Q&A: How physicians can gear up for peak asthma month in September
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Key takeaways:
- Patients tend to relax their regular allergy maintenance routines during the summer.
- Identifying allergy triggers among patients can help in managing them.
As fall draws near, so does the season for viruses and environmental allergens, which can trigger asthma. Experts say that with children returning to school and the season changing, allergists can expect to see an increase in patients.
September is peak asthma month, and Healio asked Niti Chokshi, MD, allergist, immunologist and co-owner of Complete Allergy and Asthma, Houston, and Gary Falcetano, PA, U.S. scientific affairs manager at Thermo Fisher Scientific, to weigh in on how physicians can identify and manage asthma patients’ allergies during this time.
Healio: As we get into the fall, what are the most common environmental triggers of severe asthma attacks?
Chokshi and Falcetano: With 25% of all yearly hospitalizations for asthma happening in September, it is incumbent upon clinicians to prepare their patients for the tsunami of environmental triggers that occur at this time of year. Among these triggers, the most common include viral and bacterial respiratory illnesses, ragweed pollens and mold spores. Among other allergen triggers, perennial (indoor) allergens such as dust mites, pets and mice are often overlooked as “co-conspirators” that contribute to overall airway inflammation and can exacerbate asthma symptoms.
Healio: Also, as we get into the fall, what are the most common viral triggers of severe asthma attacks?
Chokshi and Falcetano: Rhinoviruses, respiratory syncytial virus (RSV), influenza and COVID-19 are the most common viral triggers.
Healio: Where do patients most often encounter these triggers?
Chokshi and Falcetano: Weed pollen is aerosolized outdoors. Time spent outdoors can expose patients to these pollens. Molds specifically are often found in piles of fallen leaves and other decaying vegetation. Molds can also be perennial and occur in areas of the house that are hot and humid and where water leaks occur such as bathrooms. Increased indoor activities elevate patients’ risk for exposure to indoor allergens and respiratory pathogens. Children also are returning to schools, some of which may be in aging buildings with a host of indoor air quality issues. Additionally, cold air is another trigger that is increasingly encountered as we enter the winter season.
Healio: How can clinicians help patients avoid these triggers and treat them when they are encountered?
Chokshi and Falcetano: Different triggers may require a variety of techniques to maximize avoidance. For allergic triggers, it is important to first accurately identify all of the potential sensitizations that may be contributing to symptoms and then to provide specific guidance around exposure reduction techniques. For example, if someone is allergic to ragweed pollens and outdoor molds, then reducing time outdoors may help mitigate symptoms. Keeping windows closed, changing clothes and showering after being outside are some of the tried-and-true methods that can be shared with patients. If dust mite allergy is identified, then using allergen-resistant coverings on bedding and washing sheets and pillowcases frequently is important. In addition, limiting relative humidity in the home to below 50% makes it difficult for dust mites to thrive.
From a treatment perspective, having an asthma action plan in place and emphasizing the importance of adherence to prescribed controller medications is vital, as is remembering the concept of the united airway and optimally treating upper airway (rhinitis) symptoms. In patients with a confirmed weed pollen allergy, starting inhaled nasal steroids and antihistamines a few weeks prior to the season will help to pre-emptively mitigate both upper and lower airway symptoms.
Advice on hand hygiene and other infection prevention techniques along with recommending indicated vaccines (eg, influenza and COVID-19) helps to minimize their impact as well.
Healio: What role does testing play in this process?
Chokshi and Falcetano: It is difficult to identify allergic triggers based upon history alone. This is why both major allergy organizations in the U.S. recommend the diagnosis of allergic rhinitis and allergic asthma be based upon clinical history and diagnostic testing. Correlating the two provides the best way to confirm or rule out a suspected allergy.
Healio: What are the best diagnostic tools that clinicians can use to test for seasonal allergies?
Chokshi: As an allergist I use both skin prick testing and specific IgE blood testing. Primary care providers can utilize specific IgE blood testing to accurately identify allergic triggers for patients and to implement a personalized management plan. Major laboratories offer respiratory allergen profiles that are an efficient tool to identify the most common perennial and seasonal allergens in your geography to which a patient may be sensitized.
Healio: What other best practices do you recommend for helping patients prevent and mitigate these reactions?
Chokshi and Falcetano: Multiple surveys and studies have demonstrated that patients tend to become lax about filling and utilizing their asthma controller medications during the summer months. Being proactive with reminding patients to adhere to recommended treatments is especially important as we approach Asthma Peak Week — which occurs during the third week of September. This time of year sees a significant spike in asthma-related ED and hospital visits, as both adults and children are exposed to increased allergy and asthma triggers such as ragweed pollen, indoor and outdoor mold, and respiratory viruses. If a patient’s symptoms are difficult to control, referral to an allergist for specialized treatments such as immunotherapy or biologics may be the best option for achieving optimal disease management.