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What Is Well Controlled Asthma

Why Is Smoke Especially Harmful To People With Asthma

What Is Well-Controlled Asthma?
  • It reduces your lung function.
  • It may increase your chances of having asthma attacks.
  • It makes your day-to-day asthma control harder to achieve and increases the need for asthma medications.
  • It may increase your sensitivity to other environmental triggers .
  • It increases your chances of permanently damaging your airways there is a very real risk of developing chronic bronchitis and emphysema.

Children with asthma whose parents smoke have more asthma symptoms than children whose parents dont smoke. When you come in contact with other peoples cigarette smoke you breathe in second-hand smoke with all of its harmful chemicals . Infants and children of all ages develop health problems from passive smoking because they are smaller and the dangerous substances in smoke are more harmful to them. They also spend a lot of time with parents and caregivers and if the parent or caregiver smokes they are exposed to it for longer periods of time.

Infants and children who breathe in other peoples cigarette smoke can:

  • develop glue ear or middle ear infections
  • suffer more ear, nose, throat or chest infections, croup and wheezing
  • develop asthma

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?

Well Controlled Asthma Means Meeting Your Goals

  • No coughing or wheezing
  • No difficulty breathing or chest tightness
  • No waking up at night due to asthma symptoms
  • Not having to use a rescue inhaler or more times a week for symptoms
  • Being able to do whatever activity you want, without limitations and without symptoms
  • Not missing school or work days due to asthma symptoms
  • Taking your prescribed medicines without having side effects

If your asthma is well controlled, youll be able to avoid urgent visits to the emergency room or urgent care center and urgent visits to your clinic. Well controlled asthma means youre doing all the things youre supposed to! Uncontrolled or Very Poorly Controlled asthma can happen when youre not taking your medicines the way your provider prescribed them or youre skipping doses. Many people take asthma medications once or twice a day. Some people dont need a daily medicine but EVERYONE who has asthma should have a rescue inhaler with them at all times.

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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.

Components of control

Why Is My Asthma So Out Of Control

Asthma Control Symptoms

There are lots of different reasons why you might have asthma that’s 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.

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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.

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.

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Moving From Asthma Severity To Control

Asthma severity is an inherent characteristic of the patient and it is defined by the frequency and severity of symptoms as well as the level of treatment that is required to control the symptoms or, in very severe asthma, by nonresponsiveness to treatment. Thus, asthma severity reflects simultaneously the activity of the underlying disease and the required level of treatment, and it may vary over time and in different asthma phenotypes .

Conversely, asthma control refers to the extent to which the manifestations of asthma have been reduced or eradicated by treatment . Asthma control encompasses both the patient’s symptoms and limitations and the future risk of adverse asthma outcomes .

The clinical course of asthma can be extremely variable in the sense that both asthma severity and the level of control can change significantly over time. Thus, a patient with severe asthma can be well controlled and require no step up in treatment while a patient with mild asthma may have poor asthma control . This mild asthma patient needs to be reviewed and their exposure to triggering factors, compliance to medication and level of treatment prescribed need to be assessed and adjusted to achieve control. Therefore, guidelines for the diagnosis and treatment of asthma are no longer focusing on disease classification according to disease severity but are mainly targeting disease control .

How Do I Control My Asthma

What is asthma.wmv

Simply put, the goals of successful asthma treatment mean your asthma is well controlled. So, how do you actually control your asthma?

  • Meet with your health care provider and support staff to learn how to manage your asthma and keep it under control with regular asthma visits .
  • Work with your health care provider to create an asthma management plan that works for you.
  • Learn which medicines to take, when to take them and how to use inhaler devices correctly. Ask your provider about getting a prescription for a holding chamber or spacer. This is a device that attaches to metered dose inhalers that slows the spray down enough so you can breathe it in deeply and more efficiently into your lungs.
  • Identify what things cause your asthma symptoms to flare up and avoid them or reduce your contact with them if possible.
  • Watch for changes in your asthma and keep track of symptoms and when you need a rescue inhaler by using an asthma diary. You need to know when an asthma attack is brewing and how to treat it before it gets worse. If you act quickly and follow your asthma action plan, you can prevent your symptoms from getting worse.
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    Interpretation Of Findings In Relation To Previously Published Work

