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Understanding asthma
Oxford | Self-help guide
Oxford
Oxford
Living with asthma
Years ago, asthma was a debilitating condition that in
many cases seriously limited what a person could do.
Fortunately — as a result of greater knowledge about
asthma and its treatment options — the ability to manage
this disease has vastly improved over the years.
With proper care, today people with asthma live quite
normal, active lives. In fact, life with asthma at times
can even be extraordinary for Olympic gold medalists or
professional athletes who break records — despite their
asthma. When you manage your asthma, you can do almost
anything you want to do. Throughout this book, you’ll learn
how to keep your asthma under control so that you too can
continue to lead a healthy, fulfilling life.
Asthma can be different for everyone who has it.
What triggers it for one person may not for another.
This guide is not a substitute for medical advice from your
physician. Your health care provider can help you develop
your own asthma action plan. Bring this book along to
your next doctor visit and ask your health care provider to
help you complete your personalized asthma action plan on
pages 25 through 27. Before long, you can be on the road to
successfully managing your asthma.
The word “asthma” is derived from a Greek word meaning “breathlessness”
or “panting,” both of which describe symptoms present during an asthma attack
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Contents
1. Understanding asthma 5. Taking action when asthma acts up
What is asthma?............................................ 2 Heeding the warning signs..................................23
How is asthma diagnosed?............................. 2 Signs of poorly controlled asthma........................24
The asthma spectrum..................................... 3 Get control with an asthma action plan...............24
Why me?........................................................ 3
6. Asthma and exercise
2. Tracking asthma triggers What is exercise-induced asthma?.......................28
Allergens........................................................ 4 Pretreatment for exercise-induced asthma...........29
Infections....................................................... 6 Enhancing your performance...............................30
Irritants.......................................................... 6
Exercise.......................................................... 7 7. S
pecial concerns for children and teens
Aspirin and other Asthma and school...............................................31
anti-inflammatory medications................... 7 Asthma and teens................................................32
Emotions....................................................... 8
Using what you know about triggers.............. 9
8. Other things to consider
Asthma and pregnancy........................................33
3. Monitoring your asthma Asthma and other medical conditions..................33
Using a peak flow meter............................... 10 Asthma and emotions..........................................34
If your child has asthma............................... 12 Tips for traveling.................................................34
Keeping an asthma diary.............................. 12
9. Getting additional help
4. Getting the most from asthma medications Medical professionals...........................................35
How asthma medications work.................... 13 Organizations......................................................35
Long-term control medications................... 13 Additional reading...............................................36
Quick-relief medications............................. 15
Other medications....................................... 17
Administering asthma medications.............. 18 10. Glossary and appendix...............................37
Asthma medications...............................20-22
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1. Understanding asthma
When you breathe, air moves through your nose or mouth down to your windpipe (trachea). Just as the windpipe meets the
lungs, it branches off into two large airways (bronchi), one to each lung. Within the lungs, the large airways branch off into
smaller airways (bronchioles) leading to many small air sacs (alveoli). These air sacs do two very important jobs. First, they
transport oxygen from the air you breathe into your bloodstream. Second, they remove carbon dioxide from your blood so it
can be removed from your body when you exhale.
What is asthma?
Asthma interferes with normal breathing by narrowing Many people with asthma experience times when they
the airways both within and leading to the lungs. When have more problems breathing and times when they
the airways are narrowed, the amount of carbon dioxide feel perfectly normal. The times of greater difficulty are
leaving the body and the amount of oxygen entering called “asthma episodes.” During an asthma episode,
the body are both restricted. With asthma, one or more you may have sudden coughing or wheezing that can
of the following situations cause the airways to narrow. cause you to feel short of breath. Asthma episodes can
last from a few minutes to several hours or days.
Tightening of the muscles that wrap around
the airways. For people with asthma, the airways Fortunately, the airflow obstruction caused by asthma
sometimes overreact to triggers. The result is can be reversed, often rapidly. This is one of the key
spasms of the muscles encircling the airways, called ways in which asthma is different from other diseases,
bronchospasm. As these muscles contract or tighten, such as emphysema. Sometimes, bronchospasm will
the space inside the airways narrows and less air is simply stop on its own. But more often, medications are
able to pass in and out of the lungs. needed to prevent and treat asthma episodes. Although
there is no cure for asthma, with the help of your health
Inflammation of the airway linings. The same triggers care provider, you can learn to manage this disease so it
that cause bronchospasm can also cause ongoing doesn’t interfere with your daily life.
