September and October are the months when asthma patients in Colorado must begin their preparations for the “worst” part of their year. This is the time period when the “Perfect Storm” of factors can occur, making asthmatic lungs tighten and ruining the beauty of Fall in Colorado for their owners. Some with severe disease can’t attend their children’s outdoor games in cold weather; their own participation is out of the question. Likewise hunting, hiking, camping… What can we do to help?

A quick refresher

Asthma is a chronic disease, often lasting for life. Its exacerbations feature acute broncho-constriction, followed by secretion of mucus in the lungs—a classic inflammatory response. The chronic nature of the disease leads to airway remodeling over time, making sub-sequent exacerbations more serious and life-threatening. Opening the airways with bronchodilators can prevent or reverse the bronchoconstriction. Anti-inflammatory inhaled medications can reduce the mucus production and the subsequent airway wall thickening. Some drugs modulate inflam-matory responses. But nothing can cure asthma, yet. It’s our own immune system overplaying its response to environmental triggers. So our best approach is to identify and eliminate triggers the best ways that we can.

Cold air

A scarf wrapped loosely around the face may help [wash it frequently]; breathe through your nose, not your mouth. Pretreat with albuterol before sports or exertion.
Outdoor work and fun—mold spores follow rain, and dry air disperses them. Wear a respirator or face mask designed to filter air [surgical masks-ask at any pharmacy] when working in gardens, hay or crop fields, or just raking leaves off your lawn. Remember, you’re tracking that into your house, too. Launder your work clothes and vacuum your carpets frequently.

Smoke

Wood, coal and gas stoves and fireplaces emit irritants that trigger asthma. Have them serviced before use. Campfires and bonfires are too much fun to avoid: use your albuterol before and during fes-tivities. Try to stay upwind.

Now we are at the beginning of cold and flu season. Respiratory infections from mild rhinitis to influenza are asthma triggers. Gloves, frequent cleaning of household surfaces [dusting, vacuuming, and use of “germ-killing” cleaning products], good hand hygiene and avoiding the sicker kids at school are pretty much the same things our moms did and told us to do back in the day and it’s still good advice. Kids’ exposure to viruses explodes once school starts. Remember, they’ll bring home everything they’re exposed to at school. Flu shots are available now, and there is plenty of evidence that vaccination helps. FluMist, the nasal spray vaccine, is not recommended for asthma patients.

Windows are closing, the doors will be closed most of the time, and the furnace will soon be running. It’s time to put new filters in the furnace. Disposable high efficiency MERV 11 or 12 filters are recommended. Clean carpets and wash pets while it’s still warm enough to get them completely dry. Damp carpets grow mold. So do leaky pipes under sinks, dripping faucets and showers, and toilets. Repairs and intense cleaning are best done now. If black mold has started growing somewhere, get it professionally treated. Once your dwelling is clean, keep it tight during the fall pollen season, while tumbleweeds and thistles are spreading pollen. Remember, asthmatic lungs respond to both irri-tants like smoke, cold air, and exhaust fumes and to allergens like viruses, mold spores, pollen and pet dander. The immune system sees all of these as improper occupants of lung space and works to re-move, engulf, or avoid them.

Asthmatic responses to specific allergenic triggers are unique to each person. Inhala-tion of some pollens may be of little consequence to one person but hospitalize the next. Consulting an allergist to determine which antigens/allergens affect you, and whether desensitization may be possible, is a good idea. Avoidance of known asthma triggers is far better than an ER visit; reducing allergen sensitivity for longterm health improvement is better yet. Meanwhile there are some medications and asthma management strategies that help asthma patients control their disease and avoid exacerbations. Plan your approach to management; write out a plan with your doctor or child’s pediatrician. Communicate that plan with your family, friends, child’s teachers and caretakers. You may save a life!

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