CDC Expert Commentary

Asthma Control During Travel

David B. Callahan, MD

Disclosures

May 02, 2011

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Hello, I am Dr. David Callahan, with the CDC's National Asthma Control Program. I am speaking to you as part of the CDC Expert Commentary Series on Medscape. Today, I would like to discuss how clinicians can advise persons with asthma to stay healthy during travel. Good asthma control while traveling requires a bit of planning on the part of the patient, and support and guidance by the clinician, but the outcome of an enjoyable, symptom-free vacation or business trip is well worth the effort.

First, the clinician should consider the patient's current asthma control. If a patient's asthma is not under control now -- for example, if the patient needs a rescue inhaler more than twice per week -- then the initial step is to gain control through enhanced use of controller medications, reduced exposure to environmental asthma triggers, and better self-management. A visit should be arranged before travel begins to ensure the best control possible.

Depending on the length of travel, ensure that the patient has an adequate supply of controller and rescue medications. If necessary, many prescription plans permit refilling the medication early if travel is planned. The patient should also have the tools necessary to manage asthma: an asthma action plan, a peak flow meter, and a spacer or holding chamber.

As you know, respiratory infections are a cause of many asthma exacerbations. During the visit, a review of immunization records can make sure the patient is up-to-date. Persons with asthma are at greater risk for complications from influenza, so getting an annual influenza vaccine can protect the patient while on travel. Vaccines such as pneumonia and pertussis can be updated as well. At the time of the visit, the clinician can also review simple measures, such as frequent handwashing or use of alcohol-based hand sanitizers, to reduce the risk of acquiring a respiratory infection.

Exposure to environmental triggers can cause an asthma exacerbation. Tobacco smoke, even the residual "third-hand" smoke from where a smoker has been, is a problem for most persons with asthma. Recommend a nonsmoking room, or better yet, choosing lodging that does not permit smoking at all, to greatly reduce the chance for smoke exposure. Persons with asthma, with the help of their clinicians, should consider their own asthma triggers and do some research prior to travel. For example, a traveler who has spring pollen allergy could check for the expected peak pollen count days for their desired travel location and avoid those days in that location if possible. A traveler whose asthma is worsened by dust mites could ask whether beds with encased mattresses and pillows are available, or whether it is permitted to bring one's own dust-impermeable mattress and pillow covers. Some hotels offer "hypoallergenic" rooms, although these might cost more than a regular room. If visiting friends or relatives, the patient should ask, for example, whether these homes have pets that might cause an asthma attack; if so, the patient should consider alternative lodging or at least see whether there are areas of the house where pets are not allowed.

Sometimes, even the best prepared traveler runs into trouble. Ensure that your patients with asthma know how to recognize their asthma symptoms. Patients who have the name and number of a local clinician who treats asthma, as well as contact information for their own clinician, can help avoid an emergency department visit if symptoms begin to worsen. Patients might also let their travel partners know of their asthma, and how they might help if symptoms occur.

Finally, the goal of good asthma care is to be able to enjoy life with as few symptoms as possible, and that includes being able to travel to one's desired destinations. Encourage your patients to enjoy their travels and, with your help, to do so while being active and feeling well.

Web Resources

The Centers for Disease Control and Prevention National Asthma Control Program

Asthma Management and Prevention

Guidelines for the Diagnosis and Management of Asthma (EPR-3)

The National Center for Environmental Health

Air Quality Notifications

National Asthma Education and Prevention Program

Asthma and Allergy Foundation of America

American Lung Association

American Academy of Allergy, Asthma & Immunology

Allergy and Asthma Network/Mothers of Asthmatics, Inc.

American College of Allergy, Asthma & Immunology

American College of Chest Physicians

American Thoracic Society

Dr. David Callahan is a medical epidemiologist, a board-certified family physician, and a captain in the Commissioned Corps of the US Public Health Service. Dr. Callahan leads the Asthma Epidemiology and Research team of the Air Pollution and Respiratory Health Branch at the US Centers for Disease Control and Prevention (CDC). He also has an academic appointment in the Department of Family and Preventive Medicine of Emory University, Atlanta, Georgia, where he sees patients and teaches medical students and residents. As a US Public Health Service officer, Dr. Callahan responds to disasters and public health emergencies, including the 2010 Gulf oil spill, the 2009 H1N1 influenza pandemic, Hurricane Katrina, the West Nile virus epidemic, and the terrorist events and anthrax bioterrorism attacks in the fall of 2001. He holds degrees from the College of William & Mary, Williamsburg, Virginia, and the Medical College of Virginia, Richmond, and served as an Epidemic Intelligence Officer assigned to San Diego before moving to CDC headquarters in Atlanta in 2001.

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