Expert Perspective: Managing Asthma on Poor Air Quality Days
What happens during an asthma attack?
During an asthma episode or flare (also known as an â€œattackâ€), most people experience:
- a tight feeling in the chest
- shortness of breath
Asthma symptoms are caused by:
- changes in the airway, such as inflammation of tissues
- bronchoconstriction or tightening of the muscles around the airways
- an increase in mucus that can further block the airway
How can an asthma attack cause hypoxemia (low blood oxygen)?
Hypoxemia, or below-normal blood oxygen levels, may occur because of an asthma episode and difficulty breathing â€” but only if breathing stops.
This can result in decreased oxygen levels in the alveoli (lung air sacs) and less oxygen transportation to the blood through the capillary membrane.
A mismatch between airflow in and out of alveoli (ventilation) and blood flow to and from alveoli (perfusion) is the outcome of an asthma attack. An asthma attack affects ventilation more than perfusion.
What triggers asthma â€” ground-level ozone, particulate matter, or another factor?
An asthma trigger is defined as a thing, activity, or condition that makes asthma worse and can cause sudden symptoms. Both ground-level ozone and particle pollution are asthma triggers.
Other common asthma triggers include:
- tobacco products
- animal dander
People with asthma are more vulnerable to air pollution. Poor air quality days may trigger asthma episodes that need emergency department visits or hospitalizations.
Itâ€™s important to clean up our air quality to reduce these health impacts for all individuals, including those with chronic lung conditions such as asthma.
However, sadly, climate change is worsening the air quality in much of the United States.
Climate change enhances the conditions for more severe wildfires, with smoke that can spread particle pollution for hundreds of miles. It can also worsen ozone pollution in our air.
The American Lung Association (ALA) State of the Air 2020 report found that after decades of improvements in air quality, climate change is beginning to undo that progress.
Should I check air quality daily?
If you have asthma, itâ€™s recommended that you check air quality daily, especially if you plan to spend time outdoors.
The Environmental Protection Agencyâ€™s (EPA) Airnow.gov website is a great tool to check daily air quality. Thereâ€™s also an AirNow app.
What are some good resources for information on air quality?
You can learn more about air quality on the ALA website, including the status of overall air quality in your area with the State of the Air report mentioned earlier.
Additionally, the ALA offers tools on how to better manage your asthma as well as how to improve the air quality at your workplace or school.
Can lifestyle changes in people with asthma reduce the impact of poor air quality?
Yes, lifestyle changes for people with asthma and those around them can make a significant difference. Identifying what your asthma triggers are and avoiding them is an important step in managing your asthma.
One of the biggest things you can do is to quit smoking or vaping. If you donâ€™t smoke or use e-cigarettes, reducing your exposure to secondhand smoke or vape emissions will decrease the overall irritants to your lungs.
You can reduce other exposures in your home as well, such as pet dander, mold, or pests.
Outside the home, if you have a bad air quality day, itâ€™s best to not exercise outdoors. Stay indoors as much as possible.
You can also take action and play an important role in cleaning up air quality by:
- encouraging the transition to electric vehicles
- biking instead of driving when possible
- telling your representatives that cleaning up the air is important to you
If you take the pledge to Stand Up for Clean Air, the ALA will share easy, actionable steps you can take to make a difference.
Should people with asthma pause their exercise routines on poor air quality days?
When the air quality is poor, itâ€™s important for everyone to avoid strenuous activity outdoors. This is especially true for people with asthma.
Options for indoor alternatives include:
- walking in a shopping mall or gym
- using an exercise machine
- working out to an exercise video
If you have children, try to limit their outdoor playtime as well on days when the air quality is unhealthy.
Finally, itâ€™s important to note that exercising close to high-traffic areas can increase risk. Even if the air quality forecast is good, the traffic on busy highways can create high pollution as far as one-third of a mile away.
What are the main factors that worsen air quality inside homes?
There are many factors that can worsen indoor air quality.
During the COVID-19 pandemic, many people are spending more extensive time at home. Itâ€™s important to be aware of home air quality issues and asthma triggers as well as know how to reduce or avoid them.
Be aware of exposures to:
- dust mites
- pet dander
- common cleaning supplies
- household chemicals
- mold or bacteria from flood and water damage
- secondhand smoke
- residential woodburning (fireplaces and woodstoves)
- building materials such as asbestos, VOCs, and paint
Naturally occurring radon gas can build up in your home at unhealthy levels. You canâ€™t see, smell or taste radon, and exposure to high levels of this gas can cause lung cancer.
I recommend testing your home for radon. Learn about radon, how it affects the health of your lungs, as well as what you can do about it from the ALA.
What recommendations do you have for improving the air quality inside homes?
Itâ€™s important to keep your home and the area around it a smoke-free zone.
To reduce dust, clean with a damp cloth, vacuum frequently, and change your AC and furnace filters. Use HEPA filters if possible.
Consider removing your carpet, and make sure that each room has proper ventilation, especially in rooms like the bathroom, kitchen, and basement.
Ensure you have proper seals on windows and doors so air pollution canâ€™t get in. This will also help minimize pests.
Use household and personal care products that donâ€™t have chemicals (i.e., nontoxic) or strong odors.
Examples of these products include:
- household cleaners
- aerosol sprays
- scented candles
- room fresheners
Also remember to test your home for radon.
How can people with asthma reduce their risk of hospitalization during times of poor air quality?
Controlling your asthma is the best way to lower your risk of needing hospital care. You can accomplish this through good asthma management.
Develop a written asthma action plan in partnership with your doctor and healthcare team. An asthma action plan includes information on:
- how to identify your symptoms
- when or how to take medications
- how to identify your asthma triggers
- ways to avoid those triggers
In general, if itâ€™s a bad air quality day, itâ€™s important to stay indoors and minimize the amount of outdoor air that enters your home.
Prevention is key, so make sure to take your medications as prescribed by your doctor every day.
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