Agency for Toxic Substances and Disease Registry
Case Studies in Environmental Medicine (CSEM)

Environmental Triggers of Asthma
Appendix 2: Answers to Progress Check Questions

1. The correct answer is B. Asthma causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning.
2. The correct answer is D. These triggers, plus miscellaneous causes such as exercise, food allergies, gastroesophageal reflux, aspirin/NSAID sensitivity, and sulfite sensitivity, may cause or exacerbate asthma.
3. The correct answer is answer C. Hematochezia is not identified as being confused with asthma in children. Foreign body aspiration, enlarged lymph nodes or tumors, and gastroesophageal reflux can be confused with asthma in children.
4. The correct answer is A. Epistaxis is not identified as being confused with asthma in adults. COPD, pulmonary embolism, cough, and wheezing secondary to ACE inhibitors can be confused with asthma in adults.
5. The correct answer is D. Risk of asthma may be increased by living near a heavily traveled roadway, by heavy exercise on a day with an unhealthy for sensitive groups AQI of 130, and by spending more than 1 hour each day riding a diesel-powered bus.
6. The correct answer is C. Diisocyanates are the leading cause of occupational asthma, the most commonly reported lung disease associated with the workplace.
7. The correct answer is D. Medical history questions about environmental asthma triggers should include tobacco smoke, pets, bedding and laundering practices.
8. The correct answer is A. True. Significant reversibility is indicated by an increase of 12% or more and 200 mL or more in FEV1 after inhaling a short-acting bronchodilator.
9. The correct answer is C. The occupational exposure history is the key diagnostic tool.
10. The correct answer is A. Wheezing is not always a reliable indicator of airflow limitation. In mild intermittent asthma, or between exacerbations, wheezing may be absent.
11. The correct answer is D. Lead paint has not been shown to be an asthma trigger.
12. The correct answer is D. The father should contact his occupational health clinic and/or occupational health care provider per his worksite protocol for clinical evaluation. Workplaces provide material safety data sheets (MSDS) on the materials used at the worksite. Theses are also available online at: http://www.msdssearch.com/msdssearch.htm Potential health hazards and known sensitizers or substances associated with an increased risk of asthma can be discussed with the occupational health care provider. Preventive measures can be discussed as well as clinical evaluation of his health concerns. The key is to stop exposure.
13. The correct answer D. The goals for the general management of a patient with asthma should include all of the answer choices listed in this question plus:
    • normal or near-normal lung function,
    • careful monitoring and adjustment of treatment,
    • prevention of chronic asthma symptoms and exacerbations (day and night), and
    • normal activity capacity (including exercise and other physical activities).
14. The correct answer is B. In general, least toxic methods of roach control should be employed first.
15. The correct answer is D. All of the above. Important moderating factors affecting how environmental exposures may worsen or cause asthma include the age and timing of exposure relative to disease development, the dose and frequency of exposure, genetic predispositions in response, and co-exposures.
16. The correct answer is D. All of the above. Advice you can give to patients to decrease exposure to allergens or irritants in the home include covering mattresses and pillows with zippered plastic cases, avoiding smoking and environmental tobacco smoke and removing wall-to-wall carpets, particularly in bedrooms.

Previous Section