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gt;gt;But in the case of allergic asthma, those triggers are substances—animal dander, dust mites, pollen, mold, cockroach proteins, or other allergy-causing particles—that don't bother most other people.gt;gt; Non-allergic asthma triggers, on the other hand, can include exercise, cold air, pollution, and stress. Many people have a combination of both types, and the treatments are often similar for both—mostly to ease the swelling and inflammation in the lungs and open up the airways.gt;gt; So why does it matter what's causing your symptoms? Well, the more you know about your triggers—allergic or not—the better your chances of avoiding breathing problems.gt;gt;James Thompson's graduate studies in biopsychology required him to spend a lot of time working with rats. Already plagued by seasonal asthma attacks due to a pollen allergy, he became sensitized to rodents too. His lung function became so compromised that he nearly died of pneumonia at age 25. (Respiratory infections can make asthma worse.)gt;gt; Two decades later, Thompson is still allergic to rodents, but he's also learned a whole lot more about how to cope with his allergic asthma.gt;gt; "Over the past 10 years I've just been trying to understand the triggers more," he says. Thompson has found he has a combination of both allergic and non-allergic asthma. The Maplewood, New Jersey-based non-profit manager knows auto exhaust is a problem for him too. Now he tries to make sure his home is free of dust-collecting clutter and he'll cross the street to avoid inhaling bus exhaust. "When you're in your 20s you really don't notice, you don't make all these connections with your environment."gt;gt;gt;What's causing your asthma?gt; gt;The first step to figuring out how to treat your asthma is to realize that you have it. That's harder than it sounds. Do you have persistent nighttime coughing or shortness of breath? It's easy to dismiss it as due to a cold, lack of exercise, postnasal drip, or just about anything else other than an allergy to the pet sleeping in your bedroom.gt;gt;Many people with allergic asthma attribute their symptoms to a garden-variety cold, says John Winder, MD, an allergist based in Toledo, Ohio and the chair of the gt;American College of Allergy, Asthma and Immunology's Nationwide Asthma Screening Programgt;. The free screening, offered at about 200 sites across the United States, includes a breathing test and an interview with an asthma specialist.gt;gt; To date, more than 100,000 people have been screened through the program, Dr. Winder notes, and half of them were referred to a specialist for further diagnosis.gt;gt;If you do indeed have allergic asthma, the next step is to find ways to limit your exposure to the allergens that affect you. "Avoidance is the best defense," Dr. Winder says.gt;gt; To nail down the specific triggers, it's best to see an allergist, says Robert A. Nathan, MD, director of the Asthma and Allergy Associates and Research Center in Colorado Springs, Colo. While primary care doctors may suspect that a person has allergic asthma, they typically do not delve deeper to confirm the diagnosis with a skin or blood test.gt;gt; Skin prick testing is the most common way to determine if someone is allergic to a particular substance. This involves placing a tiny amount of a specific allergen (like pollen protein) into a person's skin. If redness or swelling develops within 20 to 30 minutes it indicates an allergy to the substance.gt;gt;Some allergens are easier to avoid than others, and sensitivity varies widely among individuals. For example, some people can nip a pet allergy in the bud by living in an animal-free home and taking medication for their symptoms when they visit a friend or family member who does have pets.gt;gt; "Other people are so reactive that they just have to go out to dinner with people who have dander on their clothes to have a reaction," Dr. Nathan notes.gt;gt;gt;gt;How to beat allergens at homegt;gt;You can do several things at home to limit your allergen exposure. First, clear out dust traps like wall-to-wall carpeting and clutter. If your basement is damp and musty, install a dehumidifier. Leaving a light on in the basement can also be helpful, according to Dr. Winder, because mold needs both dark and dampness to grow. Keeping the air in your house relatively dry will also help control dust mites.gt;gt;Your best bet if you're allergic to animal dander is to have a pet-free home (unless it's a dander-free pet, like a snake), but this isn't always realistic. If you can't bear to part with a furry pet, try keeping your pooch or kitty in a specific part of the house (not your bedroom). Many people find it helpful to put cheese cloth over bedroom radiators or vents to prevent allergens from circulating. (Find other tips in gt;How to Reduce Pet Allergens at Homegt;.)gt;gt;And if you're thinking about getting a pet, the consensus is that there really is no such thing as a gt;hypoallergenic dog or catgt;, although some breeds are thought to be better than others.gt;gt;If you're still suffering from symptoms despite your best efforts, you may want to consider gt;allergy shotsgt;, which have about an 85% effectiveness rate at decreasing symptoms. But keep in mind it requires a long-term commitment. It can take up to five years of once-a-week to once-a-month visits with your allergist to get the injections.gt;gt;The best way to handle dust mite allergies? Special dust mite covers for your pillows and mattress. The mattress cover never needs to come off the bed, Dr. Winder says. Wash sheets at least once a week in water that's at least 130 to 140 degrees Fahrenheit. And when you dust, use a damp cloth; a dry one will simply send dust mites floating.gt;gt;If pollen is your foe, try to avoid going out at certain times of day when pollen counts are high, Dr. Winder advises. "Early morning and early evening, late afternoon, are two prime times for getting exposed to the pollens," he says.gt;gt;And keeping the area outside your home tidy—by eliminating piles of rotting leaves or other debris on your lawn, in your gutters, or anywhere else nearby—can also help keep outdoor mold under control.gt;gt;Thompson and his family recently moved from a house with wall-to-wall carpeting on the second floor and a musty-smelling basement to a house with area rugs only, and no musty basement smell. "I've noticed a difference since we moved here, I just breathed a little easier."gt;gt;For Thompson, paying attention to his symptoms and his environment has made a big difference in how he feels. "I think there's a lot of little things you can do. I think you just need to be more aware of your surroundings and what your environment is like and how clean it is."gt;gt;gt;How to treat itgt; gt;When it comes to treatment of allergic asthma, gt;inhaled corticosteroidsgt; are the backbone of therapy because they reduce lung inflammation, according to Dr. Nathan.gt;gt;If inhaled corticosteroids don't keep symptoms under control, your doctor may prescribe a long-acting beta agonist or an