What Is Intermittent Asthma
People with intermittent asthma have symptoms that come and go. They experience symptoms less than twice a week and flare-ups are short. They have symptoms at night no more than twice a month.
People with intermittent asthma have a forced expiratory volume of 80% or more. FEV1 measures how much air a person can exhale during a forced breath. Their peak flow rate varies by less than 20%.
With intermittent asthma, symptoms dont affect your daily activities.
How I Learned To Manage My Severe Asthma & Not Let It Control My Life
I first learned I had severe asthma when I was a child. I went in for what I thought was a routine checkup: After my doctor checked my vitals taking my blood pressure, looking up my nose, peering into my ears, shining a light into my eyes I was ready to get on with my day and head home with a lollipop in hand. But as soon as I told him I sometimes had trouble breathing, he listened to my chest and his eyes widened. He had me blow into a spirometer, a test to see how well my lungs work, but I couldnt exhale enough air to move the arrow. He could tell an asthma attack was imminent, and the next thing I knew, I was in an ambulance on the way to the hospital.
He was right: I had an attack while I was being hooked up to an IV, and two more attacks quickly followed until I passed out. I was in the hospital for three weeks, hooked to a nebulizer for every two hours and then a breathing tube.
Most people dont know they have asthma or know how severe their asthma is until theyre hit with an attack. There are about 2.5 million people around the world who have severe asthma, and while less than 5% of patients have severe uncontrolled asthma, it accounts for 50% of asthma-related healthcare costs, resulting in significant morbidity rates.
Know The Symptoms Of An Asthma Attack
An asthma attack is the episode in which bands of muscle surrounding the airways are triggered to tighten. This tightening is called bronchospasm. During the attack, the lining of the airways becomes swollen or inflamed and the cells lining the airways produce more and thicker mucus than normal.
All of these factors — bronchospasm, inflammation, and mucus production — cause symptoms such as difficulty breathing, wheezing, coughing, shortness of breath, and difficulty performing normal daily activities. Other symptoms of an asthma attack include:
- Severe wheezing when breathing both in and out
- Coughing that won’t stop
- Feelings of anxiety or panic
- Pale, sweaty face
- Blue lips or fingernails
The severity of an asthma attack can escalate rapidly, so it’s important to treat these asthma symptoms immediately once you recognize them.
Without immediate treatment, such as with your asthma inhaler or bronchodilator, your breathing will become more labored. If you use a peak flow meter at this time, the reading will probably be less than 50%. Many asthma action plans suggest interventions starting at 80% of normal.
As your lungs continue to tighten, you will be unable to use the peak flow meter at all. Gradually, your lungs will tighten so there is not enough air movement to produce wheezing. You need to be transported to a hospital immediately. Unfortunately, some people interpret the disappearance of wheezing as a sign of improvement and fail to get prompt emergency care.
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Control As A Guide To Medication Adjustment
After targeted, step-based initiation of pharmacologic therapy, the classification of asthma control is used to adjust medication, stepping up or down depending on the level of control. Patients whose asthma can be classified as well controlled can be maintained on their current medications and, if stable for at least three months, a step down in therapy can be considered . Patients whose asthma is classified as not well controlled on their initial therapy are advised to step up one step and be reevaluated in two to six weeks for patients with very poorly controlled asthma, consider short-term oral systemic corticosteroid use and stepping up one or two steps, then reassessing in another two to four weeks.
ACQ = Asthma Control Questionnaire ACT = Asthma Control Test ATAQ = Asthma Therapy Assessment Questionnaire FEV1 = forced expiratory volume in one second.
note:The stepwise approach is meant to assist, not replace, the clinical decision making required to meet individual patient needs. Before step-up therapy: review adherence to medication, inhaler technique, environmental control, and comorbid conditions and, if an alternative treatment option was used in a step, discontinue and use the preferred treatment for that step.
ACQ values of 0.76 to 1.4 are indeterminate regarding well-controlled asthma.
Quick Relief And Rescue Medicines
When you feel a sudden asthma attack coming on youre in the middle of nowhere and struggling to breathe, these meds can help you get your breathing under control.
Short-acting beta agonists: These inhaled meds are usually the first choice for quick relief of asthma symptoms and include Asthmanefrin and Primatene Mist ProAir and Ventolin and Xopenex .
Anticholinergics: Also known as long-acting muscarinic antagonists , these drugs reduce mucus and help open your airways, but will take longer to work than your rescue inhaler so should not be used in place of one. Brand names include Atrovent and Spiriva .
Combination quick-relief medicines: These feature both a short-acting beta-agonist and an anticholinergic and are sold as Combivent and DuoNeb .
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Lifestyle Changes To Help Severe Asthma
As well as medication, there are lifestyle changes you can make that can help.
