Triggers

• Tobacco smoke exposure in current smokers or environmental exposure to second-hand smoke is still a major trigger of severe asthma. Nicotine dependence should be discussed at every review and assistance to reduce ongoing exposure should be offered to all current smokers. Local drug and alcohol services, or government-sponsored smoking cessation resources are available
• QUITLine has resources developed for Aboriginal people and a range of language groups
• For additional resources, see Resources – Risk Factor Components

• While the use of nicotine vaping products can be used via prescription as a step-down approach during tobacco smoking cessation, vaping is becoming a major public health issue, particularly among young people.
• The use of electronic cigarettes nearly tripled between 2019 and 2023 (AIHW, 2025).
• Evidence is still emerging on the impact of vaping triggering asthma symptoms. However, some studies do suggest that exposure to active or passive inhalation of aerosols from e-cigarettes is associated with an increase in respiratory symptoms and increased risk of developing asthma (Bayly, et al. 2018 & Perez et al. 2024).
• The amount of nicotine and chemicals in e-cigarettes is often unknown, with some studies showing that one vape cartridge contains as much nicotine as 50 cigarettes (NSW Health, 2023).
• Vaping should be addressed at all asthma reviews (particularly for young people, where there is a growing uptake of vaping). More information and help for patients can be found at the Quit Website and National Asthma Council.

• Removing dampness or mould in homes reduces asthma symptoms and medication use in adults.
• It is better if the affected patient does NOT do the cleaning.

• Consider immunotherapy or sublingual immunotherapy (SLIT) as add-on therapy in people who are allergic to house dust mite and allergic rhinitis. This may be useful in people who have asthma attacks despite ICS treatment, provided their FEV₁ is >70% predicted.
• For more information see Allergy Assessments

• Ask patients with adult-onset asthma about their work history. Patients with suspected occupational asthma should be provided education to avoid exposure to sensitizers as soon as possible.
• Referral for expert occupational asthma advice is recommended.
• For more information see Occupational Asthma

• Physical activity and exercise are encouraged because of the health benefits. As is reducing sedentary behaviour.
• Exercise has a wealth of benefits for people with asthma including, improved quality of life, improved airway hyperresponsiveness, lowered inflammation (airway and systemic), improved sleep, improved mental health and weight loss (Price et al. 2025)
• People who have exercise-induced bronchoconstriction should be provided with education on the need to use bronchodilators before (McLoughlin et al. 2022).
• In people with impaired exercise tolerance consider referring to a structured pulmonary rehabilitation program (McLoughlin et al. 2022, Osadnik et al. 2022)

See Physical Activity & Exercise

• Emotional stress, depression and anxiety are triggers, which if effectively managed may improve asthma control.
• Local psychology services can typically be accessed through GP referral.
• See Anxiety & Depression

• All patients should be advised to have annual early season influenza vaccination.
• Avoiding exposure to people with known respiratory tract viral infections when possible is also important.
• Frequent hand-washing may also help decrease the number of viral infections.

• Based on results from skin prick testing, discuss practical management strategies or avoidance of allergen exposure.
• Sublingual as well as subcutaneous immunotherapy agents are now available in Australia. However, these approaches are only useful for patients with a single treatable allergen sensitivity. Also see Allergy Assessments.
• For those with aeroallergen sensitisation rhinosinusitis management should also be discussed. See Allergic & Non-Allergic Rhinitis

• For patients who are allergic to animals, discussion of strategies to reduce or avoid contact with the animal may be useful.