(chronic) swelling and inflammation in the inner lining
of the airways. Like bronchospasm, inflammation of How is asthma diagnosed?
the lining narrows the space available for air to pass Asthma symptoms can be different from person to
through. When the lining of the airways is irritated person. For some, the main symptom is a persistent
and inflamed, bronchospasm is more likely to occur. cough. Others may experience wheezing, chest
tightness, shortness of breath or any combination
Twitchiness of the airways. The airways in a person of the above.
with asthma narrow in response to triggers such as
exercise or cold air. How easily this occurs is often Asthma tends to run in families (about 40 percent of
referred to as twitchiness or bronchial hyperreactivity. children who have parents with asthma will develop
asthma), and most people who have asthma develop
Overproduction of mucus. Mucus normally coats their first symptoms while still young. About half of
the airways and cleans away small particles of foreign those with asthma show symptoms before age 10, and
matter, such as dust and dirt, from the air passages. most develop it before age 30. But anyone can develop
When the airways become inflamed during an asthma asthma at any age.
episode, too much mucus may be produced. The excess
mucus takes up space in the airways, blocking the free Because other illnesses and diseases can cause similar
flow of air. It may also become dry and sticky, further symptoms and difficult breathing, you should see
obstructing the airways. As a result, it is more difficult your health care provider to determine whether the
to clear away the mucus by coughing, and bacteria can problem is asthma or something else. Be prepared to
grow in the mucus, resulting in bronchitis. give specific information about when and under
what circumstances your symptoms tend to occur.
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For example, your health care provider will probably periods when your asthma flares frequently; at other
ask you some of the following questions: times in your life, you may have few problems.
}} What symptoms are you having (wheezing, If you are the parent of a child who has asthma, keep in
coughing with mucus, chest tightness, shortness mind that about half of all children with asthma “grow
of breath)? out” of the disease and have lessening symptoms by the
time they are 15 years old. Some of these individuals,
}} When do these symptoms usually occur (during however, may develop symptoms again later in life.
the day or night, at home or at work, after exercise,
only during certain seasons of the year or certain The key to managing asthma is understanding your
weather conditions)? symptoms and learning what triggers and relieves them.
These topics will be discussed further in the
}} How often do you have problems (occasionally, next chapters.
daily, a few times a month, only after a cold or
other upper-respiratory illness)?
Why me?
}} Do you have any known allergies? Many people think asthma is a disabling disease —
Your answers to these kinds of questions will help your something that makes you unable to participate in
doctor develop a history of the problem. This history, sports, be active or enjoy life. Though asthma has had
together with a physical examination, will help your this reputation in past years, it just isn’t true today. With
doctor decide if further tests are needed. These may medications, asthma can be controlled so it doesn’t
include chest x-rays and spirometry. The x-rays help interfere with leading a normal, active lifestyle.
rule out other possible causes for your symptoms. If no This is not to say it will be easy for you to adjust to
other lung disease is present, chest x-rays will be fairly having asthma and to the things you need to do to take
normal in a person who has asthma. care of it. Learning that you have a chronic disease such
Spirometry is a test that involves blowing into a device as asthma can raise a variety of emotions — some not
called a spirometer. The spirometer measures the so pleasant. You may feel angry, frustrated or worried
amount and speed of air that is breathed out, indicating about what your future will be like living with asthma.
how open or narrow the air passages are. When the You may wonder why this had to happen to you.
passages narrow during an asthma episode, the force of Just remember that all these feelings are perfectly
exhaled air measured by the spirometer is lower than normal. These feelings usually pass as time goes by
normal. Some people who have asthma, however, may and you become more comfortable and confident
have normal spirometry results during times when they that you really can manage this disease and prevent
are symptom-free. This is one way your health care and treat asthma episodes. If you continue to struggle
provider can tell that the problem is asthma and not with feelings of frustration, anger, worry or fear, or if
emphysema or chronic bronchitis, both of which are these feelings are interfering with your daily life or
diseases that cause irreversible damage to the lungs. relationships, talk with your health care provider. He
or she may be able to recommend a counselor or other
The asthma spectrum mental health professional who can help you.