- Maintain a healthy weight and exercise routine. If youre taking long-term high doses of oral corticosteroids, they can increase appetite and cause weight gain. It can be difficult to manage your weight with severe asthma, as your symptoms may make exercise more difficult, and you may lack energy and motivation if youre feeling unwell. But even by making small changes to your diet and activity levels, you can make a difference.
- Quit smoking.Smoking is a major risk factor for asthma attacks, as well as being associated with numerous other health problems. If you smoke and have asthma, you should try to quit. Seek help from your doctor, nurse or a smoking cessation group to help make the change.
- Do breathing exercises. Regularly practising breathing exercises can be beneficial as they help to improve lung capacity, strength and health. There are various methods suitable for asthmatics, some of which are taught by experts or physiotherapists, and theyre easy to learn and practice at home.
- Reduce your stress levels. To reduce stress which can be a key trigger for asthma incorporating yoga, meditation or mindfulness practice into your lifestyle may be helpful.
Useful treatment tools
How Long Asthma Lasts For
Asthma is a long-term condition for many people, particularly if it first develops when you’re an adult.
In children, it sometimes goes away or improves during the teenage years, but can come back later in life.
The symptoms can usually be controlled with treatment. Most people will have normal, active lives, although some people with more severe asthma may have ongoing problems.
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Should I Still Wear A Face Mask
While COVID-19 cases continue to rise, wear a face mask in public places to protect yourself and others, even if you are fully vaccinated. It is especially important that you wear a face mask if you are immunocompromised or are at risk of severe disease due to other health conditions.
According to the CDC, the coronavirus that causes COVID-19 is airborne and spreads from person to person the coronavirus that causes COVID-19 is airborne and spreads from person to person. It can spread through droplets from your nose or mouth when you breathe, talk, sing, yell, eat, sneeze, or cough. You are most likely to catch it if you are not fully vaccinated and less than 6 feet from someone who is infected.
Studies have shown many people have COVID-19 and dont show symptoms. Or they may have the virus a few days before they show symptoms. The purpose of wearing a face mask is to keep you from spreading COVID-19 to other people if you are not fully vaccinated. Fully vaccinated people with delta variant breakthrough infections can spread the virus to others. This is especially important in places where you will be close to people, like while shopping, in a waiting room, or on public transportation. In Missouri, two hair stylists had COVID-19 and served 139 clients. Both the stylists and the salon clients wore face masks. None of their clients got COVID-19.
Personal Asthma Action Plan
As part of your initial assessment, you should be encouraged to draw up a personal asthma action plan with your GP or asthma nurse.
If you’ve been admitted to hospital because of an asthma attack, you should be offered an action plan before you go home.
The action plan should include information about your asthma medicines, and will help you recognise when your symptoms are getting worse and what steps to take. You should also be given information about what to do if you have an asthma attack.
Your personal asthma action plan should be reviewed with your GP or asthma nurse at least once a year, or more frequently if your symptoms are severe.
As part of your asthma plan, you may be given a peak flow meter. This will give you another way of monitoring your asthma, rather than relying only on symptoms, so you can recognise deterioration earlier and take appropriate steps.
Want to know more?
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Measure Your Asthma Level To Gain Control
Understanding your asthma severity has implications for your asthma control. Severity is linked to the asthma treatment and monitoring your healthcare provider will recommend.
Without measuring your asthma regularly, you will have difficulty knowing if interventions are improving your asthma or if your asthma is worsening. As a result, asthma may be limiting your day-to-day activities and you might not even realize it.
- Moderate persistent
- Severe persistent
Your asthma severity is based on the criteria described below. You classify yourself based on your worst symptom. For example, if you are waking up two nights per month with a cough or feeling short of breath, your asthma is in the intermittent asthma severity classification.
If you have symptoms two days per week, use your rescue inhaler two times per week, have a normal FEV1 between exacerbations, but wake up at night three times per week, your asthma severity is moderate persistent. Your asthma treatment will, in part, be based on your asthma severity.
Progressive, moderate to severe, persistent, or recurrent symptoms can be a sign of a serious medical condition. Anyone with symptoms such as these should seek medical attention immediately.
Prevention And Management Of Severe Asthma
Alongside taking your medication as prescribed, the best way to reduce the risk of severe asthma attacks and worsening symptoms is to avoid triggers as much as possible.
As part of your asthma management plan, its important to monitor your severe asthma symptoms. Its useful to keep a written record of your symptoms, when they occur and any triggers that may be involved. For example, your symptoms might be triggered by environmental factors, such as seasonal pollen. For women, a change in hormone levels may make things worse.
Further information: webinars and learning modules
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What Is Severe Asthma
People with severe asthma require treatment with Step 5 to control symptoms. They have uncontrolled asthma despite following their treatment plan and using proper inhaler technique.
