All About Asthma Triggers singlesFinal2A

Recommendations:
• For allergic rhinitis and/or bronchial asthma egg, shell sh, tree nuts & peanuts are
associated with immediate onset
• Milk, chocolate, wheat, citrus and food colourings are associated with delayed onset
• Maintain low humidity at home.
• Keep indoor air clean; change lters in furnace and air conditioner. Consider
installing a small-particle lter in your ventilation system. Keep dust to a minimum.
Reduce dust that can aggravate nighttime symptoms by adjusting certain items in your
child's bedroom. For example, encase pillows, mattresses and box springs in dustproof
covers. Consider removing carpeting and installing hard ooring in your home,
particularly in your child's bedroom. Use washable curtains and blinds.
• Clean regularly. Clean your home at least once a week to remove dust and allergens.
• Reduce your child's exposure to cold air. If your child's asthma is worsened by cold,
dry air, wearing a face mask outside can help.
• Reduce pet dander. If your child is allergic to dander, it's best to avoid pets with fur or
feathers. If you have pets, regularly bathing or grooming them also might reduce the
amount of dander. Keep pets out of your child's room.
• Use your air conditioner. Air conditioning helps reduce the amount of airborne pollen
from trees, grasses and weeds that nds its way indoors. Air conditioning also lowers
indoor humidity and can reduce your child's exposure to dust mites.
• After coming inside from outdoors, shower right away, wash hands and face
• Leave pollen covered clothes at the door and change right away
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All About
Asthma
Triggers
A PRACTICAL GUIDE FOR HEALTH CARE PROVIDERS
Contents
Introduction 1
Common Asthma Triggers 2
Asthma Triggers in Schools 8
Work-Related Asthma 16
Agricultural Asthma Triggers 28
Special Considerations 34
Bibliography 38
Authors
The Lung Association would like to thank the following authors
for their contribution to the development of this resource.
Madonna Ferrone RRT, CRE

Ana MacPherson RRT, CRE, MASc
Pamela Wilton RN, CAE
Janice Woychyshyn RRT, CRE, RDMS
Reviewers
The Lung Association gratefully acknowledges the
following people who reviewed the booklet.
Dr. Lisa Cicutto RN PhD CAE

Dr. Harold Kim MD FRCPC
Dr. Thomas Kovesi MD FRCP(C)
Dr. Christopher Licskai BSc MD FRCPC
Dr. Diane Lougheed MD MSc FRCP(C)
Dr Susan M Tarlo MB BS FRCP(C)
Jennifer Olajos-Clow RN(EC) MSc APN CAE
This book has been endorsed by The Lung Association’s medical societies,
the Ontario Thoracic Society (OTS) and the Ontario Respiratory Care Society (ORCS).
Introduction
All About Asthma Triggers was written by health care providers for health care providers. The idea for this guide started when
a group of asthma educators, working in the Primary Care Asthma Program (PCAP), identified a need for a practical resource to
quickly identify potential triggers and to help their patients with asthma learn how to avoid and/or limit exposures. Subsequently,
a needs assessment revealed that other health care providers, working in many different settings, often feel overwhelmed by the
amount of information available and need a better way to consolidate information and make recommendations based on the best
available evidence. We have done that for you.
This guide is intended to provide you with a quick reference for trigger identification and management, enabling you to help
your patient identify possible irritants and allergens that could be contributing factors. Irritants are inhaled substances that irritate
the airways, causing asthma symptoms, but do not cause an allergic reaction. Examples of irritants include smoke, chemical fumes
and cold air. Allergens are inhaled substances that cause an allergic reaction. Examples of allergens are pollens, animal dander and
mould. Repeated exposure over a long period of time is often necessary before asthma symptoms occur in response to an allergen.
Once you and your patient have identified potential triggers, you will be able to recommend some ways to avoid or limit
exposure. It is important that these avoidance strategies complement appropriate medication use in each individual patient, with
a goal to achieve optimal asthma control. In some cases this will be only a start and you will need to refer your patient to a specialist
or specialty centre for more testing and advice.
This booklet is organized so information about common triggers (irritants and allergens) that are found across settings is
presented first, followed by information about triggers found in specific settings such as schools, workplaces and farms/ranches.
The final section includes more general information for your consideration. All of the information must be applied based on the
needs and goals of the patient, as well as the specific needs of the health care provider and practice setting. This guide should
be used as a tool to assist in decision-making for patient care, while ensuring that appropriate supports are in place to provide
the best care possible. Medical information and evidence are constantly changing. As new research and experience broaden our
knowledge, changes in asthma management will be necessary and appropriate.
Disclaimer:
The content of this guide is based on current available evidence and has been reviewed by medical experts. It is provided for infor-
mational purposes only. The information is general in nature and is not intended to be a substitute for sound clinical judgment.
Seek the advice and expertise of other qualified health care providers with any questions you may have about specific patient care.
1 All About Asthma Triggers - A Practical Guide For Health Care Providers
Common Asthma Triggers

In this section, Common Asthma Triggers, we have included the most common
triggers found almost anywhere and everywhere. Once an individual has identified
the irritants and allergens that can worsen his or her asthma symptoms, it will gradually
become second nature to anticipate and recognize the presence of triggers in various
environments encountered in everyday living. Allergy skin testing is often very
helpful to identify allergens and the results can be a useful tool to facilitate change.
Your advice and support can help your patient learn what avoidance and management
strategies work best for him or her. Knowledge and experience will guide your
patient’s decisions. Know that this is a process that takes time, but patience and
perseverance will lead to greater awareness and better controlled asthma.
TRIGGERS WHERE THEY ARE FOUND AV O I D A N C E / M A N A G E M E N T S T R AT E G I E S
Animal Secretions (Allergen)

Allergen from animal saliva and dander Allergens are found in secretions from Note: Removal of the animal from the home/
becomes airborne and can adhere to saliva, feces, urine and skin of cats environment is the only effective way to avoid
soft materials. Symptoms can occur (most common), dogs, rabbits, horses, exposure. It can take many months before the
even when the animal is not present. other furry animals and birds. They are allergen level decreases once the pet has been
commonly found in upholstery, carpets removed from the environment.
and clothing.
• Remove pet from the home.
• Limit exposure to the pet.
• Bathe pet frequently; delegate
when possible.
• Vacuum floor and furniture thoroughly.
• Remove carpets if possible.
(Solid surface flooring preferred.)
Cockroaches (Allergen)
Common insects that can be found Allergen is found in decaying • Remove garbage from kitchens
anywhere in the home, school or work- cockroach body parts and feces and bathrooms.
place. They thrive in wet areas, where mostly in kitchens and bathrooms, • Clean up all food crumbs or
food waste has not been removed. especially near: taps, water pipes, spilled liquids immediately.
They are common in inner city areas. cupboards, appliances, toilets, • Wash dishes, cooking equipment
garbage containers and cardboard. and counters promptly after use.
• Keep counters, sinks, tables and
floors clean and clear of debris.
• Seal cracks and openings around
or inside cabinets.
• Store garbage in covered containers.
• Employ professional eradication service.
Dust (Irritant)
Indoor dust, unlike outdoor dust, Dust is found almost everywhere Note: Dust and dust mites cannot be totally
consists of a combination of materials. indoors. It is airborne, but settles on eliminated, however, the number of mites can be
surfaces such as open shelving, window reduced by following prevention strategies.
ledges, curtains, blinds, upholstery, Focus initial reduction strategies in the bedroom.
carpets and can be carried in many ways,
including: human hair, animal dander, • Minimize objects that accumulate dust.
dead insect bodies, food scraps, chalk • Delegate weekly vacuuming, if
dust and talcum powder. possible or wear a mask.
• Wait 20 minutes for dust to resettle
before using the room, after vacuuming.
• Dust surfaces frequently with
a damp cloth.
Dust mites (Allergen)
Tiny microscopic creatures that feed Dust mites are found in humid, warm • Maintain relative humidity level <50%.
on the flakes of skin that people and areas. There are large concentrations (A hygrometer is a useful, inexpensive
pets shed daily. in bedrooms (pillows, blankets, carpets/ device for measuring and monitoring
rugs, mattresses, stuffed animals, indoor humidity levels.)
upholstered furniture, duvets, sheets). • Use vacuum with HEPA filter.
• Encase mattresses and pillows in
dust-mite resistant covers.
TRIGGERS WHERE THEY ARE FOUND A V O I D A N C E / M A N A G E M E N T S T R AT E G I E S
• Wash all bedding in hot water

(55-60°C) weekly.
• Freeze non-washable items (quilts,
stuffed animals) in freezer or leave out-
side overnight in freezing temperatures.
• Remove stuffed animals from bedroom.
• Replace (if possible) carpets, rugs, heavy
draperies and upholstered furniture.
Note: A favourite stuffed animal can be washed and placed

in the drier, followed by an overnight stay in the freezer.
This will reduce the mites, while keeping a little one happy!
Exercise (Irritant)
Physical activity can trigger asthma Symptoms or EIA can occur with • Consider venue, time of day and weather
symptoms and may be a sign of any physical exertion, but increased conditions when planning activities.
uncontrolled asthma. Physical activity symptoms are more likely to occur • Warm-up exercise before and after
can be the only trigger for asthma during extreme temperatures (hot and physical activity. (5-10 minutes warm
symptoms and is known as Exercise humid or cold and dry) and/or when up to 60% of maximal heart rate)
Induced Asthma (EIA) or Exercise the person is recovering from a respira- • Prophylactic use of bronchodilator
Induced Bronchospasm (EIB). tory tract infection. Some people may medication 10-30 minutes prior to activity.
experience more symptoms on poor air • Elite level athletes should be referred
quality days. to a specialist for testing and advice.
Mould Spores (Allergen)