Asthma can range from very mild and intermittent to Family, friends, co-workers, teachers and coaches
severe and persistent, with a wide spectrum in between. can also provide valuable support if they understand
Your grade of asthma depends on your daytime and asthma. Share what you know about asthma with the
nighttime symptoms, and your breathing test results. people who care about you, and let them know how
Each level of asthma requires a different approach to they can help you if you have an asthma episode. You
treatment. The severity of your asthma can change over might even want to lend them a copy of this guide.
time, depending on how your body reacts to different
triggers at different times in your life. You may have
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2. Tracking asthma triggers
Most people don’t regularly pay attention to the way their bodies react to things around them. Becoming aware of your
body’s response to different environments and materials, however, can be an important strategy for managing your asthma.
For most people, asthma episodes are regularly triggered by one or more factors — allergens, infections, irritants, weather
conditions, exercise, emotions or even aspirin products. What causes an asthma episode in one person, however, may not
bother another person who has asthma. The first step in managing your asthma is identifying your asthma triggers and
finding ways to avoid them as much as possible.
Allergens people, the allergic reaction to specific allergens is an
Your immune system is designed to protect your body asthma episode.
from harmful intruders such as bacteria and viruses. Asthma and allergies often go hand-in-hand, but
When one of these intruders, or antigens, enters the having one of these conditions does not necessarily
body, the immune system kicks in by releasing special mean you have or will develop the other. (Although
chemicals to combat the invaders. an estimated 95 to 98 percent of children with asthma
}} What triggers asthma for one person may have nasal allergies, only 40 to 50 percent of adults
not for another with asthma have nasal allergies.) If you do have both,
}} Those who live in the inner city have an increased however, your allergies may be triggering your asthma.
risk for developing asthma (Source: National Allergies that trigger asthma
Institute of Allergy and Infectious Diseases) The first clue that you may have an allergy is if you
}} Asthma tends to flare most often at night, in the regularly experience allergy-like symptoms in specific
early morning hours or after exposure to a trigger situations. For example, maybe you have allergy
symptoms only at certain times of the year or when you
If you have a bacterial or viral infection, these may
visit a home where a cat or dog lives. Maybe you have
cause your body temperature to rise or your nose to run
year-round symptoms, indicating that you might be
as a way of ridding the antigen from the body.
allergic to something in your home, such as dust mites
In some people, the immune system can also react or molds.
when the body is exposed to certain antigens, such as
Allergies can develop slowly with repeated exposure
dust mites or pollen, that are not normally harmful
to an allergen over time. For example, a person who
to the body. These antigens are called allergens, and
grew up on a maple-lined street may be well into
the immune system’s overreaction is called an allergy.
adulthood before developing an allergy to maple pollen.
Allergic reactions affect specific areas of the body:
Even though they may have taken months or years
}} The skin — with rashes, itching, eczema or hives to develop, allergies may seem to pop up overnight.
}} The nose — with runny nose, congestion Common allergens to consider as you search for your
or sneezing asthma triggers include the following:
}} The eyes — making them itch, swell }} Animal and insect allergens. Cats, though perhaps
or become watery the most frequent culprits, aren’t the only sources
of animal allergens. Dogs, horses, guinea pigs,
}} The airways — causing asthma
birds — just about any furry or feathered friend —
Different allergens cause different allergic reactions in may also trigger allergic reactions in some people.
different people with allergies. A food allergen, such as Allergens may be found in animal dander (similar
eggs or peanuts, may cause a person with that specific to dandruff ), saliva or urine. Reptiles and fish are
allergy to break out in hives. On the other hand, an about the safest pets for people prone to animal
airborne allergen, such as animal dander, pollen, mold allergies. In addition to pets, household pests such
or dust, may cause a runny nose or itchy eyes. For some as cockroaches may serve as allergens.
