What Triggers an Asthma Attack?

When a person has asthma, attacks can seem to come out of nowhere. One minute you're feeling fine, the next you're wheezing and gasping for breath. If you look closely, however, there's always a reason for the attack.

If you have asthma, your airways are inflamed, which makes them ultrasensitive. Inflammation can cause airways to swell, hampering your breathing. More often than not, your asthma will be more noticeable when something additional disturbs your airways, which are already inflamed.

Unfortunately, triggers -- agents that bring on an attack -- are all around. Many different things, from viruses and dust mites to exercise and emotional distress, can set off an asthma attack. Even bacterial lung infections can trigger asthma attacks in children. Every case is different, however, and something that causes wheezing in one person may be completely harmless to another. Understanding your personal triggers is a crucial first step toward controlling your disease.

Here's a look at the most common causes of asthma attacks.

Allergies

Many people with asthma also have allergies to pollen, dust mites, or other things in the air. When they inhale one of these offenders, the allergic reaction can set off an asthma attack. In fact, allergies are the most common cause of asthma attacks in teenagers and children over age two.

Some typical causes of allergy-related asthma attacks:

• Dander (tiny flakes of skin), urine, and feces of pets such as cats, dogs, guinea pigs, and birds
• Dust mites, microscopic animals that often live on mattresses, pillows, and sheets
• Molds and fungus, especially in warm, humid areas
• Pollen from grass, weeds, and trees
• Allergies to foods such as eggs, milk, peanuts, soy, wheat, fish, and shellfish

Irritants

Many things can irritate the lining of your airways and set off an attack. One of the worst offenders is tobacco smoke. For instance, children with asthma who live in smoke-filled homes have more episodes of wheezing, need more medications, and take more trips to the emergency room than other asthma patients their age.

Other common irritants:

• Smoke from wood-burning stoves
• Air pollution such as smog
• Strong odors from hot grease or from products such as polishes, perfumes, room deodorizers, household cleaners, and hair sprays
• Cold air
• Changes in temperature and humidity
• On-the-job exposure to gases, fumes, and allergy-causing substances
• Airborne particles such talcum powder and coal dust
• Sulfites used to preserve dried fruits and vegetables or wines

In fact, alcoholic drinks may be a more common trigger among adults than doctors realize. A recent Asthma UK survey of nearly 700 people with asthma found that two-thirds of them reported wheezing after having a drink, one-half suffered shortness of breath and chest tightness, and one in four reported having an asthma attack after drinking. The number one culprint was red wine, followed by white wine, beer, and hard cider.

Illness and infections

A cold or flu virus that invades the airways can easily trigger an asthma attack. Respiratory viruses are the most common cause of asthma attacks in senior citizens and in children under two. Other illnesses that can cause attacks include sinusitis and heartburn (reflux disease).

Medications

Aspirin and other nonsteroidal anti-inflammatory drugs such as ibuprofen can bring on asthma symptoms in some people, especially patients in their 30s who also have nasal polyps. Beta blockers, found in drugs prescribed to lower blood pressure and glaucoma drops, have also been linked to attacks in some people.

Trauma and emotions

Strong feelings of anxiety or depression can trigger asthma attacks and make the disease more difficult to manage. "Whenever I see patients who are having severe attacks, I always ask them 'What's gone wrong [in their emotional lives]?'" says H. James Wedner, chief of allergy and immunology at Washington University School of Medicine in St. Louis.

Emotional distress may trigger attacks by disrupting the normal balance of hormones and brain chemicals. Depression and anxiety can also weaken the immune system, making a person more vulnerable to colds, flu, and other infections that can open the door for asthma. Conversely, treating the depression or emotional distress may ease symptoms of asthma. Interestingly, strong fits of laughter can also trigger asthma symptoms in some individuals.

Exercise

Surprisingly, a good workout -- especially a workout in cold, dry air -- is one of the surest ways to trigger an attack. In fact, many people have "exercise-induced asthma," which means they have asthma only when they exercise. Even people with persistent or constant asthma may notice breathing problems primarily when they exercise.

However, this is no reason to stop exercising. With a few precautions, such as keeping an inhaler within reach at all times, practically anyone with asthma can enjoy their sport or activity of choice.

Further Resources

American Academy of Allergy, Asthma, and Immunology 800-822-ASMA http://www.aaaai.org

American College of Allergy, Asthma, and Immunology 800-842-7777 http://allergy.mcg.edu

American Lung Association 800-LUNG USA http://www.lungusa.org

Asthma and Allergy Foundation of America 800-7-ASTHMA http://www.aafa.org

References

Red wine is a common asthma trigger, new Asthma UK survey warns. Asthma UK, December 27, 2016. Retrieved from https://www.asthma.org.uk/about/media/news/red-wine-common-asthma-trigger/

Bain EI. Perils in the air. Avoiding occupational asthma triggers in the workplace. Am J Nurs. Jun;100(6):88.

Thoren C, Petermann F. Reviewing asthma and anxiety. Respir Med. May;94(5):409-15.

Togias A. Unique mechanistic features of allergic rhinitis. J Allergy Clin Immunol. Jun;105(6 Pt 2):S599-604.

Bacteria to blame for asthma attacks in children, research suggests. Science Daily, October 7, 2010.