    Overall, the findings of REALISE are in agreement with previous initiatives. Our present survey offers the largest pan-European appraisal of GINA-defined control, incidence of symptoms and exacerbations, and insights into patient attitudes and understanding of the disease . The observed incidences of uncontrolled asthma and symptoms are broadly consistent with those reported in previous surveys of patients with asthma,,, underlining the validity of this study. In a recent European survey, 54% of patients had asthma that was not well controlled, compared with 45% of respondents with uncontrolled asthma in the present survey. In the 2005 International Asthma Patient Insight Research survey, conducted in a population using combination therapy, the rate of uncontrolled asthma was 51%. Notably, in the current survey, the proportion of patients in the corresponding subset with uncontrolled asthma was lower , suggesting that, although asthma control remains low overall, there may have been a slight improvement in recent years. Patients using the Internet may benefit from access to online information sources about asthma. Interestingly, a study has shown that asthma control may be improved by online self-management strategiesincluding the monitoring of control, treatment advice and online education.

    Table 6 Other European surveys and studies of patients with asthma

    There Are Two Easy Ways To Check Your Asthma Control:

    1. Baylor College of Medicine’s Rules of Two®

    • Do you have asthma symptoms or use your quick-relief inhaler more than two times per week?
    • Do you awaken at night with symptoms more than two times per month?
    • Do you refill your quick-relief inhaler more than two times per year?

    If you answer “yes” to one or more questions, your asthma may not be well controlled. Plan a visit with your healthcare provider and share your results.

    2. Asthma Control Test

    Answer five questions about your asthma to determine if your asthma is well controlled. There is a test for children and adults. This assessment provides a score. Share the results with your healthcare provider.

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    Do I Need A Referral To Specialist Care

    If youre still always having asthma symptoms, even though youre taking all your medicines as prescribed, using the correct inhaler technique, and avoiding your triggers as much as possible, ask your GP for a referral to a specialist clinic for tests to see if you have severe asthma.

    For more advice about difficult asthma call our Helpline team on 0300 222 5800, Mon-Fri 9am-5pm . Or you can WhatsApp them on 07378 606 728.

    Next review due July 2025

    Use A Peak Flow Meter

    CA Public Health on Twitter: " Is your asthma well controlled? Learn ...

    You can learn the patterns of your asthma by using a peak flow meter, which tells you how fast you can blow air out. When your airways are fully open you will get a high reading, and when your airways start to get narrow the reading becomes lower.

    You can use these readings along with your symptoms to decide when to change your treatment by following your Asthma Action Plan.

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    How Can My Gp Or Asthma Nurse Help Me

    If youre worried your asthma is difficult to control, its important to make an appointment with your GP or asthma nurse.

    At your appointment, your GP or asthma nurse can:

    • talk about the medicines or doses youve been prescribed
    • check and update your asthma action plan
    • check your inhaler technique
    • check your peak flow and talk to you about monitoring your peak flow at home
    • talk through anything making your asthma worse, including possible allergies or triggers, including triggers at work
    • discuss any other health conditions youre managing alongside your asthma
    • give stop smoking advice if you smoke or advice about exercising or losing excess weight if this would help you
    • give advice about breathing, and suggest breathing exercises
    • answer any questions you may have write these down before you go so you dont forget anything you want to ask.
    • In some cases, there may be other conditions causing your symptoms. Your GP or asthma nurse can check to make sure youve been correctly diagnosed with asthma.

    Can I get extra medicines to help my symptoms?

    If youre taking your preventer inhaler every day as prescribed, and avoiding your triggers as much as possible, but your asthma is still difficult to control, your GP or asthma nurse may decide you need a different treatment plan.

    This may include:

    Whenever your GP makes a change to your usual prescription, you should get another appointment four to eight weeks later to check the new medicines are working and are right for you.

    Why Do People Get Asthma

    Research has yet to show a definitive cause of asthma. However, researchers have determined several risk factors that can lead to asthma development.

    Family History and Genetics

    Children of mothers with asthma are three times more likely to suffer from asthma, and 2.5 times more likely if the father has asthma. More than 30 genes have been linked to asthma so far, and gene-gene interactions, gene-environment interactions and epigenetic modifications also play a part. Genetic differences also play a role in differences in response to treatment.