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}} Seasonal allergens. These primarily include
pollens. Tree pollens are most abundant during the Reducing allergens in your home
spring, grasses in the spring and summer, and weed Here are a few things you can do
pollens, such as ragweed, in late summer and fall.
Seasonal allergens vary with geographic regions.
}} Household allergens. Dust mites (microscopic }} Encase the mattress and pillows in allergen-free
insects found in household dust) and fungi covers to help reduce dust and dust mites in the
(mold and mildew) can cause year-round allergy bedding; some mattress encasings are made
symptoms. Dust mites and fungi especially like to with microfiber fabric to prevent excess heat
breed in damp places and humid environments, and moisture
such as the bathroom, basement and kitchen.
}} Opt for bare floors or easy-to-clean area or throw
Warm, humid weather can also contribute to
rugs instead of wall-to-wall carpeting
higher household allergen levels.
}} Keep pets out of the bedroom at all times (if
If you think you may have allergies, talk with your possible, keep pets out of all living areas of
health care provider. He or she may recommend your home)
that you see an allergist (a doctor specializing in }} Dust and vacuum regularly
allergies) for allergy testing. During an allergy test,
}} Don’t use feather pillows or genuine
very small amounts of allergens are placed on (a
down comforters
“scratch test”) or injected under your skin. If your
skin reacts with redness or a raised, itchy bump }} Take a quick shower before bed to rinse off any
where the allergen was placed, you are allergic to pollens or mold spores on your body and prevent
that allergen. prolonged exposure to allergens while sleeping
Treating allergies to manage asthma }} If you don’t have central air conditioning, install a
Once you know what, if anything, you are allergic window air conditioner during the warm seasons
to, you can use an asthma diary to see if your asthma to avoid the need for open windows (which allows
episodes seem to be connected with your allergies, as more pollen in from outdoors) and to help reduce
identified by skin testing. If they are, the first and most humidity; if you have central air conditioning, keep
important step for controlling both your allergies and windows closed to help prevent pollens and mold
your asthma is to find ways to avoid those things to spores from entering the house; air conditioning
which you are allergic. lowers indoor humidity levels, which decreases the
mite population
Avoiding allergens isn’t always easy. Your health care
}} Avoid hanging clothes to dry outside, where they can
provider can give you more information on how to
be exposed to pollens and mold
minimize your exposure to specific allergens. You may
find some suggestions very practical and others nearly }} Take precautions in your basement, which
impossible given your personal circumstances. tends to have higher humidity levels; avoid putting
carpeting on a cement slab floor and having
If you can’t make your entire house “allergen-free” (keep bedrooms in basements
in mind that no home is ever entirely free of allergens),
}} Don’t use humidifiers or vaporizers in the bedroom;
focus your efforts on the bedroom, which is the most
they provide an optimal environment for molds and
important room of the house because you spend six to
dust mites
10 hours a day there.
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For many people with allergies, medications provide Viral infections can also cause a cough. But because
important prevention and relief of symptoms. If coughing can also be a symptom of an asthma
your asthma is triggered by allergies, taking your episode, you don’t want to mask the asthma by using
allergy medications as directed can help prevent a strong cough suppressant. If you need relief from
or reduce the severity of asthma episodes. In some a nagging cough, you may use an over-the-counter
cases, immunotherapy or “allergy shots” are used to cough medicine containing dextromethorphan, but be
desensitize the immune system to certain allergens. sure you are also taking your asthma medications as
prescribed. Drinking lots of clear liquids (water and
Infections
juices) is the best medicine for loosening mucus in the
Bacterial and viral infections are another common airways so it is easier to cough up and clear away.
asthma trigger. Viral infections, such as colds and
flu, tend to trigger asthma episodes more frequently If colds or flu tend to trigger your asthma, your health
than bacterial infections, such as strep throat or sinus care provider can recommend asthma medications to
infections. Though these types of infections mostly begin taking early during the viral infection to help
affect the upper airways in the nose, throat and sinuses, prevent an asthma episode. Call your health care
the lower airways may also become irritated if you provider for advice if cold symptoms:
have asthma.
