The dilemma of the asthmatic patient: fight with the help of drugs or escape to a healthier environment?

Abstract

Asthma is characterized by chronic airway inflammation that underlies exacerbations in response to environmental triggers. The notable change in the environment that has occurred in recent decades, both outdoor and indoor, has contributed to increasing the concentrations of substances considered toxic to epithelia, including the epithelium of the airways. Considering the importance of environmental triggers, an avoidance strategy for environmental triggers could be useful for improving asthma control with sparing use of medications. The purpose of this commentary is to provide evidence that avoidance of environmental triggers can help control asthma with a consequent saving of anti-asthma medications. This approach requires that monitoring of pollutants to which the patient is exposed becomes part of the patient evaluation as is the search for biomarkers of inflammatory response. Many observations have shown that reduced exposure to NOx, household cleaning products and fine particulate matter is able to improve asthma control. Equally important for the control of asthma were the remediation of houses with damp and mold. Greater consideration of the environmental triggers of asthma exacerbations can help the clinician further personalize the asthma treatment strategy. The message is to combine the immunophenotyping of asthma (T2 high vs. T2 low) with a sort of phenotyping of environmental triggers.