gt;anti-leukotriene modifier, like Singulairgt;.gt;gt;Anyone with asthma should also keep a gt;short-acting beta agonistgt; on hand for emergencies. These "rescue inhalers" can ease asthma symptoms fast. They're meant to be used only occasionally, unless you're using them to prevent exercise-related asthma symptoms. Using them more than a couple of times a week indicates that asthma is poorly controlled and other medications are needed. Overuse of beta-agonists can actually make it more difficult for the airways to relax on their own.gt;gt;Medications like Allegra can help keep seasonal allergy symptoms under control. Xolair (omalizumab) is a new drug that works by tying up the antibodies that cause allergies, but it is only used in patients with severe disease because of the cost.gt;gt; In addition to paying close attention to his asthma triggers, Thompson keeps a rescue inhaler on hand. He only uses his rescue inhaler a couple of times a month, at most. And during pollen season, he tracks pollen counts online so he knows what to expect on a given day, and takes Allegra to cope with his symptoms.gt;gt;One of Thompson's former doctors prescribed him several medications for asthma symptoms, and then kept upping the dosage when they didn't help. The medications made it hard for him to sleep and gave him nightmares, so he decided to try get a better handle on his symptoms himself (and find another doctor).gt;gt; "I think that there's a lot of little things you can do," he says. "I think you just need to be more aware of your surroundings and what your environment is like and how clean it is."]]> Getty Images

gt;gt; gt;Q:gt; gt;What's the difference between asthma that is due to allergies and asthma that is not?gt; gt;gt; gt;A:gt; gt;Allergic asthma is an overreactive immunologic response that occurs because a person's body makes too much of an immune system component called immunoglobulin E (IgE). People with allergic asthma are bothered by common allergens like animal dander, dust mites, pollen, mold, or cockroaches, and they are often allergic to more than one of these things. gt;gt; When a person has asthma that isn't related to allergies, but is instead triggered by factors that act directly on the lungs, such as infections, exercise, cold air, pollution, and stress, they have non-allergic asthma. Many people with asthma have a combination of non-allergic and allergic asthma. Of the nearly 19 million adults in the United States with asthma, about half have asthma that's related to allergies. But just 20% of adults with asthma have symptoms triggered by just allergies alone.gt; gt;gt; gt;Q:gt; gt;How can you tell if your asthma is due to allergies?gt; gt;gt; gt;A:gt; gt;First and foremost is the medical history. If a patient says he only has symptoms when he's near a cat or dog, for example, or only during pollen season, it's likely to be due to allergies.gt; gt;gt; gt;Q:gt; gt;How can you know for sure what's triggering your asthma?gt; gt;gt; gt;A:gt; gt;Skin tests, also known as 'skin prick tests,' are the gold standard. They involve putting a tiny amount of the allergen into the very top layer of your skin. The area will then swell, itch, and turn red if you are sensitive to that allergen.gt; gt;gt; gt;Q:gt; gt;Do you need to see an allergist or a pulmonologist to be diagnosed with allergic asthma, or can your primary care doctor do the job?gt; gt;gt; gt;A:gt; gt;Pulmonologists deal with a myriad of lung diseases, but allergists deal primarily with asthma and other allergic conditions, so they are better prepared to diagnose and treat allergic asthma. Most importantly, we're trying to identify triggers and help the patient understand how to deal with those triggers. The primary care physician may suspect that asthma is related to allergies, but it's the allergist who can confirm the diagnosis by using objective measures, like the skin test.gt; gt;gt; gt;Q:gt; gt;Is asthma harder or easier to treat if it's due to allergies?gt; gt;gt; gt;A:gt; gt;Avoidance is the main way to treat any allergic disease. In a way, it's easier to treat allergic asthma than non-allergic asthma, because you can just stay away from the allergen. But this depends on what the allergen is, and how sensitive you are to it. The ace in the hole that patients with allergic asthma have that patients with non-allergic asthma don't have is immunotherapy, or as it's more commonly known, allergy shots. It is potentially curative, whereas medication can only address symptoms.gt; gt;gt; gt;Q:gt; gt;Does allergic asthma ever get better on its own?gt; gt;gt; gt;A:gt; gt;While some children will 'grow out of' their allergic asthma once they reach puberty, it's exceedingly rare for an adult's disease to go into remission.gt; gt;gt; gt;Q:gt; gt;Can allergic asthma be life threatening?gt; gt;gt; gt;A:gt; gt;It's rare but certainly possible, depending on the extent of exposure, how bad an attack gets, and how long it takes for you to get treatment. Every year, 3,500 Americans die from asthma, and some will have had allergy-induced asthma.gt; gt;gt; gt;Q:gt; gt;Will allergy shots help? What do they entail?gt; gt;gt; gt;A:gt; gt;Allergy shots, or immunotherapy, can definitely help, but they're a major commitment. For allergy shots to be effective, a person needs to visit an allergist regularly for several years. And while insurers typically cover immunotherapy, copayment costs can add up.gt;gt; At first, a person undergoing immunotherapy will go to the allergist once or twice a week, for three to six months, receiving slightly larger amounts of the allergen with each visit. The shot itself is very quick, but patients must wait in their doctor's office for 20 to 30 minutes to see if a reaction occurs. After this initial phase, the patient's visits are spread out to every two to four weeks. This maintenance phase can take two to five more years. A person is considered to be free of an allergy if he or she can go for two years without symptoms, which in essence means not having to take allergy medication.gt; gt;gt; gt;Q:gt; gt;At what age do people typically develop allergic asthma?gt; gt;gt; gt;A:gt; gt;Usually symptoms start before age 10, but a person can develop allergic asthma at any point in his or her life. It's rare for someone in their 60s or older to develop allergic asthma for the first time.gt; gt;gt; gt; gt;Q:gt; gt;What are some risk factors for allergic asthma?gt; gt;gt; gt;A:gt; gt;Heredity is the main risk factor. Eighty-seven percent of people with allergies have some background of allergic disease in a family member.gt; gt;gt; gt;Q:gt; gt;What allergens trigger allergic asthma?gt; gt;gt; gt;A:gt; gt;Animal dander, dust mites, pollen, and mold spores. Cockroach pieces can also be a problem in parts of the country where these insects thrive.gt; gt;gt; gt;Q:gt; gt;I'm allergic to my dog, but I can't bear to part with him. What can I do?gt; gt;gt; gt;A:gt; gt;It would be best to keep the dog out of the house, but if that's not possible, keep him out of the bedroom. If you have forced-air heat, consider putting cheesecloth over the bedroom registers