Why Has My Asthma Been So Difficult to Control this Summer?
The number of referrals for asthma and allergy consultation has been up for many allergists in the U.S. this year. The fall season has typically been the peak time of year for asthma flare-ups but summer 2010 has proven to be the likely first runner-up. Here are five reasons why.
First: There is the set-up
The mild winter which preceded our spring and summer seasons allowed for an early and protracted tree pollen season (compared to recent years). Many allergy sufferers sensitive to tree and grass pollen experienced a one-two punch as tree allergy season (February to May) rolled into grass season (May to July) in the Midwest and Northeast.
Second: Mold counts have soared because of the rain and humidity
The rains during late winter months and early spring created fertile ground for molds which represent a key trigger factor for some allergic asthmatics. Humidity levels have remained high throughout late spring and summer.
People with multiple allergen sensitivity (pollen and mold allergy) may experience a priming affect from early spring triggers. In other words, summer allergens (grass and mold) may cause worse symptoms when preceded by spring tree pollen allergy.
Some studies have reported increased Emergency Room visits associated with spikes in certain outdoor mold species, such as Alternaria.
Third: Weather changes may be problematic for asthma control
Although it has been consistently hot in many regions of this country, storms and shifts in temperature, barometric pressure and humidity have led to worsening asthma control and asthma attacks. Some of my patients are convinced their asthma flares have coincided with the weather changes. Investigators have confirmed the association of asthma flare ups with weather patterns that occur before and during thunder storms.
Fourth: Poor air quality often accompanies hot weather
Ground level ozone can become a critical non-allergic trigger during hot summer weather for those who have chronic respiratory problems. Although we need ozone in the upper levels of the earth’s atmosphere to protect us from harmful rays of the sun, ground level ozone represents up to 90 percent of all smog found in urban areas. Ozone peaks in afternoons of warm sunny days.
Other pollutants that represent potential outdoor respiratory irritants include nitric oxides (motor vehicles), carbon monoxide (motor vehicles and industry), sulfur oxides (industry), and particulate matter (many different substances in particles).
Fifth: Disrupted routine is probably the most under-rated cause of poor asthma control
The end of the school year is always an exciting time for families because the weather is nice and vacation weeks are often days away. The routine of early morning awakening, breakfast and medications becomes more inconsistent in many households. Even when one or both parents are forced to continue their daily work schedule, the family’s routine is changed when the children are no longer in school. Inhalants and pills may be taken later in the day, or morning doses totally forgotten. The more unpredictable night time events (movies, visits to friends or relatives) may lead to missed doses of medications especially when there are late night returns to home. The ultimate schedule buster is vacation itself.
Here are some tips to prevent or address the summer dip in asthma control:
1) Run your air-conditioning as much as possible in order to reduce mold intrusion and make it tougher on dust mites. Avoid opening windows in your home and car. Screens do not keep out pollen, mold or pollution.
2) Get you outdoor running, biking or other workouts done in the early morning hours when air quality and some allergens may be less prevalent.
3) Establish a summer medication schedule that accounts for later awakenings and bedtimes. Reminders such as “Post its” placed on the refrigerator or in the bathroom may be helpful. One of my patients hung a large poster that said “Time to take your inhaler” over her bed so that the message couldn’t be missed when she awakened each morning.
4) Plan ahead for vacations away from home. Have a checklist that includes all your medications and how they should be taken. Review what steps should be taken if you get sick. Who should you call? Where can you go? If driving, locate hospitals and urgent cares along the way, just in case.
5) Make an appointment to see your asthma care provider in order to discuss ways to better manage your asthma during the summer months. Ask about allergy shots. Review and update your asthma action plan.
Summer is the time to enjoy having more time with family and friends. A few adjustments in your approach to managing asthma and its trigger factors can go a long way.