Asthma: Diagnosis and Management ____________________________________________________________
Gases, Chemicals, and Foreign Contacts In addition to tobacco smoke, other air pollutants can irritate the lungs of patients with asthma. Such pollutants can worsen existing allergic symptoms and may promote development of allergies in pediatric patients. Common household soaps, detergents, and cleaners may be very irritating for a patient with asthma; contact with strong odors and sprays should be reduced. The use of natural cleaning products can be helpful; however, even the safest products and thorough cleaning may still leave an environment with airborne pollutants. Other chemical contaminants may affect the immune system directly, which would tend to increase any existing tendency to allergic reactions [8; 47; 48]. Nitrogen Oxide Traffic pollution, most often characterized by the presence of nitrogen oxide, has long been considered a trigger or cause of asthma symptoms; yet, some research reveals the link between traffic pollution and asthma to be, for the most part, tenuous. However, there have been several studies confirming the nega- tive impact of exposure to freeway traffic on lung development in children and on respiratory infections, allergy, and asthma [8; 47; 48]. The exact mechanism responsible for this associa- tion is still being investigated. Cooking with a gas stove generates a significant amount of nitrogen dioxide, the same pollutants emitted from motor- vehicle traffic. But, peak levels of nitrogen dioxide in kitchens with gas stoves are often ten times the average level on city streets, frequently exceeding standards for outdoor air set by the WHO. Other sources of nitrogen dioxide include ciga- rettes, gas fireplaces, and kerosene heaters. If a patient has a nitrogen oxide sensitivity, he or she should be encouraged to use electric stoves and heaters as often as possible and to always use a ventilation fan or open windows when cooking with a natural gas appliance [8; 47; 48]. Formaldehyde Patients with asthma seem to have more frequent symptoms if exposed to high formaldehyde levels. Formaldehyde is com- mon in both gas and liquid forms; the vapors expelled by the compound may irritate the lining of the eyes, nose, and lungs when inhaled. A formaldehyde solution is often used as a preservative in laundry detergents, air fresheners, shampoos, dish soaps, medications, cosmetics, cigarettes, and some pro- cessed foods. Additionally, it may be found in manufacturing plastics, wrinkle-free clothes, and some building materials, such as particle board, plywood, pressed board fiberboard, carpet backing, glues, and foam insulation. The frequent use of form- aldehyde in the production of so many different items makes it a very commonly encountered irritant. Materials that produce formaldehyde should be eliminated from the environment of patients with asthma as much as possible. If a manufactured product contains formaldehyde, it should be noted that the emissions generally decrease as the item ages. Formaldehyde is also created by the combustion of wood and natural gas. Flues
for wood burning fireplaces and stoves must be clear; if smoke can be smelled, there is formaldehyde present in the air. When a natural gas appliance is used, adequate ventilation, preferably with a powered vent, is necessary [8; 48; 51]. Aerosol and Scented Sprays Cleaning products, furniture polish, and even deodorant were never intended to enter the nasal airways, but substances sprayed from aerosols do just that and can trigger asthma attacks. Patients with asthma should be advised to avoid the use of aerosols as much as possible. Additionally, air fresheners and perfumes with strong odors can trigger asthma attacks in sensitive individuals. Avoidance of strong fragrances may help alleviate symptoms [8; 47]. Sulfur Dioxide The FDA estimates that 1 out of every 100 people is sulfite- sensitive and that 5% of those who have asthma are at risk of experiencing an adverse reaction to the substance. Patients with asthma should be aware of instructions and ingredients listed on all usable or edible products. It is important not only to be knowledgeable as to what is in the product but also as to what gases may be given off when used. One such example is sulfur and sulfur dioxide gas. “Sulfuric,” “sulfate,” or “sulfite” in a list of ingredients should serve as a warning for a patient with asthma; the product may give off sulfur dioxide gas [8; 52]. In 1986, the federal government established guidelines for sulfites, and a partial ban on sulfites was enacted for restaurant and market fresh salad bars. Regulations also require labels to indicate if sulfites have been added to prepared products. Many medications and processed foods, including some wines, juices, and shellfish, contain sulfites. Due to the fact that inhaled asthma medications may include sulfur-based preservatives, care should be taken when prescribing or administering medi- cations to patients with sulfite sensitivity [8; 9; 52]. Chlorine For a patient with asthma, bleach and other chlorine-based clean- ing products, such as toilet cleaner and scouring powder, should be used sparingly and with plenty of ventilation. These products release chlorine gas, which, in large amounts, can irritate air passages. Bleach and toilet cleaner should not be mixed with any other products, as chemical reactions may exacerbate the amount of chlorine gas expelled. Patients should be instructed to be careful when using any manufactured good containing hypochlorite, chloramines, ammonia, acids, morpholine, or chemicals used for swimming pool water, as all of these agents have the ability to trigger asthma attacks [8; 47; 48]. Paint The possible harmful effects of paint for people with asthma are mainly due to the presence of solvents; these solvents can act as irritants to nasal air passages. Areas where paint is being used should be well ventilated. Solvent-free, odorless paints are also available and may be useful for patients who are unable to avoid paint fumes as part of their occupation or daily lives [8; 47; 48].
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MDVT1726
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