Tiny structures produced by moulds Spores are airborne and are found • Maintain relative humidity level
for reproduction purposes. in places where mould grows. <50%. (A hygrometer is a useful and
inexpensive device for measuring and
Common spores: Common indoor areas include: monitoring indoor humidity levels.)
Alternaria showers, bathrooms, window sills, • Promote air circulation with
Aspergillus laundry rooms, kitchens, refrigerators, and use of vents and fans.
Bipolaris garbage containers, carpets, upholstery, • Clean showers/bathtubs after each
Cladosporium attics and basements. use to prevent mildew.
Epicoccum • Clean mouldy surfaces with a
Fusarium water and bleach-based product.
Penicillium • Wear mask and gloves to limit
exposure when cleaning.
• Remove carpet from humid areas.
• Discard any mouldy items when possible.
• Repair any leaks and moisture
problems promptly.
• Use dehumidifier in basements
and crawl spaces.
• Avoid musty smelling areas (cottages,
basements, garages, attics, etc.).
• Consult professional service for removal.
Note: There is no practical way to eliminate all

moulds indoors. The best way to control indoor mould
growth is to control moisture. Prevention is key.
Check www.cmhc-schl.gc.ca/en
TRIGGERS WHERE THEY ARE FOUND A V O I D A N C E / M A N A G E M E N T S T R AT E G I E S
Outdoor moulds are usually at their Common outdoor sources include: • Avoid walking, running or playing
peak in late summer and early fall, but decaying fallen leaves, soil, vegetation, in fallen leaves.
are present whenever there is no snow. rotting wood and grass of lawns. • Avoid raking leaves and cutting grass.
• Remove piles of raked leaves and
grass; delegate if possible.
• Avoid proximity to hay and straw.
• Avoid areas of heavy vegetation,
especially where it is not exposed
to adequate air circulation.
• Stack firewood to promote adequate
drying and air circulation.
• Stay indoors after a rainstorm,
as moulds may be stirred up.
Pollen (Allergen)
Pollens are tiny, invisible particles Pollens are found outdoors, but are • Close windows overnight to prevent
given off by trees, grass, flowers and easily wafted or carried indoors on pollens from drifting into the home.
certain weeds such as ragweed. clothing. There will be more of them • Use air conditioning to cool, dry and
where trees, grasses, flowers and/or clean the air in the home.
Pollens are at their peak at various weeds grow. • Minimize early morning outdoor
times from early spring until the first fall activity when pollen levels are
frost. It can be helpful to identify which highest (0400-1100 h).
pollen(s) is the allergen. • Close vehicle windows when travelling.
• Avoid outdoor activities on windy,
dry days when pollen and dust are
blowing around.
• Dry laundry indoors to prevent pollens
from adhering to linens and clothing.
Note: Many people who are bothered by pollens

find it helpful to check pollen counts when planning
outdoor activities. Check air quality levels and pollen
counts at www.ec.gc.ca or www.airqualityontario.
com (May to September)
Rodents (Allergen) The allergen is found in the feces, • Remove animal from the
dander and saliva of rodent animals environment.
(mice, rats, squirrels, gophers, • Isolate pet from bedroom and
hamsters, gerbils, guinea pigs, main living areas of the home.
chinchillas). • Limit exposure to the pet or pest.
• Wash hands with soap and water
after handling the animal.
• Seek expert service and advice to
remove animals and clean up any
areas infested by unwanted rodents.
Note: It can take many months before the

allergen level decreases after the pet or pest has
been removed from the environment.
Smoke (Irritant)
Environmental Tobacco ETS is found in any area where • Promote, encourage and support
Smoke (ETS) people smoke cigars, cigarettes, smoking cessation (Level 1).
pipes or marijuana. • Avoid second-hand smoke and
active smoking.
• Prohibit smoking in the home of
the affected person.
• Smoke outdoors, away from others.
• Prohibit smoking in vehicles.
• Avoid travelling in vehicles where
smoking is or has been permitted.
Second-hand smoke (chemical Second-hand smoke is noticeable

and cancer-causing substance that on clothing, hair, upholstered furniture
the smoker exhales) and carpet.
Third-hand smoke is the residual

tobacco smoke that lingers long
after second-hand smoke has cleared
from a room.
Other Smoke (Irritant) Smoke from fireplaces, grills, wood • Avoid outdoor fires, chimneys and
heaters, chimneys and campfires other open burning flames.
can be irritating. • Close windows as necessary when
smoke is in the air outdoors.
• Properly seal wood stoves.
Strong Scents (Irritant)

Some scented products contain several Areas where any of the following • Choose unscented products.
chemicals that constantly turn into are used: air fresheners, scented • Limit time spent in any area that
vapour in the air and attach themselves candles, shampoos, hair sprays, has an irritating scent.
to hair, clothing, and surroundings. soaps, perfume, cologne, after shave, • Substitute less volatile products
personal care products, fabric softener, for cleaning, building and repairs.
laundry detergent, bleach, cleaning • Open windows and use fans to
products, building materials, paints, remove scents/smoky odours.
cooking oils, gases from wood-burning • Maintain adequate ventilation when
stoves, fireplaces or campfires, using any product that is an irritant.
clothing, upholstery and carpets can • Read product labels before opening
be problematic. containers.
• Wear a mask when irritants cannot
be completely eliminated.
Viral Infections (Irritant)

Common viruses: Viruses are difficult to completely avoid. • Wash hands frequently, and before
Rhinoviruses (common cold) They enter the body through the nose, touching nose and mouth.
Respiratory Syncytial Virus (RSV) mouth or breaks in the skin. • Use alcohol-based, waterless cleansers
Parainfluenza for cleaning your hands when they
Influenza Rhinoviruses can survive on surfaces are not visibly soiled and/or soap and
Adenovirus (telephones, railings, keyboards) water are not available. (Recommen-
for three hours, including on your dation: Centre for Disease Control)
skin (hands). • Avoid social gatherings/visits when
people are known to be sick.
• Discuss vaccination with health
care provider.
• Do not share food, drink glasses
or eating utensils.
Note: Hand washing is the most effective way

to prevent the spread of viruses.
Weather (Irritant)
Common weather triggers include: cold People may be more affected when • Warm and humidify cold air before
air, dry air, wind, humidity, extreme heat outdoors, but weather changes can breathing in through the nose.
and thunderstorms. Changes in baro- and do alter indoor environments. (Use a scarf or hand over the nose
metric pressure, wind direction and/or and mouth to create a pocket of
intensity can also trigger symptoms. warm, humid air.)
• Limit or adjust intensity level of outdoor
activity during extreme weather conditions
(cold, humid, hot, stormy or windy days).
• Use air conditioners, dehumidifiers,
fans and other appliances to maintain
comfortable indoor environments.
• Move scheduled activities indoors
or substitute with another to maintain
exercise routines when necessary.
• Schedule daily activities to take
advantage of best weather conditions.
Note: Not all people with asthma will be adversely

affected by weather conditions, but it is important
to explore the role, if any, that weather plays in their
management. General media weather alerts may not
be applicable and may unduly limit activities.
Asthma Triggers in Schools

The school environment can present many challenges to students, teachers, other
personnel and parents/guardians. For children and youth with asthma, school is
probably the most important environment apart from their home. Exposures at
school can lead to worsening asthma, social isolation and increased absenteeism.
Asthma is the leading cause of school absenteeism attributable to a chronic disease.
In this section, Asthma Triggers in Schools, we have included the most
common triggers of asthma in the school environment and suggested some avoidance
strategies. Since asthma can be triggered by allergens or irritants indoors and/or
outdoors at school, we have organized the section in two parts.
Asthma management is improved when health care providers, students,
parents and school personnel work together to identify, eliminate and control
triggers. Increased awareness and collaboration are positive steps toward creating
“asthma friendly” schools.
OUTDOOR TRIGGERS WHERE THEY ARE FOUND AV O I D A N C E / M A N A G E M E N T S T R AT E G I E S

Allergen from saliva and dander Allergen is found in secretions from • In most outdoor school settings
becomes airborne and can adhere to saliva, feces, urine and skin of: cats this will be less of a problem, but
soft materials. Symptoms can occur (most common), dogs, rabbits, horses, should be considered in special
even if the animal is not present, there- other furry animals and birds. circumstances (field trips,
fore indirect contact is also a problem. veterinary colleges, etc.). Take
appropriate measures to avoid or
limit exposure as much as possible.
Criteria Air Contaminants

(Irritant)
Sulphur Oxide (SOx) Contaminants are found in emissions • Limit or reduce intensity of outdoor
is a gas formed from the sulphur from coal, oil and metal-containing activities on days with high ozone levels
contained in raw materials. ore combustion and refining processes. or other air pollutants, if necessary.
• Prohibit buses, cars and other
vehicles from idling on or adjacent
to school property.
• Avoid grass cutting during school
hours (reduce exhaust emissions
and fumes).
• Advocate for Air Quality Monitoring
and Improvement programs.
• Encourage anti-idling policies for
all vehicles and non-road engines
Nitrogen Oxides (NOx), (NO&NO2) Contaminants are found in emissions on the school property.
are compounds that include the gases from motor vehicles, diesel emissions, • Carefully consider grill and barbeque
nitric oxide and nitrogen dioxide. lawn and garden equipment, forest fires, use and location when planning events.
Produced mostly by burning fossil fuels, lightning and decaying vegetation. • Encourage children to play in areas
these are the cause of the reddish brown away from traffic and parking lots.
layer hanging over urban areas.
Note: Some patients may find it helpful to check
the following sites for information to help guide
Particulate Matter their management strategies: www.ec.gc.ca,
is a “mixture of mixtures” that consists Contaminants are found in emissions www.airqualityontario.com (May to September)
of airborne particles in solid or liquid from fuel combustion (including oil,
form. Particles smaller than 10 µm can diesel, coal, gas), electricity generation
penetrate into the lungs. (combustion turbines, industrial boilers,
power plants), wood stoves, forest fires
and fireplace soot.
Carbon Monoxide (CO)
is a gas that forms from burning fuel CO is found in emissions from
propane, natural gas, gasoline, oil, vehicles, propane barbeques, gas
coal and wood. grills and forest fires.
Ground-level Ozone (O3)

is a colourless and highly irritating Ground level ozone is found in smog.
gas that forms just above the Earth’s
surface. It is produced when NO and
volatile organic compounds (VOCs)
react in sunlight and stagnant air.
OUTDOOR TRIGGERS WHERE THEY ARE FOUND A V O I D A N C E / M A N A G E M E N T S T R AT E G I E S
Exercise (Irritant)
Physical activity can trigger asthma Symptoms or EIA can occur with • Warm-up activity before and after
symptoms and may be a sign of any physical exertion, but increased physical activity.
uncontrolled asthma. Physical activity symptoms are more likely to occur • Prophylactic use of bronchodilator
can be the only trigger for asthma during extreme temperatures (hot and medication 10-30 minutes prior
symptoms and is known as Exercise humid or cold and dry) and/or when to activity.
Induced Asthma (EIA) or Exercise the person is recovering from a • Elite level athletes should be referred
Induced Bronchospasm (EIB). respiratory tract infection. Some people to a specialist for testing and advice.
may experience more symptoms on • Collaborate with guardian, coach/
poor air quality days. teacher to support and facilitate
optimum participation.

