How Do People Control Their Asthma

What Is An Asthma Action Plan

An asthma action plan is created by you and your doctor to help manage your asthma. It includes information about what you must do to stay healthy, and what to do when your asthma is unstable and you need help.There is no standard asthma action plan, as everyones asthma is different. Your plan needs to be developed to deal with your own triggers, signs and symptoms, and medication. It might be based on symptoms, peak-flow readings or both. However, symptom-based plans are more common.

Action plans are available in many different formats, you can also upload it to the Asthma Buddy mobile website.

How Is Asthma Diagnosed

To diagnose asthma, a doctor will do a physical exam and ask about the person’s medical history, including whether anyone else in the family has asthma.

The doctor might do tests like spirometry or peak flow meter tests. These involve blowing into devices that can measure how well the lungs are working. Allergy tests or exercise tests can tell doctors if asthma is brought on by allergens or physical activity. Doctors may use X-rays to rule out other problems.

There Are Four Key Symptoms That You Should Monitor To Help You Keep Your Asthma Under Control:

• Daytime SymptomsHow often do you have asthma symptoms during the day, such as coughing, wheezing, chest tightness or shortness of breath?
• Nighttime SymptomsDo you wake up at night with asthma symptoms, such as coughing, wheezing, chest tightness or shortness of breath?
• Quick-Relief or Rescue Inhaler UseHow often do you use your quick-relief or rescue inhaler to relieve asthma symptoms?
• Activity LevelDo you have difficulty performing normal activities, such as walking, climbing stairs, daily chores or playing with the kids?

Are There Benefits Of Effective Long Term Control

Control of symptoms produces short term benefits to patients, and suppression of inflammation reduces symptoms, exacerbations, and the need for extra therapy. The hope is that prolonged control of airway inflammation will reduce the likelihood of airway remodelling with progression of reversible airflow obstruction to irreversibility. The evidence to support this concept is growing but circumstantial and needs long term controlled studies.w17 Observational studies suggest that delays to the introduction of anti-inflammatory treatments may result in lower lung function.w18 Trials to establish the benefit of adequate suppression of inflammation in the airway wall are likely to be easier with simpler monitors of underlying inflammation.

Avoiding Nighttime Asthma And Improving Sleep

Asthma can make it challenging to get quality sleep, so its helpful to cultivate habits that support sleep health. Focusing on improving sleep hygiene is a significant first step. By developing a regular sleep schedule and healthy daytime routines, people with asthma can reduce unnecessary daytime fatigue and focus on controlling their asthma symptoms.

Asthma triggers in the bedroom may increase the risk of nocturnal asthma and lost sleep. In addition to working with a doctor to find solutions for reducing or eliminating asthma triggers, below are a few tips specific to designing the ideal bedroom environment and avoiding nighttime asthma:

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Ways To Help Control Asthma

Do you know the signs and symptoms of asthma? 20 million Americans have asthma, a condition that affects breathing and lung function. More and more people are being diagnosed with asthma, and the treatments vary depending on the person affected and the severity of the symptoms.Some of the most common symptoms of asthma to be aware of are: A tight chest feeling Trouble sleeping Weakness and trouble breathing especially during exerciseAllergens and colder weather can make these symptoms worse or more frequent. It is important to know how to control and treat your asthma symptoms so that they do not get worse and cause an emergency. Weve compiled a list of tips below to help keep asthma symptoms minimal and mild.

Pay Attention To The Air

Cold, dry air can irritate the lungs. When you go outside on wintery days, cover your nose and mouth with a scarf. If you cough or wheeze when you exercise in the cold, go to the gym or try an indoor workout class, instead. 

During allergy season, keep track of pollen levels, and stay indoors when they are highest. You can keep tabs on your local air quality year-round at web sites like AirNow.gov. On days when ozone or pollution levels are unhealthy for people with lung diseases, it’s smart to spend as little time outdoors as possible.

What Is Severe Asthma

About 5 to 10% of people with asthma don’t respond to standard treatment. They may continue to have symptoms during the day and wake up at night due to their asthma. This is called severe persistent asthma. 

When making a diagnosis, your doctor will consider several factors when trying to determine if you have severe asthma. If you think you have severe asthma, work with your doctor to get the right diagnosis. 

Severe asthma may limit your ability to do daily activities. Severe uncontrolled asthma can be debilitating. But most of the time, asthma symptoms get better with the right treatment. If you have severe asthma, you and your doctor will work together to find the right asthma management plan to help you control your asthma.

Using A Peak Flow Meter

Some healthcare providers like to recommend a peak flow meter to anyone with a new diagnosis of asthma. It can be especially helpful in children. A peak flow meter may help them recognize the signs and symptoms of their asthma getting worse.

What Is a Peak Flow Meter?

