Editing Asthma (section)

===Exacerbation===
Some individuals will have stable asthma for weeks or months and then suddenly develop an episode of acute asthma. Different individuals react to various factors in different ways.<ref name=Baxi2010>{{cite journal | vauthors = Baxi SN, Phipatanakul W | title = The role of allergen exposure and avoidance in asthma | journal = Adolescent Medicine | volume = 21 | issue = 1 | pages = 57–71, viii–ix | date = April 2010 | pmid = 20568555 | pmc = 2975603 }}</ref> Most individuals can develop severe exacerbation from a number of triggering agents.<ref name=Baxi2010/>

Home factors that can lead to exacerbation of asthma include [[dust]], animal [[dander]] (especially cat and dog hair), cockroach [[allergen]]s and [[Mold (fungus)|mold]].<ref name=Baxi2010/><ref>{{cite journal | vauthors = Sharpe RA, Bearman N, Thornton CR, Husk K, Osborne NJ | title = Indoor fungal diversity and asthma: a meta-analysis and systematic review of risk factors | journal = The Journal of Allergy and Clinical Immunology | volume = 135 | issue = 1 | pages = 110–22 | date = January 2015 | pmid = 25159468 | doi = 10.1016/j.jaci.2014.07.002 | doi-access = free }}</ref> [[Perfume]]s are a common cause of acute attacks in women and children. Both [[virus|viral]] and bacterial [[infection]]s of the upper respiratory tract can worsen the disease.<ref name=Baxi2010/> Psychological [[stress (biological)|stress]] may worsen symptoms&nbsp;– it is thought that stress alters the immune system and thus increases the airway inflammatory response to allergens and irritants.<ref name=Gold/><ref name="Chen2007">{{cite journal | vauthors = Chen E, Miller GE | title = Stress and inflammation in exacerbations of asthma | journal = Brain, Behavior, and Immunity | volume = 21 | issue = 8 | pages = 993–9 | date = November 2007 | pmid = 17493786 | pmc = 2077080 | doi = 10.1016/j.bbi.2007.03.009 }}</ref>

Asthma exacerbations in school-aged children peak in autumn for 8 weeks, shortly after children return to school. This might reflect a combination of factors, including poor treatment adherence, increased allergen and viral exposure, and altered immune tolerance. There is limited evidence to guide possible approaches to reducing autumn exacerbations, but while costly, seasonal [[omalizumab]] treatment from four to six weeks before school return may reduce autumn asthma exacerbations.<ref name="PikeAkhbari2018">{{cite journal | vauthors = Pike KC, Akhbari M, Kneale D, Harris KM | title = Interventions for autumn exacerbations of asthma in children | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 3 | pages = CD012393 | date = March 2018 | pmid = 29518252 | pmc = 6494188 | doi = 10.1002/14651858.CD012393.pub2 }}</ref>