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.
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How Do I Know If My Asthma Is Not Well
A good way to know if your asthma is not well-controlled is by answering these questions:
- Do you have asthma symptoms more than two times a week?
- Do you take your quick-relief medicine more than two times a week?
- Do you wake up from asthma more than two times a month?
- Do you use oral corticosteroids more than two times a year?
If you answer yes to any of these questions, talk with your doctor.
If your asthma is not well-controlled, your daily activities may be limited. You may miss work or school. You may increase your chances of having complications from a respiratory infection. And you may be at greater risk for going to the emergency room, staying in the hospital, or even dying from asthma.
Cardiac Asthma Is Not The Same As Asthma
Although they share a name, cardiac asthma is not a type of asthma. Asthma is caused by the narrowing and inflammation of the airways in the lungs, while cardiac asthma is coughing or wheezing that occurs due to left-sided heart failure. Treatments for cardiac asthma typically are the same as those for heart failure. Cardiac asthma prognosis depends on several factors, including what stage your heart failure is in, your diet, and lifestyle elements, such as exercise routine and tobacco and alcohol use. The mortality rate for heart failure at one year is 22% and at five years is 43%.
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Side Effects Of Steroid Tablets
Oral steroids carry a risk if they are taken for more than three months or if they are taken frequently . Side effects can include:
- easy bruising
- muscle weakness
With the exception of increased appetite, which is very commonly experienced by people taking oral steroids, most of these unwanted effects are uncommon.
However, it is a good idea to keep an eye out for them regularly, especially side effects that are not immediately obvious, such as high blood pressure, thinning of the bones, diabetes and glaucoma.
You will need regular appointments to check for these.
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Where Am I Now
Ah, so what about those long-term side effects of using my albuterol inhaler? How did all that puffing affect me?
Well, I’m still here. I’m breathing fine. In fact, I’m still puffing. But, thankfully, the inhalers today are a heck of a lot stronger. I only need to take mine twice a day and it prevents asthma symptoms. In fact, they are so good that sometimes I don’t even feel like I have asthma anymore.
But, I’m still alive. I do not have inhaler-induced cancer. I do not have any sort of long-term effect of all that puffing. I’m fine.
And, now that I think of it, inhalers have been around since 1956.2 One would think, if there were long-term consequences of puffing, they would be well known by now. And, let it be known, that there are no long-term consequences of puffing. I think, if anything, I am living proof of that.
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Can You Outgrow Asthma
Some children with asthma stop having symptoms when they mature. By adolescence, 16% to 60% of children diagnosed with asthma seem to be in remission.
However, healthcare providers don’t usually consider asthma “cured” since, even after years of living symptom-free, you could suffer an asthma attack at any time.
The wide range of remission statistics shows that studies have been inconsistent in their design, and more research is needed to fully understand how and why some children seem to “get over” asthma.
In some studies, children who were more likely to go into remission had asthma characterized as:
- Less atopic dermatitis
Male children are also more likely to go into remission.
If your childhood asthma appears to have gone away, it may still be a good idea to avoid triggers, especially allergy triggers, as they could cause symptoms to reappear.
Little to no research has followed adults who appear to have outgrown their childhood asthma, so there’s no clear picture of whether or not this reduces the risk of long-term health effects.
Causes And Triggers Of Asthma
Asthma is caused by swelling of the breathing tubes that carry air in and out of the lungs. This makes the tubes highly sensitive, so they temporarily narrow.
It may happen randomly or after exposure to a trigger.
Common asthma triggers include:
- allergies
- smoke, pollution and cold air
- exercise
- infections like colds or flu
Identifying and avoiding your asthma triggers can help you keep your symptoms under control.
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Taking Control Of Your Asthma
If you suspect you have asthma, tell your doctor. If you already have a diagnosis, look for signs that your treatment isnât working or your asthma is getting worse.
Certain things like the common cold can cause a flare-up every now and then, but it shouldnât happen often. If you take regular medication but use quick-relief treatment more than two times a week, your asthma may be severe or isnât under control.
Tell your doctor if you have any of these symptoms. Your doctor can change the drugs you use. They may also suggest lifestyle changes or recommend you see a specialist. These adjustments should provide relief.
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Can You Get Rid Of Asthma
Some children with asthma stop having symptoms in adulthood. By adolescence, 16 to 60 percent of children diagnosed with asthma appear to be in remission.
However, health care providers often dont consider asthma to be a cure because you can suffer an asthma attack at any time, even without symptoms for years.