Tiny structures produced by moulds Common outdoor sources of spores • Avoid walking, running or playing
for reproduction purposes. include: decaying fallen leaves, soil, in fallen leaves.
vegetation, rotting wood and grass • Avoid areas of heavy vegetation,
Common spores: of lawns. especially where it is not exposed
Alternaria to adequate air circulation.
Aspergillus • Stay indoors after a rainstorm,
Bipolaris as moulds may be stirred up.
Cladosporium • Schedule landscape work, yard clean-
Epicoccum up and portable building installation/
Fusarium removal on weekends or holidays.
Penicillium • Repair water damage as quickly
as possible.
Outdoor moulds are usually at their • Consult professional service
peak in late summer and early fall, but for removal.
are present whenever there is no snow.
Pollen (Allergen)
Pollens are tiny, invisible particles given Increased pollen counts are found • Limit outdoor activities on
off by trees, grass, flowers and certain where trees, grasses, flowers and/or dry, windy days.
weeds such as ragweed. Pollens are at weeds grow and will be worse on • Schedule outdoor activities and
their peak at various times from early dry, windy days. work during the afternoon when
spring until the first fall frost. It can be counts are lower.
helpful to identify which pollen(s) is • Limit outdoor activities on days
the allergen. with high ozone levels or other
air pollutants.
Note: Many people who are bothered by pollens

find it helpful to check pollen counts when planning
outdoor activities. Check air quality levels and pollen
counts at www.ec.gc.ca or www.airqualityontario.com
(May to September)
OUTDOOR TRIGGERS WHERE THEY ARE FOUND A V O I D A N C E / M A N A G E M E N T S T R AT E G I E S
Rodents (Allergen) The allergen is found in the feces, • Limit exposure to the animal.
dander and saliva of rodent animals • Seek expert service and advice
(mice, rats, squirrels, gophers, to remove unwanted pests and
hamsters, gerbils, guinea pigs, complete clean-up on school property.
chinchillas). • Schedule removal and clean-up
activities on weekends or holidays.
Weather (Irritant)
Common weather triggers include: cold • Warm and humidify cold air before
air, dry air, wind, humidity, extreme heat breathing in through the nose.
and thunderstorms. Changes in baro- (Use a scarf or hand over the nose
metric pressure, wind direction and/or and mouth to create a pocket of
intensity can also trigger symptoms. warm, humid air.)
• Limit or adjust intensity level of
outdoor activity during extreme
weather conditions (cold, humid,
hot, stormy or windy days).
• Limit outdoor activity during
extreme weather conditions.
• Move scheduled activities indoors
or substitute with another to maintain
exercise routines when necessary.
• Schedule daily activities to take
advantage of best weather conditions.
Note: Not all people with asthma will be adversely

affected by weather conditions, but it is important
to explore the role, if any, that weather plays in their
management. General media weather alerts may not
be applicable and may unduly limit activities.
INDOOR TRIGGERS WHERE THEY ARE FOUND AV O I D A N C E / M A N A G E M E N T S T R AT E G I E S

(Direct or Indirect Contact) Allergen is found in secretions from • Remove classroom animals
Allergen from saliva and dander saliva, feces, urine and skin of: cats from the school.
becomes airborne and can adhere to (most common), dogs, rabbits, horses, • Students and personnel should wash
soft materials. Symptoms can occur other furry animals and birds. These are hands with soap and water after
even if the animal is not present. commonly found on upholstery, rugs/ handling animals.
carpets and clothing. • Clean cage/remove litter away
from students and staff.
• Careful consideration and
collaboration is necessary when
service dogs are present.
• Avoid upholstered chairs and
carpets in schools.
Chemicals/Agents (Irritant)
Solvents, acids, flammables, biological The chemicals/agents are found in • Conduct science experiments in
and microbiological agents, caustics, science rooms/laboratory, industrial properly designed, ventilated rooms.
and compressed gases. shops, vocational classrooms and • Use fume hoods and local exhaust
greenhouses. Activities that may systems as appropriate.
involve these are soldering, welding • Read labels and heed precautions.
and baking. Chemicals are found in • Use personal protective equipment.
machining solvents, fuels, paint and • Follow safety precautions to prevent
adhesives. air contamination through spills.
• Request Material Safety Data Sheets
from suppliers.
• Comply with WHMIS legislation.
Cockroaches (Allergen)
Common insects that can be found Allergen is found anywhere there are • Remove garbage from washrooms
anywhere in schools. They thrive where decaying cockroach body parts and and kitchen areas.
water and food are improperly stored. feces. They are found mostly in kitchens • Clean up all food crumbs or spilled
Predominant in inner city areas. and bathrooms near taps, water pipes, liquids immediately.
cupboards, appliances, toilets, garbage • Wash dishes, cooking equipment
containers and cardboard. and work tops promptly after use.
• Keep sinks, tables and floors clean
and clear of debris.
• Seal cracks and openings around
or inside cabinets.
• Store garbage in covered containers.
• Schedule any extermination
processes on weekends or holidays.
INDOOR TRIGGERS WHERE THEY ARE FOUND A V O I D A N C E / M A N A G E M E N T S T R AT E G I E S
Dust (Irritant)
Indoor dust, unlike outdoor dust, Dust is found almost everywhere • Dust and mop with a damp cloth.
consists of a combination of materials. indoors. It is airborne, but settles on • Remove carpets.
surfaces such as open shelving, window • Reduce classroom clutter.
ledges, curtains, blinds, upholstery, • Use of HEPA filters in vacuum
carpets and can be carried in many equipment.
ways, including: human hair, animal • Use dustless chalk.
dander, dead insect bodies, food scraps,
chalk dust and talcum powder. Note: It is very difficult to avoid exposures to dust,
especially in schools. Collaboration will be required.
• Maintain relative humidity level

<50%. (A hygrometer is a useful,
inexpensive device for measuring and
Dust mites (Allergen) monitoring indoor humidity levels.)
Tiny microscopic creatures that feed Dust mites can be carried in many • Minimize objects that accumulate dust.
on the flakes of skin that people and ways, including on human hair, animal • Vacuum (HEPA filter) carpets daily.
pets shed daily. They thrive in warm dander, dead insect bodies, food scraps, • Wear a mask while vacuuming.
and humid environments. stuffed toys and chalk dust. • Wait 20 minutes for dust to resettle
before using the room, after vacuuming.
• Dust surfaces frequently with
a damp cloth.
• Replace (if possible)
upholstered furniture.
Exercise (Irritant)
Physical activity can trigger asthma Symptoms or EIA can be caused by • Warm-up activity before and
symptoms and may be a sign of any physical exertion, but increased after physical activity.
uncontrolled asthma. Physical activity symptoms are more likely to occur • Prophylactic use of bronchodilator
can be the only trigger for asthma during extreme temperatures (hot and medication 10-30 minutes prior to
symptoms and is known as Exercise humid or cold and dry) and/or when activity, as appropriate.
Induced Asthma (EIA) or Exercise the person is recovering from a respira- • Elite level athletes should be referred
Induced Bronchospasm (EIB). tory tract infection. Some people may to a specialist.
experience more symptoms on poor
air quality days.
Indoor Air Quality (Irritant)

Nitrogen Oxides (NO&NO2) Nitrogen oxides are given off by gas • Promote adequate ventilation
of fuel-burning appliances. stoves, gas or oil furnaces. and air circulation.
• Ensure qualified installation
and maintenance of appliances
and heating systems.
Carbon Monoxide (CO)
is gas that forms from burning fuel CO is given off by furnaces, fireplaces, • Install CO detector/alarm.
propane, natural gas, gasoline, oil, gas stoves, grills, space heaters, • Never operate gas-powered
coal and wood. water heaters and engine exhaust engines in confined areas.
(auto mechanic shop). • Promote adequate ventilation
and air circulation.
• Ensure qualified installation
and maintenance of appliances
and heating systems.

