ORIGINAL ARTICLE
Triggers in adult asthma: are patients aware of triggers and doing right?

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Abstract

Background

As triggers have a potential to induce asthma exacerbations, awareness of the patients to individual triggers as well as protective measures might be helpful to prevent asthma attacks. Though allergens and allergen avoidance have been studied extensively, there are only few studies on non-allergic triggers and their avoidance for adult patients with asthma. In this study, we wanted to investigate asthma triggers and compliance to the preventive measures in an adult population.

Methods

One hundred and thirty one adult asthma patients were enrolled into the study. A face to face interview was done by using a questionnaire including individual asthma triggers, prevention measures against major modifiable triggers and knowledge sources of the cases.

Results

Regardless of asthma severity, 59.5 % of the subjects reported to be triggered by more than 10 factors. The most common triggers were air pollutants (89.3 %) and weather changes (81.7 %). Severe group was more frequently affected by medications, emotional stress, weather changes and indoor pollutants than other severity groups (p = 0.017, 0.014, 0.049 and 0.018, respectively) whereas stress was reported more frequently by females than males. Prevention measures were insufficient regarding some major triggers.

Conclusion

Adult patients are vulnerable to several triggers regardless from underlying severity of the illness. Insufficient compliance to the major preventive measures indicates that new strategies are needed to prevent asthma attacks caused by modifiable triggers.

Introduction

Asthma is a chronic inflammatory disease of the airways which affects millions of people throughout the word. Asthma exacerbations may be caused by a variety of factors defined as “triggers” which include both allergens, and non-allergic factors such as viral infections, pollutants, drugs and others.1., 2., 3., 4., 5. Therefore, awareness of the patients about individual triggers as well as measures against these triggers might be helpful to prevent some asthma attacks. However, creating a low-allergen environment in patients' homes and reduced exposure to indoor allergens has been shown to be ineffective at reducing asthma symptoms.1., 2.,6 Therefore, other non-allergic triggers and actions taken against these factors, as well as assessing the outcomes in asthma control could be of interest.

The main non-allergic asthma triggers are indoor air pollutants, including passive and active smoking, harmful fumes and gases from heating devices, outdoor air pollutants including exhaust gases, certain weather and atmospheric conditions, influenza infections, psychological factors, physical activities and certain medications such as aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), and beta blockers.1., 2. Actually, all of these factors are a part of routine daily life of patients with asthma, and therefore have potential to induce asthma episodes in vulnerable cases. Although the studies which investigate the effect of tertiary prevention actions taken against indoor allergens on asthma outcomes are from some time ago, there is evidence that preventive measures for non-allergic asthma triggers might provide a beneficial outcome on asthma symptoms and, therefore, on asthma control. However, the number of studies on asthma triggers and preventive measures is limited and mostly analysed children based on the reports of parents or caregivers.7., 8., 9., 10. There are only a few studies which investigate asthma triggers in adult asthma.3,11., 12. These studies indicated that non-allergic triggering factors were important predictors of patients' general well-being; asthma control; and management of asthma, compared to allergic triggers.

In this study, our principal objective was to document the profile of asthma triggers of our adult patient group and their ability to cope with these triggers in their daily life. In detail, our aims were: 1) to quantity asthma triggers; 2) to determine what behaviours these adults have used to reduce their exposure to major triggers; and which factors affect these behaviours; and 3) to assess asthma information sources in an adult clinical population in Turkey.

Section snippets

Patient selection and the study design

The study was conducted in the outpatient allergy clinic of our tertiary university hospital. A total of 131 adult patients with asthma were consecutively enrolled into this cross-sectional study. Asthma diagnosis was based on a history of recurrent symptoms of wheezing, shortness of breath, cough and demonstration of objective signs of reversible airway obstruction by means of at least > 12 % increase in FEV, after 15 minutes with an inhalation of 200 μg salbutamol.1., 2.

Demographics (age,

Demographics and disease characteristics

A total of 131 adult patients with asthma [F/M: 106/25 (80.9/19.1 %) and mean age 45.4 ± 0.9] were included in the study. The mean duration of asthma was 11.7 ± 0.9 years. Sixty five patients (49.6 %) had positive SPT. Most of the patients had mild persistent asthma (n = 57; 43.5 %) (Table I).

Regarding the severity of asthma; there were no differences between gender, education level, occupation, family history of allergy and individual atopy rate. The patients with moderate to severe asthma

Discussion

Although the importance of the environmental triggers on asthma management has been well described, this issue for adult patients with asthma seems to be neglected. Emphasizing this data, this study showed that our group of female predominant asthma patients are faced with several triggering factors regardless of the underlying severity of the disease. More importantly, preventive measures against some modifiable triggers were insufficient.

In this study, the degree of asthma severity of the

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