You have been diagnosed with asthma, which is a condition that can make breathing difficult. Managing your asthma correctly is very important to leading an active and healthy life. Your first step in managing your asthma should be forming a strong partnership with your doctor. Together, you can develop a personalized treatment plan to help control your symptoms.
What is Asthma?
Asthma is a chronic lung disease. This means that it cannot be cured. For most patients it can be controlled.
Asthma causes the airways to be very sensitive. Airways become inflamed and narrow. Breathing becomes difficult. The inflammation leads to edema (eh-DEEM-ah), or swelling, of the airways. Edema causes cells in the airways to break down. This breakdown of cells releases chemicals into the airways that lead to more edema and inflammation. Increased inflammation, swelling, and mucus block the flow of air, making it difficult for you to breathe.
Certain “triggers” can cause asthma episodes.
Signs and symptoms of asthma
The typical symptoms of asthma include:
- Shortness of breath
- Chest tightness
Asthma treatment is different for infants, children, and adults. Treatment varies and is based on your asthma symptoms, and how often you have these symptoms. For children with asthma, please refer to the UPMC Children's Hospital of Pittsburgh's website.
Goals of Asthma Treatment
Talk to your doctor and asthma team about your personal treatment goals. According to the National Asthma Education and Prevention Program (NAEPP), the general goals of asthma treatment should include:
- Be free from severe symptoms day and night, allowing you to sleep through the night
- Have the best possible lung function
- Be able to participate fully in any activities of your choice
- Not miss work or school because of asthma symptoms
- Need few or no urgent care visits or hospital stays for asthma
- Use medicines to control asthma with as few side effects as possible
- Be satisfied with your asthma care
To reach these goals, your personal asthma treatment plan may include:
- Avoiding triggers (staying away from things that bother your airways)
- Medicines (know how they work and how to take them)
- Monitoring your symptoms
- Seeing your doctor regularly
- Knowing when to get medical and emergency help
- Peak flow, which is a measurement of air flow, monitoring
Every person with asthma has different triggers that can bring on an asthma attack. Controlling your environment by reducing or stopping exposure to your triggers is an important part of treatment.
Here are some typical triggers and ways to control them:
- Animal dander: Animal dander comes from the skin, hair, or feathers of all warm-blooded pets including dogs, cats, birds, and rodents. If you have asthma, it is recommended that you don’t have a pet. If you must have a pet, it should never be allowed in your bedroom. Wash your pet weekly. If you have forced-air heating, filter or seal the air ducts that go to the bedroom. You should also avoid products made with feathers (such as pillows). Use a vacuum fitted with a HEPA filter.
- Dust mites: Dust mites are microscopic insects found in the home. Many people are allergic to them. Put your mattress and pillows in airtight covers. Wash all bed linens, clothing, and stuffed toys weekly in hot water to kill dust mites. The water temperature should be 130 F. The use of an air conditioner or dehumidifier may decrease the amount of dust mites.
- Cockroaches: Cockroaches and their droppings cause allergic reactions in many people. Use poisoned bait or traps to control cockroaches. Cockroaches are attracted by water and food debris. Do not leave food or garbage exposed. Permit eating only in the kitchen or dining room. Keep food in the refrigerator or in sealed containers. Keep your kitchen counters clean. Remove garbage daily. Vacuum and mop floors regularly. Repair leaky faucets.
Pollens: Pollens are some of the most common allergens. To minimize your exposure, stay inside with your windows closed as much as possible during the high-pollen season. Stay inside especially during the afternoon when the pollen count is high.
- Indoor molds: Mold is caused by damp conditions. It puts off tiny spores, which can cause allergic reactions when breathed in. Fix all leaks and eliminate water sources associated with mold growth. Clean your bathroom, kitchen, and basement regularly. Use dehumidifiers with the setting placed between 25 and 50 percent in damp basement areas. Avoid sources of mold, such as wet leaves, garden debris, and stacked wood. Avoid standing water or areas of poor drainage.
- Tobacco smoke: If you have asthma, you should not smoke. No one should smoke in your home. Choose no smoking areas in restaurants, hotels and other public places. UPMC offers smoking cessation classes. Call 1-800-533-UPMC (8762) for more information. You can also call the Pennsylvania Free Quit line for telephone support at 1-800-QUIT NOW. Counselors are available day and night, every day, and can link callers with local services. People with a hearing impairment can call 1-877-228-4327. An on-line resource, www.smokefree.gov, allows you to choose the type of help that best fits your needs.
- Cold air: Breathing very cold air can irritate your airways and lead to an asthma attack. Cover your mouth and nose with a scarf in the winter.
- Infections: Lung infections, like bronchitis and pneumonia, can be dangerous for people with asthma. Increased mucus and inflammation in the airways make it very hard to breathe. Stay away from people with colds or the flu. Talk to your doctor about over-the-counter cold medicine before taking any of them yourself. Get a flu shot each year and ask your physician if you should get a pneumonia vaccine.
- Exercise: You do not have to avoid exercise because of your asthma. In fact, exercise is strongly encouraged. Talk to your doctor about developing a safe exercise plan and how to use your medicine before you exercise. Always warm up and cool down. Avoid exercising outside in the afternoon and evening when pollen, mold, or ozone counts are high. Avoid exercising when your asthma is not well controlled or your peak flow results are low. (see p. 22 for peak flow)
- More irritants: Strong odors from painting or cooking, scented products, strong emotional expression (such as crying or laughing hard), and stress can also be asthma triggers.
- Other triggers:
- Medicines (Some medicines can make asthma worse and even life-threatening. Make sure you tell all doctors that you have asthma and what medicines you take for it.)
