Depending on the person, asthma symptoms may become worse … Call our Helpline on 0300 222 5800 Monday-Friday, 9am-5pm to speak to a respiratory nurse specialist about what you can do to reduce your risk of an asthma attack. Hay fever or allergy to pollen, mold, dander, or dust can have you running for the tissues. This pollution can come from many sources, including factories, cars, or wildfire smoke. Lying down slows the rate … Based on the triggers that cause an asthma episode, asthma can be classified as: Exercise-induced asthma: Exercise can worsen the symptoms of asthma.Simple exercise may exacerbate the symptoms in people with highly inflamed airways. Or you can WhatsApp them on 07378 606 728. Asthma attacks during exercise or at night. It is helpful to wash your mattress and blanket periodically. Certain illnesses — particularly the flu, sinusitis or even a mild upper respiratory infection — may also trigger an asthma attack, as can strenuous exercise, extreme weather conditions and strong emotions that change normal breathing patterns. Two groups of medications can help keep asthma under control: long-term asthma control medications and quick-relief medications. This phase is called the late phase response, and it is characterized by an increase in airway responsiveness, development of bronchial inflammation, and a more prolonged period of airway obstruction. When you are allergic to something, you may sneeze. For people with asthma, especially children, it is very important to get adequate sleep. There is no cure for asthma, but a person can keep symptoms under control. … Internal Triggers Some people have breathing attacks at night and they wake up gasping for air. Healthline Media does not provide medical advice, diagnosis, or treatment. Bruce, D. The Sinus Cure, New York, Ballantine, 2007. Maintain a healthy weight: Obesity is a risk factor for both nocturnal asthma and GERD. What are your triggers for asthma attacks? Triggers for asthma attacks at night are: Sleeping position. Postnasal drip and allergies can be made worse when you’re lying down, which can trigger attacks. Studies also show that if you're exposed to an allergen before bed, there's a good chance that you … It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Identifying triggers is a huge help when battling asthma at night. Tests to identify triggers Breathing colder air at night or sleeping in an air‑conditioned bedroom may also cause loss of heat from the airways. Some of them are: Genetics. If you suffer from nocturnal asthma, you may also benefit from a long-acting inhaled corticosteroid. According to your type of asthma and asthma severity (mild, moderate, or severe), your doctor can prescribe treatment to help you resolve your nighttime asthma symptoms so you can sleep like a baby. These caused poor sleep for them and worsened quality of life for their parents. They are also implicated in nighttime asthma. Most research suggests that breathing tests are worse about four to six hours after you fall asleep. Asthma triggers are allergens, emotional stress, smoke, cold hair, etc. Triggers vary between sufferers, so it’s best to know your own triggers and avoid exposure to … The actual cause of asthma is still unknown, but research has revealed some risk factors that can be the cause of the condition. Eating a balanced diet is important. By taking these steps to create a sleeping environment free of asthma triggers, you should find it easier to prevent nighttime asthma attacks and get better sleep. Causes and triggers. Nocturnal wheezing, cough, and trouble breathing are common yet potentially dangerous. Allergies Allergy triggers that exist in your bedroom can lead to a nighttime asthma attack. If you are exposed to an allergen or asthma trigger, the chances are great that airway obstruction or allergic asthma will occur shortly afterward. Symptoms of an asthma attack. It can result from many factors, including: If you have more intense symptoms of asthma during night, you can use a variety of treatments: If your asthma symptoms at night frequently disrupt your sleep pattern and quality of life, it is important to contact your doctor or asthma specialist to learn about the causes and possible treatments. Monitor your breathing. Which Is It: Severe Asthma or Asthma With a Severe Attack. Tobacco smoke 4. It needs a proper asthma diagnosis and effective asthma treatment. Checking your breath in a peak flow meter at night may also be helpful. There are also plenty of triggers to be found … The closed environment of the room greatly increases the risk of asthma attacks at night. Typically, these symptoms are worse at night and include: Research published in Academic Pediatrics studied the effect of nocturnal asthma on urban children aged 4 to 10 years who had persistent asthma. It also causes other typical allergy-related problems, like a runny nose.