}} Worsen after three to five days
For some people, their first asthma episode comes }} Don’t improve and remain bothersome after
during or shortly after having bronchitis or pneumonia. seven days
While these asthma episodes can last several weeks or
even months, they may not occur again. Some people, }} Are not resolved after 14 days
however, may develop ongoing asthma problems. You should also call for advice if your asthma flares up
with the cold or if you are coughing up colored mucus
Avoiding trigger infections from your chest. For colds in children, call for advice if
}} Keep healthy with nourishing foods, lots of fluids, fever persists and cold symptoms are very bothersome
regular exercise and plenty of sleep after three days.
}} It may be impossible to prevent getting a cold, flu
Irritants
or other upper-respiratory infection entirely
Asthma symptoms are aggravated by many factors,
}} Avoid close contact with those who have colds or both outdoors and indoors. These irritants are different
flu, especially during the first few days of illness from allergens because they do not trigger the body’s
}} Wash your hands regularly immune system as allergens do — they simply irritate
}} Ask your doctor if you should get a flu shot in the airways.
the fall of each year; remember that flu Examples of irritants include:
immunizations provide protection against the
strains of influenza present that year only and }} Smoke from tobacco or wood
must be repeated each fall }} Various dirt particles in the air
Viral infections generally must take their own }} Extremes or sudden changes in weather, including
course. Antibiotics have no effect on viruses. Using a temperature, barometric pressure, or humidity
decongestant, however, may help relieve stuffiness and
}} Air pollution
congestions that can irritate your asthma.
}} Fresh flowers
}} Fumes and fragrances from a variety of products
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Avoiding irritants The most common activities that can cause an asthma
You will probably find that some of these irritants episode are aerobic activities, such as jogging or
trigger your asthma, while others do not. You’ll also cross-country skiing, which involve continuous
notice that some are easier to avoid than others. movement sustained over a long period. During those
As with allergens, you can use an asthma diary to kinds of activities, air is breathed in through the mouth.
help you identify which irritants, if any, tend to This air is colder and drier when it reaches the lungs
trigger your asthma. than air that is inhaled through the nose. In those with
exercise-induced asthma, the colder, drier air acts as an
Tobacco smoke is a particular concern, especially in
irritant to the lower airways, causing them to spasm.
homes with children who have asthma. Studies have
shown that very young children who live in homes Not all sports or exercise involve this kind of
where someone smokes are more likely to develop continuous, sustained movement. Football, baseball and
asthma and to have asthma episodes that require tennis are examples of sports involving shorter sprints.
emergency room care. School-age children also have Brisk walking can provide aerobic exercise without
more school absences if parents or other members of the need to breathe through the mouth. Swimming is
the household smoke. In addition, smokers themselves often recommended as one of the best aerobic activities
are known to develop more frequent upper-respiratory for people who have asthma. Though it does involve
infections. breathing through the mouth, the surrounding water
tends to humidify the air, making swimming less likely
Make your home off-limits to smoking. When
than other activities to trigger asthma.
reserving a hotel room, request a non-smoking room.
If you choose to jog or participate in activities that can
Cold air may irritate the lungs of some people with
trigger your asthma, ask your health care provider to
asthma. Short of packing up and moving to Arizona,
recommend pretreatment medications to avoid asthma
those with asthma can prepare for fluctuations in the
episodes, then allow yourself an adequate warm-up period.
weather by dressing appropriately. In very cold or windy
weather, wear a scarf or face mask over your mouth to Pay attention to your body’s reactions to exercise.
ward off cold blasts. Exercise-induced asthma can occur either during or
after exercise. Be sure to have appropriate medications
Outdoor air pollution is an irritant you can’t totally
available in case you have an asthma episode.
avoid, but you can lessen its impact by rolling up your
car windows or closing up the house and turning on the Aspirin and other anti-inflammatory medications
air conditioning. Watch the weather reports, and avoid }} Aspirin and other nonsteroidal anti-inflammatory
strenuous outdoor activities on days when the pollution drugs (NSAIDs) act as triggers in a small
level is high. percentage of people with asthma. Because aspirin-
induced asthma episodes can be severe and come
Exercise
on very quickly, you should avoid taking aspirin and
In years past, exercise-induced asthma led people to
other NSAIDs if you have aspirin-sensitive asthma.
believe that those with asthma could not participate
in sports or physical activities. We now know that by }} Ibuprofen (Advil®, Motrin®, Nuprin®) and
carefully choosing activities and using pretreatment naproxen (Aleve®) are other NSAIDs that are
medications when needed, people who have asthma can available without prescription. A variety of other
be just as physically active as anyone else. over-the-counter medications contain aspirin.