Tiny airborne structures produced Spores are found in portable • Maintain relative humidity level <50%.
by moulds for reproduction purposes. classrooms, showers, washrooms, • Collaborate to move students or staff
window sills, kitchens areas, garbage from portable classrooms.
containers, carpets, upholstered • Promote air circulation with use
furniture and near plumbing. of vents and fans.
• Clean shower areas daily.
• Clean mouldy surfaces with a
water and bleach-based product.
• Wear mask and gloves to limit
exposure when cleaning.
• Remove carpet from humid areas.
• Discard any mouldy items.
• Repair any leaks and moisture
problems promptly.
• Consult professional service
for removal.
Note: There is no practical way to eliminate all moulds

indoors. The best way to control indoor mould growth
is to control moisture. Prevention is key.
Check www.cmhc-schl.gc.ca/en
Pollen (Allergen)
Tiny invisible particles given off Pollens are found outdoors, but are • Close windows to prevent pollens
by trees, grass, flowers and certain easily wafted or carried indoors on from wafting into the school.
weeds such as ragweed. Pollens are clothing. There will be more of them • Use air conditioning to clean,
usually at their peak in early spring where trees, grasses, flowers and/or cool and dry the air.
until the first fall frost. weeds grow.
Rodents (Allergens) The allergen is found in the feces, • Remove animal from the classroom.
dander and saliva of rodent animals • Wash hands with soap and water
(mice, rats, squirrels, gophers, ham- after handling the animal.
sters, gerbils, guinea pigs, chinchillas). • Seek expert service and advice to
remove animals and clean up any
areas infested by unwanted rodents.
• Schedule any clean-up or removal
on weekends or holidays.
Note: It can take many months before the

allergen level decreases after the pet or pest has
been removed from the environment.
Strong Scents (Irritant)

Scented products can contain several Irritating scents can come from air • Discourage use of strongly
chemicals that constantly turn into fresheners, candles, shampoos, soaps, scented products.
vapour in the air and attach themselves perfume, cologne, fabric softener, • Advocate for the use of less
to hair, clothing and other soft surfaces. personal care products, cleaning volatile cleaning products.
products, building materials, paints
and smoky-smelling fabrics.
Viral Infections (Irritant) Viruses thrive in most environments • Wash hands frequently. (Always
Rhinoviruses (common cold) and are difficult to completely avoid. after bathroom use, before food
Respiratory Syncytial Virus (RSV) They enter the body through the nose, handling, before eating and before
Parainfluenza mouth or breaks in the skin. touching nose or mouth.)
Influenza • Use alcohol-based, waterless
Adenovirus Rhinoviruses can survive on surfaces cleansers for cleaning your hands
Conovirus (telephones, railings, keyboards) when they are not visibly soiled and/
for three hours, including skin (hands). or soap and water are not available.
(Recommendation: Centre for
Disease Control)
• Arrange for children or personnel
to stay home when sick.
• Discuss vaccination with health
care provider.
• Do not share food, drink glasses
or eating utensils.
Note: Hand washing is the most effective way

to prevent the spread of viruses.
Volatile Organic VOCs are found in solvents, inks, • Substitute safer products as
Compounds (VOC) (Irritant) adhesives, glues, waxes, varnishes,
lacquers, powdered pigments, acid
often as possible.
• Store and use potentially toxic
Volatile organic compounds (VOC) clays, plaster, paper, paints, firing kilns, school supplies as directed on labels.
are carbon-containing gases and spilled liquids, paint strippers, cleaning • Remove opened containers of paint
vapours that participate in atmospheric supplies, pesticides, building materials and other products to a storage
photochemical reactions, such as (formaldehyde), furnishings, office area away from students and staff.
gasoline fumes and solvents. equipment (copiers, printers) correc- • Comply with WHMIS legislation.
tion fluids, carbonless copy paper, • Utilize integrated pest management
permanent markers and photographic techniques to reduce the need
solutions. for pesticides.
• Use the least toxic compounds
(labelled low VOC or zero VOC).
Note: Schedule potential asthma-triggering

activities (maintenance, intensive clean-up, repairs
and renovations) on weekends or holidays. Notify
parents and employees of potential asthma triggering
activities in advance to reduce accidental exposures.
Work-Related Asthma
Work-Related Asthma
Work-Related Asthma (WRA) is the most common chronic work-related respiratory
disease in Canada and is responsible for an estimated ten to fifteen per cent of new
onset adult asthma. Work-related asthma is defined as: asthma caused by exposure
to an agent found in the workplace according to the Canadian Thoracic Society
Guidelines. WRA can be classified into two categories:
• true “occupational asthma” which is a term reserved for asthma caused
by an exposure in the workplace.
• “work aggravated” asthma which is a term used to describe pre-existing
asthma worsened by workplace exposure.
Identifying and diagnosing WRA can be a challenging experience for health care
providers. It is important to identify if asthma symptoms are worse during working
weeks than during periods off work such as holidays. If so, then a physician
assessment is needed to start investigations for possible work-related asthma. In
this section, Work-Related Asthma, we have organized the information in a simple
format. There is no way to avoid long lists of agents that most of us cannot pro-
nounce or begin to understand, but we think you will find it easy to use this guide
by first identifying the occupation and/or industry where your patient works. From
there the lists are narrowed down to include the most common triggers in that work-
place environment. You and your patient can do some initial work to see if any of
the listed agents are known to be present in his or her workplace.
Once WRA is suspected, there are many tools and programs in the workplace
and community to assist you. Workplace Hazardous Materials Information System
(WHMIS) is a legislated program that requires labelling of containers of controlled
products and the provision of a material safety data sheet (MSDS) with each product.
Patients should be encouraged to refer to the MSDS information to assist in the
identification of potential triggers. The most important management recommendation
is to have an early and thorough medical assessment to confirm or exclude a diagnosis
of work-related asthma if this is suspected. This almost always involves a referral to
a specialist in work-related asthma. Early identification of occupational sensitizers
and the removal of sensitized patients from any further exposure are also important
aspects to the management of work-related asthma. Your patient can facilitate the
process of identification and diagnosis by providing as much information as possible.
Work-Related Asthma
AV O I D A N C E / M A N A G E M E N T S T R AT E G I E S
In this section, general guidelines are provided to facilitate prevention or limit exposure
to an asthma-causing agent and to give guidance to control the level of exposure.
In work-related asthma, there are four strategies that apply in all situations:
• Identify asthma-causing agents in the workplace.
• Eliminate asthma-causing agents in the workplace.
• Substitute a safer agent in the workplace if the asthma-causing agent cannot be eliminated.
• Control exposure by substituting the agent with a less harmful material or utilize engineered
and hygiene measures in the workplace.
You and your patient can collaborate with personnel in the workplace to:
• Request workplace reassignment.
• Improve ventilation with installation of an exhaust ventilation system to capture emissions and vent away
from work area or enclose the industrial process.
• Use respiratory Personal Protective Devices (PPD). (Will not completely prevent WRA and requires worker
adherence as well as professional guidance to assure correct device selection and user training.)
• Use of industrial hygiene techniques as appropriate for the agent (refer to MSDS).
• Schedule regular preventative maintenance of equipment to avoid spills and other accidents.
• Seek assistance from an occupational clinic such as Occupational Health Clinics for Ontario Workers (OHCOW),
or a respiratory physician. (Check other province-specific resources.)
• Monitor ongoing exposure levels, compare industry standards and develop exposure profiles. The Industrial Accident
Prevention Association (IAPA) can assist with a monitoring process.
• Seek medical assessment and maintain medical surveillance and follow-up (pulmonary function testing, health
evaluation) for the worker.
O C C U P AT I O N / I N D U S T R Y AGENTS
Aircraft Manufacturing • Cobalt, vanadium, chromium, platinum, nickel, metal-working fluids

• Amines: triethanolamine (TEA), diethanolamine (DEA), triethylene tetramine (TETA)
Industry
Adhesive Industry • Aliphatic amines, ethanolamine, polycyclic compounds

• Colophony-fluxes (rosin), abietic acid
• Diisocyantes: (TDI-toluene diisocyanate, HDI-hexamethylene diisocyanate, MDI-
methylene diphenyl diisocyanate, NDI-naphthalene diisocyanate, IPDI-isophorone
diisocyanate, BIC-1,3-bis cyclohexane pre-polymer)
• Acrylates: methyl methacrylate, cyanoacrylate, alkylcyanoacrylate, diacrylate
• Pyrolysis aldehydes
• Acid anhydrides: maleic anhydride, phthalic anhydride, trimethyl anhydride,
TCPA (tetrachlorophthalic anhydride), HHPA (hexahydrophthalic anhydride),
himic anhydride, pyromellitic anhydride
• Styrene
Animal Breeder • Birds, cow (bovine) dander, cat, crab, deer, dog, fish-based glues, goats,
guinea pig, hamster, horses, mink, mouse, rabbit, rat, rodents, sheep
Animal Foodstuffs • Aquatic/microscopic organisms: crab allergens, arctic snow crab, lobster,
clam, shrimp meal, powdered marine sponge, cuttlefish bone dust, red soft coral,
Industry prawns, mussels, fish, fishmeal products, sea squirts
Work-Related Asthma
Automotive Industry • Cobalt, vanadium, chromium, platinum, nickel, metal working fluids
• Diisocyantes: (TDI-toluene diisocyanate, HDI-hexamethylene diisocyanate, MDI-
methylene diphenyl diisocyanate, NDI-naphthalene diisocyanate, IPDI-isophorone
diisocyanate, BIC-1,3-bis cyclohexane pre-polymer)
• Amines: triethanolamine (TEA), diethanolamine (DEA), dimethylethanolamine
• Tetrachlorophthalic anhydride
• Acrylates: methyl methacrylate, cyanoacrylate, diacrylate
• Polyurethanes
• Polyvinyl chloride (PVC)
Baker/Bakeries • Flour and grains (wheat, rye, barley, rice, maize, soy, buckwheat, lupin seed, pea)
• Spices (paprika, coriander, mace-shell of nutmeg, Myristica fragrans, garlic dust,
sesame seed)
• Nuts
• Eggs, egg powder, ovalbumine, vitellus, yolk
• Lactalbumin (found in milk), milk powder
• Colour (camine red), gluten
• Lathyrus sativus (grass pea), soybean lecithin
• Yeast (Saccharomyces cerevisiae)
• Enzymes (alpha amylase, cellulose, xylanase, papain, proteases, glucose oxidase
glucoamylase, fungal amylase, hemicellulase, amyloglucosidase)
• Moulds: alternaria, aspergillus
• Insects: flour beetle, flour moth, cockroach, granary weevil
• Flour handler: konjac flour, white pea flour (Lathyrus sativus), mites, parasites
• Crustacea
Breeder • Pigeon, dove, cockatiel, parakeet, duck, turkey (feathers and droppings)
Brewing Trade • Aspergillus (mould), chloramine (sterilizing agent)
Carpenter/Woodworker • Formaldehyde
• Diisocyantes (toluene diisocyanate)
Furniture Making • Ethylene diamine (shellac/lacquer)
• Hexamethylene tetramine (lacquer)
• 3-carene dust
• Insects: Chrysonilla sitophila, grass pea (Lathyrus sativus)
• Wood: abiruana, acacia, african maple, african zebrawood, antiaris, ash,
australian blackwood, beech, box tree, brazilian walnut, cabreuva, california
redwood, cedar of lebanon, cocabolla, coniferes, ebony, gaboon/okoume, imbuia,
iroko, kotibe, mahogany, makoré, mansonia, maple, mukali, neurospora, oak,
obeche (Triplochiton scleroxylon), okoumé (marine plywood), pau, perbora,
samba, sequoia, spruce, teak, western red cedar, eastern white cedar
Carpet Manufacturing • Guar gum

