Triggers of asthma symptoms in adolescents and trigger awareness by their parent/guardians (P/G) have not been formally evaluated.

We conducted a cross-sectional study in 162 adolescents with asthma, recruited through the Baltimore City Schools and surrounding counties. Subjects underwent several evaluations including a questionnaire querying for asthma triggers and skin testing. The P/G independently responded to the same questionnaire.

The most common triggers identified by the adolescents were: exercise 89%, colds/flu 83%, dust 71%, weather changes 71%, emotions 63%, grass 52%, cats 48%, cold air 47%, irritants 45% and dogs 35%. Foods were the most unusual triggers (e.g. milk 9%, seafood 8%, peanuts 3%). For the two most common triggers reported by the adolescents, concordance with the P/Gs' report was good (exercise 71%, colds/flu 70% concordance). However, concordance for dust, emotions, grass, cats, cold air, irritants, and dogs was rather poor (<53%). We also examined the concordance between the adolescents' responses and their skin testing results. Concordance between dust as a trigger and dust mite skin test was 64% (p=0.018), 71% for cat (p=0.0005), 55% for grass (p=0.41) and 44% for dog (p=0.29). The P/G responses were not better than the adolescents in predicting the skin test results.

A) Exercise and colds/flu are the most common reported triggers of asthma in adolescents and are recognized well by both patients and their P/Gs. B) With the exception of cat, allergic triggers identified by the adolescent or the PG frequently do not have a biologic basis.