Asthma Proof Your Environment – Eliminating Asthma Triggers

Intro: This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Eliezer Nussbaum, Medical Director, Pulmonary Allergy, Asthma and Cystic Fibrosis Center, Miller Children's Hospital Long Beach. Dr. Nussbaum is also a Professor of Clinical Pediatrics at the University of California, Irvine, and Chief of Pediatric Pulmonary Medicine. Welcome, Dr. Nussbaum.

Eliezer Nussbaum, MD: Thank you.

Deborah Howell (Host): We're very, very pleased to have you on the show today. Today we're going to be talking a little bit about asthma triggers and how we can help asthma-proof our environments. But first, could you please tell us what happens during an asthma attack?

Eliezer Nussbaum, MD: Since asthma represents inflammation as well as bronchoconstriction, meaning the airways are tight, patients basically manifest asthma attack by being short of breath, wheezing, coughing, primarily a nocturnal cough. And the reason that they cough is basically because of the inflammatory process to have a lot of mucus, and it's like looking at a house and you see smoke coming, you know there is a fire somewhere. So if a patient is coughing, it really represents a problem such as inflammation, which is basically mucus production, which is part of the asthma manifestation. So during an asthmatic attack...

Deborah Howell (Host): And what exactly is wheezing? Everybody talks about wheezing, but what really is it?

Eliezer Nussbaum, MD: Okay, the explanation can be very simple. If you put the kettle on the stove to make tea, when the water reach a boiling point, you hear a whistle. And then you know basically that you have steam going through a very tight hole. So when you, for example, when you try to whistle, when airflow goes through a very tight opening, it creates what's called a high-pitched sound. It's a turbulent flow which you hear as a wheezing. So when you hear a whistle or a wheezing, it means air is going through a very tight fit. So wheezing represents the fact that the airways are very tight and they are constricted, and therefore the airflow goes through a very narrow passage like a very narrow tunnel. And that's the wheezing. The cough itself is basically the mucus that the patient's primal instinct is trying to get rid of. And the shortness of breath is simply because the airways are very tight, so in order to mobilize a certain amount of air, you need to breathe faster. The analogy will be if you run a marathon or you are on the treadmill in the gym, your breathing is really fast to accommodate for the oxygen demand. So it's basically oxygen demand and oxygen supply. So if you are really tight and each breath you mobilize a smaller amount of air volume, the compensatory mechanism is to do it more times, so you're breathing really fast. The same like if somebody has a heart problem, the heart rate will go up in order to accommodate the fact that the heart is not as efficient as it should be.

Deborah Howell (Host): Excellent. Thank you so much. I've always wondered that. Let's talk about some of the asthma triggers. What are the most common ones?

Eliezer Nussbaum, MD: The most common ones are basically viruses can be a trigger. For example, RSV, we call it respiratory syncytial virus, or the common rhinoviruses that are prevalent, they can be basically a trigger factor. And this is why we strongly recommend to have a flu shot, which covers 70% of your viruses that can be a significant trigger, primarily during the winter. And by the way, if I am speaking too fast, just stop me.

Deborah Howell (Host): Oh no, no, you're doing great. But that raised a question for me. Why is it so important for parents to know about their child's asthma triggers and what they are?