Read labels carefully, or ask your pharmacist before
taking any non-prescription medication, especially
pain relievers and cold remedies. Choose products
containing acetaminophen (Tylenol®) for treating
fever or pain, such as headaches.
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Emotions }}Technique 1: Quieting response
Excitement, stress, fear and other emotions — even
1. Sit comfortably.
laughter — are said to trigger asthma episodes in some
(You can also learn to do this while
people. In reality, however, the emotions themselves are
standing, such as waiting in line, or just
not the direct trigger; rather, the asthma episodes occur before an anticipated stressful event.)
as a result of more rapid or heavier breathing brought
on by crying, laughing or feeling anxious. So even when 2. Draw in a deep breath through your nose,
emotions are involved, asthma is still a physical disease. and hold it for five seconds (count to five
slowly). Exhale slowly through your mouth,
Stress management techniques and tell all your muscles to relax. Repeat this
Practicing stress management techniques can be an two or three times to become more com-
effective way of reducing asthma episodes triggered pletely relaxed.
by emotional upset. Both techniques involve deep 3. If circumstances permit, imagine a pleasant
diaphragmatic breathing (breathing from the thought (“I’m able to relax and let go
diaphragm, so your abdomen — not your chest — throughout the day”) or a pleasant scene (a
moves in and out). calm lake or a mountain stream).
In addition to promoting relaxation, these techniques e quieting response technique takes from
Th
are useful during asthma episodes to help you get more 30 to 60 seconds.
air while waiting for medications to begin working. You
will be able to use these techniques best during asthma
}}Technique 2: Deep breathing
episodes or times of emotional upset if you practice
them regularly during non-stressful times. 1. Choose a quiet spot, and get comfortable.
Relaxation techniques 2. Gently blow out all the air in your lungs.
Here are some specific techniques that can aid in
3. Slowly count to eight while inhaling through
relaxation and stress management. The more you
your nose (count “1-and-2-and-3-and,”
practice these relaxation techniques, the more they can to eight). Then hold your breath, again to
help reduce asthma episodes. the count of eight. Finally, slowly exhale
through your mouth while counting to eight.
Daily practice, especially at first, will help make these
relaxation techniques become second nature for you. 4. Resume slow, rhythmic breathing for a few
When this happens, it will be even easier for you to use minutes. The in-and-out cycles should be
the techniques when you need them most — during an equal in length. Go deeper than shallow,
asthma episode or when you are under a lot of stress. upper-chest breathing. If you are breathing
Parents can coach their children through these exercises as you should from your diaphragm, your
and encourage them to use them if they feel an asthma chest should barely move, but your abdomen
will expand and contract.
episode beginning.
5. Repeat the whole process again.
A written asthma management plan can also offer
reassurance and confidence for people with asthma.
Sometimes, fear can intensify an asthma episode. Just
knowing that you can effectively treat the episode and
continue to breathe can help prevent an episode from
worsening because of fear.
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Using what you know about triggers
Managing asthma triggers is the most effective approach for preventing asthma episodes. Once you know what
triggers your asthma, you can begin to find ways to avoid triggers.
Asthma trigger checklist
Think about what triggers your asthma. Put a check mark next to the items that affect you.
Allergic triggers
__ House dust (dust mites) __ Animals
__ cats
__ Seasonal allergens — pollens from trees, grass, __ dogs
ragweed or other plants __ rodents (hamsters, guinea pigs)
__ birds
__ Mold outdoors, mildew indoors
__ Other
Irritants
__ Tobacco smoke __ Outdoor pollution
(smog, car or truck exhaust, etc.)
__ Weather conditions — extremes or sudden
changes in temperature, barometric pressure __ Fragrances or fumes from various products:
or humidity
_________________________________________
__ Air pollution
_________________________________________
__ Indoor pollution (smoke from fireplaces or
wood-burning stoves; fumes from building
products, carpeting, paint; etc.)