• Tributil tin oxide (fungicide)
• Trimethylhexanediamine, isophorondiamine (coating)
Cellarman • Sulphites
Work-Related Asthma
Cheese Finer/Maker/ • Mites: Acarus siro (flour mites), Blonia kulagini, house dust mites
• Penicillium casei
Washer • Enzymes: pepsin, lysozyme
• Enzymes in rennet production: proteases, pepsine, chymosines
Chemical Industry • Formaldehyde

• Ethanolamine
• Diisocyantes: (TDI-toluene diisocyanate, HDI-hexamethylene diisocyanate,
MDI-methylene diphenyl diisocyanate, NDI-naphthalene diisocyanate,
IPDI-isophorone diisocyanate, BIC-1,3-bis cyclohexane pre-polymer)
• Piperazine
• Aliphatic polyamine
• Acrylates: methyl methacrylate, cyanoacrylate
• 1,2-benzisotiazoline-3, lasamide
• Chloramine
• Methylchloro-isothiazolinone
• Captafol (fungicides)
• Chloramine T, chlorine, acid/alkaline gas, vapours, aerosols.
• Sulphites
Chemist/Chemical • Diazomethane (TDI, MDI, HDI)

• Enzymes: papain
Laboratory Staff • Amines, aliphatic amines, polycyclic compounds
• Piperazine
• 1,2-benzisotiazoline-3, 3-tetramethyluronium, hexafluorophosphate (TBTU)
Coffee Industry • Green and roasted coffee, coffee leaves, Hemileia vastatrix (mould)
Construction Worker Refer to carpenter/woodworker
Cook/Chef • Spices: coriander, fennel, fenugreek

• Maiko (Japanese cooking)
• Carrot (Daucus carota L)
• Green bean (Phaseolus multiflorus)
• Mushroom (Boletus edulis)
• Eggs, valbumine, vitellus, yolk
• Crustacea
Cosmetic Industry • Enzyme: papain

• Formaldehyde
• Ethanolamine, aliphatic amines, polycyclic compounds
• Cosmetician: chamomile
Work-Related Asthma
Dentist/Dental Assistant • Acrylates

• Gutta-percha
Dental Hygienist • Palladium salts
• Latex
Detergent Manufacturer • Enzymes: amylase, cellulose, Esperase, Subtilisins, lipase, Bacillus subtillis
Diamond Worker • Cobalt, nickel, tungsten
Dyeing Industry • Reactive dyes

• Diisocyantes
• Acid anhydrides
• Sulphites
Electronics/Electronic • Colophony-fluxes (rosin), rosin core solder

• Nickel, nickel salts
Component Industry • Acid anhydrides
• Aliphatic amines, polycyclic compounds
• Palladium salts
Electrical Industry • Colophony-fluxes (rosin)

• Acid anhydrides: hexahydrophthalic anhydride(HHPA),
methyl tetrahydrophthalic anhydride (MTHPA)
• Polyethylene
Electroplating Industry • Chromium, nickel, nickel salts, potassium dichromate
Entomologist • Gypsy moth, butterfly, lesser mealworm
Epoxy Resin Industry • Urea formaldehyde

• 4-Methylmorpholine
• Acid anhydrides: maleic anhydride, phthalic anhydride, trimethyl anhydride,
TCPA (tetrachlorophthalic anhydride), HHPA (hexahydrophthalic anhydride),
himic anhydride, pyromellitic anhydride
• Acrylates: methacrylates, methyl 2-cyanoacrylate
• Styrene
Factory Worker (general) • Plexiglass (dust), palladium
Fertilizer Maker • Chlorine, acid/alkaline gas, vapours, aerosols
Work-Related Asthma
Fishing Industry • Aquatic/microscopic organisms: crab allergens, arctic snow crab, lobster, clam,
shrimp meal, powdered marine sponge, cuttlefish bone dust, red soft coral,
prawns, mussels, fish, fishmeal products, sea squirts (hoya), nacre (mother of pearl)
• Insects: anisakis simplex, beetles (tenebrio monitor, alphitobius, diaperinus
domestica), ech inodorus plamosus (larvae), chironomid midges, green bottle,
moths, butterflies (galleria mellonella), caddis fly, mealworm, larvae, insect
larvae (galleria mellonella), mealworm larvae (tenibrio molitor), herring
worm (anisakis simplex)
• Fish store: daphnia (water flea)(fish food store), chironimid midges
(fish food), echinodorus larva (fish food)
Flame Retardant / Fire • Himic anhydride
Flight Crew • Screw worm fly (Cochliomyia homnivorax)
Florist • Latex (balloons)

• Leafy plants (Bells of Ireland, ficus, albilfloxia)
• Flowers (baby’s breath, carnation, chrysanthemum, limonium (statice),
marianne thistle, mimosa, cyclamen, roses, rose oil, safflower, spathe, yarrow)
• Mites
• Entada gigas (cacoon seed used for decorating), decorative flowers
Foam Producer/Installer • Diisocyanates: TDI (toluene diisocyanate), HDI (hexamethylene diisocyanate),

MDI (methylene diphenyl diisocyanate), NDI (naphthalene diisocyanate), IPDI
(isophorone diisocyanate), BIC (1,3-bis cyclohexane pre-polymer)
• Aliphatic amines: 4-methylmorpholine, N,N dimethylethanolamine
Food Industry • Aquatic/microscopic organisms: crab allergens, arctic snow crab, lobster, clam,
shrimp meal, powdered marine sponge, cuttlefish bone dust, red soft coral,
prawns, mussels, fish, fishmeal products, sea squirts
• Enzymes: bromelain, papain, trypsin, fungal pectinase & glucanase (food processing)
• Plants: maiko (Japanese cooking), aniseed, fenugreek
• Shark cartilage
• Pectin (christmas candy maker), carob bean (jam factory), acacia gum
• Raspberry (freeze-dried)
• Carmine (food dye)
• Artichoke, asparagus, cacao, cabbage, chicory, courgette (zucchini)
• Egg, valbumine, vitellus, yolk
• Dairy: lactoalbumin (milk protein), lactoserum
• Spices: coriander, fennel, fenugreek, nutmeg, paprika, sesame, saffron, onion seed,
garlic dust, aromatic spices
• Flour: mites and parasites
• Antibiotics: betalactoglobuline, sulfamide
• Sulphites
• Pancreatin from pig
Work-Related Asthma
Food Packaging/Packer • Acid anhydrides

• Garlic dust
• Polyvinylchloride (heated)
• Fungal lactase (enzyme)
Foundry Worker • Formaldehyde

• Furfural
• Diisocyantes (diphenylmethane)
• Aluminum, fluorides, nickel, chromium, iron oxides
• Fumes and gases from molten metals and bonding resins
Furrier • Paraphenylene diamine, methylmorpholine (dyeing process)
Gardener • Grass, copperleaf (acalypha wikesiana)
Grain Handler Refer to agriculture
Greenhouse Worker Refer to agriculture
Groomer • Secretions from saliva, feces, urine and skin/dander of cats (most common),
dogs, horses, and other furry animals
Hairdresser • Persulfate salts

• Henna (found in hair bleaches and hair-colouring preparations)
• Sericin (hair lacquer spray)
• Formaldehyde
• Monoethanolamine
• Karaya
Health Care Provider • Ispaghula/psyllium (bulk laxative), Sulfathiazole

• Sevoflurane, isoflurane
• Aerosolized medications: pentamidine, ribavirin
• Latex
• Adhesives: methacrylate, cyanoacrylates
• Sterilizing agents: formaldehyde, gluteraldehyde, ortho-phthalaldehyde
(endoscopy), ethylene oxide
• Proteolytic enzymes, subtilisins (enzymatic cleaner)
• Disinfectants: amine compounds (amino alcohols and aliphatic polyamines),
pine products (colophony, tall oil), tributyltin oxide (fungicide and disinfectant),
cleaning products that contain chlorine bleach with ammonia, acetic acid,
ammonium compounds (benzalkonium chloride), chlorhexidine, hexachloro-
phene, chloramine
• Sulfur dioxide (SO2), isononanoyl oxybenzene sulfonate (laboratory),
proteases, amylase, ninhydrin
• Moulds and dust
• Nurses: who crush tablets, mix powders or prepare lypholized solutions
Work-Related Asthma
Herbalist/Horticulturist • Please refer to pharmacist section

• Chukung (Cnidii rhizoma), banha (Pinellia ternata) and sanyak (Dioscorea radix),
chamomile tea dust (Matricaria chamomilla)
Jeweler • Palladium salts, platinum
Laboratory Staff/ • Formaldehyde

• Insects: locust, cricket, fruit fly, grasshopper, cockroach, sheep blowfly
Laboratory • Enzymes: amylase, bromelain, papain, fungal xylanase, bovine serum albumin
• Dander: rat, mouse, guinea pig, rabbit, gerbil, hamster, cat, dog, monkey
• Urine: lab animals
• Ninhydrin (detergent ingredient)
• Mould: aspergillus niger
Lifeguards • Chloramines, nitrogen chloride

(Indoor swimming pools)
Logging • Mould: chrysonilia sitophila
Machinist • Cobalt, vanadium, chromium, platinum, nickel, metal-working fluids

• Amines: triethanolamine (TEA), diethanolamine (DEA)
Manicurist • Ethyl methacrylate
Mechanic • Diisocyantes
• Chlorendic anhydride
• Cobalt, vanadium, chromium, platinum, nickel
Metallurgist • Nickel, nickel salts