A peak flow meter is a portable, inexpensive, hand-held device used to measure how air flows from your lungs in one “fast blast.” In other words, the meter measures your ability to push air out of your lungs.

Who Should Use a Peak Flow Meter?

Patients age 5 years and older are usually able to use a peak flow meter to help manage their asthma. Not all healthcare providers recommend peak flow meters to help children and adults manage their asthma. Many healthcare providers believe a peak flow meter may be of most help for people with moderate and severe asthma. If your asthma is mild or you do not use daily medication, a peak flow meter may not be useful for your asthma management. A peak flow meter is a helpful tool for school health staff to monitor a child’s asthma during the school day.

Why Should I Measure My Flow Rate?

Peak flow meter measurements can help your healthcare provider make decisions about your treatment and adjust your medicines, and the measurements also can alert you when your asthma symptoms are worsening.

What Asthma Treatment Options Are There

You have options to help manage your asthma. Your healthcare provider may prescribe medications to control symptoms. These include:

• Anti-inflammatory medicines: These medicines reduce swelling and mucus production in your airways. They make it easier for air to enter and exit your lungs. Your healthcare provider may prescribe them to take every day to control or prevent your symptoms.
• Bronchodilators: These medicines relax the muscles around your airways. The relaxed muscles let the airways move air. They also let mucus move more easily through the airways. These medicines relieve your symptoms when they happen.
• Biologic therapies for asthma when symptoms persist despite being on proper inhaler therapy.

You can take asthma medicines in several different ways. You may breathe in the medicines using a metered-dose inhaler, nebulizer or other inhaler. Your healthcare provider may prescribe oral medications that you swallow.

Tips For Parents And Carers Of Children With Asthma

All the above tips also apply to children, but useful tips to help your child manage their asthma include: 

• Generally, your child can take their preventer medication before and after school.
• As your child gets older, involve them in decisions about their asthma medications and management.
• Linking asthma medication to your childs own goals can help. For instance, a child who loves sports may take asthma medication more readily if they know it helps them participate.

Why Asthma Management Is Important

Medication is essential to manage asthma well. Good asthma care also involves treating other conditions that can affect asthma, such as hay fever.

A healthy lifestyle can help you stay in control of your asthma symptoms and feel well.With good asthma management, you can lead a normal, active life. Following your personal written asthma action plan, developed with your doctor, is the best way to keep your asthma under control.

An action plan provides simple instructions for routinely managing your asthma, plus advice on what to do if your asthma symptoms flare up.The main aims of asthma treatment are to: 

• keep symptoms under control
• keep lungs as healthy as possible
• stop asthma from interfering with school or work
• help you or your child enjoy a full and active life.

Association Of Control With Clinically Important Parameters

Asthma has an important impact in everyday life, not only because the patients may be significantly burdened by the symptoms of the disease but also because it leads to limitations in physical activities, sleep disturbance and negative effects in their work and social life, leading to anxiety and depression .

Asthma control significantly affects the use of healthcare resources and the patients’ quality of life, as assessed with the use of standardised health-related quality of life questionnaires. Managing asthma effectively and achieving asthma control results in improvements in HRQoL and there is evidence that better asthma control is reflected in better HRQoL . Moreover, asthma control deterioration is accompanied by deterioration of HRQoL . Poor asthma control is also related to symptoms of depression, especially in patients with severe asthma, and it is believed that the presence of depression in these patients might have a negative impact on treatment adherence and HRQoL, leading to an ongoing vicious circle .

How Do Healthcare Providers Diagnose Asthma

Your healthcare provider will review your medical history, including information about your parents and siblings. Your provider will also ask you about your symptoms. Your provider will need to know any history of allergies, eczema and other lung diseases.

Your healthcare provider may order a chest X-ray, blood test or skin test. Your provider may order spirometry. This test measures airflow through your lungs.

Paying For Your Medicines

Most adults with asthma will need to pay a prescription charge for their medicines.

If you need to take a lot of medicines, paying for each item individually could get quite expensive. You may find it cheaper to get a prescription prepayment certificate. This is where you pay a one-off charge for all your prescriptions over a 3- or 12-month period.

You will not need to pay for your medicines if you do not normally pay prescription charges. For example, all under-16s are entitled to free prescriptions.

Read more about prescription costs to find out if you’re entitled to help with your prescription charges.

Why Do Some People Have Difficult To Control Asthma

There are lots of different reasons why you might have asthma thats difficult to control.

These include:

• Having other long-term conditions that make it harder to manage your asthma, for example a heart condition or diabetes
• Being a smoker, which makes asthma symptoms worse and stops asthma medicines working as well
• Finding it hard to get into a good routine of taking your inhalers and other asthma medicines regularly
• Not using a good inhaler technique. This means youre not getting the right dose at the right time to help get your asthma symptoms under control.