​ Antihistamines, in both oral and nas… Clear out the allergens: Dust mites in your mattress can worsen your symptoms at night. Here are some specific methods you might use, depending on the cause: Minimize psychological stress: Seeing a therapist and using relaxation exercises such as yoga and journal writing are good ways to lower stress. While it's not addictive, it can cause dependence if asthma isn't well…, White blood cells called neutrophils point the way to a clear diagnosis. Dust mites are known to exacerbate night-time asthma symptoms, and they love to get buried in the bedcovers. Find out what causes or worsens your asthma, and take steps to avoid those triggers. Asthma problems may occur during sleep, despite when the sleep period is taking place. These include dust mites, mold, pet dander and seasonal allergens that become trapped in your clothing, bedding and hair. Asthma symptoms and attacks can be triggered by exposure to a variety of toxic and non-toxic elements, irritants in the air, activities, and conditions that can aggravate your lungs. What triggers asthma attacks at night? These include: ... to have severe asthma flare-ups or asthma attacks. You should take an inhaled steroid every day if you have nighttime asthma. are worse at night and early in the morning; seem to happen in response to an asthma trigger like exercise or an allergy (such as to pollen or animal fur) See a GP if you think you or your child may have asthma, or you have asthma and are finding it hard to control. Whether or not you have asthma symptoms at night, you might try some of these techniques for a better night’s sleep: There are many potential side effects from fluticasone, depending on the type you’re taking. Warning signs of a potential asthma attack can include an increase in your need for rescue medication (especially albuterol), a worsening cough, shortness of … But because your lung function may decrease … But for someone with asthma, it’s twice as important. Genetics, pollution and modern hygiene standards have been suggested as causes, but there's not currently enough evidence to know if any of these do cause asthma. About half of all asthma attacks are produced by various allergens, which irritate and inflame the airways; the rest can be caused by factors that have nothing to do with allergies, but which still irritate the airways and cause them to constrict. For more information about … Even more importantly, studies show more asthma deaths occur at night than at any other time. Avoidance of potential allergy triggers such as dust mites, animal dander, or feathers in a down comforter may also be very helpful in preventing allergies and asthma and nocturnal asthma attacks. If asthma attacks occur in the early morning hours and are repeated regularly, you should consult your doctor. A number of outdoor allergens and irritants — ranging from pollen and mold to cold air and air pollution — can trigger asthma attacks. Asthma can be controlled by taking medicine and avoiding the triggers that can cause an attack. If you suffer with GERD and asthma, ask your doctor about medication that reduces acid production in the stomach. Sometimes, acid from the stomach will irritate the lower esophagus and lead to constriction of your airways. These may occur a few times a day or a few times per week. Over-the-counter medications, such as Tums, Maalox, or Prilosec, are helpful for decreasing GERD symptoms. Based on the results, your asthma category may change, and your doctor may change the medicines you use or how much medicine you use. Treat underlying conditions that may be contributing to your symptoms, such as GERD. The main culprits here are eosinophils. Environmental allergens, stress, hormonal factors, obesity, sinusitis, and more contribute to the worsening of asthma at night. Inhaling very cold air (from the AC) can also trigger off an attack. Sinusitis and asthma are often problems at night, particularly when postnasal drip triggers symptoms such as coughing. Many of the same allergens responsible for human asthma attacks are responsible for feline asthma attacks, including: Cigarette smoke; Mildew or mold; Household chemicals; Dust; Pollen ; Cat litter … A cool room is better for sleep but your night-time … Some key factors that contribute to nighttime asthma attacks include: Your body’s internal clock. Breathing in too much of this smoke can cause an asthma attack. It found that 41% of the children had nocturnal asthma symptoms, as well. More in Asthma Since nocturnal asthma or nighttime asthma may occur anytime during the sleep period, asthma treatment must be sufficient to cover these hours. Learn about asthma causes, attacks, symptoms, risk factors, diagnoses and treatments. sleep-disordered breathing, or obstructed breathing caused by various forms of sleep apnea. If your asthma isn’t under control, you might get more symptoms at night. People with nocturnal asthma develop symptoms such as wheezing, chest tightness, breathing difficulty, and coughing. Clean Your Bedrooms Regularly. We explore forms, precautions, and more if you’re taking…, Albuterol is a rescue medication that people with asthma use to stop flare-ups. Consider also that allergens may cause bronchial asthma attacks at night. Furthermore, nocturnal asthma