affect most individuals. Patients with asthma, however, can have dramatic responses to exposure to some or most irritants due to the chronic inflammation of their airways and their hyper- responsive system [13; 47]. For these patients, an allergy test would reveal no specific allergies. There are many different types of triggers; some act in isolation, and others work together. The severity of an asthma attack depends upon the number of irritants, allergens, or other stimuli in the environment and the degree of lung sensitivity to these triggers [13; 47]. The following information regarding specific asthmagens and how they may be effectively avoided may be constructive to the patient education process. Pollen Pollen is likely the most difficult allergen to avoid. To a great degree, this is because pollen release occurs at different times of day for different plants. For example, most grasses release pollen from about 7:30 a.m. throughout the day; however, if the ground is damp, the release will be delayed until the moisture has evaporated. A few species of grass and other plants delay pollen release until afternoon hours, so pollen may be entering the air all day. All types of plants generally favor warm, sunny days for releasing pollen and avoid rainy, wet weather. Rain also washes residual pollen out of the air. So, days of rain may be a relief to pollen-sensitive individuals with asthma. However, on cloudy and/or wetter days, there is a pollen buildup, which results in a massive release of pollen on the next day of good weather. These pollen release patterns may correspond with incidences of asthma symptoms in sensi- tive patients [8; 47; 48]. For certain patients with asthma, it may be useful to realize that pollen settles quickly in rural areas, reaching ground level between 8:00 p.m. and 10:00 p.m. In the city, hot pavements and buildings keep upward air currents going and pollen stays aloft longer. As most pollen lands in the city between roughly midnight and 2:00 a.m., it may contribute to night-time symp- tom aggravation in urban patients with asthma. If a patient with asthma has a noticeable response to a specific type of pollen, staying indoors or avoiding heavily wooded areas at release times may help alleviate symptoms. A daily pollution index figure should be available from a regional office of your state’s Department of Environmental Conservation [8; 47; 48]. Many local and online weather stations include pollen counts in their daily reports as well.
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