This information is taken from the revised GINA Report, Global Strategy for Asthma Management and Prevention (2007), available on the Global Initiative for Asthma (GINA) website. Please refer to the full guideline document for more detailed information.
Asthma exacerbations may be caused by a variety of factors, sometimes referred to as “triggers,” including allergens, viral infections, pollutants, and drugs. Reducing a patient’s exposure to some of these categories of risk factors (e.g., smoking cessation, reducing exposure to secondhand smoke, reducing or eliminating exposure to occupational agents known to cause symptoms, and avoiding foods/additives/drugs known to cause symptoms) improves the control of asthma and reduces medication needs. In the case of other factors (e.g., allergens, viral infections and pollutants), measures where possible should be taken to avoid these. Because many asthma patients react to multiple factors that are ubiquitous in the environment, avoiding these factors completely is usually impractical and very limiting to the patient. Thus, medications to maintain asthma control have an important role because patients are often less sensitive to these risk factors when their asthma is under good control.
Other Factors That May Exacerbate Asthma
Rhinitis, sinusitis, and polyposis are frequently associated with asthma and need to be treated. In children, antibiotic treatment of bacterial sinusitis has been shown to reduce the severity of asthma.1 However, sinusitis and asthma may simply coexist. Apart from sinusitis, there is little evidence that bacterial infections exacerbate asthma. Gastroesophageal reflux can exacerbate asthma, especially in children, and asthma sometimes improves when the reflux is corrected.2,3 Many women complain that their asthma is worse at the time of menstruation, and premenstrual exacerbations have been documented4. Similarly, asthma may improve, worsen, or remain unchanged during pregnancy.5
References:
1.Rachelefsky GS, Katz RM, Siegel SC. Chronic sinus disease with associated reactive airway disease in children. Pediatrics 1984;73(4):526-9.
2. Harding SM, Guzzo MR, Richter JE. The prevalence of gastroesophageal reflux in asthma patients without reflux symptoms. Am J Respir Crit Care Med 2000;162(1):34-9.
3. Patterson PE, Harding SM. Gastroesophageal reflux disorders and asthma. Curr Opin Pulm Med 1999;5(1):63-7.
4. Chien S, Mintz S. Pregnancy and menses. In: Weiss EB, Stein M, eds. Bronchial asthma Mechanisms and therapeutics. Boston: Little Brown; 1993:p. 1085-98.
5. Barron WM, Leff AR. Asthma in pregnancy. Am Rev Respir Dis 1993;147(3):510-1.