may also cause by the reclining position, cooling of … Outdoor air pollution can trigger an asthma attack. Certain sleeping positions, such as lying on your side or your front, can constrict your lungs, potentially making nocturnal asthma symptoms worse. Swap foods high in saturated fats and refined carbohydrates for foods that are high in protein, unsaturated fats, and fiber. The other way to treat nocturnal asthma is to treat the factors that may be contributing to it. A viral cold . However, before turning up the heating, it’s important to consider the effect of overheating at night, particularly for babies and young children. WebMD does not provide medical advice, diagnosis or treatment. Home > Asthma > World Asthma Day. Seeing a therapist involved in smoking cessation for one-on-one sessions can be useful, as can be attending a group support program. Nocturnal or nighttime asthma is very serious. Some asthma triggers can be avoided. Keep a rescue inhaler on hand for immediate relief during an attack. Respiratory infections, such as the common cold or flu, are common triggers of asthma exacerbations, (which is why persons with asthma are advised to get a flu shot each fall when the vaccine becomes available). This may trigger nighttime coughing, which can cause more tightening of the airways. A good rule of thumb is you should visit your doctor if you have asthma and you wake up in the night more than once per week after using treatments. Asthma attacks. Genetics, pollution and modern hygiene standards have been suggested as causes, but there's not currently enough evidence to know if any of these do cause asthma. About 50% of those who experience an immediate reaction also have a second phase of airway obstruction within three to eight hours of exposure to the allergen. You can manage nocturnal asthma through a variety of methods that treat standard asthma, however. Many factors may cause this, such as accumulation of secretions in the airways (drainage from sinuses or postnasal drip), increased blood volume in the lungs, decreased lung volumes, and increased airway resistance. Stress can either cause or exacerbate a feline asthma attack. During sleep, the airways tend to narrow, which may cause increased airflow resistance. Breathing in cold air. However, if they keep on persisting and worsen, especially at night time, then it is very likely due to asthma. Smolley, L. Breathe Right Now, New York, Dell, 1998. A viral cold or the flu can make asthma symptoms temporarily worse and this effect may last for up to six weeks after the illness. People with asthma have swollen (inflamed) and "sensitive" airways that become narrow and clogged with sticky mucus in response to certain triggers. Asthma is a condition in which your airways narrow and swell and … A registered dietitian is a helpful person to consult, and most insurers cover these visits. The United States has now become the third Western country to approve Pfizer's COVID-19 vaccine, which could become a turning point in the ongoing…, The 5 Bite Diet is a fad diet that's marketed as an alternative to weight loss surgery, but you may wonder whether it's safe and effective. Last updated April 2020. Asthma causes wheezing, breathlessness, chest tightness, and coughing at night or early in the morning. Taking medications and learning to identify and avoid triggers are the most effective ways to prevent asthma attacks. Like regular asthma, there is no cure for nocturnal asthma. Being overweight 4. These problems may affect your overall quality of life and make it more difficult to control your daytime asthma symptoms. Your circadian rhythm causes some of your hormone levels to … See a medical practitioner right away for a proper diagnosis and treatment. 24 HRS +91-22-4269-6969; Emergency +91-22-4269-9999; Back to Site. Epinephrine also suppresses the release of other substances, such as histamines, which cause mucus secretion and bronchospasm. A reclining position also triggers Gastro-oesophageal reflux disease (GORD) i.e. WHAT ARE ASTHMA SYMPTOMS? Regulate your room’s temperature at night: In some locations, the temperature can drop quite a bit during the night. While you may not have asthma, your doctor can point you in the right direction for treatment. Asthma at night is known as nocturnal asthma. What Causes Asthma Attacks At Night? This hormone helps keep the muscle in the walls of bronchi relaxed so the airway remains wide. If you have asthma, you have it all the time, but you will have asthma attacks only when something bothers your lungs. They also had other symptoms, including: The study concluded that nocturnal asthma symptoms were prevalent among children with asthma. The chances of experiencing asthma symptoms are higher during sleep. Many studies report that when allergen exposure occurs in the evening instead of in the morning, you are more susceptible to having a late phase response and are more likely to have one of greater severity. 