- Step 5: This step is for patients who are considered to have severe or difficult-to-treat asthma. They should be referred to a pulmonologist. Treatment involves a high-dose ICS-LABA or short-course oral corticosteroids. Doctors may recommend a phenotype assessment to determine add-on therapy such as long-acting muscarinic antagonists and biologics.
Uncontrolled Asthma Vs Severe Asthma: How To Get The Right Diagnosis
- Lung Health and Diseases
More than 25 million Americans struggle with asthma, a chronic condition that makes breathing difficult. Whether you have lived with asthma since childhood or developed it later in life, it is important to monitor your symptoms and avoid your triggers to manage the disease. Many times, regular flare-ups can be treated with a combination of quick-relief and controller medications. Unfortunately, this may not be enough to get your symptoms under control.
If you feel asthma is interfering with your life, it can be frustrating to know what to do next. This is when it may be time to talk to your doctor about the possibility of severe asthma.
Daily symptoms, such as chest tightness, shortness of breath, coughing and wheezing, are signs of uncontrolled asthma and may require the use of quick-relief medication a few times a week or even daily. In addition, you may commonly experience nighttime flare-ups and may even have to visit the emergency room. As you might expect, with these symptoms you may miss work, stop exercising, and have difficulty performing daily tasks. If you have signs of uncontrolled asthma as listed above, you will want to discuss this with you physician because you may be able to find a solution.
But what if you continue to struggle?
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How Is Asthma Diagnosed
There is no one test available that confirms you have asthma. Instead, your doctor will diagnose it by reviewing your medical history, family history, and your recurrent symptoms, while also watching for improvement when you start on asthma medications. There are also a number of tests that may be done as part of your evaluation, including chest x-rays, blood tests, and allergy tests. Pulmonary function tests may also be performed, but they come with a caveat: If youre not experiencing asthma symptoms at the time theyre administered, these tests may come back as normal. Still, they can add important pieces to the puzzle. Lets take a closer look at some of the tests your doctor may use.
How Common Is Severe Asthma
It is estimated that as many as 250,000 Canadians suffer from Severe Asthma. Fatalities are higher in this group compared to patients with mild-to-moderate disease. Each year, about 250 Canadians die from asthma. Globally, 250,000 patients with asthma die prematurely on an annual basis because of their condition.
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Whats An Asthma Attack
When you breathe normally, muscles around your airways are relaxed, letting air move easily. During an asthma attack, three things can happen:
- Bronchospasm: The muscles around the airways constrict . When they tighten, it makes the airways narrow. Air cannot flow freely through constricted airways.
- Inflammation: The airway linings become swollen. Swollen airways dont let as much air in or out of the lungs.
- Mucus production: During the attack, your body creates more mucus. This thick mucus clogs airways.
Which Biologic Should I Choose For My Asthmatic Patient
When choosing a biologic medication for their patients with severe uncontrolled asthma, clinicians should always take into account the asthma endotype, clinical biomarkers, and patient-focused aspects .
Omalizumab should always be the first biological option in allergic non-eosinophilic severe asthmatics, with high levels of blood IgE, and with at least a documented positivity to a perennial aeroallergen. Contrariwise, patients with a non-allergic eosinophilic phenotype should be treated with an anti-IL-5 biological drug. Finally, anti- IL-4/IL-13 should be reserved to patients with severe eosinophilic type 2 asthma OCS dependent .
Given to the a lack of comparison studies, to date there are no recommendations about the selection of appropriate anti IL-5 biologic drug among those available. Hence, the choice is empirical and possibly shared between physician and patient.
According to GINA guidelines, a 4-month trial should be carried to evaluate asthma control. In the event of poor asthma control, a switch to a different biological treatment can be attempted if the patient meets the eligibility criteria.
Nevertheless, the right time and the right modality of switching from one biologic to another and the treatment time are still unknown. Large studies focused on biological drug switch in patients with severe asthma are ongoing and will help physicians to ease therapeutic strategies.
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Classification Of Asthma Control
The guideline recommends that every patient with asthma be able to recognize symptoms that suggest inadequate asthma control.4,5 As with asthma severity, assessment of control is determined by current impairment and future risk. The symptoms and history used to determine current impairment are the same as those used to determine impairment in evaluating disease severity, namely daytime symptoms, nighttime awakenings, frequent use of short-acting beta agonists for symptom relief, and inability to do normal activities because of symptoms.
Several questionnaires have been validated for the evaluation of symptom control.69 The Asthma Therapy Assessment Questionnaire ,10 the Asthma Control Questionnaire ,11 and the Asthma Control Test 12 provide validated control scores that can be used to categorize asthma into three control categories: well controlled, not well controlled, and very poorly controlled.
How Do You Monitor Asthma Symptoms
Monitoring your asthma symptoms is an essential piece of managing the disease. Your healthcare provider may have you use a peak flow meter. This device measures how fast you can blow air out of your lungs. It can help your provider make adjustments to your medication. It also tells you if your symptoms are getting worse.
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