An asthma attack may be sudden and can be mild or severe. Episodes, which usually begin at night, can last for a few minutes or days.

Other signs and symptoms are chest tightness and enlargement. Severe attacks can cause bluish skin, exhaustion, inability to speak and mental changes like rest­lessness or confusion.

There are two types of asthma: extrinsic and intrinsic. The extrinsic type is caused by external factors to which a person is sensitive or allergic to. The list of allergens that can trigger an attack varies in individuals and includes pollen, dust, molds and certain foods.

"The asthma patient is often sensitive to various stimuli or trigger factors around the house, school or workplace: tobacco smoke, air pollution, paint and paint thinners, hair sprays, perfume, cleaning fluid, liquid chlorine bleach, spray starch, dust, room deodorizers and spray furniture polish. He or she may be sensitive to changes in weather: sudden blasts of cold air, humid changes, a change in seasons, or walking the dog on a cold night," said Dr. Robert B. Mellins, professor of pediatrics, in "The Columbia University College of Physicians and Surgeons Complete Home Medical Guide."

"Patients may be allergic to foods such as nuts, peanut butter, chocolates, eggs, orange juice, fish and milk. They may also be sensitive to plants or plant products like pollens, grasses, hay, ragweed and mold spores. Animals may trigger an episode: rabbits, cats, dogs, birds and feather products like down comforters, chickens, hamsters, gerbils. Physical exertion may induce an episode: running too fast, running up stairs. Emotions may intensify asthma: excitement, sadness, worry, laughing too hard, crying, couching, getting very angry and breathing too hard," he added.

Pollution can also trigger an asthma attack. This is true in big cities were smoke-belching vehicles reign the streets.

"Main and contributory causes of asthma include outdoor and environmental pollution. In cities, atmospheric pollution may be more of a problem. Indoor pollution re­sults from poor ventilation, keeping in tobacco smoke or even smoke from cooking," said Dr. Michael Tan, executive director of the Health Action Information Network.

Certain drugs can likewise cause asthma, the reason why sufferers should check their medicines first. Without knowing it, the pills they're popping for their ailments may be responsible for their asthma attacks.

The common culprit in drug-induced asthma is aspirin. This was pointed out by Dr. Isadore Rosenfeld of the New York Hospital - Cornell Medical Center in "Modern Prevention: The New Medicine."

"Aspirin can also bring on an asthmatic attack in vulnerable individuals. I reported in the American Heart Journal an account of two patients with chronic asthma who went into shock and came close to dying after taking two aspirin tablets each. I advise all patients with asthma to avoid aspirin and to use acetaminophen instead. I also caution them about tartrazine, a commonly used food additive for coloring food, which, like sulfites, can precipitate an acute attack," Rosenfeld said. (Next: Occupational asthma.)

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