to block allergens. Wash your hands after petting and playing with the dog. And you may want to think about allergy shots.gt; gt;gt; gt;Q:gt; gt;If I'm allergic to dust mites, do I really have to wash sheets in hot water or is warm water enough?gt; gt;gt; gt;A:gt; gt;Dust mite allergies are best controlled by putting special mite-proof covers on mattresses and pillows, and by washing bedding in the hottest water available at least once a week. Water should be at least 130 to 140 degrees Fahrenheit, and the hotter it is, the more dust mites it will kill.gt; gt;gt; gt;Q:gt; gt;What medications are used to treat allergic asthma?gt; gt;gt; gt;A:gt; gt;The same medications are used to treat allergic and non-allergic asthma. There really aren't any studies of medications specifically for allergic asthma.gt;gt; The backbone of therapy should be gt;inhaled corticosteroidsgt; to treat inflammation. If that's not enough to control symptoms, a long-acting beta agonist or a gt;leukotriene modifier, like Singulairgt;, may be prescribed. Anyone with asthma should keep a gt;short-acting beta agonistgt; on hand for emergencies, but this should be used no more than once or twice a week, and less frequently if possible. Medications like Allegra can help keep seasonal allergy symptoms under control. Xolair (omalizumab) is a new drug that works by tying up the antibodies that cause allergies, but is only used in patients with severe disease because of its cost.gt; gt;gt; gt;Q:gt; gt;Do people with allergic asthma need to take medications year-round, or is it OK just to take them during allergy season?gt; gt;gt; gt;A:gt; gt;If asthma is clearly allergen-induced, it can be safe to have a drug holiday for a period of time. For example, a person with seasonal allergies who doesn't have non-allergic asthma probably won't need to take medication once pollen season is over. I will usually test pulmonary function outside of their allergy season to determine if a patient with seasonal allergic asthma may have non-allergic asthma as well.gt; gt;gt; gt;Q:gt; gt;If someone feels fine, do they need to be taking their medications?gt; gt;gt; gt;A:gt; gt;It depends, and it's something patients must discuss with their allergist or primary care physician. Some people need to take inhaled steroids regularly to keep their asthma under control, while others may have allergen-free periods when this isn't necessary. Just feeling good isn't a good reason to skip medication, because the lungs may still be inflamed.gt; gt;gt; gt;Q:gt; gt;Is it possible to overuse a bronchodilator inhaler?gt; gt;gt; gt;A:gt; gt;Yes it is. Bronchodilator inhalers are only for 'rescue' use, when a person truly needs help breathing.gt; gt;gt; gt;Q:gt; gt;If so, how often is too often?gt; gt;gt; gt;A:gt; gt;Anything more than twice a week, unless the inhaler is being used for exercise-related symptom prevention, is too much. Patients who need to use it more than twice a week need to reassess their asthma control therapy. Using bronchodilator inhalers several times a day increases mortality risk. Bronchodilators open the airways by relaxing the muscles around them, and overly frequent use can make it more difficult for these muscles to relax on their own. The lungs basically lock up.gt; gt;gt; gt;Q:gt; gt;Are there some interesting new allergic asthma treatments on the horizon?gt; gt;gt; gt;A:gt; gt;Drugs that block interleukins or inhibit the action of prostaglandins look promising. But I don't see anything ahead that will revolutionize the treatment over what we have now.gt; gt;gt; gt;Q:gt; gt;Is there such thing as a 'hypoallergenic' cat or dog?gt; gt;gt; gt;A:gt; gt;Not really. Dogs that may have a gt;less allergy-provoking type of dandergt; will still bring in dust, pollen, and mold from outdoors, and I still don't believe there are hypoallergenic cats. What we promote is gt;frequent bathing of all types of animalsgt;.gt; gt;gt; ]]> Courtesy of Dr. Robert Nathan

gt;asthmagt;, but you’ve got plenty of company. Exercise-induced asthma is surprisingly common among people who work out in cold climates, whether they’re jogging around the neighborhood or gunning for gold in Vancouver.gt;gt; This week, for example, Norwegian cross-country skier Marit Bjørgen won the bronze medal in the women’s 10-kilometer race, even though she uses gt;asthma medicationgt;. In fact, half of cross-country skiers and one-quarter of aspiring winter Olympians in general have exercise-induced asthma according to a 2000 study of 170 athletes conducted by the United States Olympic Committee.gt;gt;"Any [exercise] outdoors on a mountaintop is a culprit, but just jogging in Central Park will do it as well," says Len Horovitz, MD, a pulmonary specialist with Lenox Hill Hospital, in New York City. Exercise-induced asthma doesn’t have to slow you down, however. With the right medications and precautions, exercise-induced asthma won’t keep you from your daily workout, or even from competing at an elite level.gt;gt;gt;How cold and exercise cause asthmagt;gt;Wheezing, chest tightness, and the other gt;symptomsgt; of exercise-induced asthma generally begin several minutes after you begin working out. For some people, the symptoms start soon after they finish exercising. gt;gt;Although athletes who compete in warm-weather sports may suffer from exercise-induced asthma as well, mixing exercise and cold, dry air is especially problematic. For many people with regular asthma, in fact, just stepping outside in frigid temperatures is enough to cause symptoms.gt;gt;"Both cold air and exercise in and of themselves can trigger asthma symptoms, but doing them together is more likely to trigger an gt;exacerbationgt;," says Thomas M. Leath, MD, an assistant professor of pediatrics at Texas A&M Health Science Center College of Medicine.gt;gt;When the air is dry—as it often is in cold climates during the winter—your lungs can become even more irritated, Dr. Horovitz adds. "The evaporative loss and cooling of the airways triggers the process of bronchial constriction," he says. "One sport you don’t see exercise-induced asthma in so much is swimming. The humidity at water level is such that there isn’t as much evaporation as in running or winter sports." (Chlorine, however, can trigger asthma symptoms, Dr. Horovitz notes.)gt;gt;gt;The combination of cold air and exercise is "a double whammy," says Steve N. Georas, MD, the director of pulmonary and critical care medicine and the director of the Mary Parkes Center for Asthma, Allergy and Pulmonary Care at the University of Rochester Medical Center, in New York.gt;gt;The bronchospasms that characterize exercise-induced asthma refer to a contraction (or spasm) of lung airways. Experts aren’t certain what’s behind this phenomenon. One theory is that the increased blood flow caused by exertion forces the blood vessels in the airways to expand, leading to constriction of the airways, Dr. Georas says. Another theory holds that cold air activates certain inflammatory cells in the airways.gt;gt;"Asthma [is] as an inflammatory disease where, for some reason, the body’s immune response