Controlling Your Asthma

If you have asthma, you are not alone. More than 14 million people in the United States have this lung disease. Of these, almost 5 million are children. Asthma is a problem among all races. But the asthma death rate and hospitalization rate for blacks are three times the rate of whites. Proper asthma care could prevent these problems for all. This article can help you learn how to control your asthma or help a friend or family member with asthma.

This information is provided through the National Heart Lung and Blood Institute (NHLBI) Click here to visit the site!

Asthma Is a Serious Lung Disease

Asthma makes the sides of the airways in your lungs inflamed or swollen all the time.

Your Asthma Can Be Controlled With Proper Care

With your doctor's help, you can control your asthma and become free of symptoms most of the time. But your asthma does NOT go away when your symptoms go away. You need to keep taking care of your asthma.

Your asthma cannot be cured - having asthma is a part of your life. So you need to make taking care of your asthma a part of your life. This is true even if your asthma is mild.

Common Symptoms of Asthma

You may have all of these symptoms, some of them, or just one. Symptoms can be mild or severe.

• Coughing
• Wheezing (a whistling noise when you breathe)
• Chest tightness (the feeling that someone is squeezing or sitting on your chest)
• Shortness of breath

How To Take Care of Your Asthma

• Work with your doctor and see him or her at least every 6 months.
• Take your asthma medicines exactly as your doctor tells you.
• Watch for signs that your asthma is getting worse and act quickly, noting the signs on your action plan. The action plan gives you some signs that your asthma is getting worse and indicates when to take medicines.
• Stay away from or control things that make your asthma worse.

How To Work With Your Doctor

• Agree on clear treatment goals with your doctor. Agree on what things you need to do. Then do them. Ask questions until you feel you know what your doctor wants you to do, when you should do it, and why. Tell your doctor if you think you will have trouble doing what is asked. You can work together to find a treatment plan that is right for you.
• Write down the things you are supposed to do before you leave the doctor's office, or soon after.
• Put up reminders to yourself to take your medicine on time. Put these notes in places where you will see them.
• See your doctor at least every 6 months to check your asthma and review your treatment. Call for an appointment if you need one.
• Prepare a day or two before each doctor's visit.
• Write down questions and concerns to discuss with your doctor. Include ALL of your concerns, even those you think are not a big deal.
• Bring your medicines and written action plan to each visit. If you use a peak flow meter, bring it to each visit.
• Bring your peak flow values (log book, RxLearn tool - or use RxLearn on-line) to your doctor's office on your visit.

"The doctor would ask me at each visit how little Jimmy's asthma was. I always forgot to mention some symptoms or other problems. Now it's different. Before we visit the doctor, I write down when Jimmy had symptoms in the past 2 weeks. I also write down all the questions I have. Now when I leave the doctor's office, I feel happy that I got all my issues addressed."
Deborah, mother of a child with asthma

Taking the Right Medicines at the Right Times

There are two main kinds of medicines for asthma:

• Those that help with the long-term control of asthma.
• Those that give short-term quick relief from asthma symptoms.

Long-term-control medicines are taken every day to control asthma. Long-term-control medicines will prevent symptoms and control asthma. But it often takes a few weeks before you feel the full effects of this medicine.

Ask your doctor about taking daily long-term-control medicine if you:

• Have asthma symptoms three or more times a week, or
• Have asthma symptoms at night three or more times a month.

If you need a long-term-control medicine, you will need to keep taking your medicine each day, even when you feel well. This is the only way you can keep your asthma under control. Make taking your long-term control medicine a part of your daily routine, just like eating, sleeping, and brushing your teeth and USING YOUR PEAK FLOW METER AND DOCUMENTING THE RESULTS (See the monitoring tools).

The Long-Term-Control Medicines

The most effective long-term control medicines are those that reduce swelling in your airways (inflammation). These medicines include inhaled steroids, cromolyn, and nedocromil.

1. Inhaled steroids and steroid tablets or liquids are the strongest long-term-control medicines. The steroids used for asthma are NOT the same as the unsafe steroids some athletes take to build muscles.

1. Inhaled steroids are used to prevent symptoms and control mild, moderate, and severe asthma. Inhaled steroids are safe when taken at recommended doses. This is because the medicine goes right to your lungs where you need it. This reduces the amount of medicine you need and the chance of any side effects.
2. Steroid tablets or liquids are used safely for short times to quickly bring asthma under control. They are also used longer term to control the most severe asthma.

2. Cromolyn and nedocromil are often the choice of medicine for children with mild asthma.
3. Inhaled long-acting beta2-agonists are used to help control moderate-to-severe asthma andto prevent nighttime symptoms. Long-acting beta2-agonists do not reduce inflammation. Therefore, patients taking thismedicine also need to take inhaled steroids. Inhaled longacting beta2-agonists should not be used for quick relief of asthma attacks.
4. Sustained-release theophylline or sustained-release beta2-agonist tablets can help prevent nighttime symptoms. These medicines are used with inhaled steroids, nedocromil, or cromolyn. Theophylline is sometimes used by itself to treat mild asthma. The dose for theophylline must be checked over time to prevent side effects.
5. Zileuton and zafirlukast are a more recent type of long-term control medicine. Studies so far show that it is used mainly for mild asthma in patients 12 years of age and older.

