Asthma - Causes of Acute Asthma Exacerbation

Asthma - Causes of Acute Asthma Exacerbation | Mnemonic ICE CREEAAMB

By -VHTC

16 July

What Is Asthma?

Asthma is a chronic inflammatory condition of the airways characterized by:

Bronchial hyperreactivity
Reversible airflow obstruction
Episodes of wheezing, coughing, chest tightness, and breathlessness

Asthma affects over 300 million people globally and is one of the most common chronic respiratory diseases in both children and adults.

What Is an Asthma Exacerbation?

An exacerbation (or flare-up) is a sudden worsening of asthma symptoms that may require immediate medical attention. It results from increased inflammation, bronchoconstriction, and mucus production.

Exacerbations Can Be:

Mild: Self-managed with inhalers
Moderate: Needs doctor supervision
Severe: Requires hospitalization and oxygen support

Causes of Acute Asthma Exacerbation | Mnemonic ICE CREEAAMB

ICE CREEAAMB Mnemonic: Causes of Asthma Exacerbation

The mnemonic ICE CREEAAMB summarizes the most common and clinically significant triggers:

I – Infection
C – Cold air & pollution (Chemicals)
E – Emotional stress
C – Catamenial (menstrual-related)
R – Running / Excessive exercise
E – Excessive cold air
E – Environmental allergens
A – Aspirin / Acid reflux
A – Activity or movement overload
M – Medications (especially Beta-blockers)
B – Beta-blockers (repeated to stress importance)

Detailed Explanation of Each Trigger

I – Infection

Viral upper respiratory tract infections (e.g., RSV, rhinovirus)
Bacterial sinusitis
Pneumonia

Why? Infections increase airway inflammation and mucus.

C – Cold Air & Pollution / Chemicals

Cold, dry air causes bronchoconstriction
Pollution (PM2.5, NO2, SO2)
Strong odors, cleaning agents, perfumes

E – Emotional Stress

Stress triggers autonomic changes, increasing airway reactivity
Anxiety may worsen breathing pattern (hyperventilation)

C – Catamenial Asthma

Worsening asthma before or during menstruation
Linked to hormonal changes, especially drop in progesterone

R – Running / Exercise-Induced Asthma

High-intensity activities cause rapid breathing through the mouth
Leads to airway drying and bronchospasm

E – Excessive Cold Air

Reinforces that repeated exposure to cold climates can worsen asthma
Especially relevant in winter months

E – Environmental Allergens

Dust mites
Pollen
Mold spores
Pet dander

A – Aspirin / Acid Reflux

Aspirin-exacerbated respiratory disease (AERD) is a known syndrome
GERD causes acid to irritate airways, worsening symptoms

A – Activity or Movement

Sudden physical overload or fatigue can precipitate attacks
Improper warm-up or overexertion are key triggers

M – Medications

Beta-blockers, even topical (e.g., timolol eye drops)
NSAIDs
ACE inhibitors (can cause cough, mimicking asthma)

B – Beta-blockers (Re-emphasized)

Non-selective beta-blockers like propranolol worsen bronchospasm
Avoid in all known asthmatics

Environmental and Lifestyle Triggers

Trigger	Source
Smoke	Cigarettes, biomass fuel
Dust	Carpets, bedding, books
Humidity	Mold growth in poorly ventilated areas
Pets	Dander, especially from cats and dogs
Strong smells	Paint, perfume, incense sticks

Medication-Induced Exacerbations

Drug Class	Examples	Effect
Beta-blockers	Propranolol, timolol	Bronchoconstriction
NSAIDs	Aspirin, ibuprofen	AERD
ACE inhibitors	Enalapril	Chronic cough
Sedatives	Benzodiazepines	Respiratory depression in severe asthma

Catamenial Asthma and Hormonal Impact

Occurs in 30–40% of women with asthma
Worsening symptoms during luteal phase
Possible link to estrogen and progesterone fluctuations
Treatment may include hormonal contraceptives

Risk Factors and Vulnerable Groups

Children <10 years
Obese individuals
Allergic rhinitis or eczema
Urban populations (due to pollution)
Low-income groups (due to poor ventilation, smoke exposure)

Signs and Symptoms of Exacerbation

Shortness of breath, especially at night
Audible wheeze
Tightness in chest
Persistent cough
Use of accessory muscles
Drop in peak expiratory flow (PEFR)

How to Prevent Asthma Flare-ups

1. Avoid Triggers

Identify personal triggers and minimize exposure
Use air purifiers, avoid dusty rugs

2. Medication Compliance

Use inhaled corticosteroids (ICS) daily
Keep rescue inhaler (salbutamol) handy

3. Vaccination

Get flu and pneumococcal vaccines

4. Action Plan

Have a written asthma action plan
Recognize early warning signs

5. Exercise Smart

Warm-up, use pre-exercise bronchodilator if advised

Emergency Management of Acute Exacerbation

Treatment	Route	Purpose
Salbutamol	Inhaled (MDI or Neb)	Relieves bronchospasm
Ipratropium	Inhaled	Added benefit in moderate/severe attacks
Steroids	Oral/IV	Reduce airway inflammation
Oxygen	Mask or nasal cannula	Maintain saturation >94%
Magnesium sulfate	IV	Severe exacerbation rescue option
Mechanical ventilation	As needed	For respiratory failure cases

Clinical Case Examples

Case 1: Winter-Induced Exacerbation

A 14-year-old develops breathlessness every winter morning while cycling to school. History of mild asthma. Cold air and exertion are triggers.

Management:

Prescribed salbutamol MDI before exercise
Advised scarf over mouth and nose

Case 2: Aspirin-Triggered Asthma

A 35-year-old female with asthma presents with worsening wheezing after taking aspirin for a headache. Diagnosed with AERD.

Management:

Avoid NSAIDs
Switched to paracetamol
Initiated leukotriene receptor antagonists

Frequently Asked Questions (FAQs)

Q1. Can emotional stress really trigger asthma?

Yes. It can alter breathing patterns and increase airway reactivity.

Q2. Is exercise bad for asthmatics?

No. With proper warm-up and medication, most people with asthma can exercise safely.

Q3. What’s the most dangerous asthma trigger?

Infections and medication errors (like beta-blockers) can quickly lead to life-threatening attacks.

Q4. Can asthma be cured?

No. But it can be well-controlled with proper management.

Q5. Should every asthmatic use a peak flow meter?

It’s highly recommended for moderate to severe cases to monitor daily variability.

Final Takeaway

Acute asthma exacerbations are preventable with awareness, avoidance of triggers, and adherence to treatment. The ICE CREEAAMB mnemonic gives you an easy way to recall the major causes of flare-ups—from cold air and infections to exercise and stress.

Early recognition, proactive control, and having an asthma action plan are key to reducing hospital visits and improving quality of life.