has sent out an alarm about something going wrong in the lungs," says Dr. Georas. "Once that alarm has been set off, there’s airway inflammation."gt;gt;gt;How to fight itgt;gt;The first-line treatment for exercise-induced asthma is a gt;bronchodilatorgt;. Usually delivered via rescue gt;inhalersgt;, these drugs (such as albuterol) fight symptoms by relaxing the muscles that line the airways in the lungs.gt;gt;The most commonly used bronchodilators, a class of drug known as gt;beta2-agonistsgt;, are prohibited by the International Olympic Committee (IOC). Because beta2-agonists can promote muscle growth, athletes with asthma must prove they have the disorder and must receive permission to medicate themselves; otherwise, they run the risk of being disqualified from the Games. "The IOC has really cracked down on this," says Dr. Georas. "A few years ago, a lot of people declared themselves asthmatic, which was thought to be a way to get inhaled steroids."gt;gt; Fortunately, if you don’t need the IOC to sign off on your medications, preventing and treating exercise-induced asthma is pretty straightforward. The best treatment will depend on how often you exercise and whether you can predict when it will occur.gt;gt;If you experience asthma symptoms every time you exercise in cold weather, you may want to use a bronchodilator 10 to 15 minutes before exercising to prevent an attack, Dr. Horovitz recommends.gt;gt;If your asthma isn’t predictable, keep an inhaler handy while you exercise instead of using it beforehand. "There are patients in whom it’s intermittent. Sometimes they can exercise, sometimes they can’t," says Dr. Georas. "If you feel chest tightness coming on, have your inhaler on you."gt;gt;In addition to medication, there are other precautions athletes can take. Warming up for a few minutes before hitting full exercise mode, breathing through your nose (to warm and humidify the air before it hits your airways), and wearing a scarf or face mask around your mouth can all prevent symptoms, says Dr. Leath. Masks that contain inserts known as heat exchangers have also been shown to fight exercise-induced asthma in cold weather.gt;gt;These treatments are effective enough that exercise-induced asthma rarely keeps people from the winter sports they enjoy. Dr. Leath has heard many patients complain of cold air making their asthma worse, but he hasn’t seen any asthma exacerbations so severe that they prevent winter activity. gt;gt;"The whole goal of gt;asthma therapygt; with each patient is to allow them to conduct their daily activities unfettered," says Dr. Georas. ]]> LIFE.com

gt;gt; So why do asthma symptoms seem to get worse with every change in the weather? Although it seems confusing, there are some annual trends, as well as reasons why asthma symptoms are worse at particular times of the year.gt;gt;For example, severe asthma episodes tend to peak during the autumn months, especially among children. A 2001 gt;studygt; that examined tens of thousands of asthma hospitalizations in Canada over a 12-year period, for instance, found that there were more than twice as many hospitalizations in October as there were in July or August. Other studies have discovered similar patterns.gt;gt;However, one study conducted in Detroit found that when there was a rapid 10-degree rise in temperature or a 10% rise in humidity—as can happen in spring and summer—hospitalizations for children with asthma increased in the next day or two.gt;gt;In truth, asthma symptoms can flare at any time of year due to well-known gt;asthma triggersgt;, such as pet dander, secondhand smoke, and exercise. But knowing the triggers that can vary by season—such as pollen, temperature, humidity, pollution, and viruses—can help people with asthma figure out if they should be stepping up their medication.gt;gt;gt;Fallgt;gt;Cold air can cause an asthmatic’s lungs to tighten up, so you might guess that a fall peak in asthma episodes is due to cooler weather. But the patterns found in the Canadian study have also been reported in far-flung places including Hong Kong and the tropical island of Trinidad—so cold weather isn’t entirely to blame.gt;gt;In fact, the main culprit is believed to be cold-and-flu season, which kicks into gear once kids head back to school. Classrooms filled with runny noses, and grimy hands are breeding grounds for cold and flu viruses, which schoolchildren inevitably spread to their families.gt;gt;People with asthma aren’t more likely to catch a virus than people without asthma, but when they do, their illness tends to be longer and more severe. Respiratory tract infections aggravate the chronic lung inflammation of asthma, which can lead to wheezing, coughing, difficulty breathing, and asthma attacks. (The flu, common cold, and other respiratory infections are responsible for about 80% of wheezing episodes in children, and about 50% of such episodes in adults.)gt;gt;“The old adage, ‘If you treat a cold, it lasts a week; if you ignore it, it lasts seven days’, is not true for an asthmatic,” says Bradley Chipps, MD, a pediatric pulmonologist and allergist in Sacramento, Calif. “Unless treated, the symptoms will go on for weeks sometimes.”gt;gt;The flu, whether it’s swine flu (H1N1) or seasonal flu, can be even more perilous. A recent analysis of cases found that 28% of people gt;hospitalized with swine flu had asthmagt;. People with asthma are more vulnerable to complications stemming from the flu—such as pneumonia—and are more likely to be hospitalized, which is why the Centers for Disease Control and Prevention recommends that all people with asthma over six months old get the seasonal and swine flu shot. And it has to be the shot, whether it’s a seasonal or swine flu vaccine. (The FluMist vaccine, which is delivered via nasal spray, can cause wheezing and should be avoided by asthmatics.)gt;gt; The sudden spike in asthma-related doctor’s appointments and ER visits among children that coincides with the start of the school year—a pattern that has been observed all around the Northern Hemisphere—is so predictable that it has come to be known as the September epidemic.gt;gt;Allergens also are a problem in the fall. The ragweed season begins in late summer, but in some areas it can last well into October. This plant, which is found in the greatest quantities in the East and Midwest, is a nightmare for people with asthma who are sensitized to this allergen. Each plant produces up to a billion grains of pollen in a season, and the lightweight grains can carry on the wind for hundreds of miles.gt;gt; gt;gt;gt;gt;Wintergt;gt;Although fall is the peak time for a flare-up of asthma symptoms, winter weather that descends on many parts of the country in December can also pose a problem.gt;gt;Cold, dry air can aggravate asthma, especially during exercise, when air is inhaled in larger amounts. “A major precipitant for wheezing is cold, dry air, especially when outside and exercising,” says Dr. Chipps. “When one looks at Olympic athletes, some of the highest instances of gt;exercise-induced bronchospasmgt; are in cross-country skiers, and also