What are the most common triggers for people with asthma?

In terms of, once you have asthma, triggering an attack of asthma then there are very common things such as viral infections. That’s probably the commonest cause of genuine worsening asthma and asthma attacks. On a more short term basis then some people find exercise, breathing cold air, those are the sorts of things that will trigger them, and then of course there are allergens which you can either experience indoors such as house dust mite, cats, or outdoor, such as grass, pollen and fungal spores.

So theres a range of different things that can do it, both physical and in terms of allergens. But of course on top of that stress, emotion, can act as very potent triggers. On many occasions I’ve had people who will tell me that moments of high emotion, such as funerals will exacerbate an attack.

Can you tell me what, how easy it is to ascertain what the triggers are in people?

That is more difficult. Some people will say to you, this is what it is. I know that if I eat peanuts that I will have an attack of asthma. In children very often exercise is a classic, very easily recognised trigger. School teachers will say, Hes not trying at games. And it’s not that, it’s just they get breathless so, and viral infections clearly, you know, I had a cold. It went to my chest. My asthma got worse. Is something that’s fairly easy to recognise.

More difficult are those triggers which you are more hidden, such as perhaps allergens that you’re not aware of. Or maybe even certain chemicals that you’re exposed to at work. Those sorts of things may well be much more difficult to, to understand, except with extensive investigations.

We were going up this hill, and I was getting more and more breathless. And I was, I knew I wasn’t super unfit or anything. And I got to the point, I was getting so breathless I thought, I cannot do this. And I actually had to drop out of the walk.

And I had been having troubles with breathing before, I had been troubled, I had recently become allergic to dogs and I was coughing a lot when I was near this friend’s guide dog. And, I thought why, you know, this, with this reaction to the dog and also similar reaction when I was around a couple of people who had been smoking. They weren’t smoking at the time but there was smoke on their clothes. And I was coughing and coughing, and I took my hay fever medication, but that didn’t do it.

Then I had this problem getting up the hill and getting so breathless I couldn’t do it, I couldn’t get up the hill, and I had to stop, literally, wait for everybody else to go back up and then come back down and get me half way, half way there.

I thought wait a second, something’s wrong here. And I said to my GP what the problem was and I said, This isn’t asthma is it? Because I’d had hay fever for over twenty years by then, and she said, Well it kind of sounds like it is. And she gave me at the time, just a steroid inhaler. She said, take, you know, told me to take it, two puffs in the morning, two at night and see what happened.

And it eased off the symptoms, and the next walk I went on with my friends, I could go all the way. And that sort of told me something [laughs].

I think you have to know your condition. And you have to put time aside to find out it and understand because quite often you won’t get told things. I was always told that my environment years ago didn’t affect my asthma. I knew that was wrong and now of course with today’s knowledge they were, I’m now aware that I was right. You know I have to keep soft furnishings to a minimum. Try and have hardwood floors. So reduce the dust in your house. Reduce the level of house dust mites in your house. Cleanliness is, you almost get OCD about it [laughs]. You have to keep a clean environment, otherwise your asthma will suffer. And you have to watch yourself and figure out what sets it off. I can go out in windy weather in summer and I’m fine. If I go out in windy weather in winter, I’m not fine.

It will induce if I breathe in cold air, it will induce an asthma attack and I’ve got to be aware of that. Whereas I don’t, practicing consultants are always aware of the many, many different things that can set it off.

I’m not a person that gets terribly severe asthma, and it varies from the time of year. So in the summer I get very little asthma if at all, but there are certain triggers in the winter that will bring on my asthma. Such as cold weather, and wind. If I go out in the wind that’s bound to bring on asthma.

I can generally keep my asthma under control by taking daily inhalers. When I get asthma I can usually keep it down. But there are occasions, particularly if I get a cold or chest infection then none of the normal medication will do anything. So I have to go to the doctors and get steroids. And after two or three weeks it will go back to normal. He also gives me some antibiotics because it’s normally a chesty cold and that is not good for asthma at all.

