Doctors Might Have Been Focusing on the Wrong Asthma Triggers

[Nevilledog]

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The Atlantic
@TheAtlantic
Asthma attacks unexpectedly dropped during the pandemic. Now doctors are rethinking long-held assumptions about one of the biggest public health problems in the U.S., reports @sarahzhang:

Doctors Might Have Been Focusing on the Wrong Asthma Triggers
The pandemic was a big social experiment that sent asthma attacks plummeting.
theatlantic.com
9:18 AM · Jul 9, 2021

https://www.theatlantic.com/health/archive/2021/07/the-pandemic-drove-asthma-attacks-down-why/619396/

Nicole Lawson spent the beginning of the pandemic incredibly worried about her daughter, who has asthma. Five-year-old Scarlett’s asthma attacks were already landing her in the ER or urgent care every few months. Now a scary new virus was spreading. Respiratory viruses are known triggers of asthma attacks, and doctors also feared at the time that asthma itself could lead to more severe coronavirus infections. So Lawson’s family in Ohio hunkered down quickly and masked up often to keep Scarlett healthy.

The ensuing months, to everyone’s surprise, turned into “this beautiful year,” Lawson told me. Scarlett hasn’t had a single asthma attack. Not a single visit to the ER. Nothing. She’s breathing so much better, and all it took was a global pandemic that completely upended normal life.

All around the country, doctors have spent the pandemic wondering why their patients with asthma were suddenly doing so well. Asthma attacks have plummeted. Pediatric ICUs have sat strangely empty. “We braced ourselves for significant problems for the millions of people living with asthma,” says David Stukus, Scarlett’s doctor at Nationwide Children’s Hospital. “It was the complete opposite. It’s amazing.” (Fears about people with asthma getting more severe COVID-19 infections haven’t been borne out either.) Studies in other countries, including England, Scotland, and South Korea, also found big drops in hospital and doctor’s-office visits for asthma attacks.

The massive global experiment that is the pandemic is now leading doctors to rethink some long-held assumptions about the disease. Asthma is a chronic condition that occasionally flares up, leading to 3,500 deaths and 1.6 million emergency-room visits a year in the United States. These acute attacks can be triggered by a number of environmental factors: viruses, pollen, mold, dust mites, rodents, cockroaches, pet dander, smoke, air pollution, etc. Doctors have often scrutinized allergens that patients can control at home, such as pests and secondhand smoke. But patients have stayed at home for a year and suffered dramatically fewer asthma attacks—suggesting bigger roles for other triggers, especially routine cold and flu viruses, which nearly vanished this year with social distancing and masks.

*snip*

[Roland99]

1. Allergies trigger it in my son

If he’s around cats or dogs it hits him hard. So those allergens could exist in the air in school and busses and restaurants and ....

Eliminate social interaction and those causes go away

[PatSeg]

11. Yes, for me cats were always the worst trigger

Certain cleaners, fragrances, and other chemicals also can bring about an attack. I think with people being at home most of the time, they are less likely to be exposed to allergens that could affect them and they are more able to avoid those allergens. We don't have as much control when we are out and about.

[Dream Girl]

2. I didn't read the whole thing, but I would assume the drop in pollutants would be a bis factor

In the reduction in attacks.

[pnwmom]

6. They're focussing on the drop in respiratory infections. nt

[caraher]

9. Not according to the article

They do mention that, for instance, kids may have had less exposure to school bus diesel exhaust. Yet toward the end there's this:

If viruses indeed play a bigger factor in asthma attacks than initially thought, doctors might have been mistakenly fixating on other factors. “We’ve forever talked about the environmental contribution to asthma. There are pollutants and irritants and allergens inside the home,” says Stukus, who is also a member of the Asthma and Allergy Foundation of America’s Medical Scientific Council. If these factors really were so important, though, asthma attacks should have gone up, not down, during the pandemic.

[Dream Girl]

12. I think someone is in love with their own hypothesis. Virus? Meh. It just makes since the the drop

In Environmental pollution from vehicle exhaust must be a huge factor. Particularly for people in urban areas. Not sure why they would latch on exposure to viruses as the major factor.

[Freddie]

3. Common cold triggers it in my husband and daughter

Would have been a good year for them except daughter got Covid. She complained of tightness in the chest and used her nebulizer. Was scary but she felt mostly better after 10 days.

[pnwmom]

7. Me, too. Any kind of respiratory virus. n/t

[wnylib]

8. Oh yeah. If I get a cold or flu, it develops into

viral bronchitis and triggers numerous asthma attacks in one day.