hockey players.” (He adds, however, that hockey-related asthma can also be caused by the chemicals used to smooth the ice.)gt;gt;But people with asthma don’t have to be exercising to notice the effect of cold air. For some people, even walking around outside in cold weather can cause symptoms. “It’s not purely exercise induced,” says Melinda Rathkopf, MD, an allergist and immunologist who practices in Anchorage, Alaska, where winter temperatures routinely reach the teens. “For some asthmatics, cold air can be one of their triggers.”gt;gt;If cold air is a trigger for you, wearing a scarf around your face will help warm and humidify the air you breathe. If that doesn’t do the trick, special masks containing heat exchangers can be helpful. These masks—which essentially function like a scarf, only more so—have been shown to keep lung function from declining during exercise. Using an inhaled gt;bronchodilatorgt; (such as albuterol) 15 to 20 minutes before exercising outdoors can also help counteract the effects of cold air.gt;gt;In the wintertime, asthmatics also need to be careful about the weather inside. When windows are shut against the cold air outside and heaters and humidifiers are turned on, a different problem can arise. “By increasing the warmth and humidity inside, we contribute to indoor allergens,” says Dr. Rathkopf. “Specifically, dust mites and mold do better in high humidity.”gt;gt;Another irritant found indoors is the smoke from fireplaces and wood stoves. When Dr. Rathkopf sees patients for the first time, she asks them to list their method of home heating on the intake questionnaire. “Try to minimize the use of wood-burning stoves,” she tells her patients, “and make sure that ducts and flues are clean and well ventilated.”gt;gt; gt;Springgt;gt; For asthmatics, spring means one thing above all: pollen season. Pollen is a potent allergen that, when inhaled, can inflame airways and cause asthma attacks. (Like cold-and-flu season, high pollen counts are associated with an increase in asthma-related hospital visits.)gt;gt;“Pollen is a major seasonal cause of increasing asthma,” says Dr. Chipps. As with cold, dry air in the wintertime, exercising outdoors can make people with asthma especially vulnerable to asthma attacks. Fortunately, pollen concentrations are relatively predictable. “gt;Pollen countsgt; are the highest between about 4 a.m. and 10 a.m. every day, so if you’re going to be exercising during the pollen season, you’re better off doing it later in the day,” he says.gt;gt;The pollen season is a one-two punch. Trees begin to release pollen around March (depending on where you live), and just when you’re recovering from the tree pollen, grass pollen peaks in May and June. “Parents come in and say that their kid gets a cold at the end of every school year—but it’s probably tree allergies,” says Dr. Rathkopf. “Sneezing, itching, and runny nose are often mistaken as a cold.”gt;gt; In warmer climates, pollen is in the air for much of the year. In colder climates with distinct seasons that experience deep freezes in the winter, the pollen season is often shorter yet much more intense, according to Dr. Rathkopf.gt;gt; Although spring lacks the extreme weather of winter and summer, the season’s unpredictable weather can still cause problems. The Detroit gt;studygt; of children with asthma, which was published in the , suggested that changes in temperature and humidity—rather than the levels themselves—are responsible for triggering asthma exacerbations. The study, which controlled for levels of pollutants and allergens in the air (which are affected by weather), found that a 10-degree increase in temperature and a 10% change in humidity were associated with a slight uptick in asthma-related emergency room visits.gt;gt;“The reason we did this project was because of something we saw in clinic,” says Alan Baptist, MD, the lead author of the study and the director of the University of Michigan asthma program. “We often ask patients, ‘What triggers your asthma?’ And a lot of times, patients and parents of small children with asthma will say, ‘When the weather changes.’”gt;gt;gt;gt;gt;gt;Summergt;gt;Summer usually provides some relief for people with asthma. The worst of the spring pollen season is over, and cold-and-flu season has yet to begin. Asthma episodes tend to be lowest in the summer months, in fact, but that doesn’t mean they can’t still cause problems for some asthmatics. Some people with asthma react poorly to heat and humidity, though this is far from universal and varies widely from patient to patient. “Some patients do horribly in very high-humidity climates, and some aren’t bothered at all,” says Dr. Chipps. “It’s clearly not a one-size-fits-all thing.”gt;gt;Summer weather also tends to coincide with poorer air quality, especially in dense urban areas. Traffic-related pollution and sunlight can combine to promote the production of ozone—a powerful asthma trigger—and the stagnant, humid air of heat waves traps particulate matter and other pollutants, causing them to hang in the air and become more concentrated. These gt;bad air daysgt; make people with asthma more vulnerable to breathing problems and asthma attacks.gt;gt;“We tell our patients to watch for days of high heat and humidity, and to be especially mindful on ozone action days,” says Dr. Baptist. He encourages his patients to use a peak flow meter to monitor their lung function on these sweltering days.gt;gt;Thunderstorms—a fixture of summer—are yet another asthma trigger. The gusty winds that accompany thunderstorms stir up mold and fungal spores, and rainwater breaks up pollen grains into hundreds of microscopic pieces, both of which spell trouble for asthmatics. Thunderstorms often cause a spike in asthma-related ER visits. “Often we get very high levels of mold during the time around thunderstorms, and we see increases in [emergency department] visits at that time,” says Dr. Chipps.gt;gt;Toward the end of summer, pollen becomes a problem again, as the ragweed season kicks off in mid-August. In many places, concentrations of an airborne fungus, Alternaria, also peak in August and September. These allergens continue into the fall, and before you know it, it’s cold-and-flu season again.]]> Getty Images