Generally what happened was, my asthma came about in the summer and tapered off towards the end of the summer and was nonexistent through most of the winter until sort of the end of the spring time. At which point I was told that it was hay-fever related. And ever since then, over the years it’s got better and got worse, its fluctuated without the need of sort of apparent sort of any reason. But it’s always stuck to sort of about mid June to mid August, I’ll get asthma and it will be at dawn and the dusk. So during the middle of the day it’s probably fine. But as soon as the sun rises essentially, as soon as the sun rises and the morning when I’m asleep I have difficulty breathing, I have to use an inhaler. I usually try and use the, the brown inhaler sort of a month before I know I’m going to get the symptoms, so you know, May. I start using it then and try and use it all the way through. I’m probably supposed to use it on an annual, you know, all the time, but kind of when it goes away you think you don’t need it. So I stop using it when my asthma stops and then I start using the brown one when it kicks in again the next year. And use the blue inhaler as and when I need it. So it’s quite mild.

I’ve never had an asthma attack as such. You hear about people have like a heavy asthma attack and not being able to breathe at all. Mine is just annoying. You know, it will sort of graduate up to the point where it’s just uncomfortable and without an inhaler that uncomfortable feeling lasts, you know, it could be a, you know, a couple of hours. But using the inhaler will stop it and until the next either dawn or dusk when it comes back on again. Or exercise during the summer as well.

Will make it worse?

Yes, but that’s usually a strange one. I’ll exercise for say ten minutes and also running for ten fifteen minutes and I won’t have a problem but as soon as I stop my asthma will kick in and then I have to use the inhaler and then I’ll be able to carry on again.

I know if I have a cold, so I avoid people with colds. My family have got to learn to know that if they’ve got snivelling children they shouldn’t come near me. I try and avoid large sort of shut in gatherings, where there might be people with colds. And if I hear them start to sneeze or they’re blowing their nose a lot I move away and I’m fanatic about washing my hands. I come home and scrub my hands as soon as I come in whenever I’ve been touching things out of the house. And that has served me very well because I’ve got a lot fewer colds.

I do remember at some phase with the consultant him saying to me, If you get a cold and you get congestion in your lungs, and you don’t’ get rid of it, you’ve got stuff in there, mucus, then germs will think, Oh lovely environment to get into’ and you’ll get more and it becomes a sort of vicious circle you can’t get out of. So it’s very important to make sure that you clear your lungs at the end of a, a cold or whatever’s caused it. And that also has worked very well too. I try to make sure that if I’m given any extra medication or I up it that I clear my lungs so that I’m totally not coughing stuff before I, you know, go back to normal medication.

…you know, I suppose I’d been unwell for periods, you know, and instead of just having a cold and you’d recover, I mean, I’m, I always thought I’m just chesty and colds go on. If I do get a, a cold it goes to my chest and it takes me longer because I’m asthmatic to get rid of the mucus and stuff. So it’s a more long drawn out thing.

So I dread getting colds and try to avoid them. And when I was working obviously you’d have to go on working but I didn’t want to go take my germs, you know, I think if everybody stayed at home for the first couple of days and didn’t take it with them a lot of people who suffer from asthma and other things that go on from respiratory infections and things would belife would be a lot easier.

People don’t, they, particularly now of course people, if you’ve got a job they’re trying to keep it and they’re not going to, you know, stay at home because they’ve got a cold.

There are times when the asthma gets the upper hand, obviously. I had a cold in May this year and it yeah it went to my chest and things are bad, I just zapped it with everything. And I’ve got over it much more quickly than I usually do. But on the whole I think I manage it. It fits in with me. And most of the time I, I don’t even think about having asthma.

So I get something like a cold and it goes onto my chest and I get very chesty, I develop a chest infection and then my asthma’s bad. And, and what can happen then is that’s when it can be really difficult to walk say from the chair to the kitchen to make a cup of tea and back again. And my breathing can go from being, when I’m sitting in the chair I can feel absolutely fine. But if I get up to do something my breathing can go in seconds from being as apparently normal as it is now to not being able to catch my breath at all. You know, literally in less than a minute.

It, you know, it just switches. Which is when it gets frightening really. But at that, and that will get better over, so that so… So I might get a cold, it goes onto my chest over a period say two or three days and then over the next week my breathing will be really difficult and I might have four, six of these attacks where I just can’t breathe at all and I have to stop everything and sit down and use my blue inhaler. And in between I’m a bit wheezy and, you know, slow. It’s a bit like, you know, and I was talking about when it started, I felt like my batteries had run out.

So it’s a bit like my batteries are only operating at quarter power. And then over the next three or four weeks it will slowly improve.

