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Many different factors are known to trigger flares of breathing difficulties in asthma sufferers. Exercise which includes inhalation of cold air, respiratory viral infections, airborne pollen and mold spore allergens and food allergens may all cause potentially severe asthma attacks. The role of air pollution from both industrial and automobile emissions has also become apparent in the past ten years.

During the summer months in many urban communities, "breathing alerts" are now commonplace. Pollutants such as ozone (O₃), sulfur dioxide (SO₂), nitrogen dioxide (NO₂) and "smog" when elevated in the atmosphere even slightly can induce the human airways to close and go into spasm. Asthma patients have sensitive airways which react to much smaller amounts of air pollution than normal individuals.

The precise incidence of air pollution as an aggravating factor in asthma and emphysema is difficult to tell. One study which evaluated the problem found that there was a three-fold increase in the visits to the Emergency Room by children with asthma during intense periods of air pollution. Many studies have documented that asthmatic children are more adversely affected by air pollution than adults with respiratory illnesses. Estimates are that a 50% reduction in air pollution would result in a 50% reduction in disability and death from asthma and emphysema.

What are the levels of pollutants that can trigger breathing problems? Each patient is unique, and will respond differently, however, ozone levels above 0.2 parts per million (ppm) in one hour's time is considered dangerous especially to asthmatic patients. Sulfur dioxide levels of 1 to 1.5 ppm are found during major periods of air pollution. Nitrogen dioxide levels should be below 1 ppm to keep from irritating the airways.

Asthma patients need to know what is in the air before they go outside in order to avoid having problems breathing. Pollen and mold spores, as well as irritating pollutants, can make breathing unnecessarily troublesome. Here are several things to keep in mind before asthma patients begin to embark on outdoor activities:

1. Avoid inhaling cold air (wear a warm air mask in winter);

2. Avoid outdoor activities when air quality is poor;

3. Remain in air conditioned areas, cars and homes when high humidity, high pollen counts and high air pollution readings exist;

4. Prevent asthma attacks from occurring by taking asthma medications as prescribed by your doctor/allergy and asthma specialist;

5. If your asthma is already a bit out of control, put off your outdoor journey for the day. He who hesitates is lost was not spoken of the asthma sufferer.

Paying attention to what is in the air is similar to knowing exactly what it is you are eating. If you don't know what it is, don't put it in your mouth. Similarly, if you are not certain what is in the outdoor air, don't put it into your lungs!