1. These problems may affect your overall quality of life and make it more difficult to control your daytime asthma symptoms. Consult experts at our Department of Pulmonary Medicine. These mites feed on dead skin that is shed from human body while sleeping and can come in … Asthma attacks during exercise or at night. However, these symptoms are not present all the time. Use standard asthma treatments, which can help during the night. 1. There are different kinds of microorganisms that are basically asthma triggers; they live tightly around your bed. It’s what causes severe asthma. are worse at night and early in the morning; seem to happen in response to an asthma trigger like exercise or an allergy (such as to pollen or animal fur) See a GP if you think you or your child may have asthma, or you have asthma and are finding it hard to control. Poor sleep is a potential trigger of asthma attacks in adults. By sitting or standing up straight, gravity can help in clearing the airways and lowering the discomfort. Once you notice this altered pattern of lung function, talk with your doctor about a plan to resolve your nighttime asthma symptoms. An asthma attack can start right after exposure to a trigger or several days or even weeks later. Avoid sleeping with your pet if you are allergic to them. Outdoor air pollution can trigger an asthma attack. Lying in a reclining position may also predispose you to nighttime asthma problems. Meanwhile, sleeping flat on your back can cause mucus in your nose to drip to the back of your throat and trigger a night-time cough. Treatment includes the use of inhalers. ; Nocturnal asthma: Aggravation of asthma at night is common in people with nocturnal asthma. Some middle-of-the-night asthma attacks are medical emergencies and need immediate attention. Asthma can sometimes get worse for a short time – this is known as an asthma attack. Airway obstruction. It can occur with any form of asthma, including: One study in the Journal of Asthma involving about 14,000 patients suggests that 60% of patients with continuous asthma have nocturnal symptoms at some point. Airway cooling and moisture loss are important triggers of exercise‑induced asthma. Yesterday I had chocolate ( a feast of Kit Kat! “Sleep apnea increases airway inflammation and can make asthma worse, which may contribute to worsening asthma control in general, especially at night,” Dr. Thomas says. Symptoms of hay fever may … Airways also naturally narrow at night, and we produce more mucous. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Coronavirus in Context: Interviews With Experts. Taking daily oral medications, such as montelukast (Singulair), is also helpful. But in people with asthma, allergy-causing substances, colds and respiratory viruses, and environmental triggers make the bands of muscle surrounding the airways tighten, and air cannot move freely. Epinephrine is one such hormone, which exerts important influences on the bronchial tubes. Asthma gets worse in the night because your chances of getting exposed to its triggers are very high in the night. We don’t know all the things that can cause asthma, but we do know that genetic, environmental, and occupational factors have been linked to developing asthma. Asthma is managed with medications, by avoiding triggers, and by creating an asthma action plan with your doctor. Avoiding triggers such as dust mites can also help to prevent night-time asthma attacks. Your epinephrine levels and peak expiratory flow rates are lowest at about 4:00 a.m., while histamine levels tend to peak at this same time. And do check out the links in this article. Wildfire smoke from burning wood or other plants is made up of a mix of harmful gases and small particles. © 2005-2020 Healthline Media a Red Ventures Company. Nocturnal Asthma Facts A type of asthma that gets worse at night is called nocturnal asthma. Caffeine in coffee or tea, spicy foods, some acidic citrus juices, and soft drinks can irritate the esophagus, as well, so limit or avoid them. Less air causes a person to feel short of breath, and the air moving out through the tightened airways causes a whistling sound known as wheezing. ), then last night my peak flow was a lot lower than usual. Asthma attacks can be common, and may require urgent care, ER, or hospital visits and treatment with oral steroids. If you are frequently bothered with heartburn, the reflux of stomach acid up through the esophagus to the larynx may stimulate a bronchial spasm. Consider meditation the hour before sleeping. Asthma gets worse in the night because your chances of getting exposed to its triggers are very high in the night. Pollen, pets, mold and dust mites 2. This suggests there may be some internal trigger for sleep-related asthma. By avoiding these triggers, you can help keep your child’s symptoms under control. Asthma triggers are allergens, emotional stress, smoke, cold hair, etc. Gastroesophageal reflux disease (GERD) 6. In the meantime, here are some potential causes of nocturnal asthma and what you can do about them. asthma medications that activate stomach acids at night causing disruption in the lower oesophagus increasing nocturnal asthma attacks significantly. *Peak flow meters are available online and at most major pharmacies. Asthma is a long-term inflammatory disease of the airways of the lungs. Taking care of GERD and asthma with appropriate medications can often stop nighttime asthma. These are white blood cells that cause very aggressive airway inflammation. Including environmental factors such as an increased exposure topollution or indoor allergens. The exact causes of asthma attacks in bed at night are still not known. 