Extensive remission statistics suggest that studies have been designed inconsistently, and more research is needed to fully understand how and why some children seem to overcome asthma.
In some studies, children who were more likely to be in remission had asthma characterized by:
- Episodic asthma
- Mild initial asthma severity
- Fewer allergies and allergy symptoms
- Less atopic dermatitis
Boys were also more likely to go into remission.
If your childhood asthma seems to have gone away, it may still be a good idea to avoid triggers because they may cause symptoms to come back.
Few studies have tracked adults who appear to have surpassed childhood asthma, so there is no clear picture of whether this reduces the risk of long-term health effects.
Understanding Childhood Asthma
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When To See A Gp
See a GP if you think you or your child may have asthma.
Several conditions can cause similar symptoms, so it’s important to get a proper diagnosis and correct treatment.
The GP will usually be able to diagnose asthma by asking about symptoms and carrying out some simple tests.
Find out more about how asthma is diagnosed.
Uncontrolled Asthma Vs Severe Asthma
If you continue to have symptoms even when you take medication, you may have a different type of the condition called severe asthma. If this is the case, you can have symptoms every day. This can affect your life in many ways. You may:
- Find it difficult to perform at work or school
- Need to take time off from work or school
- Constantly wake up and be unable to sleep well
- Feel stressed and have depression or anxiety
Serious attacks can make you go to the hospital — severe asthma symptoms can lead to two or more emergency room/hospital visits a year.
Youâll need to take corticosteroids to manage your symptoms. If your asthma is severe, you could have side effects from the medications you take to control it long-term.
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What Are The Long
In the long term, chronic inflammation and bronchospasms from asthma can make structural changes in the airway causing it to become permanently narrowed. The airway tubes become scarred and thickened, and the bronchial muscles get enlarged, leading to reduced lung function and breathing difficulties.
Asthma increases the risk for bronchial infections. Asthma can also affectsleep quality and lead to sleep deprivation. It can affect the ability to take part in exercise and sports, which can in turn, potentially lead to conditions such as diabetes, obesity and high blood pressure.
Severe asthma increases the risk for respiratory failure. Though rare, an acute asthma attack can diminish oxygen supply to the body, cause weakness and fatigue, and can sometimes even lead to death.
What Should I Do If I Have A Severe Asthma Attack
If you have a severe asthma attack, you need to get immediate medical care.
The first thing you should do is use your rescue inhaler. A rescue inhaler uses fast-acting medicines to open up your airways. Its different than a maintenance inhaler, which you use every day. You should use the rescue inhaler when symptoms are bothering you and you can use it more frequently if your flare is severe.
If your rescue inhaler doesnt help or you dont have it with you, go to the emergency department if you have:
- Anxiety or panic.
- Bluish fingernails, bluish lips or gray or whitish lips or gums .
- Chest pain or pressure.
- Very quick or rapid breathing.
Read Also: Where Does Asthma Affect Your Body
Future Risk Of Lung Function Decline In Severe Asthmatics
Only a few studies to date have examined the longitudinal changes in lung function in severe asthmatics. In a 6-year follow-up study of 97 patients with severe asthma in the Glenfield cohort, the recorded annual mean decline in the post-bronchodilator FEV1 was 25.7 mL/year.46 Of note, there were 3 clusters in that study differing in terms of eosinophilic airway inflammation and the rate of post-bronchodilator FEV1 decline, of which the cluster with low-grade but positive sputum eosinophilia and large variations over time showed the highest rate of lung function decline .46
The longitudinal course of lung function was also examined over a period of 10 years in a prior retrospective study of 54 Japanese patients with severe asthma .48 The mean daily ICS dose was 1,830 mcg of beclomethasone dipropionate equivalent, the mean OCS use duration was 67.3 ± 62.9 days/year and annual exacerbation rate was 0.48 ± 0.51. Two phenotypes emerged in that study according to the rapidity of lung function decline, rapid and slow , based on a forced vital capacity decline rate of 20 mL/year. However, the mean annual rate of change in the FEV1 was +0.6 mL/year. Annual exacerbation rate, OCS use and age were positively associated with the rapid FVC decline in that Japanese cohort.48 However, the possible relationship between lung function decline and asthma control status was also not examined in detail.