Most of the things for me it’s just making sure it’s, you know, it’s properly controlled with my medication and things like, you know, having, having my flu jab so that I’m less likely to get flu, because that’s a really bad you know, I have had flu once when it was a strain that wasn’t in the jab it’s just really bad luck, and I was really ill. Which kind of underlined for me how important the flu jab is. Because sometimes you think, Well

Hmm, is it doing

…you know, does it make a difference? But, yeah, having flu was definitely not fun with asthma on top.

And it does seem to work most years.

I was wheezing very badly and it did scare me, it’s, it does scare you because its sort, it’s new that’s happening to you and as I said, in those days, you, people knew very little about the problem. And I begun to find it hard to, I did notice that it depended where I’d go. Like if I walked past grass, right, or hay or anything like that, then I would start to feel very wheezy and totally out of breath. And animals had a big effect on me as well.

Can you remember the first time that you really noticed that you had it, that you really noticed you were wheezing?

Yeah. My, my eyes really watered and also my eyes were swollen up. And I was, I could not breathe and they had to call an ambulance. And that is one of the first times that I was aware that, you know, some, something wasn’t really right.

Over the years it’s got worse. You know, I’m aware it’s got worse. And my lungs have got a lot worse as well. I’m not hiding it. My asthma really developed through smoking.

I don’t smoke now of course, because I’d be dead if I did. But yes, my asthma really developed. If I hadn’t smoked and I gave up cigarettes an awful long while ago, but then I went onto cigars and that really ruined my lungs completely.

Right.

You know, I’m quite happy to admit that now. But I didn’t realise it at the time of course.

And did you quit smoking after or before being diagnosed or around that time?

About the same time. I suppose it was about a year or so later.

Okay. And was that the… What was your motivation to quit smoking? Was it?

Well because the doctor told me I’d be dead in two years if I didn’t.

I find food is the odd one because that’s the one that seems most people, even my friends who are asthmatic, don’t seem to have that much of a problem with. The one they used to actually cause me a lot of problems as a child was fizzy drinks and I just seem to be the one person that has that problem, but that was enough to send me to A & E as a child up until I was about ten. If I drink say, if I drank a can of something every day for about a week, I will start getting symptoms. So I try and stay off it as much as I can, or just not, you know, basically don’t drink as much. So I’ve got avoid that. Certain foods do it, for example not having, ice cream for example in the winter, or anything that’s sort of frozen in the winter. I try and avoid that or it will trigger it off. A bit of a problem with milk. I still have a problem with that, especially cold milk and that, sort of seems to if I drink a lot of it that seems to set it off a bit as well.

Do you avoid them completely or would you kind of do it in moderation and see how it goes?

I did sort of cut out milk for a long time. But I think I ended up with a calcium deficiency, so and I think eventually, when I started it just bothered my stomach than my breathing. So then you’ve got that lactose free in the alternatives so I started using that more, because I started going basically with the calcium deficiencies and stuff. So it’s not as much of a problem.

But the rest for example, avoiding, yes, I mean I can avoid having frozen stuff because it always ends to be stuff that’s not good for you in the winter time, so I can sort of live without that. Fizzy drinks I find hard work, because I don’t drink alcohol and I do find that it tends to, I just seem to always have an unsettled stomach anyway for some reason. Fizzy drinks help that in one case but it causes the problem the other way, so it balance I can be quite annoyed.

One thing I did want to say about asthma and is the, the mental implications and the, and the, how to put it, the effect the brain can have on your asthma.

Theres so much people don’t realise the… I don’t know how to put it… the, like the stress, anxiety, the psychological, that’s it, the psychological impact or the impact of psychology on your asthma.

So your emotional state?

Yes.

Yeah.

Yeah, if you get stressed you know, stressed at work, you can do anxious for something, you know, if you’re upset about something, anything like that can set you asthma off. And so many people don’t realise it, and, and then when your asthma’s not so good or your breathing generally, you know, if you’re breathless and then you start panicking, worrying and getting anxious about it, it just spirals, and I now know that anxiety and stress are one of my big triggers, psychological thing. You know, if I think I’m going to get ill, then I can, I can almost make it, make it happen, almost self -fulfilling because you think, Oh, I’ve sneezed, I’ve got a cold I’m going to be ill.

Start to panic.

Yeah, you start to panic and it’s just one thing after another. So you have to learn a lot of relaxation and calming techniques.

I went to the doctor and she said, You’ve got asthma.” Why? How? You know, I just couldn’t understand why I suddenly had asthma. I’d had nothing before.

But I was going through a very stressful part of my life and it, she said that it was, in the main, stress-related.