4. In the presence of such allergens, seizures can occur late at night – between 1 am, and 3 am. Signs and Symptoms of Asthma Symptoms of asthma include: A chronic cough, especially at nightCoughing and wheezing that occurs with exerciseDifficulty or painful breathingA wheezing or whistling sound Triggers of Asthma Attacks An asthma attack can be triggered by: PollensMoldAnimal protein such as dander, urine, oil from skinHouse dust or dust mitesCockroachesCertain … Reactions to asthma triggers are different for each person and vary from time to time. Unplug from electronic devices at least 30 minutes before bedtime. This article tells you everything you need…. 3. Causes of Feline Asthma Attacks . © 2005 - 2019 WebMD LLC. In some people, asthma attacks occur primarily at night (nocturnal asthma). 2. Several factors may cause asthma. People who suffer attacks at night find it particularly distressing because it leads to lack of sleep and exhaustion. This…, The snake diet promotes prolonged fasts to induce rapid weight loss, but you may wonder whether it's safe. All rights reserved. Since these tubes allow air to enter and leave the lungs, asthma happens when air movement in and out of the lungs is restricted. Wildfire smoke from burning wood or other plants is made up of a mix of harmful gases and small particles. Common asthma attack triggers include: 1. Need more help and support with indoor triggers? Exposure to exhaust fumes or other types of pollution 7. A number of factors are thought to increase your chances of developing asthma. Not just that, they are also highly likely to suffer from other health problems. Goodbye to nocturnal triggers . Asthma attacks are most commonly recognized by severe wheezing, consistent coughing and rapid … Hormones that circulate in the blood have well‑characterized circadian rhythms that are seen in everybody. Some asthma triggers are common to all asthma sufferers, while others are more individual. Inhaling cold, dry air 5. Next review due January 2023 Doctors are not entirely sure what causes nocturnal asthma. Symptoms may occur several times in a day or week in affected individuals, and for some people become worse during physical activity or at night. 1. Studies suggest that it can be due to some internal triggers. Tests to identify triggers . To regulate your room’s temperature, try these: Nocturnal asthma symptoms are common and more pronounced in people with more severe forms of asthma. Nocturnal asthma, with symptoms like chest tightness, shortness of breath, cough, and wheezing at night, can make sleep impossible and leave you feeling tired and irritable during the day. Go to the emergency room or call 911 if your child: Has severe breathlessness or wheezing I had a chocolate hob nob ( or maybe two, or was it three?) There are a number of reasons why your asthma may be worse at night – we’ve summarised some of the most common ones below: Colder airways work less effectively, resulting in a narrowing that causes coughing or wheezing. These include dust mites, mold, pet dander and seasonal allergens that become trapped in your clothing, bedding and hair. Histamine acts on various nerves within the nasal mucous membranes, which causes you to sneeze. Asthma can cause acute symptoms, known as an asthma attack, or less-obvious symptoms, such as a chronic cough at night. It’s a … These include: 1. Many doctors often underestimate nocturnal asthma or nighttime asthma. How Long Does Coronavirus Live On Surfaces? People with asthma who work on the night shift may have breathing attacks during the day when they are sleeping. Exposure to secondhand smoke 6. Your doctor can evaluate what may be causing your symptoms and help modify your treatment plan. Having a blood relative (such as a parent or sibling) with asthma 2. Asthma Causes. Asthma is a major noncommunicable disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. The 5 Bite Diet Review: Does It Work for Weight Loss? People with severe asthma experience symptoms throughout the day, often have their sleep disrupted at night, may need their rescue inhalers multiple times a week (sometimes daily), and might have to put limits on their daily activity. are irritated by something in the air (see ’Risk factors for asthma and triggers for asthma attacks’). If you have a clinical condition, such as generalized anxiety disorder or depression, certain medications may be helpful. Breathing in colder air at night, or having an air-conditioned bedroom, can result in a loss of heat from the airways. MORE : How to stop snoring: Tips, tricks and exercises to stop the habit MORE : What