gt;gt;(The next most common complications on the list were diabetes and a weakened immune system, at 15% each.)gt;gt;“Asthma was the most common underlying medical condition that we saw,” says Seema Jain, MD, a medical epidemiologist at the Centers for Disease Control and Prevention (CDC). Dr. Jain’s team analyzed 272 people who were gt;hospitalized with H1N1gt; for more than 24 hours between April and June. gt;gt;Twenty-five percent were admitted to the intensive care unit and 7% died. Overall, 29% of children and 27% of in adults in the study had asthma, while only about 8% of the U.S. population has asthma, according to Dr. Jain. gt;gt;Richard Gower, MD, the president of the American College of Allergy, Asthma, and Immunology, says about 25 million people in the United States have the chronic lung condition, including 8 million children. gt;gt;gt;Asthma is an accident waiting to happengt;gt;Asthma is more common in children than in adults, and swine flu seems to strike younger people more often than older ones—a complete flip-flop from seasonal flu.gt;gt; In the study, 45% of the hospitalized patients were under age 18, and only 5% were 65 or older. “If you are a young adult and you have asthma, you are in double jeopardy,” says Dr. Gower.gt;gt;For many people, swine flu symptoms include fever, congestion, and possibly nausea, diarrhea, and vomiting, which are some of the symptoms that differ from seasonal flu. (Seasonal flu rarely causes nausea or an upset stomach). Most of the time, the symptoms can be successfully battled with time, liquids (chicken soup, anyone?), and bed rest. gt;gt;But for people at high risk, including those with asthma, an H1N1 infection can be a different story. gt;gt;“Asthma is sort of an accident waiting to happen,” says Dr. Gower, who is also an allergist/immunologist at Marycliff Allergy Specialists, in Spokane, Wash. People with asthma are at risk for breathing trouble with infections in general, not just H1N1.gt;gt;The lungs of people with asthma tend to bronchospasm, meaning they tighten in response to triggers, such as pollen, pet allergens, bacteria, viruses, or other insults. In the case of an infection like H1N1, the lungs produce mucus in response to the germ, and the mucus can get trapped in the narrow airways, setting the stage for pneumonia.gt;gt;“You add an insult and it just triples, quadruples, gets 10 times worse very suddenly, and flares the asthma,“ says Dr. Gower. “The bronchospasm occurs and it squeezes the airways dramatically down to narrow, narrow passages—and, in fact, closure—and the mucus that is dramatically increased gets trapped and that’s a setup for pneumonia.”gt;gt;So what should you be doing about H1N1 if you—or your children—have asthma?gt;gt;gt;Take your medicationgt;gt;People with chronic asthma often need to take gt;controller medicationsgt; that fight underlying lung inflammation. The problem is, they need to take this type of medication every day, gt;even if they are feeling finegt;. It can help protect the lungs from triggers like infections.gt;gt;But many people forget to take the medicine or skip doses when they aren’t having asthma symptoms. gt;gt;If you have a young child with asthma, make sure they take their medication as directed, says Dr. Gower. It gets tricky if your child is a teen, because they are notorious for skipping asthma medication, and may lie about it too, he says. gt;gt;Parents need to talk to teens and explain that although they may have gotten away with skipping asthma drug doses in the past, “this is a brand new ball game,” he says. “They really should raise the threshold of their lungs by taking chronic medicines if they have chronic asthma.”gt;gt;Dr. Gower also recommends that patients have—and use—a peak flow meter, which is a device that you can blow into to gauge lung function. gt;gt;“It empowers the patient or the parents,” says Dr. Gower. “Even if the patient says they are doing fine and they are giving their best effort to blow into the peak flow meter and it’s going down and it gets into the yellow zone then into the red zone, that’s a real warning sign that that asthma is getting worse no matter what you are doing.”gt;gt;gt;gt;Get vaccinatedgt; gt;Being in a high-risk group for H1N1 means that people with asthma should get the vaccine as soon as possible, says Dr. Gower.gt;gt;“They have a vaccine that’s good; it’s made the same way as the regular flu shot that’s been out for many, many years, so they really shouldn’t worry more about the side effects on [the H1N1 vaccine] than the other one,” says Dr. Gower. “I think it’s very safe. I think they should take it if they meet any of the criteria.”gt;gt;Although there is a nasal spray version of the H1N1 vaccine, people with asthma should wait for the vaccine administered as a shot, gt;according to the CDCgt;. The nasal spray contains weakened H1N1 virus and is not recommended for high-risk individuals. The shot contains dead virus, which is safer for asthmatics. gt;gt;“People with asthma would be a group that would be considered high risk; they should wait for the shot to come out,” says Dr. Jain. “Remember the seasonal influenza shot is available; they should be able to get that.” People with asthma are also at risk from seasonal flu, she notes, so they should get that shot now.gt;gt;Due to vaccine shortages, people may have to wait for an H1N1 vaccine. Only 28 to 30 million doses will be available in October 2009, according to the CDC. (Earlier in the year, it was estimated that there would be 120 million by then.) Children ages 6 months to 8 years will need two doses of the flu vaccine, which are given four weeks apart.gt;gt;In the meantime, if you (or your child) have asthma, one of the best things you can do while H1N1 is circulating is to try to avoid infection in the first place, says Dr. Gower. gt;gt;You may want to consider skipping parties or other events if there will be children attending who could be ill. “You can communicate by phone, congratulate them, but don’t go over and step into the lion’s dens, so to speak, of infection,” he says. He also recommends that parents reinforce public health recommendations to wash hands, and to cover coughs and sneezes.gt;gt;“You can teach your children that as well and protect others from them and protect them from others,” he says.gt;gt;gt;gt;Get rapid treatment if you do get sickgt;gt;If you do have asthma and get sick with H1N1 symptoms, you should call your doctor, experts say. “They don’t necessarily have to go in to see the physician, but they need to contact them if they have high risk conditions,” says Dr. Jain.gt;gt;However, if it’s a child with asthma who is not doing well—say, they have a fever of 103° or 104° and are getting worse—Dr. Gower recommends getting help sooner rather than later.gt;gt;“You can be exposed to things in the hospital, but if you’re that sick, with H1N1 going around, and a respiratory flare, I think it’s better safe than sorry,” he says.gt;gt;Dr. Jain also notes that her study found that early antiviral treatment of hospitalized patients really helped—the sooner, the better. gt;gt;Although most of the patients had antivirals in the hospital, they found that those who ended up in the ICU or who died tended to get antiviral drugs (such as oseltamivir, zanamivir, amantadine, and rimantadine) later than others.gt;gt;“If you look at the timing of it, you’ll see that patients in ICU or who died were not treated within two days,” she says. “The median time of onset of illness to initiation of antiviral was three days versus five days, so basically the patients who were most sick had a delay in treatment.” gt;gt;However, zanamivir (Relenza) is not recommended for treating people with asthma because of a risk of side effects, including bronchospasm, gt;according to the CDCgt;.gt;gt;Dr. Jain says it’s important to focus on both vaccinations and rapid treatment for very ill patients.gt;gt;“The main issue here is antiviral use; that’s one of our main findings,” she says. “We really would like to emphasize [that] there’s vaccination, and that’s an important message and that’s out there, and you see that in the media, but I think the fact that antiviral also should be utilized in patients who are hospitalized is also key.”gt;gt;]]> Getty Images

