With the arrival of spring comes fresh blooming flowers, greener grass and leaves growing on trees. But what also arrives is pollen – a common trigger for allergies that can lead to over-inflamed ear, nose and throat passages – which may be especially troublesome for individuals with asthma.

“It is always important for an asthmatic to understand their triggers and problem months,” says Erik Hinderlie, director of the Pediatric Asthma Education program at the MGH Chelsea HealthCare Center. “Spring is one of those times there tends to be a spike in ER visits for people with asthma.”

Know your triggers and trigger months

“Pollen is a potent trigger,” says Hinderlie. “Your immune system overreacts to the allergic reaction which causes swelling in the ear, nose and throat area. This over-inflammation is what triggers the asthma to flare up.”

Allergy medications are most helpful during these months, as they help control the inflammation, Hinderlie says, noting many find it helpful to start taking this medication throughout May, or at peak allergy times, which can help keep asthma from flaring up.

For pediatric patients, the end of summer may be another peak time for ER or doctor visits. “End of August, early September when school is back in session can be very challenging because viruses and colds tend to trigger asthma,” says Hinderlie. “When your children go back to school, they are with a bunch of other kids and germs spread more easily. One kid sneezes and everyone can be affected.”

Patients should take care to wash their hands and monitor their symptoms. Hinderlie also recommends patients visit with their care team in August for a “tune-up” to know what to look out for before going back to school and hitting the next peak asthma season.

Use controller medications and spacers

Inhaled corticosteroids are commonly used to keep asthma in control and are the active ingredient in many anti-inflammation medications. The inhaled steroid relaxes the airway muscle and keeps it open. “With asthmatics, the airways are usually twitchy and likely to swell. These inhaled steroids keep the airway from swelling and keep it open,” says Hinderlie. Patients usually use two puffs of the inhaler, twice per day. “It’s very easy to do and can prevent the worst things that can happen with asthma.”

It is highly recommended – even with adults – to use a spacing device with the inhaler. The device is a plastic tube that directs the medications directly into the airways, and some inhalers feature a built-in spacer. Without a spacer, it is difficult to receive the full dose since the puff will instead stay on the throat, tongue or mouth, Hinderlie says.

Have an action plan handy

“An action plan is guidance for the patient – and their family – at home,” says Hinderlie. “This treatment plan can be kept on the refrigerator for easy reference, allowing for early action when you notice your symptoms worsen to prevent asthma from getting worse.”

Set up like a stop light, the action plan has three zones:

Green zone: This shows what medications to use to remain healthy. The patient’s controller medications are indicated here.

Yellow zone: “This is the hold up, let’s check what might be happening zone,” says Hinderlie. Here, a person could be experiencing coughing, chest tightness or wheezing and it is recommended to start using albuterol – a bronchodilator sometimes used as quick asthma relief or in conjunction with an inhaled corticosteroid – while continuing green zone medication.

Red zone: Stop and assess your child. In this zone, Hinderlie says, patients should begin to take albuterol every two hours and call for medical attention. Still continue using green zone medications and, if you have it, take prednisone as well. “If your symptoms are pretty serious and feel like you can’t breathe, getting medical attention is paramount.” 

This article was published in the 05/25/18 Hotline issue.