If you have asthma, you know the dreaded choking sensation, the faintness, and the anxiety. It's as if someone made you run around the block, then pinched your nose shut and forced you to breathe through a straw. And you know all too well that once an asthma attack starts, it won't go away by itself.
Asthma sufferers make up an estimated five to ten percent of the population. And while no two persons with asthma are
alike in the subtle characteristics of the condition, they do have one thing in common: They have trouble breathing properly. The reason is that their lungs are supersensitive and easily provoked into constriction by a wide variety of outside factors, called triggers. As you have probably discovered, perhaps the hard way, many things can set an asthma attack into motion someone's perfume, a smoke-filled room, a friendly dog, a flowery garden, a strong wind, or even a good laugh. (Asthma, however, is a hereditary condition, so unless a person is genetically predisposed, nothing will make asthma happen.) Triggers can be allergic or nonallergic, and reactions can be immediate or delayed.
While there is no cure for asthma, the good news is that asthma-whether mild, moderate, or severe can be managed.
Doctors who specialize in treating asthma can be very helpful. Every patient with asthma should see a doctor to be sure another cause of wheezing is not present and, if true atopic asthma is present, to develop a therapeutic program for managing the disorder.
In addition to working with your doctor, you can take measures to help control your asthma. The key is to track down the triggers and, as completely as possible, eliminate them from your life. In short, you can help counter an asthma attack before it happens.

Smite the mite.

"Dust mites are microscopic insects that thrive on food debris and high humidity," says Allan M. Weinstein, M.D., an asthma/allergy specialist in private practice in Washington, D.C. "Since they are among the most common allergic asthma triggers, dustproofing is a must." His suggestions:

Enclose your mattress in an airtight, dustproof cover;
then cover it with a washable mattress pad. Keep a
bedspread on the bed during the day.
Wash your sheets in hot water every week, wash your
mattress pads and synthetic blankets every two weeks,
and wash your pillows every month.
Use polyester or dacron pillows, not those made of
kapok or feathers, and enclose them in airtight,
dustproof covers.
Avoid carpeting, which is difficult to clean; stick to
bare floors with washable area rugs.
Choose washable curtains instead of draperies.
Avoid dust-catchers (such as knickknacks) all over the
house, especially in the room where you sleep; the
less clutter the better. If possible, avoid storing
out-of-season clothing or bedding in the bedroom;
never store things under the bed.
Try not to do heavy cleaning, but if you must, use
only a vacuum cleaner and damp cloth to clean; dust
mops and brooms stir up the dust. Always use hot
water "Cold water is like a day in the sun to a dust
mite,'' says Weinstein.
Wear a mask over your mouth and nose while cleaning,
and leave the room when you're done.
Run an air conditioner or dehumidifier in warm
weather, especially in spring and fall when mites
multiply. Aim to keep the humidity level in your home
under 40 percent but above 25 percent.
Consider using an air purifier, in the bedroom to keep
the room free from dust particles.

Minimize mold.

"Fungus is a parasite that can literally 'grow on you,"' says Stuart Young, M.D., an asthma/allergy specialist in New York. "It can grow on nonliving organic material, too, in several forms-mold, dry rot, and downy mildew." Fungi reproduce by producing spores. The spores are the real problem, as millions of them float through the air to be inhaled in every breath, touching off an allergic reaction that can contribute to asthma. To stave off the spores, Young advises you to:

-Keep your windows closed, because the mold spores can
come right in through the windows even if the windows
have screens.
-Stay out of attics, basements, and other dank, musty
places.
-Wear a face mask and give your bathroom a going-over
for signs of mold. (Better yet, have anonallergic
family members do this.) The most likely spots for
mold growth: dark areas, such as the backs of
cabinets and under the sink.
-Examine all closets regularly to see that molds have
not set up housekeeping in unused shoes and boots.
-On a regular basis, have a family member or friend
investigate the inner workings of air conditioners,
humidifiers, and vaporizers in your home where molds
like to grow.
-Periodically check houseplants for mold growth. In
fact, getting rid of mold will help your plants, as
well.

Make peace with pollen.

