ENVIRONMENTAL MODULATION FOR ASTHMATIC (And Asthmatic-like) SUBJECTS
Modified and Created by NAZARIO A. MACALINTAL JR., MD,FPCP, FPCCP*
for MCMC IM PHIC requirements vApril2009
Avoiding allergens and irritants that make you wheeze or short of breath or cough is indispensable in reducing the severity and frequency of asthma attacks. A lot of these so-called ‘trigger’ factors exist at home, in the office or even outdoors. These guidelines attempt to assist you in defining them in order to limit your exposure.
ON DUSTS AND MOLDS
1. Special attention should be given to areas where you stay mostly, e.g., sala, bedroom, classroom, warehouse, factory, or office.
2. While it is true that arranging your furnitures, e.g., storing loose items in drawers or closets, for easy dusting may help, it does not prevent the dust from floating in the air - only to gravitate again. To vacuum the area is better, using water filter if possible.
3. Carpeted areas are not for asthmatics since dusts and molds accumulate on them. Wood and tile floors are better.
4. Cloth upholsteries are to be avoided. Leather or synthetic fibers are easier to keep dust-free although we have more dusts here than abroad..
5. Avoid “kapok” pillows (You must tell your grandma about it!) and those hairy blankets. Hypoallergenic washable pillows are available in most department stores or in some lung or allergy clinics.
6. Keep stuffed toys out of an asthmatic patient’s room (Or put them in plastics if your daughter insists it be kept in her room).
7. If you have air-con units, have their filters cleaned frequent*ly. Molds do live there. Filtrette3M may help.
8. Electric fans should be cleaned regularly as well, paying attention to the grille, and the anterior and posterior sides of the blades. Do not forget to remove the motor cover at the back and vacuum the motor itself - it is where dusts get stuck most. (Remember that every time the unit is switched on, all subsequently delivered air are passing through these dirty areas first.)
9. If there are window screens, they should be easily removable for cleaning. Remember, static electricity in these screens can make dusts accumulate there and therefore the air going into the room from the windows will always be enriched so to speak with the dusts that has collected in the screens. To clean, they should periodically be brushed with soap, rinsed with water, dried and vacuumed, just like electric fan blades and air-con filters.
10. Do not stock books and magazines particularly the new msprint ones, in areas where you frequent most, like your bedroom. All paper products undergo spontaneous combustion and newsprint ones turn into dusts and fibers much faster than the glossy or plastic-coated ones.(Library custodians who are asthmatic will have problem maintaining their remission.)The library, if existing in your homes must be outside the bedroom, and should be vacuumed frequently.
11. If the bed has a space underneath, this should not be converted into a storage area as dusts will accumulate and are less likely to be cleaned adequately. When the area is cleaned, the lower side of the bed itself must be vacuumed.
12. The head part of the bed should not be near the windows as dust entering through the latter are most likely to gravitate to the pillows first than to the floor.
13. Curtains should be frequently changed and vacuumed regularly. Vertical blinds are easier to keep dust-free and may be more preferable than curtains to asthmatics.
14. Limit or remove flowering plants in the room. Plastic ones are the breeding places of mosquitoes and become dusty as well. Hydroponic ones (those grown in water) may be a better alternative (but watch out for more mosquitoes thriving in your area since they love still water - unless you can create waterfalls in your house!)
5. Molds tend to accumulate in the bathroom, the moistures collecting mostly behind toilet and under the sink. These areas should be cleaned regularly as well.
ON ANIMAL DUNG / DANDERS
- Keep hairy or feathered pets out of the room where you frequent most. Never let them sleep on the sofa or on your bed. And avoid embracing or kissing them. (Cat’s hairs are most allergenic).
- Having a neighbor with piggery or poultry or aviary may present a problem for asthmatics.
ON INDOOR POLLUTANTS
1. You cannot smoke, passively or actively ( Be active in no-smoking campaign - it’s for all of us)
2. Some patients develop asthma attacks with hairsprays, perfumes, car deodorants, chalks or paints, even the freshly delivered newspapers - and attacks can be severe. (Unfortunately but true, you may have to watch out anything 'new' to your nose!).
3. If you have transferred to a newly repaired/constructed house or office, ask someone to vacuum the area - including the ceiling. If you’re the one doing the task, wear mask. Micro-organisms producing respiratory tract infections can come from these areas and exacerbate/trigger an asthma.
4. Students working in school laboratories and handling chemicals (or cadavers), and even the computer students/ office staff (using printers with toners that burn to produce prints) may complain of headache, dizziness, itchy eyes ,throat and/or skin as well as develop difficulty of breathing while in such workplace (Sick-Building Syndrome).
5. If you work in a factory where powders are used like gloves factory, your asthma can deteriorate. Try to talk it out with your employee (for magicians try other tricks instead, but not rabbits or doves).
6. Asthmatic pupils are better off in the rear seats away from the blackboards where chalk dusts abound. Asthmatic teachers may have to modify electric fan positions to create good air exhaust from the room to minimize inhaling the chalk dusts - and away from the asthmatic pupils, too!