Future Risk Of Corticosteroid
It is estimated that about 1% of the general population receives SCS treatments at any time point and respiratory conditions, including asthma, are reported to account for a major proportion of these prescriptions.50,51,52 It is well known that the use of SCS in patients with different health conditions is positively associated with higher risk of psychiatric events, infection, gastric problems and fractures.53,54 Until recently, however, morbidities from SCS exposure had not been described in asthmatic populations. This knowledge gap was a significant issue, as susceptibility to developing drug-related morbidities may differ according to age, sex, underlying disease, and doses or durations of drug exposure.
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People Experiencing Any Severe Illness May Develop Health Problems
People experiencing any severe illness, hospitalization, or treatment may develop problems such as post-intensive care syndrome, or PICS.
PICS refers to the health effects that may begin when a person is in an intensive care unit , and which may persist after a person returns home. These effects can include muscle weakness, problems with thinking and judgment, and symptoms of post-traumatic stress disorder . PTSD involves long-term reactions to a very stressful event. For people who experience PICS following a COVID-19 diagnosis, it is difficult to determine whether these health problems are caused by a severe illness, the virus itself, or a combination of both.
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 provider may order spirometry. This test measures airflow through your lungs and is used to diagnose and monitor your progress with treatment. Your healthcare provider may order a chest X-ray, blood test or skin test.
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How Do You Know Asthma Is Well Controlled
This condition is considered well managed when a person experiences symptoms no more than two days a week and the symptoms do not interfere with sleep more than 1-2 nights per month. This means that all normal day-to-day activities can be performed without difficulty. Well-controlled asthma also means no more than 1 asthma attack per year that requires several days of treatments to manage the attack. The peak flow doesnt drop below 80% of the best personal number and there is no need to take relievers for more than 2 days weekly.
It is also important to know the difference between uncontrolled asthma and severe asthma. If a person with asthma continues to have symptoms despite taking the medication and following a treatment plan, then this may be a case of severe asthma. Severe asthma interferes with day-to-day activities, causes missed days at school or work and significantly affects sleep and energy levels. Severe attacks require emergency visits and hospitalization. More drugs and higher doses of medication are needed and yet the symptoms are not well under control. Doctors now classify asthma as intermittent, mild persistent, moderate persistent, and severe persistent. To prevent complications, the goal is to have the symptoms under control as much as possible, regardless of the severity of asthma.
Why Is My Asthma Worse At Night
Asthma that gets worse at night is sometimes called nighttime asthma or nocturnal asthma. There are no definite reasons that this happens, but there are some educated guesses. These include:
- The way you sleep: Sleeping on your back can result in mucus dripping into your throat or acid reflux coming back up from your stomach. Also, sleeping on your back puts pressure on your chest and lungs, which makes breathing more difficult. However, lying face down or on your side can put pressure on your lungs.
- Triggers in your bedroom and triggers that happen in the evening: You may find your blankets, sheets and pillows have dust mites, mold or pet hair on them. If youve been outside in the early evening, you may have brought pollen in with you.
- Medication side effects: Some drugs that treat asthma, such as steroids and montelukast, can affect your sleep.
- Air thats too hot or too cold: Hot air can cause airways to narrow when you breathe in. Cold air is an asthma trigger for some people.
- Lung function changes: Lung function lessens at night as a natural process.
- Asthma is poorly controlled during the day: Symptoms that arent controlled during the day wont be better at night. Its important to work with your provider to make sure your asthma symptoms are controlled both day and night. Treating nighttime symptoms is very important. Serious asthma attacks, and sometimes deaths, can happen at night.
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Reduce The Dangers Of Untreated Asthma
At the New York Asthma Allergy and Sleep Center, we work closely with patients, families and caregivers to keep asthma under control. We understand the barriers that families face in ensuring that their children have access to good care and the medications they need. Our team will work with you and follow up closely to ensure that your child is breathing better and is less at risk for serious exacerbation. Dr. Shukla and his staff aim to achieve the highest level of control at the lowest possible dose of medication.
Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease, or COPD for short, is an umbrella term denoting a number of different, yet closely related lung conditions. These diseases are marked by breathing problems caused by the obstruction of the airways in one way or another.2 The most common conditions classified found at the root of COPD are:
- Emphysema
- Bronchitis
- Chronic obstructive airways disease
While COPD can cause severe breathing problems and symptoms similar to asthma, the two should not be confused, since they belong to completely different categories of pulmonary diseases. More specifically, asthmatics who experience flare up of symptoms still have a relatively normal lung function whereas in COPD the lung function remains continuously impaired.
While the two conditions are not closely related, people diagnosed with severe or difficult to control asthma have higher chances of developing COPD as the time goes by. Recurrence of chest infections and smoking are also classified as risk factors.
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