• Aluminum
• Furfural
• Diisocyantes
• Amines: aliphatic amines, polycyclic compounds
• Chromic acid
• Palladium salts
Metal Workers/ • Cobalt, vanadium, chromium and compounds, platinum, nickel,

metal-working fluids (MWF),
Fabricating • Amines: triethanolamine (TEA), diethanolamine (DEA), tungsten chloride,
• Plastic chemical (epoxy resins, polyamines, carboxylic anhydride derivatives)
• EPO 60 (mould making)
• Chrome plater: chromic acid, chromium oxide
Work-Related Asthma
Miller • Flour and grains (wheat, rye, barley, rice, maize, soy, buckwheat)
• Enzymes (alpha amylase, cellulose, xylanase, papain, proteases, glucose
oxidase glucoamylase, fungal amylase)
• Insects: Beetles, moths, butterflies, grain weevil, book louse, lesser
mealworm, grain mite
Miner/Mining • Nickel, nickel salts

• Mould: rhizopus nigricans
Mortician • Formaldehyde
Mould Makers • Metal dust and fumes

• Diisocyanates: TDI (toluene diisocyanate), HDI (hexamethylene diisocyanate),
MDI (methylene diphenyl diisocyanate), NDI (naphthalene diisocyanate), IPDI
(isophorone diisocyanate), BIC (1,3-bis cyclohexane pre-polymer)
Museum Curator • Beetles (coleopera)
Oil Industry • Castor bean, olive oil cake, flax, rapeseed oil
Painter (Spray) • Latex

• Diisocyantes (TDI, MDI, HDI, PPI, hexamethylene, isophorone)
Paint Industry • Amines: ethylene diamine (shellac), hexamethylene tetramine (lacquer),
dimethylethanolamine, ethanolamine, triethylene tetramine
• Chromium, chromic acid
• Acrylate
Paper Industry/Pulping • Formaldehyde

Industry • Chlorine, acid/alkaline gas, vapours, aerosols
• Sulphites
Pet Shop Employee • Birds, cat, crab, deer, dog, fish-based glues, guinea pig, hamster, mink,
mouse, rabbit, rat, rodents, shellfish
Petrochemical Industry • Nickel, nickel salt

• Amines
Pharmaceutical Industry • Ispaghula/psyllium (bulk laxative)

• Antibiotics: tylosin (used in animal health and growth agent), spiramycine,
erythromycine, oleandomycine, amoxicillin, piperacillin sodium, cephalosporins,
penicillins, ciprofloxacin, chloroquine, thiamine, cimetidine, ampicilline
(phenylglycine), isoniazid, tetracyclines, thiamphenicol
• Opiate compounds (codeine, morphine)
• Anti-hypertensives: hydralazine, methyldopa, aescin
Work-Related Asthma
• Glycine (manufacturing of salbutamol)

• Pancreatic extracts, endocrine glands
• Sulphonechloramides
• Chloramine-T, phosdrin sulphathiazole
• Enzymes: bromelin, papain, flaviastase, egg lysosyme, pepsin, trypsin,
pancreatin, chymotrypsin, serratial, lysozyme chloride, peptidase
• Piperazine
• Rose hip (plant), Brazil ginseng, Korean ginseng (sanyak), voacanga
africana (small tropical African tree used to produce drugs)
• Acid anhydrides: phthalic anhydride (PA)
• Aliphatic amines, polycyclic compounds, ethanolamine
• Diisocyantes
• Sulphites
• Lactase
• Henna
• Alage chorella (algae)
Photographer/ • Aliphatic amines, polycyclic compounds, ethanolamine, ethylene diamine

• Pyrazolon
Photographic Processor • Chromic acid, chromium oxide
Plastics Industry • Formaldehyde

• Diisocyantes, (diphenylmethane, toluene diisocyanate)
• Acid anhydrides, phthalate anhydride(PA), tetrachlorophthalic anhydride
(TPCA), trimellitic anhydride (TMA), maleic anhydride, trimethyl anhydride,
hexahydrophthalic anhydride (HHPA), himic anhydride, pyromellitic anhydride
• Ethanolamine, aliphatic amines, polycyclic compounds
• Styrene
• Azodicarbonamide, diazonium, tetrafluoroborate
• Polypropylene
• Enzyme: trypsin
• Acrylates and methacrylates: methyl 2-cyanoacrylate
Plastic Bottles/ • Ground bugs (Lygaeidae)

• Polyvinyl chloride (dust)
Bottling Industry • Diecetyl phtalate
Platinum Refinery • Platinum, ammonium hexachloroplatinate, chloroplatinum,

potassium hexachloroplatinate
Plywood Factory Worker Neurospora
Pottery / Stain Glass Cobalt
Work-Related Asthma
TRIGGER AGENTS
Printing Industry • Acacia gum, diazonium, chromium and compounds
Potroom • Aluminum
Roofer • Chromium
Rubber Industry • Formaldehyde

• Aliphatic amines, polycyclic compounds, ethanolamine
• Azodicarbonamide, diazonium, tetrafluoroborate
• Diisocyanates: methylene diphenyl diisocyanate, naphthalene diisocyanate
• Latex
Sawmill Employee • Wood: abiruana, acacia, african maple, african zebrawood, antiaris, ash,
australian blackwood, beech, box tree, brazilian walnut, cabreuva, california
redwood, cedar of lebanon, cocabolla, coniferes, ebony, gaboon/okoume,
imbuia, iroko, kotibe, mahogany, makoré, mansonia, maple, mukali, neurospora,
oak, obeche, okoumé (marine plywood), pau, perbora, samba, sequoia, spruce,
teak, western red cedar, eastern white cedar
• Mould: Trichoderma koningii
Service Personnel / • Chloramines, benzalkonium chloride,

• Quaternary amine
Janitor • Dictyostelium discoideum (slime mould)
• Lauryl dimethyl benzyl ammonium chloride(floor cleaner)
• Toluene diisocyanate (floor varnisher)
• Bis(tri-n-butyltin)oxide (carpet deodoriser)
• Amine compounds: amino alcohols and aliphatic polyamines
• Pine products (colophony, tall oil)
• Tributyltin oxide (fungicide and disinfectant)
• Mixing cleaning products that contain chlorine bleach with ammonia
• Acetic acid
Sewage Worker • Sewage filter fly
Ski Manufacturer • N,N-Dimethyl-1,3-propanediamine
Smelter • Aluminum, nickel, nickel salts
Solderers • Aluminum fumes, zinc chloride fumes

• Colophony-fluxes (rosin)
• Ethanolamine, aminoethylethanolamine
Steel Industry • Vanadium
Work-Related Asthma
TRIGGER AGENTS
Tanner (Leather Worker) • Vinylsulfone

• Formaldehyde
• Aliphatic amines, polycyclic compounds, acryolamine
• Casein
• Chromium and compounds, nickel
• Potassium dichromate
• Sulphites
Textile Industry • Reactive dyes

• Sericin
• Acryolamine
• Vinylsulfone
• Latex
• Chromium and compounds
• Sulphites
• Dermestidae spp (wool), furfuryl (wool)
• Synthetic textile fibres (rayon, nylon)
• Polyester (orlon, terylene)
• Cotton, flax, hemp, jute, kapok, sisal (natural fibres)
• Carmine (colouring)
• Methylmorpholine (fur dyeing)
• Insect (silkworm)
Tinsmith • Diisocyantes
Tobacco Industry • Leaf
Toy Manufacturer • Latex
Veterinarian/ • Antibiotics: tylosin (used in animal health and growth agent), spiramycine,
erythromycine, oleandomycine
Veterinarian Assistant • Piperazine
• Birds, cow (bovine) dander, cat, crab, deer, dog, fish-based glues, goats, guinea
pig, hamster, horses, mink, monkey, mouse, rabbit, rat, rodents, sheep, shellfish
Water Plant • Sulfites
Welder • Abietic acid, metal working fluids

• Chromium and compounds, nickel, nickel salts, aluminum, zinc, vanadium
• Potassium dichromate
• Aminoethanolamine
• Alkyl aryl polyether alcohol, polipropylene glycol
Agricultural Asthma Triggers

Farming exposes farmers, farm workers and others involved in agricultural
processes to many irritants and allergens that may trigger asthma symptoms.
Agricultural asthma is a form of work-related asthma. The incidence of
occupational asthma in Ontario farm workers is estimated to be from four
to thirty per cent. This estimate may be low, as many cases go unreported.
In this section, Agricultural Asthma Triggers, we have organized the
information according to the most common types of farming in Canada. Work
with your patient to identify potential triggers. It is also important to consider
common triggers (listed in other sections) and seasonal variables that could be
contributing to symptoms.
Helping your patient to manage agricultural asthma will have special
challenges in many cases. While some of the avoidance strategies are fairly
simple, many are costly and involve the hiring of expert services for consultation,
installation and training. For the most part, the work is time-sensitive and cannot
be delayed or delegated to others. Often farmers and farm workers do not have
the same resources that workers in other sectors have to facilitate and support
change. Help your patient to identify community agencies and associations that
can provide information and assistance.
FA R M T Y P E TRIGGERS & WHERE THEY ARE FOUND A V O I D A N C E / M A N A G E M E N T S T R AT E G I E S
General
Includes the most common triggers Mites: There are four basic strategies that
generally found in most farm Barn mite (Acarus siro, Acarus should be applied in an agricultural/
environments, with the potential farris, Blomia Kulagini, Euroglyphus) farm environment:
to affect any of the workers and/or Two spotted spider mite
visitors to the site. (Tetranychus urticae) • Identify asthma-causing agents.
• Eliminate asthma-causing agents.
Mould Spores • Substitute a safer agent if the
asthma-causing agent cannot be
Feed enhancer: eliminated.
Phystase • Control exposure by substituting
Betaglucanase the agent with a less harmful material
Amprolium hydrochloride or utilize engineered and hygiene
measures.
Common antibiotics in feeds:
Tetracyclines, sulphas, neomycin, Note: Respirators offer the single greatest
bacitracin, lincomycin, apramytin, tylo- protection against work-related asthma, but
sin, lasalocid, spiramycin, amprolium. cannot provide complete protection.
Fodder or animal feed: • Use Personal Protection Equipment