Pollen is released when plants are blooming-trees in the spring, grass in the late spring and early summer, ragweed from mid-August until the first frost. Plants that are pollinated by the wind are much more of a problem for asthmatics than are those pollinated by insects. "The goal is to learn how to live with pollen, not hide away from it," says Loomis Bell, M.D., chief of pulmonary-critical care medicine at St. Luke's-Roosevelt Hospital Center in New York. He recommends that you avoid cutting grass or even being outside while grass is being mowed. Keep your windows closed as much as possible-pollen can get through screens, too-and use an air conditioner to cool your home instead. Room air purifiers are also available that can purify recirculated air, removing particles of all sorts that are suspended in the air and further cleansing the air by passing it through a charcoal filter. After being outside in the midst of pollen, take off your clothes and wash them or at least run a vacuum over the articles of clothing. Wash yourself too, and don't forget your hair.

Don't pet a pet.

The best approach is to not have a pet that can trigger your asthma, advises Young. The problem is not the hair of the animal but the dander-the dead, dry skin that flakes off. The animal licks the skin, and the dander remains in its saliva. "If giving up a pet is impossible, the next logical step is to make very strict rules about living with an allergenic animal," Young warns. Do not allow your pet into the bedroom-ever. If the animal is in the bedroom at any time during the day, the dander will remain for hours. Leave the pet home if you are going for a car ride that would necessitate very close contact with the animal. If you do have direct contact with your pet (or any animal, for that matter), wash your hands right away. If you simply cannot keep your hands off your pet, at least keep your face away, kiss the air-your pet will still get the idea.
In addition, try bathing your dog or cat once every other week in warm water with no soap. Bathing the animal in this way significantly reduces the amount of allergen on your pet's fur; according to Clifton T. Furukawa, M.D., clinical professor of pediatrics at the University of Washington School of Medicine in Seattle.

Kick the cigarette habit.

Tobacco smoke can be an irritant that triggers asthma as well as an allergen that touches off an allergic response leading to asthma. Tobacco smoke is one of the worst irritants known: It paralyzes the tiny hairlike cilia along the mucous membranes of the respiratory tract. It also reduces immune response and leaves a smoker much more susceptible to upper-respiratory infection. "There is not a single redeeming feature to cigarette smoking," cautions Weinstein. "Given the known health risks associated with smoking, asthma patients should make every effort to stop smoking-either on their own or with the help of a smoking-cessation program."
Nonsmokers who live with a smoker are no better off. So if there's someone in your household who won't quit smoking, ask that individual to take his or her habit outdoors.

Weather the weather.

While each person responds to weather conditions and weather variations differently, some general trends may be noted. "Keep close watch on how the weather affects you," advise Young. (That means paying attention to factors including temperature, wind velocity, barometric pressure, and humidity.) "Then try to avoid conditions that cause you problems." For example, you should stay indoors when it is very cold, since a blast of cold air can cause a spasm in your bronchial tubes. Stay indoors if the wind is strong, too. While gusts of wind can blow pollution and smog away, they can also blow pollen in your direction. If you enjoy walking in the rain, you're in luck, because rain tends to wash away roving allergens, pollutants, and irritants.

Watch what you eat.

The question of whether foods trigger chronic asthma has yet to be answered. Some foods, such as nuts, shellfish, milk, eggs, and strawberries, can result in an array of allergic responses, including asthma symptoms. Sulfites in wine can have a similar effect. "While the information available today suggests that the chances are small that food allergies are a trigger for chronic asthma in adults, it is still wise to reduce or eliminate your consumption of certain foods that you notice make your asthma worse. But consult your doctor if you think the foods are nutritionally necessary," says Weinstein.
Allergies to certain types of food, especially milk and wheat, are more often a trigger of asthma in children. If milk and wheat seem to be causing problems for your asthmatic child, eliminate these foods. Check labels, and avoid foods that list milk, milk solids, casein, whey, or caseinate as ingredients. (Talk to your doctor about alternate dietary sources of nutrients
such as calcium).
Eating away from home can sometimes be a problem, says Weinstein. If you are invited to dinner and don't know what
dinner will be, eat something at home before you leave so you won't be left hungry. If you are eating in a restaurant, inquire about the ingredients in the dish you want to order as well as the method of preparation. No matter where you have your meal, common sense suggests that you avoid overeating, eating too fast, and talking while you are eating. Steer clear of alcohol, too, especially if you are taking medications for your asthma. One final reminder:

Avoid so-called cytotoxicity tests and similar methods that promise to root out hidden food allergies and cure asthma (see "The Quack Comes Back").

Stay healthy.