- Sulfites in food, such as dried fruit or beverages (wine)
- A condition called GERD (gastroesophageal reflux disease), which can cause heartburn and make asthma symptoms worse, especially at night
- Exposures to irritants or allergens at work
Peak Flow Rate Monitoring
A peak flow meter is a device that measures how well air moves out of your lungs. The peak flow rate can be used to find out if there is narrowing in the airways. By taking your medicine before the symptoms occur, a serious attack may be avoided. It is recommended that all patients age 5 and older who have moderate or severe asthma should use a peak flow meter.
How to use a peak flow meter
- Place the indicator at the base on the numbered scale.
- Stand up.
- Take a deep breath.
- Place the meter in your mouth, and close your lips tightly around it.
- Blow out as hard and fast as you can.
- Write the number down.
- Repeat this exercise two more times.
- Write down the highest of the three numbers. Your best number is the peak flow rate.
Finding your personal best
Your “personal best” number is the highest peak flow number you can achieve over a two-week period, when your asthma is under good control. Good control means you feel good and do not have any asthma symptoms. To find your personal best, take peak flow readings every day for two weeks. Take the readings in the morning and in the evening, before and after taking your inhaled bronchodilator. Your personal best is the highest reading that you achieve. Write down these readings.
Once you know your personal best peak flow reading, your doctor can adjust your treatment plan based on the numbers. The peak flow numbers are put into zones that are set up like a traffic light. This will help you to know what to do when the numbers change.
Green Zone: This zone is 80 to 100 percent of your personal best. This means that all is clear. There are no asthma symptoms. Use your daily plan as prescribed.
Yellow Zone: This zone is 50 to 79 percent of your personal best. This means to proceed with caution. You should follow the backup plan prescribed by your doctor, which may include additional medication or other special instructions. You may not have any symptoms when you are in the yellow zone, but you should talk to your doctor to prevent a further drop.
Red Zone: This zone is less than 50 percent of your personal best. This indicates a medical alert. Use your quick relief inhaler and call your doctor immediately if your peak flow reading does not return to the yellow or green zone and remain there.
Record your peak flow readings on the diary sheet included with your peak flow meter or on a calendar. Be sure to give this information to your doctor.
Monitoring Your Symptoms and Detecting an Attack
It is important to begin treatment early in an asthma attack.
Early warning signs include:
- A drop in peak flow rate
- Chest tightness
- Shortness of breath
Your doctor and asthma team might want you to record your symptoms in an Asthma Symptom Diary. Talk to your asthma team about keeping an asthma symptom diary.
Below is an example of how symptoms can be recorded:
||NO symptoms (wheeze, cough, chest tightness, or shortness of breath) even with normal physical activity|
||Symptoms during physical activity, but not at rest. It does not keep you from sleeping or being active.|
||Symptoms while at rest; symptoms may keep you from sleeping or being active.|
||Severe symptoms at rest (wheezing might even be absent); symptoms cause problems walking or talking; muscles in the neck or between ribs are pulled in when breathing. (Go to the emergency room)|
Peak flow rates should be checked on a regular basis and recorded. These readings will help your doctor plan your care. A drop in peak flow usually occurs before the other symptoms. This drop often occurs days earlier. For many people, especially children, the only sign of a problem is a cough, especially at night.
Follow your plan
Your doctor will create a personalized plan for you so that you know what to do in case of an asthma attack. Asthma is a chronic condition. This means it can be treated, but it cannot be cured.
You need to follow your treatment plan carefully to help control your asthma. Signs that your asthma is not controlled include
- Waking at night with an attack
- Increased use of bronchodilators
- Decreased activity level
- A peak flow reading in the yellow or red zone
When should I premedicate?
Premedicating means using your inhaler before you have symptoms. You can premedicate before you exercise or before you come in contact with known triggers. This can help reduce or prevent symptoms. Talk to your doctor about premedicating.
When to seek emergency medical care
Asthma can be life-threatening. If you experience any of the following signs, go to a hospital emergency department:
- Your wheeze, cough, or shortness of breath gets worse, even after you have taken your medicine and it has had time to work.
- Breathing becomes difficult.
- You have trouble walking or talking.
- You stop playing or working and cannot start again.
- Your lips or fingernails are blue or gray. If this happens, go to the emergency department or call 911 immediately.
Evaluating your results
Your doctor will evaluate you on a regular basis to see how well your treatment plan is working. It’s very important to stick to your treatment plan, even when you feel well.
Many people stop taking their medication when they are symptom-free. Remember: asthma is a chronic condition. It doesn’t just go away. You will have good and bad periods.
- Following your treatment plan, even when you have no symptoms, will help you stay well.
- Write down your treatment plan so you don’t forget it.
- Bring your peak flow readings to follow-up visits. These readings will help your doctor adjust your medicines.
- If you keep a Symptom Diary, take it to follow-up visits.
- Be alert to signs that your asthma is not controlled and tell your doctor.
- Be aware that stress can cause asthma attacks.
If you have any questions about this information, please call your doctor at ___________________
This information is meant to be used along with your doctor’s advice. It does not replace individual education given to you by your health care team. It is here to support your education. If you have questions or concerns, talk with your doctor. You should not use this information to diagnose and treat yourself.
Keep a record of your medications, how much to take, and how often to take them.
I will need to get a new inhaler _____________________________________________
Name of inhaler Before (date) _____________________________________________
My Medication(s) _____________________________________________
Name Dose Times per day _____________________________________________
Resources for Asthma
Reviewed November 2011.