7 Tips for Living with Asthma in a Big City

Nobody quite knows what causes asthma—but experts say that urban dwellers often have a tougher time managing their symptoms, thanks to a variety of environmental exposures. Here are seven tips for breathing a little easier in the big city.

1. CALL THE EXTERMINATOR.

Cockroaches are a gross—but common—part of urban life, and they live in most buildings and neighborhoods without discrimination. Sadly, their feces and shedding body parts can trigger allergies and asthma attacks in people who are sensitive to cockroach antigen, or proteins in the debris. And even if you don’t spot the bugs scurrying through your own apartment, there are still traces of them nearly everywhere you go in the city, says Dr. Minsoo Kim, an allergist at Columbia University Medical Center.

You can’t totally escape roaches, but taking proactive measures to reduce exposure to cockroach allergen can definitely improve your symptoms. Make sure your home is clean and clutter free, keep food and garbage in tightly sealed bags and containers, and ask your super or homeowner to address any obvious infestations. If they refuse to cooperate, show them a letter from your doctor. Also, consider getting allergy shots. (The same goes if you’re allergic to mice.)

2. GET ALLERGY SHOTS YOU DON'T THINK YOU NEED.

Believe it or not, three of the biggest allergy and asthma triggers in urban areas are dust mites, cockroaches, and—get this—cats. You can reduce the amount of dust in your home, but even if you don’t own a kitty, chances are many strangers on the subway and in the streets do.

“Cat is one of the most mobile allergens, so if someone has a cat and interacts with you, there’s enough allergen floating in the air just from their clothing to actually cause sensitization, and potentially cause problems for people who have cat-associated asthma,” says Dr. Morris Ling, an allergist-immunologist at Massachusetts General Hospital. “You’re going to interact with more people in a city, and because of that you will inevitably encounter a threshold level of cat allergen that could make your symptoms worse.”

In short, going out of your way to avoid your neighborhood bodega cat sometimes isn’t enough. If you live in a city and you know that cats trigger your symptoms, get allergy shots.

3. MOVE AWAY FROM THE HIGHWAY.

“Studies show that the closer you are to an urban center, or high traffic area, the higher the prevalence of asthma severity is,” Ling says. “The reason is that pollutants like diesel exhaust particles, nitrogen oxides, carbon monoxides, and volatile organic compounds irritate the airway, and they actually stimulate the immune system.”

Just moving a half-mile or a mile away from a high traffic area can radically improve your quality of life—so consider looking for apartments near, say, a quiet park that's far away from downtown.

4. WASH YOUR HANDS OFTEN.

“Respiratory viruses are actually the most common exacerbating factor in making asthma worse,” Ling says. “They are responsible to 50 to 80 percent of asthma exacerbations, and the most common cause is actually rhinovirus.”

Since cities are so crowded, you have a greater chance of being exposed to someone with the rhinovirus than you would in a less densely populated area—especially if you use public transportation. Some people, particularly in Asia, wear woven-cloth surgical masks to avoid catching sickness from strangers. But these thin mouth coverings might not be an effective means of protection (plus you’ll likely get some stares on the subway). However, you can minimize your chances of falling ill by frequently washing your hands, staying home when you’re sick, and minimizing contact with people who are.

5. WORK FROM HOME ON BAD AIR QUALITY DAYS.

Media outlets often broadcast "ozone-advisory," "ozone-alert," or "ozone-action" days, which refer to local smog conditions that might be harmful to people with asthma and other respiratory conditions. Ozone is far more common in urban areas, so make sure to monitor your city’s air quality levels on a regular basis and stay inside if it's bad. Can’t skip work? Ask your boss about working from home on days that might cause your symptoms to flare up.

6. SWITCH CITIES.

Love city life and can’t imagine moving to the suburbs? Take a close look at your asthma triggers, and try to find an urban area that doesn’t exacerbate your symptoms. “Asthma is a very heterogeneous condition, and it has different manifestations for different people,” Kim says. If your problem is poor air quality, look for a city that has cleaner air. Constantly catching colds on the subway? Consider going somewhere where you can own a car.

7. PAY ATTENTION TO YOUR TRIGGERS (AND TAKE YOUR MEDICATION).

It's tempting to stop taking your asthma medication if you're feeling better or if you're concerned about side effects. However, it's important to adhere to your doctor's treatment plan—and to educate yourself about your condition, Ling says. "I think patients have a very important role to play. They need to know about their asthma, and the more aware they are of their own triggers, symptoms and treatments, the better outcome they'll have. In the busy city, it’s easy to ignore these things."