Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

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Healthy Environment

A healthy lifestyle includes your environment. Find out about choices that can support health and wellness for you and your loved ones.


Triggers can cause your asthma symptoms to worsen. If you avoid your triggers and limit exposure to those you cannot avoid, you may need less asthma medicine to keep your asthma in good control. These are the most common types of asthma triggers:

  • Allergies (allergens)
  • Infections
  • Smoke, air pollution, and other irritants
  • Physical activity

Less common asthma triggers can include stress, changes in weather, food preservatives (sulfites), and even over-the-counter medicines, such as aspirin. You may also consider using artificial Christmas trees, as live trees can trigger an asthma attack.

Managing and avoiding triggers may involve finding ways to reduce exposure to indoor and outdoor allergens. You will also need to plan ahead and prepare for physical activity, avoid infections, manage stress, and minimize the effects of air pollution whenever possible.

Additional References:

Manage Indoor Allergens

Most households contain allergens. The most common indoor allergens are:

  • Dust mites
  • Pets that have fur or feathers
  • Cockroaches
  • Mold

You can take some simple steps to reduce these allergens in your home.

Dust mites

Dust mites are very tiny microbes found in common household dust. They can be found in every part of the house. However, it is especially helpful to keep your bedroom as dust-free as possible. Regular and thorough cleaning of your home can reduce your exposure to indoor allergens.

Here are some tips for reducing dust mites:

  • Enclose mattresses, box springs, and pillows in allergy-proof, zippered covers.
  • Wash sheets and pillow cases weekly in hot water.
  • Wash blankets in hot water every 2 weeks.
  • Avoid keeping books and other things that collect dust in your bedroom.
  • Use a damp cloth or mop to dust your bedroom every week.
  • Wear a mask when cleaning or leave the house and have someone else do the cleaning.
  • Remove carpeting when possible and replace with hardwood or linoleum floors.
  • If you cannot remove the carpet, vacuum it every week using a vacuum cleaner with a HEPA filter or special allergy bags to decrease dust.
  • Change heating and air conditioning filters every 2 to 3 months.
  • Use a dehumidifier in your bedroom to reduce moisture.

If you have pets, keep pets that have fur or feathers out of the house, especially out of your bedroom. Fur, feathers, and dried saliva on cat hair can trigger asthma. Wash your hands after touching pets. Also, consider using a HEPA filter for your vacuum cleaner or a portable air filter in rooms where pets are present.

Bathing your pets on a regular basis may be helpful but is not a substitute for relocating your pet.


If you have cockroaches, hire an exterminator if you can not get rid of them yourself. If you live in a multiple-unit building, it is best if all the units can be treated by an exterminator at the same time. However, here are some other tips for dealing with roaches that you might want to try first:

  • Clean your kitchen completely after every use.
  • Keep all parts of your kitchen dry.
  • Store food in tightly closed containers.
  • Take the garbage outside every night.
  • Caulk around cracks in cabinets and around plumbing.
  • Use roach traps or bait rather than sprays, which are less effective and may leave unhealthy residue.
Mold and mildew

Mold and mildew are types of fungus. Mildew (early-stage mold) and mold grow rapidly in moist environments. Molds produce allergens and irritants that can make your asthma worse.

Here are some steps you can take to eliminate the source of moisture and effectively deal with the mold problem.

  • Fix water drips and leaks.
  • Repair areas of your home where there has been water damage (walls or ceilings damaged by roof leaks, etc.).
  • Avoid using humidifiers or vaporizers.
  • Use a dehumidifier if moisture or mildew is a problem.
  • Scrub mold off hard surfaces with detergent and water, and dry completely. Wear rubber gloves.
  • Using chlorine bleach is generally not recommended.
  • Keep plants out of bedrooms and elsewhere indoors.
Perfumes, sprays, and strong chemicals

Ways to reduce your exposure to perfumes, sprays, and strong chemicals:

  • Avoid contact with aerosol sprays and strong scents or odors whenever possible.
  • Wear a mask when cleaning or leave the house and have someone else do the cleaning.
  • Use exhaust fans or keep windows open for fresh air if you cannot avoid strong odors indoors.

Replace strong chemical household cleaners with your own homemade cleaners using baking soda, lemon juice, or white vinegar.


Reduce Exposure to Outdoor Allergens

Common outdoor allergens can trigger asthma, especially in the spring and the fall. Pollen season usually begins in February or March and lasts through October. Trees pollinate first, followed by grasses and weeds.

There are several strategies for reducing exposure to outdoor allergens, including:

  • Expect higher pollen counts in spring and fall.
  • Keep home and car windows closed during high pollen times.
  • On windy days, pollen counts are higher, so reduce time outdoors.
  • Don't hang your laundry outside to dry since allergens can collect on it.
  • Wear a filter mask to mow the lawn or rake leaves or have someone else do the work when you are not there.
  • Limit outdoor activities such as hiking or picnics during pollen season.
Smoke, smog, air pollutants, and other irritants

Smoke, air pollutants, and other irritants can trigger your asthma. Some examples include:

  • Smoke from cigarettes, cigars, fireplaces, wood burning stoves, and incense
  • Smog
  • Perfumes and other fragrances
  • Aerosol sprays including hair spray
  • Strong chemical fumes from kitchen and bathroom cleaners, paints, glues, and other chemicals

Ways to reduce your exposure to smoke, smog, and air pollutants:

  • Keep your home and car free of smoke.
  • Avoid smoky places.
  • If you smoke, quitting is the single most important change you can make for your health and well-being.
  • Avoid using fireplaces, wood burning stoves, or incense.
  • Avoid using kerosene heaters or using your gas oven for heat.
  • Stay inside and keep windows closed on smoggy days.
  • Avoid strenuous outdoor physical exercise on smoggy days.