Infections
__ Viral upper-respiratory infections — colds __ Bacterial infections — strep throat, sinus
and flu infections, pneumonia or bronchitis
Exercise of physical exertion
__ Specific sports or other activities: _______________________________________________________
_______________________________________________________________________________________
Emotions
__ Crying or laughing __ Anger
__ Stress __ Fear (especially when an asthma episode begins)
Infections
__ Aspirin __ Ibuprofen (Advil ®, Motrin®, Nuprin®)
__ Other NSAIDS __ Naproxen (Aleve®)
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3. Monitoring your asthma
The goal for those with asthma should be to live like everyone else, without asthma getting in the way of life’s wonderful
possibilities. A good asthma management plan should be able to reduce the severity and frequency of asthma symptoms, as
well as prevent unscheduled visits to the doctor or hospital.
Your health care provider can teach you asthma
self-care techniques. Work with him or her to develop
a management plan that’s best for you. You will Just as fingerprints are different from person
know your plan is working if it helps you achieve to person, so is asthma; your symptoms
the following asthma-management goals: and treatment plan may be different from
someone else’s
}} Reduce the severity and frequency of
asthma symptoms
Asthma episodes range from mild to severe
}} Alleviate nighttime awakenings
and can last from a few minutes to a few days
}} Allow for fuller activity
}} Prevent unscheduled visits to the doctor or hospital When your asthma is well controlled, you can
live a healthy and active life
Most asthma management plans include the following
elements:
}} Watching for early warning signs by monitoring
symptoms or using a peak flow meter to measure Using a peak flow meter
lung function A peak flow meter is a good tool for assessing and
}} An asthma diary to record peak flow readings, monitoring asthma. This inexpensive, hand-held device
asthma episodes and circumstances surrounding measures the maximum or “peak” speed at which air
asthma episodes can be exhaled from the lungs. During an asthma
}} Appropriate medications for preventing and episode, the peak flow is slowed because the airways are
controlling asthma episodes constricted and partially blocked.
}} Guidelines for when to call a health care provider As early as 24 hours before asthma symptoms appear,
Your health care provider will teach you how and your breathing capacity may already begin to drop. The
when to take medications and help you identify your peak flow meter can detect this drop so that you can
asthma triggers and ways to avoid them. By reading start taking appropriate medications before wheezing
this guide, you’re already off to a good start. Learning or coughing even begins. But not everyone who has
self-care techniques, including when and how to use asthma needs to use a peak flow meter. Some people are
medications, puts you in control of your asthma. very good at recognizing early signs of asthma episodes
and treating them appropriately.
Early detection of an asthma episode can also make
it easier to identify your asthma triggers. For example,
a weather change or a visit to a home with a pet on
Saturday afternoon may be the trigger behind an
asthma episode but if you don’t notice any asthma
symptoms until Sunday, it may be more difficult to
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draw the connection between the cat or the weather
change and your asthma. A routine peak flow Steps for using the peak flow meter
measurement taken on Saturday, however, may make it
easier to identify the real trigger. Peak flow meters can
help you recognize triggers that otherwise might be 1. Move the pointer to the base of the
overlooked. numbered scale.
Even some children as young as three years old can 2. Hold the peak flow meter, being careful not
learn to use a peak flow meter. Your health care to block either the mouthpiece or the air exit.
provider may initially recommend that you take a peak 3. Stand up.
flow meter reading two or more times a day. Usually the 4. Take a deep breath.
readings are taken right after waking up in the morning
5. Place the meter in your mouth, closing your
and again before going to bed. You may also be asked
lips gently around the mouthpiece.
to take a breath before and after taking inhaled
medications. Your doctor can help you determine the 6. Blow out as hard and fast as possible.
best testing times for you. (The device measures the maximum
speed of your expiration, not how much air
Peak flow zones you exhale. A short and fast blow gives the
Peak flow readings are divided into three zones — best reading.)
green, yellow and red — like a traffic light. Readings 7. W
rite down the number indicated by the
in the green zone mean you are doing fine, while pointer.
readings in the yellow zone mean your asthma is not 1 . Repeat steps 1 through 7 two more times
well controlled and you should take medications as (unless the test has provoked a coughing
prescribed in your asthma action plan. Readings in the attack).
red zone mean a severe asthma episode is under way
2. R
ecord the highest of the three numbers
and you should call your health care provider or seek achieved. This is your peak flow reading.
immediate medical attention.