A problem in the upper airways-such as a respiratory infection-can cause trouble in the lower airways-the bronchial tubes-and precipitate an asthma attack. "Everybody wants to be in a state of good health," says Bell. "For a person with asthma, maintaining good health can mean a dramatic lessening of symptoms." Bell suggests that you stay away from people who have a cold or the flu, drink plenty of fluids, and avoid getting overtired; otherwise, you will be more susceptible to infections. If, despite your best efforts, you do develop an infection, see your doctor; early use of antibiotics, when appropriate, can be quite helpful.

Exercise your options.

For years, people with asthma have been told to avoid exercise because it would induce attacks. Research has shown, however, that the more asthma-tics exercise, the more exercise they can tolerate. "If you have asthma, you should partake in regular aerobic exercise," says Bell. He recommends that you start by warming up with light exercise before a more-vigorous workout. (Young recommends using cromolyn sodium, a prescription medication, 15 to 20 minutes before aerobic exercise, discuss this with your doctor). Begin with short workouts and gradually increase them. At least at first, keep a bronchodilator with you. If you feel tightness in your chest and can't work through it, use the device. If you are out in very cold or dry air,
wear a scarf around your nose and mouth to heat the air before breathing it in. Cool down with light exercise at the end of your workout. If one type of exercise still brings on attacks, try another form of exercise. You may not be able to tolerate running, for example, but you may be able to swim regularly.

Avoid aspirin.

Aspirin and certain products that contain aspirin can trigger asthma attacks in certain people. "It's just wise to stay away from the whole family of aspirin products if you have asthma," says Weinstein. "This is especially true for patients with nasal polyps, for whom aspirin ingestion can be life threatening. Even if you have not experienced an asthma flare in the past, it could occur at any time." Weinstein encourages anyone with asthma to keep aspirin
out of the medicine chest by checking labels on every over-the-counter drug that is purchased. (Avoid those that list "aspirin" and those that contain the initials "ASA," "APC," or "PAC"; ask your pharmacist if you are unsure whether the medication you want to purchase contains aspirin.) If you feel that you must take aspirin, get your doctor's approval.
According to an expert report from the National Asthma Education Program, people with asthma should also stay away
from certain nonsteroidal anti-inflammatory agents (ibuprofen is one such medication) that have effects similar to aspirin's. Opt instead for such "usually safe alternatives" as acetarninophen, sodium salicylate, or disalcid. You may also need to avoid tartrazine (yellow food dye #5), which is found in a number of soft drinks, cake mixes, candies, and some medications, if it
aggravates your asthma.

Take a deep breath.

Breathing exercises provide a form of relaxation and can be of benefit to some patients during an asthma attack. However, it would be a mistake to rely on breathing exercises alone to control an asthma flare, says Weinstein. As long as this rule is not broken, breathing exercises are fine for those patients who find them beneficial. "You can practice controlled breathing, which concentrates on slow inhalations through the nose rather than panting breathing through the mouth," says Weinstein. He suggests that before starting these breathing exercises, you blow your nose to make sure that your air passages are clear of all foreign matter. Then sit in a chair in a comfortable position. Take a deep breath and feel your breath going as far down as possible. Your abdomen should expand as you do this exercise. Exhale slowly, feeling your abdomen relax as your breath comes out of your nose. Repeat this exercise at least three times a day (but never right after eating).

Keep your weight down.

"Unfortunately, some asthma medications can result in weight gain. An overweight person has to breathe more heavily, and the heart works harder to pump blood all around the body. Weight reduction is very important," says Bell. If you are overweight, you and your doctor should work together to establish a diet plan that will reduce your calorie intake without depriving you of necessary nutrients.

Mind your mind.

The notion that asthma is "all in your head" has gone the way of many medical myths. Asthma is an illness with both physical and emotional aspects. For example, asthma attacks
can be triggered by emotional changes, such as laughing or crying, or by stress. "The human body interacts with the mind," says Young, "so by putting your mind at ease, you can dramatically reduce the panicky feeling that can make an already existing attack worse" He recommends developing an upbeat mind-set by committing yourself to feeling better. A positive attitude works wonders to enhance your other coping methods. In addition, be forthright about your asthma; others will respect your directness and, in most cases, try to make things easier for you.

Learn to relax.
Since stress and emotional upsets can trigger asthma attacks, it may be helpful to set aside time each day-preferably the same time-to practice some form of relaxation.

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