Avoid Infections

Common infections, such as the cold or flu, can trigger asthma in some people. A sinus infection or bronchitis can also cause an asthma attack. Tips on how to reduce your exposure to infections include:

  • Wash your hands frequently or apply hand sanitizing gel.
  • Cover your mouth when you cough or sneeze and wash your hands afterwards. Use paper towels to dry your hands.
  • Get a flu shot each fall.

Prevent Flare-ups during Physical Activity

Regular physical activity makes your heart and lungs stronger and helps reduce stress. It may also improve asthma. However, physical activity may also trigger asthma. This can happen when you run, especially in a cold, dry environment. Any physical exertion can trigger some people's asthma.

You can be physically active or play sports even though you have asthma. In fact, many professional and Olympic athletes have asthma.

To successfully participate in physical activity, it is important for you to prevent and manage asthma flare-ups:

  • Make sure your asthma is in good control before starting physical activity.
  • You may need to take 2 puffs of your quick-relief medicine about 10 to15 minutes before starting physical activity.
  • Wear a scarf or mask over your nose and mouth if the weather is cold and dry.
  • Be physically active indoors instead of outdoors if there are high levels of outdoor triggers, such as pollen and smoke.
  • Try swimming in an outdoor pool. This activity does not usually trigger asthma symptoms. Indoor pools may have higher levels of chlorine, which can cause problems for some people with asthma.

Drugs to Avoid

We may recommend that you avoid some common over-the-counter medicines because they can have adverse affects in people with asthma. These include:

• Aspirin. Most people with asthma can take aspirin. But in a small number of people, aspirin can cause your airways to tighten, resulting in wheezing and shortness of breath. Aspirin sensitivity often develops in adulthood. The only way that you can tell if you are sensitive to aspirin (and related medications) is to experience a bad reaction with your asthma.

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Drugs like ibuprofen and naproxen are used to treat inflammation and are often taken for pain. Just like aspirin, they can cause severe attacks in people with aspirin-sensitive asthma.

Aspirin and NSAIDs are sold over-the-counter under different names. Carefully read labels on products that may contain aspirin, like cold remedies, allergy medicines, pain killers, and relievers of stomach discomfort.

Prescription medicines to avoid include the following:

• Beta blockers. Beta blockers are mostly used to treat high blood pressure, angina (heart pain), irregular and fast heart beat, and congestive heart failure. Older types of beta blockers such as propanolol could cause severe tightening of the airways. However, the newer beta blockers such as atenolol are less likely to do so. If you need a beta blocker, talk to us so that we can adjust your medications.

• ACE inhibitors. These are another class of drugs used to treat high blood pressure. One of the most common side effects of ACE inhibitors is persistent dry cough, which occurs in up to 20 percent of people. If you start coughing while you're taking an ACE inhibitor, remember that the cough might not be caused by your asthma. If the cough is caused by the ACE inhibitor, it will usually go away a week or so after you stop taking the medicine. If you develop other problems that make your asthma worse, call us to see whether you should stop taking your ACE inhibitor.

We will review all of your medicines and make any needed adjustments.

Manage Your Stress

Stress can make breathing more difficult. When you feel anxious or frightened, your asthma symptoms may get worse.

Many people with asthma find that it helps to practice deep breathing, relaxation exercises, and other stress-management techniques to reduce stress.

Learn to pay attention to your breathing. Belly breathing or deep breathing relaxation is an easy technique to incorporate into your daily routine to reduce your stress level. Deep breathing includes the following steps:

  • Put one hand on your belly and one on your chest.
  • Breathe in and push your belly out. The hand on your belly should move out as you take a deep breathe in.
  • Close your eyes and push all the air out of your lungs through your mouth with pursed lips as though blowing up a balloon.
  • Next, take a slow deep breath in, filling up your lungs and feeling your belly rise.
  • Breathe in and out 3 times in this deeper way.

Some people find it helpful to talk with a mental health provider to help manage stress more effectively.

Monitor Weather Changes

Changes in weather, including hot or cold temperatures, and changes in barometric pressure, humidity, or wind can affect asthma.

  • Limit your time outdoors during very hot or very cold temperatures, and on windy days.
  • Wear a scarf over your mouth in cold weather to warm the air before it enters your airways.

Avoid Sulfites

Sulfites are preservatives found in dried fruits, bottled lemon or lime juice, wine, molasses (often in barbecue sauces), condiments, and many other foods. Read labels carefully. Ask restaurants and grocery stores about the sulfites in their foods.

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder. This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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