gt;gt;
The new study, which appeared in the , showed that children and adolescents with asthma who had a genetic variant called Arg16 and used their inhaler daily had a 30% greater risk of asthma exacerbations—periods of time when asthma worsens to the point that a child misses school or needs stronger medication—compared with those who did not have an altered copy of the gene.gt;gt; 
Those with two copies of the gene had a 70% increased risk of asthma exacerbations if they used their asthma inhaler daily. Youngsters with the gene who didn’t use an inhaler daily were not at higher risk of exacerbations compared with other children without it.gt;gt;
However, it’s not clear if the gene makes asthma worse in general—so that the youngsters needed more medication—or if overuse of the inhaler was truly exacerbating their symptoms. Asthma affects 6.8 million children under 18 in the US, and is the most common chronic condition in children.gt;gt; 
In the study, which included 1,182 children and young adults (ages 3 to 22), 43.8% had one copy of the gene and 15.3% had two copies.gt;gt;gt;
Many study participants were taking a steroid, which is known as a “controller” medication because it fights underlying inflammation, plus albuterol, which is one of the most commonly used drugs in inhalers in the U.S. Others were taking a steroid and the drug salmeterol, which is known as a long-acting bronchodilator, plus albuterol as needed. Others were taking albuterol alone.gt;gt;
Albuterol is sold under names such as Ventolin, Proventil, and ProAir. It’s a short-acting bronchodilator, or “rescue drug,” in that it can open up airways and make breathing easier in people who are having an asthma attack, but it is not meant to be used on a routine basis. (Inhalers can also be used to deliver other types of medication besides albuterol). About 52 million albuterol prescriptions are filled annually in the United States.gt;gt;In contrast, long-acting bronchodilators like salmeterol are used for asthma control but are not used without inhaled steroids or a tablet to control inflammation because it’s known that they can mask the symptoms and lead to more serious asthma attacks if used alone.gt;gt;
“[This study] shows for the first time that there is an increase in risk of exacerbations per copy of the Arg16 allele in children and young adults with asthma taking frequent (once daily or more) as-required doses of inhaled albuterol,” concluded researchers who were led by Kaninika Basu, MD, of Ninewells Hospital and Medical School, in Dundee, Scotland.gt;gt;
The findings did not hold in individuals who used their inhalers less frequently, and that is the most telling part of this study, according to many childhood asthma experts.gt;gt;
Harold J. Farber, MD, an associate professor of the pediatric pulmonary section at Baylor College of Medicine and Texas Children Hospital, in Houston, and the author of Control Your Child’s Asthma, puts it like this: “If you need to use rescue medication more than twice a week, your asthma is not in good control.gt;gt;
“This is more data that overuse of albuterol is a bad thing,” he adds.gt;gt; gt;
As far as the long-acting bronchodilators with combination steroids go, “make sure that it is benefiting your child’s asthma,” Dr. Farber says. “If your child’s asthma is well-controlled with inhaled steroids alone and you don’t have day-to-day symptoms, you don’t need these combination medications.”gt;gt;
The most important message is that well-managed asthma does not require very much short- or long-acting bronchodilators, stresses William J. Calhoun, MD, a professor of medicine and the vice chair of the department of medicine at the University of Texas Medical Branch, in Galveston.gt;gt; 
“If your child’s asthma is well-managed with a good controller, their use of these drugs will be minimal to begin with,” he says. “[Generally] good asthma control is measured by the need for albuterol twice a week or less.”gt;gt; 
If your child is using it more frequently, that is a red flag that he or she needs to see a doctor, according to Dr. Calhoun.gt;gt;

“If your child is using a lot of their rescue medication, they need to get their asthma management reviewed,” agrees Stanley Szefler, MD, the head of pediatric clinical pharmacology at National Jewish Health, in Denver. “Tell your doctor if your child is using their short-acting once a day or more,” he suggests.gt;gt;
This article also begs the question of whether adults and children with asthma should be tested for this gene, he says. “This article would push you in the direction of yes,” he says.gt;gt;
It may be a chicken-or-egg situation. “Maybe this gene is associated with a worse form of asthma, so people with it are taking their medications more frequently,” he says.gt;gt;“It would not surprise me if within 5 or 10 years we are routinely checking to see if people with asthma have this gene,” Dr. Farber adds.]]> Getty Images

gt;gt;In particular, the medications known as short-acting beta2-agonists (a type of bronchodilator) can provide quick relief from asthma symptoms—but they can also be damaging if they are used too often. Using short-acting beta2-agonists too often is a sign that asthma is out of control.gt;gt;To learn more about the risks posed by the overuse of short-acting beta2-agonists, read the following information from our gt;A–Z Health Librarygt;.gt;gt; gt; gt; gt; gt; gt; gt; gt; gt;gt; gt; gt; gt; gt; gt;gt; gt; ]]>

gt;gt;Polluted air contains particulate matter, lead, ozone, nitrogen dioxide, carbon monoxide, and sulfur dioxide—all of which can cause problems in people with allergies or asthma. Even if pollution is low, airborne pollen and mold can make a trip outdoors particularly daunting for people with respiratory conditions.gt;gt; gt;How to tell if it's a bad air daygt;gt;The first step toward protecting your lungs is to know your city or town. More than 115 million people nationwide still live in counties with pollution levels considered potentially harmful to their health.gt;gt;Air quality varies widely around the United States. Ozone, for instance—which can pose a major problem for asthmatics—tends to be more prevalent in urban areas, though it can be found in suburban and rural areas as well. If you live in Fargo, N.D.