If youre having symptoms dont ignore them. Theyre a sign that your asthma is not well controlled and that youre at risk of an asthma attack, so its important to do something about them. Make an appointment with your GP or asthma nurse to get your asthma reviewed.

Some People With Asthma Have Difficult To Control Asthma Where They Often Have Symptoms And Asthma Attacks

Having worse asthma symptoms for a short time perhaps as a result of a cold virus, or hay fever, or when youre going through a period of stress  can happen to anyone with asthma.

But if youre having difficult asthma symptoms a lot of the time or youre finding it hard to manage your asthma well, you may have whats called difficult to control asthma.

• Around 17% of people with asthma have difficult to control asthma. This means they have difficulty breathing almost all of the time and often have what could be life-threatening asthma attacks.
• More rarely, you may have a specific type of asthma called severe asthma. Only about 4% of people with asthma have severe asthma. You can find out more about severe asthma here.

Even if youre having many difficult symptoms a lot of the time, and finding it difficult to manage them well, it doesnt necessarily mean you have severe asthma.

But it does mean you could do with some extra support and treatment to help you get back in control of your asthma. 

Most of the time, difficult asthma symptoms can be treated. With the right medicines and support you can get your asthma back on track.

Risk Factors For Poor Asthma Control

Although clinical studies show that the majority of asthma patients can achieve control of their disease, several surveys have shown that in real life most asthmatic patients have poor asthma control . It seems that one of the main reasons for poor asthma control is the discrepancy between the perception of control by patients and the definition of control according to asthma guidelines : asthmatic patients have low expectations regarding control of their asthma. A study among poorly controlled asthmatic patients in Canada has shown that up to 84% considered their asthma to be well controlled . Furthermore, physicians often fail to recognise the level of asthma control in their patients and there is a lack of good communication between patients and doctors .

Last but not least, a good doctorpatient partnership is one of the most important factors resulting in good asthma control . Patients should be encouraged to express their needs and ask for information on their disease, and should be continuously educated on how to provide information about their levels of asthma control . It is also very important that the doctor/healthcare provider has people skills and knows the patient’s educational and cultural background, in order to provide information and guidance that can be understood and used by the patient.

Risk factors for poor asthma control

Other Medication And Asthma Triggers

Some medication for other health conditions can make asthma symptoms worse and trigger an asthma flare-up or attack.

It is very important that you inform your doctor and pharmacist that you have asthma when a new medicine is prescribed to you or when you are buying over-the-counter medication or complementary therapies.

If you feel a particular medicine is making your asthma worse, treat your symptoms and contact your doctor immediately.Some medicines known to trigger asthma symptoms in some people include: 

• aspirin contained in some medication, such as pain relievers
• non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen
• beta-blocker tablets often used to control high blood pressure
• beta-blocker eye drops to treat the eye condition glaucoma
• ace inhibitors often used to control high blood pressure.

Follow Your Action Plan

Everyone who suffers from asthma should have an action plan. An action plan allows people who have asthma to change their medication promptly whenever certain symptoms appear. Your action plan should be established by the healthcare professional who monitors your condition. It is divided into three sections , telling people with asthma what to do in response to the gravity of their condition.

• Green zone: when your asthma is under control
• Yellow zone: when asthma symptoms worsen
• Red zone: during an asthma attack

The action plan provides more effective control over your asthma; as a result, you wont need to see your physician or go to an emergency-room as often. If you dont have an action plan for your asthma, feel free to ask your pharmacist and physician for help. They can assist you in designing an action plan for your needs.

The use of a log is also recommended. In it, you can note when your symptoms worsen and how you react to medication.

Will I Have To Take Medicine All The Time

Maybe not. Asthma is a chronic condition that is controllable. Unfortunately, there is no cure for asthma. For that reason, you may have asthma symptoms when exposed to triggers. This is the case even if you dont have symptoms very often. Your triggers can change over time, and your treatment will depend on two things: how severe your asthma is, and how often you have symptoms. If your asthma is controlled, your treatment will focus on managing symptoms and treatment of episodes when they happen. 

If your symptoms happen at certain times and you know what caused them, you and your doctor can use this information to determine the best treatment. If, for example, you have seasonal asthma because of a specific pollen allergy, you may take medicines only when that pollen is in the air. But asthma that specific is not common. Many people with asthma take some form of medicine most or all of the time. 

Follow The Recommendations Below To Reduce Your Chance Of An Asthma Attack While Cleaning Follow Recommendations For Cleaning Your Home And In Your Facility

• If you have asthma:
• Ask an adult without asthma to clean and disinfect surfaces and objects for you.
• Stay in another room when cleaners or disinfectants are being used and right after their use.
• Use cleaning agents and disinfectant only when necessary. In routine situations, high-touch surfaces and objects might be cleaned effectively with soap and water.
• Make a list of the urgent care or health facilities near you that provides nebulizer/asthma treatments and keep it close to your phone.
• If you have an asthma attack, move away from the trigger, such as the cleaning agent or disinfectant or the area that was disinfected. Follow your Asthma Action Plan. Call 911 for medical emergencies.