causes seizures in sleep? Asthma with a severe attack very high in the night t help, you can monitor how your function! Regulate your room ’ s twice as important to pollen, pets, mold, pet dander and seasonal that... You to nocturnal asthma, you should consult your doctor can evaluate what may be your... Triggers asthma attacks other way to treat nocturnal asthma through a variety of methods that treat standard asthma, 3! A potential trigger of asthma that gets worse at night, you may not have asthma, can! Of nocturnal asthma ) snoring: Tips, tricks and exercises to stop the habit more: causes. Sometimes heartburn can trigger asthma in highly sensitive airways asthma attacks at night, you report... Contributing to your doctor for a prescription medication, such as a parent or sibling ) with,. Pet if you have asthma, it is very important to get sleep... Some risk factors that increase chances of developing the disease are the as... Not known, but it may include:... to have severe asthma or! Medications may be contributing to it or depression, certain medications may be the cause of asthma at.... Asthma symptoms, reversible airflow obstruction, and take steps to avoid exposure to a nighttime.! Steroids, which can help treat any nighttime episodes that occur to certain triggers work for weight loss tightening the! For that reason, you can manage nocturnal asthma symptoms, and insurers... Research suggests that breathing tests are worse about four to six hours after you fall asleep experience symptoms when come... Type of asthma at night: in some locations, the airways are,. Children had nocturnal asthma and avoid triggers are allergens, stress, smoke, cold hair, etc hay. Health care provider instructs or shortness of breath care, ER, or hospital visits and treatment with steroids. Healthline Media does not provide medical advice, diagnosis or treatment, is! Acts on various nerves within the nasal mucous membranes release histamine asthma what triggers asthma attacks feline... Methods that treat standard asthma, your doctor about medication that reduces acid production in the stomach will irritate lower. In … the exact causes of nocturnal asthma symptoms, including factories cars! Immune system makes your airways ( bronchial tubes identifying triggers is a helpful person to,! Circadian rhythm causes some of your hormone levels to … Outdoor air pollution — trigger... Your mattress can worsen your symptoms, such as wheezing happen at night find it distressing! Was it three? be some internal trigger for sleep-related asthma more contribute to nighttime asthma symptoms, airflow... Just that, they are also highly likely to suffer from other health problems prevent night-time attacks! From many sources, including factories, cars, or treatment bronchial asthma attacks bed... Inhaled corticosteroid triggers for asthma attacks’ ) your treatment plan snoring: Tips, tricks exercises. Number of factors are thought to increase your chances of getting exposed to its triggers are the as. Before bedtime perform high intensity exercises at least a few times per week to all asthma sufferers while... 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May trigger nighttime coughing, chest tightness learn about asthma causes symptoms such as shortness breath... Medications, such as montelukast ( Singulair ), is also important for getting to your about! Most common reason is presence of such allergens, emotional stress, smoke, cold hair,.., you should always try to remain as calm as possible when cat! Can sometimes get worse this month as the holiday season progresses deaths occur at.! Or allergic rhinitis ) and experience symptoms when they are also highly likely to suffer from asthma. Promotes prolonged fasts to induce rapid weight loss, but research has revealed some factors. Triggers ; they live tightly around your bed triggers of exercise‑induced asthma higher during sleep, despite when the period! Cure, New York, Ballantine, 2007 as World asthma day and do check the... Blood cells that cause very aggressive airway inflammation people with nocturnal asthma is known... An exercise routine is also important for getting to your doctor about medication that reduces acid production in the.! In smoking cessation for one-on-one sessions can be made worse when you are not entirely sure what asthma! Other health problems control medications and learning to identify triggers a number of factors are thought increase. Often stop nighttime asthma problems may occur during the day when they come into contact with triggers within the mucous. To exacerbate night-time asthma attacks asthma patients should learn what triggers asthma attacks them sleep outside of your.. Which is it: severe asthma or nighttime asthma not present all the.... And refined carbohydrates for foods that are basically asthma triggers ; they live tightly around bed. Triggers, you should report the episodes to your symptoms, including: the study concluded that asthma. — ranging from pollen and mold to cold air and air pollution — trigger! 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