Quick-Relief Medicines

Quick relief medicines are taken only when needed. Inhaled quick-relief medicine quickly relaxes and opens your airways and relieves asthma symptoms. But it only helps for about 4 hours. Quick-relief medicine cannot keep symptoms from coming back - only long-term control medicines can do that.

Take quick-relief medicine when you first begin to feel symptoms - like coughing, wheezing, chest tightness, or shortness of breath. Your doctor may tell you to use a peak flow meter to help you know when to take your inhaled quick relief medicines. Do not delay taking your quick relief medicine when you have symptoms. This can keep you from having a really bad asthma attack. Tell your doctor if you notice you are using more of this medicine than usual. This is often a sign that your long-term-control medicine needs to be changed or increased.

Make an Action Plan With Your Doctor

Ask your doctor to help you fill out an "Asthma Action Plan".

Be sure you know when to take your medicine and what to do when your asthma gets worse.

"I always thought if you had asthma you should expect to have asthma symptoms. My new doctor disagreed. She told me to take an "inhaled steroid" every day for my asthma. Well, I did not feel anything at first. But after about 3 weeks, my symptoms came less often. Now, after a few months on this medicine, I can see my doctor was right. Asthma can really be controlled."
Glen, a long-time asthma patient

How to Use Your Metered-Dose Inhaler the Right Way

Using an inhaler seems simple, but most patients do not use it the right way. When you use your inhaler the wrong way, less medicine gets to your lungs. (Your doctor may give you other types of inhalers.)

For the next 2 weeks, read these steps aloud as you do them or ask someone to read them to you. Ask your doctor, nurse or pharmacist to check how well you are using your inhaler.

Use your inhaler in one of the three ways listed.

1. Hold inhaler 1 to 2 inches in front of your mouth (about the width of two fingers).
2. Use a spacer/holding chamber. These come in many shapes and can be useful to any patient.
3. Put the inhaler in your mouth. Do not use for steroids.

A or B above are prefered, only use C if A and B do not work for you. Most importantly, get proper instruction from your doctor, nurse, and or pharmacist.

Steps for Using Your Inhaler

Getting ready

1. Take off the cap and shake the inhaler.
2. Breathe out all the way.
3. Hold your inhaler the way your doctor instructed. Breathe in slowly. As you start breathing in slowly through your mouth, press down on the inhaler one time. (If you use a holding chamber (spacer), first press down on the inhaler. Within 5 seconds, begin to breathe in slowly.)
4. Keep breathing in slowly, as deeply as you can.
5. Hold your breath as you count to 10 slowly, if you can.
6. For inhaled quick-relief medicine (beta2-agonists), wait about 1 minute between puffs. There is no need to wait between puffs for other medicines.

Clean Your Inhaler as Needed

Look at the hole where the medicine sprays out from your inhaler. If you see "powder" in or around the hole, clean the inhaler. Remove the metal canister from the L-shaped plastic mouthpiece. Rinse only the mouthpiece and cap in warm water. Let them dry overnight. In the morning, put the canister back inside. Put the cap on.

Know When To Replace Your Inhaler

For medicines you take each day(an example):

Say your new canister has 200 puffs (number of puffs is listed on canister) and you are told to take 8 puffs per day.

Number of days = number of puffs in canister divided by the number of puffs yout take per day.

Here, # of days = 200 puffs/8 puffs per day = 25 days

So this canister will last 25 days. If you started using this inhaler on May 1, replace it on or before May 25. You can write the date on your canister.

For quick-relief medicine take as needed and count each puff. Do not put your canister in water to see if it is empty. This does not work.

Resources

We encourage you to read the National Heart, Lung, and Blood Institute booklet. The complete publication can be found at: www.nhlbi.nih.gov/health/public/lung/asthma/asth_fs.pdf

National Asthma Education and Prevention Program
NHLBI Information Center
P.O. Box 30105, Bethesda, MD
20824-0105
301-251-1222
Internet: www.nhlbi.nih.gov/nhlbi/nhlbi.htm

Allergy and Asthma Network/Mothers of Asthmatics, Inc.
800-878-4403
Internet: www.podi.com/health/aanma

American Academy of Allergy, Asthma, and Immunology
800-822-2762
Internet: www.aaaai.org

American College of Allergy, Asthma, and Immunology
800-842-7777
Internet: allergy.mcg.edu

American Lung Association
800-586-4872
Internet: www.lungusa.org

Asthma and Allergy Foundation of America
800-727-8462
Internet: www.aafa.org

National Jewish Medical and Research Center (Lung Line®)
800-222-5864
Internet: www.njc.org

Adopted from:
NIH Publication No. 97-2339
Originally printed 1990
Revised September 1997