asthma

An important part in living with asthma is keeping it in control. What does asthma control mean for you? Although asthma cannot be cured, most people with asthma can control it. If your asthma is not well controlled, you are likely to have symptoms that can make you miss work or school and keep you from doing things you enjoy.

Asthma control means that you can enjoy a better quality of life including:

  • Having minimal or no limitations on daily activities (work, school, home, recreation)
  • Having fewer and less severe symptoms Understanding and avoiding exposure to asthma triggers
  • Limiting the impact of attacks when they occur

Asthma is a chronic disease that affects your airways. If you have asthma, the inside walls of your airways are inflamed and swollen. The inflammation makes the airways very sensitive, and they tend to react strongly to things that you are allergic to or find irritating. Also, there is tightening of the muscles surrounding the airways (bronchospasm). Asthma is

  • Reversible, but not curable
  • Episodic - people are mostly healthy between bouts if asthma is controlled
  • Often accompanied by sinus or allergy symptoms
  • Often seasonal, depending on triggers

When your asthma symptoms become worse than usual, it is called an asthma episode or attack. Not all asthma attacks are the same. Some are worse than others. There are four things that contribute to an asthma attack:

  • Hypersensitivity – Once the airways have been exposed to a trigger, they become easily irritated with repeated exposure.
  • Bronchospasm – The muscles around the airways tighten up & make the airways smaller.
  • Inflammation – The airways become swollen & irritated. This also makes the airways smaller & makes breathing more difficult. 
  • Mucus production – Inflamed airways produce excess mucus which clogs the already narrowed openings.

Airways are tubes through which air passes on the way to and through the lungs.  The following illustration shows the difference between a normal airway and one in the midst of an asthma attack.

 

 

asthma attack 

Symptoms may include some or all of the following:

  • Cough
  • Shortness of breath at rest or with exercise 
  • Trouble exhaling
  • Wheezing
  • Chest tightness
  • Coughing up phlegm
  • Nighttime awakening with shortness of breath

Triggers are the things that cause an asthma attack or symptoms to worsen. There are many different kinds of triggers, for example:

  • Strong emotions (laughing or crying)  
  • Hot or cold air
  • Odors (perfume, cleansers, air freshener, etc)  
  • Exercise 
  • Exposure to animals (cats, dogs, horses, etc)  
  • Dust mites, cockroaches
  • Smog
  • Pollens, weeds, grasses   
  • Smoke 

Medication can be classified as either maintenance (controller) or rescue.  Maintenance medicines are taken every day to control lung inflammation.  Rescue medicines are taken only when asthma symptoms worsen.

Maintenance (controller) medicines must be used on a regular schedule to work.

  • Inhaled steroids reduce the inflammation and hyperreactivity in the airways and are the most commonly used maintenance medicines. Examples are Advair, Flovent, Pulmicort, Azmacort, and QVAR  (note that these are a different kind of steroid than the controversial “anabolic steroids” used by some athletes).  
  • There are non-steroidal controller medicines, such as Severent, and Spiriva, which relax the airway muscles.
  • The third type of asthma controller medicine are leukotreine modifiers, which act by stopping the chemical reactions that cause bronchospasm and inflammation. Some examples of these are Singulair, Accolate, and Zyflo.

Rescue medicines quickly relax the airway muscles, reversing bronchospasm, which makes it easier to breathe. Albuterol and Xopenex are the most common rescue medications. They start working in less than five minutes and may last up to six hours.

Remember that maintenance medicines are used to help prevent asthma attacks, and rescue medicines are to treat them.  If you are using your rescue medicine more than twice a week, your asthma is not under control; you should schedule an appointment with your health provider to re-evaluate your condition. 

To help determine if you have asthma, your doctor can order tests such as:

  • Pulmonary function testing or spirometry. You breathe into a machine that measures how much air you can take in and blow out, and how fast you blow out.
  • Allergy tests may determine if you have allergies that are causing your symptoms.

Can other conditions make asthma worse?

Yes! Acid reflux (GERD) is caused by stomach acid going up your food pipe (esophagus) to your throat and can either mimic asthma or make your asthma worse.  You may or may not have symptoms with GERD, which can include heartburn and coughing, especially when lying flat.  Additionally, allergies and/or hay fever can make your asthma worse if it is not treated.

Before the appointment:

Being prepared for your provider appointment is a significant part of your asthma self-management. Additionally, providing important information can assist your doctor to better assess if your asthma is under control. By answering key questions you can help your provider better understand the specific ways asthma affects you.  Take time to consider the following and prepare notes to take to the appointment:

  • What are your asthma triggers and have they changed since last visit?
  • How often do you experience asthma symptoms and what are they?
  • When do symptoms occur?  At night, during the day, both?
  • How do you treat your symptoms? How often have you used your rescue inhaler?
  • Does your asthma ever prevent you from doing daily activities?
  • How many times have you missed work or school since your last visit?
  • How many visits to emergency room or urgent care for asthma have you made since your last visit?

The Asthma Control Test is a useful tool to describe your asthma control to your doctor. The Asthma Control Test (pdf) is available for your use.

At the appointment:

Discussing asthma control with your doctor is key to your asthma management.  Review your answers to the above questions or your Asthma Control Test (pdf) with your provider during the appointment.  Also, discuss your list of current medications (over the counter and prescription) with your provider as well as any peak flow measurements you have recorded since your last visit.  Lastly, leave your appointment with an action plan (pdf), your options, and an understanding of how to use your medications for better asthma control.

Asthma and Allergy Foundation of America
www.getaheadofasthma.com

Asthma and Allergy Foundation of America
(800) 727-8462
www.aafa.org 

National Asthma Education and Prevention Program
National Heart, Lung and Blood Institute

(301) 592-8573
www.nhlbi.nih.gov

American Lung Association
800-LUNGUSA
www.lungusa.org

Asthma class schedule