    People are more likely to have asthma if they have certain types of allergies, such ones which can affect the eyes and nose. However, not everyone who has allergies will get asthma and not everyone who has asthma is affected by allergies. Respiratory allergies and some types of asthma are related to an antibody called immunoglobulin E , which the immune system produces in response to allergens. To protect the body, the IgE causes allergic reactions that can affect the eyes, nose, throat, lungs and skin.

    Premature Birth

    Children born before 37 weeks are at increased risk of developing asthma later in life.

    Lung Infections

    Babies or small children may be at risk of developing asthma later in life if they had certain lung infections at a very early age.

    Occupational Exposures


    Women can develop adult-onset asthma during or after menopause.

    Environment Air Quality


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    What To Do If Your Asthma Is Poorly Controlled

    If your asthma is poorly controlled you need to speak with your healthcare provider. Uncontrolled asthma is very serious and could lead to a life-threatening asthma attack. Its vital that you take your asthma seriously and recognize when your symptoms arent properly controlled. Over time, poorly controlled asthma can cause permanent damage to your airways that cannot be reversed. This is called airway remodeling. It is important to have proper treatment for your asthma to avoid this permanent damage.

    If your asthma is not well controlled, talk to your healthcare provider about your symptoms. You can gain control of your asthma by:

    • Taking your controller medication as prescribed to minimize symptoms and reduce inflammation in the airways
    • Avoiding your personal asthma triggers as much as possible
    • Carrying your reliever medication with you at all times
    • Working with your healthcare provider to create an Asthma Action Plan and following it
    • Discussing your asthma with your healthcare provider on a regular basis so that your asthma never becomes uncontrolled and your treatments can be adjusted if necessary.

    Effects Of Asthma Control On Economic Burden And Healthcare Cost

    What is Good Asthma Control?

    The annual cost of asthma largely depends on the level of control. The cost per uncontrolled asthma patient is more than twice as high as that of a patient with controlled asthma . A previous study in Europe has shown that the cost of asthma therapy ranges from approximately 509 per year in controlled asthma to 2281 in patients with uncontrolled asthma . Asthma control was the main determinant of the cost of persistent asthma . Patients with poor asthma control require more hospitalisations, more visits to emergency departments and more use of healthcare services . The financial burden related to uncontrolled asthma originates not only from the cost of medication and the use of healthcare services, but also from indirect costs, such as the loss of working days and the absence from non-work-related activities, which are significantly more prominent in patients with uncontrolled disease .

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    Breathing: Normal Airways Vs Asthma Airways

    Normal: In someone with optimal lung function, air is inhaled through the nose and mouth, passing through the trachea before moving into the bronchi . The bronchi branch into smaller tubes, ending in many small sacs called alveoli. Its in the alveoli that oxygen is passed to the blood and carbon dioxide is removed.

    Asthma: In someone with asthma, the airways are inflamed, and when triggered, can constrict even more, obstructing airflow to the lungs.

    What Is A Peak Flow Meter

    A peak flow meter is a handheld device that measures your PEFR. You can use it at home to help identify triggers, predict attacks, and know when to seek emergency care. Your healthcare provider can also use your results to decide if you need changes in your treatment plan.

    If you have any of these symptoms, see your healthcare provider. You need to be evaluated for any significant changes in your respiratory health.

    Spirometry is a healthcare practitioner-administered test that helps measure the function of your lungs. This and other tests can help determine the extent of any changes and how your treatment might need to be revised.

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    Classification Of Asthma Severity

    Ideally, asthma severity is determined before initiating therapy. The EPR-3 guideline classification divides asthma severity into four groups: intermittent, persistent-mild, persistent-moderate, and persistent-severe. Mild-intermittent, a classification in previous reports, has been eliminated. This term really only applies to mild disease, and not to patients with periods of moderate or severe exacerbation.

    Classification of a patient’s disease also depends on current impairment and future risk. Impairment is determined by patient symptoms and objective measurement of lung function. The guideline recommends that, at a minimum, assessments of the patient’s symptoms include daytime symptoms, nighttime awakenings, frequency of short-acting beta agonist use for symptom relief, and inability to do normal activities because of symptoms . Spirometry is recommended as a component of the determination of current impairment. As mentioned previously, future risk is categorized by the frequency of oral systemic corticosteroid use.

    Components of severity
    2 per year 2 per year
    Consider severity and interval since last exacerbation frequency and severity may fluctuate over time for patients in any severity category relative annual risk of exacerbations may be related to FEV1


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