Other triggers, though, are allergens like mold and some pollens, especially poplar tree pollen.

[IronLionZion]

13. Same here

it was nice to not have a cold at all during this pandemic

[JohnSJ]

4. This isn't rocket science, air pollution

[caraher]

10. It's actually not obvious, according to the article

See my post above

[ShazzieB]

14. A lot of people here seem to be commenting without knowing what the article really says.

Some of these posts are directly contradicted in the article itself.

[Hugin]

5. There are two related, but, indpendent variables at work in the isolation protocols.

The first tries to reduce the total number of people one is exposed to and the other by restricting the total distance traveled reduces the different pools of people (or groups) one experiences.

I'm thinking what they are seeing is because so many fewer environments are sampled by the asthma sufferer or the second variable. Which limits the potential to encounter their trigger.

[Percy]

16. Which would imply it's not any one thing that triggers the asthma attack

but an excess of immune system stimulants or challenges that leads to an overload.

There are doctors treating other immune related conditions who are approaching the problem by treating the immune system as a whole with "immunoodulators". The idea is the immune system is overstimulated and overactive, overprotective, and calming it would lead to resolving the condition.

I think it's a really interesting idea. And it's so true that we're exposed to so so many things environmentally which cause our bodies to work really hard to stay healthy.

[Hugin]

18. That could be why it is so difficult to nail down any specific trigger.

Even within a specific individual. Because, it can be different with each attack, if the attacks are caused by susceptibility at any given time due to a state of overload or overstimulation.

Yeah, that is interesting.

What's more, the excited state could be caused by exertions, emotional, or physical stressors unique to a person's recent experiences.

The key here would be to, as you say, calm the potential asthmatic's system so that an over reaction is much less likely and responds in a measured way.

This is sort of the opposite of what is done now with the rescue inhalers and epinephrine. Which, I suppose will always have a role in an emergency treatment, but, it would be nice to not rely on them.

Okay, we've got this one solved... NEXT!

[Percy]

19. Okay, okay ... we don't have the cure

but we get the concept! And it applies to all autoimmune illnesses. And it's a systemic approach which is the great lesson nature keeps repeating so successfully in all her systems over and over.

From what I've read I really believe, and hope, our researchers will be making a breakthrough in this area soon.

Let's touch back in 10 years and see how it went.

[meadowlander]

20. I have a number of different triggers and my asthma improved significantly during lockdown.

My triggers are:

Stress - reduced during lockdown by working at home
Colds/flus - reduced significantly by not being exposed to as many people - I went from having the flu eight times in 2019 to zero times in 2020
Cold weather - reduced by not going outside
Dust mites and pet dander - increased by staying in my house more
Eating too much sugar or other rubbish - reduced by not being able to go out for meals or snacks

I think the main thing was improving my eating habits by eating at home all the time which reduced my overall level of inflammation.

[Hugin]

21. I'd bet you're exactly correct.

"my overall level of inflammation"

The inflammation is the underlying result of what I was calling 'over stimulation' by a series of various triggers above.

Although, I've met few asthmatics who haven't developed a list of their triggers after a lifetime of very scary attacks. A hard won gallery of, "Well, I won't be doing THAT again!"

The list you've put together is especially insightful, because, you know the range of exertions, emotional, and physical stressors in your particular case which can bring about an attack.

Now, you've been able to go as far as placing those triggers to the patterns of your life between 'regular' and 'isolation' to be able to determine what the specifics of a different lifestyle are which reduce the likelihood of an attack.

Also, maybe, treatments can be found which reduce the inflammatory response in sensitive people to a point where they are more resilient to a cluster of these triggers bringing on an attack.

I think that's great! I'm all for everyone living a better life through science.

[Initech]

15. Lewis Black said it best - what's good for one person might kill the person sitting next to you!

[dickthegrouch]

17. I've experienced a significant reduction in migraines

Don’t know about asthma, never suffered from it AFAIK. But I did get about 12 migraines a year. Only 2 in the last 18 months.
Could all be related.

[obamanut2012]

22. I've also experienced way less asthma triggers

Even with mask wearing and being inside more with my cat, etc. Fascinating.

[intheflow]

23. I don't get the jump to looking for viral connections, here.

I mean, couldn't it just as easily be that masks filtered just enough toxins and pollen? Or that asthma could be triggered by daily stressful situations, like going to school or work?