But gradually over time I’ve looked at it I’ve analysed where my problems are because everybody has a different trigger. I know that certain types of stress will bring it on. I also know that if I have a really bad cold my nose gets stuffed up, my breathing then becomes difficult. I know the kinds of foods that make me worse.

And it was at that I time I started to I got the internet and I was doing research on the internet and I saw something called, on the Mayo Clinic a woman who said she was getting wheezy every time she had a period. And I thought every month. And I started keeping a record, and that was it. And of course, it suddenly dawned on me, I got, when I was 13, that’s when you get the rush of hormones, when you’re 40 you go into the menopause, you get the next rush.

And I went to the doctor and they all agreed it was something it was called catamenia asthma and he was really quite distraught that he hadn’t thought of it himself. He said hed never heard of it. And apparently it’s quite common. More commonly known in America than it is here but the consultant I’ve got here is really very good and he referred me to a gynaecologist who said, Well the only thing they can do is give you a hysterectomy, and probably it’s not worth it yet, you know, now because of your age. So I thought well when, when I stop, when I stop having my periods it’ll get a lot better and it did, but it didn’t go away altogether and apparently because your hormones never go away, but it’s a lot, lot better.

People are often surprised that I have a dog because aren’t you allergic to’ I’ve had allergy tests and I’m allergic to anything with fur and feathers but not dogs. The doctors have tested me four, five times because they’re convinced I should be. I’m allergic to everything else, but they’ve decided its mind over matter my body doesn’t want to be allergic to dogs because I love them. Yeah, it’s I mean, everything I can’t go to my brother’s house, brother and his wife and my niece because they’ve got a cat, but they had the cat before or my sister-in-law had the cat before she married my brother. So, you know, we can’t really ask her to get rid of the cat, but my aunt has always has had cats as well, so I’ve never really been to my aunt’s house because I can’t. I can’t horse ride, I can’t, you know, like birds and that sort of stuff. if I go anywhere, I have to check first if they’ve got cats or I mean a lot of my friends, we meet up in town or we meet or they come here because I know it’s a safe clean environment. I mean other triggers for me include things like, cleaning products, bleach I mean, I went to my grandmother’s house a few weeks ago and her cleaner had been in and left, left bleach in one of the loos which, you know, is perfectly normal, it’s what people do, but I’d have only been in the house five, ten minutes and I knew that there was bleach somewhere; I couldn’t smell it but I could feel it.

So, my grandmother had popped down to the shop and I was hunting round her house trying to find the bleach where is it?’

And it was in the in her en-suite and, you know, so I had to flush the loo and get rid of it and then I was fine. But you’d have thought I was mad for a minute, going round the house sniffing, wheres the bleach?’ But I was getting tighter and tighter and I knew that if I could get rid of the bleach, use my inhaler, I’d be fine but if I left it there, I’d have just got worse and worse and could have ended up in hospital.

Theres just so much rubbish being talked about asthma. People who, you know, say, even professionals will say, Oh well, you must get rid of all plastic bags, all cats, all dogs, all feather-filled pillows, all plants because of the mould, all, everything. And obviously no carpets. Well, I’m not allergic to house dust mite. So, that would be a waste. And I remember being a kid and my mate, or some other kid in the school, had been told that they must get rid of their dog because when they go, go home for the holidays their dog gives them asthma. Well, I don’t know how it happened but the, the parents got rid of the dog so the child had an asthma attack because he was stressed

He was stressed

Yes.

Yeah.

It wasn’t the dog at all.

And what kind of allergies would you say you have? Or had at the time?

I was tested actually for it, cats and house dust. But then I don’t like cats much, so they couldn’t find an allergy to dogs, because I like dogs. So I don’t know really how widely it is. I’m sure pollen is also a factor because at certain times of year; presumably cats and house dust are there all the time. So, it must be pollen too.

Are you able to avoid the triggers, the things that set your asthma off? Is that something that you try to do or?

I try, well for a while I tried to avoid cats [laughs] and staying in peoples houses who have cats but strangely enough they don’t always affect me. We spent some weeks living in a neighbour’s house just across the road here while we were having these extensions done, and they have two cats with whom I got on extremely well and they thought I was God’s gift, and they, as far as I know never affected me at all. Whereas other peoples places I can’t go in. Theres a place I visit regularly every, a friend’s house, I visit for a meeting every few months, and his place never fails to set me off, and they’ve got half a dozen long haired cats. So some do, some don’t.