Vetch (Vicia sativa) (grows in (PPE) when spraying, harvesting,
a cultivated grain field) weeding, tilling or working in animal
confinement buildings.
Inorganic dust: • Wet feed or bedding prior to
Metal cages and steel gratings distribution to lower levels of
airborne endotoxins.
Nitrogen Fertilizers: • Fit all openings to manure pits
Anhydrous ammonia (82-O-O) with substantial metal grill covers
Aqua ammonia (20-0-O) to provide natural ventilation and
Ammonia nitrate (34-O-O) to prevent accidental falls or entries
Ammonia nitrate-lime (26-O-O) into the pits.
Ammonia sulfate (21-O-O-243) • Strictly enforce worker re-entry
Calcium nitrate (15.5-O-O-19Ca) intervals to work areas to reduce
Nitrate of soda (16-O-O) exposures to hazardous materials
Urea (46-O-O) and triggers.
Phosphate Fertilizers:
Normal superphosphate (0-20-O)
Concentrated superphosphate (0-45-O)
Nitrogen/Phosphate Fertilizers:
Monoammonium phosphate (11-52-O)
Ammonium phosphate sulfate
(16-20-O-153)
Potassium Fertilizers:
Potassium chloride
Potassium sulfate
Potassium nitrate
Fertilizer Content: Sulfur, calcium,

magnesium, borates, sulfates of copper,
iron, manganese, and zinc.
Anhydrous ammonia
(injected into soil)
Insecticides
(chemicals used to control insects)
Organophosphate
Miticides/Acaricides
(chemicals used to control mites)
Fungicides
(chemicals used to control moulds)
Chlorothalonil
Herbicides
(chemicals used to control
unwanted plants)
Rodenticides
(chemicals used to control rodents)
Nematicides
(chemicals used to control nematodes)
Disinfectants: Chloramine-T,
ammonium, aldehydes.
Livestock
Cattle/Dairy/Other Endotoxin is present from • Increase ventilation in
contaminating bacteria of: confinement buildings.
Cow dander • Reduce number of animals
Cow urine per unit area.
Sheep epithelium • Increase frequency of manure
Goat epithelium removal.
Horse hair • Install ammonia level sensors.
Rabbit hair • Use respirators that remove ammonia.
Rabbit epithelium • Use ventilated hoods or safety
Mink urine cabinets during animal manipulations.
Deer dander • Avoid wearing street clothes.
Dairy cattle/milk production • Store work clothes at the workplace
Beef cattle/ranching, Sheep, Goat and wash separately in hot water.
Horse, Rabbit, Other livestock, • Keep cages and animal areas clean.
Honey Bees. • Wear gloves, aprons, coveralls.
• Install ventilated animal cage
racks or filter-top cages.
• Replace sawdust bedding with
absorbent pads or corncob bedding.
Poultry Endotoxin is present from • Increase ventilation in

contaminating bacteria of: confinement buildings.
Egg proteins • Reduce number of animals
Poultry mites per unit area.
Poultry dander • Increase the frequency of
manure removal.
Feathers and feather tips: • Substitute alternative litter
Chicken, duck, goose, turkey. materials in poultry confinement.
• Install ammonia level sensors.
Confinement Units: mixtures of • Use respirators that remove ammonia.
organic poultry dust, skin debris,
feathers, insect parts, aerosolized feed, Note: Full face respirators capable of removing
poultry excreta, bacteria, high levels ammonia and 95% or more of particulate matter
of ammonia in poultry urine, and Anisa- are available.
kis Simplex (microscopic worms).
Swine Endotoxin is present from • Increase ventilation in

Hog, Pig contaminating bacteria of: confinement buildings.
Swine epithelium • Reduce number of animals
Pig urine per unit area.
Pig dander • Increase the frequency of
manure removal.
Confinement Units: mixtures of • Substitute alternative litter
organic dust, skin debris, feathers, materials in poultry confinement.
insect parts, aerosolized feed, bacteria, • Install ammonia level sensors.
high levels of ammonia in pig urine, and • Use oil misting systems.
Anisakis simplex (microscopic worms). • Use respirators that remove ammonia.
Fruit and Vegetable Fruit Mites: Note: Respirators offer the single greatest protection
Fruit tree red spider mite (Tetranychus against work-related asthma, but cannot provide
urticae), Acarian-mite or tick complete protection.
(Panonychus ulmi), Citrus red mite
(Panonychus citri). • Use Personal Protection Equipment
(PPE) when spraying, harvesting,
Fruit Mould: weeding, tilling or working in animal
Downy Mildew (Plasmopara Viticol). confinement buildings.
Vine grower:
Acarian - McDaniel spider mite
(Tetranychus macdanieli),
Pollen (Diplotaxis erucoides).
Extracts from fruits:

raspberry powder, peach leaf.
Granary Worker
Soybean, Oilseed (except soybean) Grain dust: • Use oil misting systems.
Dry pea and bean, Wheat, Corn, Consists of different types of grain, • Use PPE when grain handling.
Other grain insect parts, mould, bacteria, bird • Ensure adequate drying and
and rodent droppings, pesticides conditioning prior to storage.
and silica. Includes: wheat, rye, barley, • Store grain at recommended moisture
rice, maize, soy, buckwheat. content levels to limit mould growth.
• Utilize anti-mould sprays or
Storage mites: preparations to reduce mould.
Tyrophagus longior, T. putrescentiae, • Spray water or canola oil on feed
Glycyphagus destructor, G. domesticus, or bedding prior to distribution
Acarus siro, A. farris, Dermatophagoides in enclosed spaces and automatic
pteronyssinus, D. farinae, Ornithonys- feeding systems.
sus sylviarum. • Install exhaust fans in all storage
areas. Use covers or screen equip-
Beetles: ment during transfer of grain.
Tenebrio monitor, Alphitobius, • Extend exhaust pipes to higher,
Hay Diaperinus domestica, grain weevil. faster moving air (above head height).
All other miscellaneous crops
Other food crops grown under cover Insects:
grain mite, grain pests, Eurygaster
and Ephestia, Lesser mealworm,
Oilseed rape (canola).
Greenhouse Mites Note: Respirators offer the single greatest protection

Acarian - Two spotted spider mite against work-related asthma, but cannot provide
Horticulturist (Tetranychus urticae), Cream coloured complete protection.
Landscape mite (Amblyseius Cucumeris).
• Use Personal Protection Equipment
Insects (PPE) when spraying, harvesting,
Includes: predatory, pests, pollinators. weeding, tilling or working in animal
Mould spores
Pollen and plant oils:

Sweet pea, bell pepper pollen,
amaryllis, cauliflower and broccoli
pollen, sunflower pollen and seeds.
Chemicals:
Includes: fertilizers, pesticides,
herbicides, insecticides.
Vegetable aerosols (inhalation of

vapours) Includes: potato, asparagus,
carrot, green bean.
Flowers: Sea lavender, chrysanthe-

mum, solanum melongena, madagascar
jasmine, freesia, amarylis, baby’s
breath, carnation, limonium (statice),
marianne thistle, mimosa, cyclamen,
roses, rose oil, safflower, spathe, yarrow.
Plants: Umbrella tree (schefflera),