7. Beware of hair dyes, too! (although patients may quip “Doc, Beauty first, before breathing!&^$#$^@#! Di bale nang hikain, umitin naman ang buhok! !@$%T^#$^&!)
8. Some patients get spastic coughing on taking the morning bath, (and could smell the chlorine). It may help to collect the water on a pail overnight to allow the chlorine to dissipate.
ON OUTDOOR POLLUTION AND POLLEN
- Living in one of the most polluted areas in the world is indeed a cruel setting for the local asthmatic (Metro Manila ranks third after China and Mexico in having the dirtiest air in the world. Bow, Philippines!!!). Unless our government’s priorities change radically to include serious pollution controls, it will be a long time we can be free of such problem. In the meantime patients are constrained to live with the situation and must try to lessen exposure.
(No, going to Baguio is not necessarily a better place to go - it is indeed morepolluted than Manila, as per local news! Blame it on diesel AUV taxis, plus the previous government's lax attention to Clean Air )
2. If you are traveling within the metropolis in a non-air-conditioned vehicle, it may help you to carry a small damp face towel(infant's towel are small to fit in the eyeglass plastic case ,and you can wash them before and after reaching your workplace, or the shopping mall) to trap the dirt from the air you breathe.
3. Avoid the pollen season when planning to go out of the country (spring, summer, or early fall). You may need to stay indoors during these seasons to minimize your attacks.
4. You may have to reconsider plans of going out-of town like to farms, or go mountain climbing, and the like where pollen/ other inhaled triggers are abundant. Your doctor may prescribe some prophylactic or maintenance meds - and stand-by emergency drugs, just in case.
5. If you are travelling to countries with cooler climates, it may be best to check with your doctor the precautions you may have to undertake BEFORE you fly there. Remember sudden change in temperature of the air you inhale at times can produce an attack. Ask what medications you have to take days before your flight. Similarly, if you are going back to the Philippines, your recent stay in your place of origin may temporarily alter your sensitivity to the local air pollutants so abundant here. It is not uncommon that those local residents experience itchy skin, eyes and even itchy throat when they arrive. For the asthmatics, these can translate to renewed asthma attacks.
6. Asthmatics are generally banned from scuba diving, even if under good control. Attacks while deep under water can be horrifying - be it from cold water, jelly fish sting, or from simple panic..
ON FOODS AND DRUGS
1. About ten percent of asthmatics are sensitive to sulfites, a substance used to make foods in the hotels or restaurants fresh-looking and are also used as preservatives in some anti-asthma medications like inhalers. Wine, beer, fresh-cut fruits, fresh looking mushrooms, and lettuce served in hotels ordinarily have these preservatives.If you have such allergy, you may need to avail of the sulfite-free preparations abroad. Or, you may have to be shifted to dry-powder inhalers (DPI’s). Notify your doctor about it.
2.Avoid artificially colored fruit drinks specially the yellow ones. Some patients are sensitive to tartrazine and other dyes. (Even those now famous iced tea may come in strong and give you either asthma attack or numb lips. Watch out!!)
3. There are reports that some asthmatics react to the famous Chinese food flavor enhancer, monosodium glutamate (Vetsin).
4. Aspirin and other non-steroidal anti-inflammatory agents (often called NSAIDS) can worsen asthma if they are aspirin sensitive. Severe shortness of breath can occur - and attacks can be life-threatening. Acetaminophen is a safe alternative.
5. Other medications like anti-hypertensives can cause or worsen asthma like attacks.Beta-blockers and converting-enzyme inhibitorsare examples. Consult your doctor about them.
6. A considerable number of referred asthmatics have worse symptoms while taking mucolytics. The phlegm of an asthmatic has a different characteristic from other causes of cough and may not promptly respond to mucolytics, at times paradoxic Though such medications should be effective for other respiratory illnesses, it may not necessarily be beneficial to asthmatics whose airways are irritable or ‘twitchy’.
7. The same precaution goes for expectorantswhich is designed to exaggerate cough to put out the phlegm. Not all asthmatics have that much phlegm and among patients whose problem is more of airway spasm, the expectorants may not produce the expected relief but worse coughing instead.
OTHER PRECAUTIONS
1. Any respiratory infection, whether viral or bacterial, can worsen asthma. See your pulmonologist when they occur.
2. There are also asthmatics who worsen with exercise or with exposure tosudden changes in temperatures. Brown-outs, being very common locally in the past, and during a simmering summer can create a very bad atmosphere for the asthmatics. Consult your doctor as to how these attacks can be anticipated. (One patient's mother told me: "Doc, I prefer to pay P5,000 to MERALCO than to the hospital!" So there.)
If you have any questions regarding your asthma, see your doctor.
"Prescribing medications is one of the easiest thing to do (to the patient). The more challenging are the first and last parts - to define the extent of the problem , and what can be done to prevent it"
-DR.MAC