—one of the cities with the cleanest air in the nation—you are likely to breathe easier than if you live in Los Angeles, which has the highest ozone levels in the country.gt;gt; Local weather stations often provide this information on their websites, and radio stations typically give ozone alerts. In addition, many websites can tell you if pollutants, ozone, or pollen counts are high in your area on any given day.gt;gt; gt;gt;gt;AirNow.govgt;, a site run by federal government agencies, provides a daily Air Quality Index as well as other useful information on air quality.gt;gt;The American Academy of Allergy, Asthma & Immunology’s National Allergy Bureau has a gt;daily mold and pollen reportgt;.gt;gt;The American Lung Association rates the air quality annually by state at gt;stateoftheair.orggt;.gt;gt;The Environmental Protection Agency has a feature on its website called “gt;My Environmentgt;”, which gives you an up-to-date air-quality forecast for your zip code.gt;gt;gt;Pollen.comgt; offers a four-day allergy forecast using data from the National Weather Service.gt;gt;However, it’s not just pollen or air pollution that can trigger problems. Michael Benninger, MD, the chairman of the Head and Neck Institute at the Cleveland Clinic, in Ohio, says changes in barometric pressure and temperature can also spell trouble for people with allergies to pollen and mold, people with severe sinus symptoms, and even people without allergies.gt;gt; gt;gt;gt;How to cope on bad air daysgt;gt;Once you’ve figured out what factors are most likely to pose a problem (usually by trial and error, or testing for allergies), and know the conditions in your area, there are several things you can do to cope.gt;gt;One option is to reduce excessive exposure on days that might trigger symptoms. For example, Dr. Benninger recommends avoiding areas where pollen, mold, or other allergens are high. If you know that grass and trees are a problem, don’t spend the day in a lush, tree-filled park; if you have to mow your lawn, wear a mask with a filter to reduce exposure to grass. Staying indoors with the windows closed and the air-conditioning on is also helpful, Dr. Benninger says.gt;gt; Todd Rambasek, MD, of ENT & Allergy Health Services, in Cleveland, says there are three things that typically affect your ability to breathe outside:gt;gt; gt;gt;How much of an allergen or pollutant is present.gt;gt;How heavily you are breathing. (For example, you breathe more heavily when exercising.)gt;gt;How well your symptoms are controlled, if you have asthma.gt;gt;People with asthma often need to use an everyday controller medication, which is a drug that eases underlying lung inflammation. Bronchodilators are another type of asthma drug that can be used to expand airways and relieve symptoms, such as shortness of breath or coughing. However, if you are using a bronchodilator inhaler all the time to treat symptoms, it’s a sign that your asthma isn’t under control and that you should be taking controller medication daily.gt;gt;“If people take daily controller medications, they are less likely to have problems when they are near triggers,” says Dr. Rambasek.gt;gt;In addition to regularly taking controller medications—such as fluticasone, Singulair, and Azmacort—asthmatics should also carry albuterol, a common bronchodilator, according to Dr. Rambasek. Using a bronchodilator inhaler about 30 minutes before going outside can be helpful, he says.gt;gt;Over-the-counter antihistamines such as Claritin (loratadine) tend to work well and are relatively safe for those with allergies, Dr. Rambasek says. Dr. Benninger recommends using topical anti-allergy eye drops and Afrin for itchy eyes and congestion if symptoms are infrequent, though he cautions that Afrin should only be used for a few days at a time.gt;gt;Dr. Benninger also advises patients to begin taking medications two to three weeks prior to allergy season. Steroid nasal sprays are particularly beneficial when taken in advance if you have allergies that affect your sinuses, he says.gt;gt;gt;gt;gt;Smart ways to exercise on bad air daysgt;gt; If you know your triggers and have the appropriate medication on hand, there are still things you can do to prevent problems. If you exercise outdoors, try walking instead of running to reduce exertion. Don’t run near high-traffic roads, if possible, and if you know what direction the wind is blowing, exercise upwind, Dr. Rambasek says.gt;gt;If you are allergic to pollen, exercise when the counts are lower, in the early morning or evening, and avoid hot, windy days, he adds. Ozone levels tend to peak from 4 p.m. to 6 p.m. during the day.gt;gt; Anne Marie Ditto, MD, an associate professor of medicine in the allergy-immunology division at the Northwestern University Feinberg School of Medicine, in Chicago, says she generally tells patients not to avoid the outdoors. Instead, she recommends that people control their asthma and allergies so they won’t have flare-ups. But there is one exception: people with asthma on high-ozone days.gt;gt;“If you are in a city with an ozone action day, we tend to say, 'Stay inside if you are not well controlled...or try to avoid a lot of outdoor activity,’” she says. “It might not be a good day to go outside and play baseball.”gt;gt;Dr. Ditto says ozone causes inflammation and heightens sensitivity to outdoor allergens such as pollen or mold. This can increase the chance of an asthma attack.gt;gt;Dr. Rambasek agrees.gt;gt; “For someone with an ozone allergy and asthma, avoidance is their best bet because treatments aren’t phenomenal,” he says. “For someone with nasal allergies to pollen, treatment is good so we often don’t recommend avoidance. But we don’t have any shots to reduce people’s sensitivity to ozone.”]]> (GETTYIMAGES)

gt;gt; The good news is that the more you know about asthma, the better your chance of stopping the coughing, wheezing, and shortness of breath that led to the diagnosis in the first place. There is no cure for asthma, but the condition can be managed successfully by taking medication and identifying (and avoiding) asthma triggers.gt;gt; The tricky part is that as time goes on, people with asthma can start to feel perfectly healthy, due to the medication. It can be hard to remember that even though the asthma symptoms are gone, the disease is still there. It can be dangerous to stop or cut back on medication in the belief that asthma has disappeared. This can leave your child vulnerable to serious breathing trouble or hospitalization the next time he or she encounters an asthma trigger. (Some children may eventually “outgrow” asthma, but only a doctor can say for sure if it’s safe to taper off medication.)gt;gt;Your doctor can help you set up an asthma plan for your child, but the ball’s in your court to stick with it. Following this plan will help minimize your child’s symptoms and allow him or her to be as active as possible.gt;gt; To learn more about living with asthma, read the following information from our gt;A–Z Health Librarygt;.gt;gt; gt; gt; gt; gt; gt; gt; gt; gt;gt; gt; gt; gt; gt; gt;gt; gt; ]]> (GETTYIMAGES)

gt;gt;These medications, which can be taken in a once-a-day pill form, improve lung function by treating the underlying inflammation of asthma over the long term. These drugs are used for persistent cases of asthma and should be taken once a day, whether or not your child is experiencing asthma symptoms.gt;gt; To learn more about leukotriene pathway modifiers, read the following information from our gt;A–Z Health Librarygt;.gt;gt; gt; gt; gt; gt; gt; gt; gt; gt;gt; gt; gt; gt; gt; gt;gt; gt; ]]>