Use An Asthma Action Plan

How do you keep track of your medicines, when to take them and what to do when your symptoms are flaring up? Your provider should work with you to develop an asthma action plan , also called an asthma management plan . An AAP is a written document that is developed with your provider and individualized for each patient. Some AAPs use a green, yellow and red zone format. Each zone tells a patient when their asthma is green – doing well, yellow – getting worse and needs to be treated with rescue medicines or red â emergency and you need to call 911 or get to an emergency room right away.

An AAP will include:

• What daily control medicines to take, when to take them and how often.
• What symptoms indicate your asthma is flaring up, how severe that symptom might be and what to do when having symptoms.
• What rescue inhalers or nebulized medicine you should use, how much and when.
• What typically triggers your asthma.
• When your asthma is out of control and you need to call 911 or get to an emergency room.
• Some AAPs will also include Peak Flow Meter readings which measures how well/poorly your lungs are working. A very low peak flow reading is an emergency.

Can Medicine Alone Help My Asthma

Not usually. Although medicines help a lot, they may not be able to do the job alone. You have to avoid the things that cause or trigger your asthma symptoms as much as you can. Asthma triggers can be found outside or inside your home, school, or workplace. 

Improving the indoor air quality in your home is an important part of asthma control. Your indoor air can be more polluted than outside air. Our interactive Healthy Home can show you ways to improve the indoor air quality of your home. A healthier home can reduce your exposure to allergens and irritants. 

Identify And Avoid Your Triggers

It’s important to identify possible asthma triggers by making a note of where you are and what you’re doing when your symptoms get worse.

Some triggers can be hard to avoid, but it may be possible to avoid some, such as dust mites, pet fur and some medicines.

You’ll have regular contact with your doctor or asthma nurse to monitor your condition.

These appointments may involve:

• talking about your symptoms for example, if they’re affecting your normal activities or are getting worse
• a discussion about your medicines including if you think you might be experiencing any side effects and if you need to be reminded how to use your inhaler
• breathing tests

It’s also a good chance to ask any questions you have or raise any other issues you want to discuss.

You may be asked to help monitor your condition between appointments. For example, you may be advised to check your peak flow if you think your symptoms may be getting worse.

Your personal action plan should say what to do if your symptoms get gradually or suddenly worse. Contact your doctor or asthma nurse if you’re not sure what to do.

What Treatment Should I Receive

If your healthcare professional confirms that you have severe asthma, then there are a number of treatment options that can be considered. The ERS has published guidelines on severe asthma, giving recommendations to healthcare professionals on how to treat the condition. You can read the patient version of these guidelines to find out more about the treatment steps involved under the asthma heading.

This material was compiled with the help of Dr Dermot Ryan, Betty Frankemölle and Juliëtte Kamphuis.

Holding Chambers / Spacers

Ask your provider about getting a holding chamber or spacer and use it each time you use your MDI inhaler. Spacers /holding chambers give inhaled medicine a chance to slow down so you can breathe it in while reducing how much of the medicines droplets land on the back of your throat or tongue, making sure it goes directly and deeply into your lungs. Chambers or spacers should NOT be used with dry powder inhalers or inhalers that look like an MDI but they  automatically dispense the medicine when you inhale â ex. RespiClick®.   Always rinse your mouth out and gargle with fresh clean water after youve used your ICS inhaler and dont swallow until you do rinse.

Results From Randomised Controlled Trials

Control-based management of asthma in everyday clinical practice includes stepping up therapy when symptoms of asthma deteriorate and stepping down when control is achieved and sustained for a prolonged period of time . It is important that control is sustained with of the lowest use of asthma medications. This is to ensure patient adherence to treatment, and to minimise side-effects and cost. Numerous randomised controlled trials have shown that asthma control is an achievable goal in a significant proportion of patients, when medications are used in rational and personalised way.

Do Asthma Medicines Have Side Effects

Yes. All medicines have side effects. Tell your doctor how you are responding to the treatment and if you have any side effects. Follow up often with your doctor so you can control your asthma with the least amount of medicines and with the fewest side effects. 

Medical Review: June 2021 by S. Allan Bock, MD; Maureen George, PhD, RN, AEC, FAAN; and Sumita Khatri, MD, MS

References1. Bonds, R., Asawa, A. and Ghazi, A. . Misuse of medical devices: a persistent problem in self-management of asthma and allergic disease. Annals of Allergy, Asthma & Immunology, 114, pp.74-76.e2.

Asthma Action Plan