Eliezer Nussbaum, MD: Okay, let me tell you about a few more triggers before we move forward. So another trigger can be exercise activity. Some people may run and it can trigger an asthmatic attack. Environmental, such as smoke, for example, these can be also a trigger. Pollens during the spring, you could have certain environmental, basically, trees, grass, and so forth. Additionally, the air pollution can be a trigger. So kids who live close to freeways or highways can have an asthmatic attack as a trigger. Also, any infection that really affects the lungs can be a trigger for an asthmatic attack. So what are some of the most... these are the most common triggers. Now, your question, what should parents do in order to minimize those triggers? Number one, first of all, to be compliant with treatments. If a treatment is being designed by a physician, either a pediatrician or an asthma expert, the compliance or adherence is of paramount importance. Additionally, the flu shot. Avoidance of undesired environmental factors such as smoking, minimize the smoking. If a kid is allergic to animal, and basically it's not to the hair itself, it's basically to the offending allergens that animals bring with them. Dust, for example, can be a factor that can trigger asthma, and it's not the dust itself, it's the dust mites, small creatures that can generate an asthmatic attack. So, as a preventive or proactive... we need to be proactive first of all. As the flu shot, avoiding environmental pollution, avoiding smoke, avoiding animals if you're allergic to animals. Avoiding dust, meaning covering the pillows and the mattresses with hypoallergenic covers, which you could get at Target. And in addition to vacuuming, to vacuum the mattresses and different parts of the house very frequently, let's say once a week or at least twice a month. Additionally, removing carpets from the child's environment. If the child sleeps in a room that has carpeting, it needs to be removed, because you can never clean a carpet well. If you know a carpet cleaner who could really get into those fibers and can guarantee me that they can remove all the dust, please give me a call, I'll hire that person. So I don't have in my house a lot of carpeting. I have basically floors without carpeting.

Deborah Howell (Host): Okay. So let's get into some of the asthma treatments that Miller Children's Hospital offers.

Eliezer Nussbaum, MD: Okay. Miller Children's Hospital has what's called a high-end one-stop shop, and it offers treatment for the entire spectrum of asthmatics, simple asthma and complicated asthma. We have also what's called a difficult asthma clinic, which indicates treatment from basic therapy like preventive therapy in the clinic in the outpatient department, which incorporates short-acting beta-2 agents, inhaled corticosteroids, or a combination of the above, or additional treatments such as leukotriene receptor antagonists. Those that basically block the release of cytotoxic chemicals that trigger the asthma chain. Then we have patients who are sicker and they need to be on stronger steroids. And then we could take you all the way from the outpatient department, which we see as a preventive or proactive approach to minimize any asthmatic attacks and prevent admissions to the hospital, basically to the intensive care unit where the sickest patients are being hospitalized with asthma, and they require intensive care. So we are also involved in that aspect. So we are basically involved from the preventive level all the way to the acute level in the pediatric ICU. We also have a pulmonary wing where we concentrate our asthmatic patients, and we provide education. We believe that one ounce of prevention is better than one pound of cure. So we have the personnel in the pulmonary wing - it's a big wing - that will basically house those asthmatic patients. And we have the education by the respiratory therapists, we have social workers, we have our team who are asthma experts who are also board-certified not only in pulmonary, but also in allergy immunology.

Deborah Howell (Host): So Dr. Nussbaum, if a parent is interested in receiving care for their child, how can they schedule an appointment at the pulmonary center at Miller Children's?

Eliezer Nussbaum, MD: Okay, there are a few avenues. One is to dial the following number, which is 562-933-8567. Secondly, to go to the Miller's website. Thirdly, to go to our group website, which we devised. It's one of the fanciest websites you will see, and the website is Breathing 4 Kids. Breathing, the number 4, kids, K-I-D-S. And if you go to that website, we have videos, we have a variety of explanations to parents, we have articles, we basically present the staff that takes care of those patients.

Deborah Howell (Host): And what are the... this is the last question because we have less than a minute.

Eliezer Nussbaum, MD: You can ask me more, no problem.

Deborah Howell (Host): Well, sadly we have about 45 seconds left. Just could you give me two or three signs that parents should take their child to the hospital for treatment?

Eliezer Nussbaum, MD: Okay. Increasing frequent cough, primarily nocturnal cough. Any shortness of breath. Diminished level of energy, the child doesn't want to do PE, loss of appetite. Wheezing, definitely. Any shortness of breath during physical activity. But it starts with cough, and then the cough becomes nocturnal cough, and you see that the child is really not the same kid you saw yesterday. And if a child has a virus and let's say a flu, this will really nail it.

Deborah Howell (Host): Thank you so much, Dr. Nussbaum. To listen to our podcast or for more info, please visit memorialcare.org. That's memorialcare.org. Have a fantastic day. I'm Deborah Howell. This has been your Weekly Dose of Wellness.