grass juice, weeping fig (ficus
benjamina), Bells of Ireland, albilfloxia.
Mushroom Mould spores Note: Respirators offer the single greatest protection
White Mushroom (Agaricus bisporus) against work-related asthma, but cannot provide
complete protection.
Mites and other insects (predatory,
pests and pollinators) • Use Personal Protection Equipment
(PPE) when spraying, harvesting,
Pollen and plant oils weeding, tilling or working in animal
Chemicals including: fertilizers,
pesticides, herbicides and insecticides.
Special Considerations
Ideally, by the time you get to this last section of the guide, you and your patient
have been able to identify the triggers that are potentially exacerbating his or her
asthma symptoms. In this section, Special Considerations, we have included some
extra information for you to think about. Although limited, this information is
intended to remind you that further assessment of any potential contributing fac-
tors may be necessary. Again, sometimes the evidence is not compelling and can be
controversial; however, it is up to us, as health care providers to make good use of
both the scientific data available, as well as the collective wisdom and experience
of good practice. We encourage you to seek more information and/or expert advice
about any of these special considerations that may be pertinent to your patient.
TRIGGER WHERE THEY ARE FOUND A V O I D A N C E / M A N A G E M E N T S T R AT E G I E S
Food
Food allergy is a very uncommon cause The most common foods causing Note: Although caution and good judgement are
of asthma. Typically, food allergy that serious allergic reactions include: essential, proper allergy skin testing and assessment
causes asthma symptoms occurs with eggs, fish, milk, peanuts, shellfish, soy, are required to confirm a suspected food allergy.
episodes of anaphylaxis. Therefore tree nuts (walnuts, cashews), wheat Thorough assessment by an allergist is highly
other symptoms such as throat tightness, and sesame seeds. recommended.
pruritis, urticaria and/or even symptoms
of low blood pressure occur when food • Eliminate the identified food(s)
allergy is a cause of asthma. A proper from the diet.
assessment and allergy testing must be • Read food labels carefully.
performed to confirm the existence of • Inform those involved in meal
a food allergy. If food allergies and planning/food preparation (family,
asthma coexist, the person is at more caregivers, schools, restaurants).
risk of life threatening events. • Ask about ingredients always.
• Educate children as soon as possible
(ask, identify and self-advocate).
• Wear a Medic Alert® bracelet.
• Discuss/seek expert advice about the
Food Additives need for Epipen® or Twinject®.
While many food additives such as Sulphites are commonly found in:
dyes and preservatives have long been dried fruits, wine, bottled lime or lemon Note: Anaphylaxis Canada is a valuable
suspected of causing increased symp- juice, prepared potatoes and shrimp. resource for health care providers and patients;
toms, only sulphites have been proven www.anaphylaxis.org
to do so.
Emotions
Psychological factors, especially stress, • Initiate discussion about the impact
can trigger or exacerbate asthma of emotions on health in general and
symptoms. Studies have shown that more specifically breathing.
psychological factors can lead to • Practise relaxation techniques.
increased airway inflammation. • Review and adjust management strat-
egies (Action Plan), as appropriate.
Hormones
Some women notice that their asthma • Discuss adjustment to medication
symptoms are worse just before men- routine (Action Plan).
struation begins or during ovulation.
Pregnancy
Asthma control during pregnancy may • Discuss plans for pregnancy with
remain unchanged, improve or become physician in advance, when possible.
worse. Generally, control will return • Seek advice and guidance from physi-
to the pre-pregnancy level three months cian once pregnancy is confirmed.
postpartum. Well-controlled asthma • Avoid irritants and allergens as
increases maternal comfort and much as possible to decrease
improves safety and outcomes for need for medication.
both mother and baby. • Discuss choice, risks and benefits
of medications.
Rhinitis, Sinusitis
Research suggests that inflammation Discuss signs and symptoms of • Treat rhinitis and sinusitis.
of the upper airway from rhinitis and rhinitis and sinusitis with every patient • Discuss management of rhinitis
sinusitis results in increased bron- who has asthma. and sinusitis with physician.
choconstriction of the lower airways. • Manage allergic triggers as described
Increasing evidence is suggesting the in other sections.
concept of one airway, one disease.
Up to 80% of patients with asthma have
rhinitis and about 15% of patients with
allergic rhinitis have asthma. Rhinitis
and sinusitis are associated with more
severe asthma symptoms and increased
exacerbations in patients with poorly
controlled asthma. Rhinitis and
sinusitis must be treated.
Aspirin (ASA)
Non-Steroidal Anti-Inflammatory Taking a careful history can help • Avoid ASA and NSAIDs as well as
Drugs (NSAIDs) to identify this. any medications containing these.
ASA/NSAIDs can induce increased • Notify pharmacist and physician
asthma symptoms in about 28% of for inclusion on records.
adults, but rarely affect children.
Beta Blockers
Beta Blockers are medications commonly Check with pharmacist or other • Discuss potential alternative medica-
used to manage hypertension, cardiac source to accurately identify these tion choices with physician.
disease, eye disease and headaches. medications.
They will interfere with Beta-agonists
(bronchodilators) and patients with
asthma will not benefit optimally from
their reliever medication.
Gastroesophogeal
Reflux (GERD)
The relationship between GERD and As many as 89% of patients with • Avoid fatty foods, caffeine, chocolate,
asthma is controversial although many asthma may have GERD and many peppermint, citrus juices, tomato
studies have shown an interaction of those patients may have “silent” products and alcohol.
between the two diseases. Studies have reflux, with no symptoms. Therefore • Avoid large meals.
shown that if you have asthma you have it is important to discuss signs and • Avoid eating before going to bed.
a higher chance of having GERD. symptoms of GERD with patients. • Elevate head of bed.
• Stop smoking.
• Consider medication.
Obesity
Asthma is thought to be more prevalent • Discuss weight management strategies.
in obese people. Obesity is also thought • Increase exercise, as appropriate.
to make asthma more difficult to control • Refer to Canada’s Food Guide:
and causes increased symptoms. The www.hc-sc.gc.ca
exact mechanism is not understood.
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TRIGGER WHERE ARE THEY FOUND A V O I D A N C E / M A N A G E M E N T S T R AT E G I E S
Dust mites Dust mites are also found everywhere, • Wash all bedding in hot water
Tiny microscopic creatures that feed on but in large concentrations in bed- (130-140°F) weekly.
the flakes of skin that people and pets rooms. Cotton fibres (pillows, blankets, • Freeze non-washable items
shed daily. They thrive in warm and carpet, mattresses, stuffed animals, (quilts, stuffed animals) in freezer (or
humid environments. upholstered furniture) leave outside overnight in freezing
temperatures).
• Remove stuffed animals from bedroom.
• Replace (if possible) carpets, rugs, heavy
draperies and upholstered furniture.
Exercise
Physical Activity can be the only trigger Any physical exertion. Note: A favourite stuffed animal can be washed
for asthma symptoms. And is known as and placed in the drier, followed by an overnight stay
Exercise Induced Asthma (EIA). in the freezer. This will reduce the mites, while keep-
ing a little one happy!
Physical activity can trigger asthma
symptoms and may be a sign of • Prophylactic use of bronchodilator
uncontrolled asthma. medication 20-30 minutes prior
to activity. (Level 1)
• Warm up before and after
physical activity.
• Consider venue, time of day
and weather conditions when
planning activities.
• Elite level athletes should be
referred to a Specialist for testing
and advice.
Mould Spores
Tiny structures produced by moulds Spores are airborne and are found Note: There is no practical way to eliminate all moulds
for reproduction purposes. in places where mould grows. indoors. The best way to control indoor mould growth
is to control moisture. Prevention is key.
Common spores: Common indoor areas include:
Alternaria showers, bathrooms, window sills, • Maintain relative humidity level
Aspergillus laundry rooms, kitchens, refrigerators, <50%.(A hygrometer is a useful and
Bipolaris garbage containers, carpets, upholstery, inexpensive device for measuring and
Cladosporium attics, basements monitoring indoor humidity levels.)
Epicoccum • Promote air circulation with open
Fusarium windows and use of vents and fans.
Acknowledgements
Penicillium • Clean showers/bathtubs after each
Common spores: use to prevent mildew.
Alternaria
The Primary Care Asthma Co-ordinators’ Group
Aspergillus
The Ontario Lung Association • Maintain relative humidity level
Bipolaris
The Lung Association is also grateful to the Government of Ontario for <50%.(A hygrometer is a useful and
Cladosporium
funding that supported the development, printing and distribution of this publication. inexpensive device for measuring and
Epicoccum monitoring indoor humidity levels.)
Fusarium • Promote air circulation with open
Penicillium Common spores: windows and use of vents and fans.
Alternaria • Clean showers/bathtubs after each
Aspergillus
Ontario’s useoftothirteen
Asthma Plan of Action is a long-term strategy based on the current Canadian asthma guidelines and is comprised prevent mildew. initiatives that
cross-ministerial
Bipolaris
include • Maintain
health promotion and prevention, management and treatment, research and surveillance. For children and adults relative
with asthma, humidity
the goals of the Planlevel
are to reduce
mortality, morbidity and health care costs through an integrated approach with the Ministry of Health and Long-Term Care coordinating and overseeing the efforts.
573 King Street East
Toronto, Ontario, Canada M5A 4L3
www.on.lung.ca
To order copies of this publication, call The Lung Association’s Asthma Action Helpline at
1-888-344-LUNG (5864). It is also available at: www.on.lung.ca
© Ontario Lung Association 2009

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Common Asthma Triggers 2

Asthma Triggers in Schools 8

Agricultural Asthma Triggers 28

Madonna Ferrone RRT, CRE

Dr. Lisa Cicutto RN PhD CAE

Common Asthma Triggers

TRIGGERS WHERE THEY ARE FOUND AV O I D A N C E / M A N A G E M E N T S T R AT E G I E S

Animal Secretions (Allergen)

TRIGGERS WHERE THEY ARE FOUND A V O I D A N C E / M A N A G E M E N T S T R AT E G I E S

• Wash all bedding in hot water

Note: A favourite stuffed animal can be washed and placed

Mould Spores (Allergen)

Note: There is no practical way to eliminate all

TRIGGERS WHERE THEY ARE FOUND A V O I D A N C E / M A N A G E M E N T S T R AT E G I E S

Note: Many people who are bothered by pollens

Note: It can take many months before the

TRIGGERS WHERE THEY ARE FOUND AV O I D A N C E / M A N A G E M E N T S T R AT E G I E S

Second-hand smoke (chemical Second-hand smoke is noticeable

Third-hand smoke is the residual

Strong Scents (Irritant)

TRIGGERS WHERE THEY ARE FOUND AV O I D A N C E / M A N A G E M E N T S T R AT E G I E S

Viral Infections (Irritant)

Note: Hand washing is the most effective way

Note: Not all people with asthma will be adversely

Asthma Triggers in Schools

OUTDOOR TRIGGERS WHERE THEY ARE FOUND AV O I D A N C E / M A N A G E M E N T S T R AT E G I E S

Animal Secretions (Allergen)

Criteria Air Contaminants

Ground-level Ozone (O3)

OUTDOOR TRIGGERS WHERE THEY ARE FOUND A V O I D A N C E / M A N A G E M E N T S T R AT E G I E S

Mould Spores (Allergen)

Note: Many people who are bothered by pollens

OUTDOOR TRIGGERS WHERE THEY ARE FOUND A V O I D A N C E / M A N A G E M E N T S T R AT E G I E S

Note: Not all people with asthma will be adversely

INDOOR TRIGGERS WHERE THEY ARE FOUND AV O I D A N C E / M A N A G E M E N T S T R AT E G I E S

Animal Secretions (Allergen)

INDOOR TRIGGERS WHERE THEY ARE FOUND A V O I D A N C E / M A N A G E M E N T S T R AT E G I E S

• Maintain relative humidity level

Indoor Air Quality (Irritant)

INDOOR TRIGGERS WHERE THEY ARE FOUND A V O I D A N C E / M A N A G E M E N T S T R AT E G I E S

Mould Spores (Allergen)

Note: There is no practical way to eliminate all moulds

Note: It can take many months before the

INDOOR TRIGGERS WHERE THEY ARE FOUND A V O I D A N C E / M A N A G E M E N T S T R AT E G I E S

Strong Scents (Irritant)

Note: Hand washing is the most effective way

Note: Schedule potential asthma-triggering

Aircraft Manufacturing • Cobalt, vanadium, chromium, platinum, nickel, metal-working fluids

Adhesive Industry • Aliphatic amines, ethanolamine, polycyclic compounds

Brewing Trade • Aspergillus (mould), chloramine (sterilizing agent)

Carpet Manufacturing • Guar gum

Chemical Industry • Formaldehyde

Chemist/Chemical • Diazomethane (TDI, MDI, HDI)

Construction Worker Refer to carpenter/woodworker

Cook/Chef • Spices: coriander, fennel, fenugreek

Cosmetic Industry • Enzyme: papain

Dentist/Dental Assistant • Acrylates

Diamond Worker • Cobalt, nickel, tungsten

Dyeing Industry • Reactive dyes

Electronics/Electronic • Colophony-fluxes (rosin), rosin core solder

Electrical Industry • Colophony-fluxes (rosin)