The exact ranges of these zones vary from person
to person. Height and age are factors, and the best
possible peak flow readings vary somewhat between
men and women and among different ethnic groups.
Your health care provider will help you determine your
“personal best” peak flow and then use this number to
establish the three zones of your asthma action plan.
Green (all clear) represents 80-100 percent of your
personal best reading; yellow (caution) indicates 50-80
percent of your personal best; and red (danger) shows
below 50 percent of your personal best. Once these
zones are established, your doctor can recommend an
asthma action plan specially tailored to your needs.
Asthma action plans will be discussed in detail in
Chapter 5.
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If your child has asthma Keeping an asthma diary
Children, too, can be involved in their own asthma care, One of the most important steps in managing
learning to watch for early symptoms and taking their persistent asthma is to keep a daily written record,
own peak flow meter readings. However, until your or asthma diary, that shows peak flow meter readings,
child is old enough to accurately keep an asthma diary medications taken, asthma symptoms and
and follow an asthma action plan unassisted, you will possible triggers.
need to take special care in monitoring, treating, and
recording symptoms and peak flow readings. By keeping a daily written record of your symptoms
and peak flow readings, you can begin treatment earlier
In addition to the common warning signs described and reduce the number and severity of asthma episodes.
in this chapter, watch for wheezing during the night. Your doctor may also use the information recorded in
Increased amounts of mucus production in the airways your asthma diary along with peak flow readings taken
may produce coughing and wheezing in a sleeping in the office to determine whether your medications are
child. Your child may need to use his or her inhaler or doing the job.
nebulizer during the night. When asthma is properly
managed, however, there should be no nighttime The information you record in your asthma diary is
asthma symptoms. important for developing an asthma action plan that
meets your individual needs. An asthma diary can also
Talk with your child’s teacher or daycare provider about help you identify possible asthma triggers you may not
asthma. Let them know what symptoms to watch for. have been aware of before.
Make sure the day care provider, teacher and the school
health office have copies of your child’s asthma action Keep your asthma diary in a safe, accessible place, and
plan. Also be sure your child has a separate supply of take it along on each visit to your health care provider.
medications that is kept in a readily accessible place at A sample asthma diary is shown on page 40.
school or daycare.
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4. G
etting the most from
asthma medications
There is no “cure” for asthma. However, medications can prevent and control symptoms. Most people with asthma can lead
normal, healthy lives.
Each person’s asthma is unique. In the same way, ways
to treat asthma must be targeted to each person’s
needs. Some people with asthma take medicine daily. Asthma cannot be cured, but it can be
Others take it only as needed. managed. Remissions (or periods with no
symptoms) may occur.
Asthma is classified by the severity of your symptoms
and breathing test results. The most common is mild
Most people with asthma need to be seen by
intermittent asthma. Persistent asthma can be mild, their doctor at least once a year.
moderate or severe. The type and amount of medicine
is matched to the severity. The treatment first gains
control of the asthma symptoms. Then it keeps control Some over-the-counter drugs can cause bad
with the minimum effective dose. reactions if taken with asthma drugs. Check
with your doctor or pharmacist before taking
Learning about your medications will help you to use other drugs.
them safely and effectively. You should know what they
do and how they work. You should learn when to take
them and any side effects. Taking them as directed is
essential. Work with your health care provider to tailor Long-term control medications
a program to your needs. The best way to control an asthma episode is to prevent
it. Many types of medications are used for long-term
How asthma medications work control. Anti-inflammatory drugs work to prevent
Many medications are used for asthma. Your doctor mucus production and airway swelling. They do not
prescribes for the severity of your asthma. Many with give fast relief of asthma symptoms. They do help
mild intermittent asthma can manage well with a control asthma with regular use. To work, they must be
quick-relief drug. Most people with frequent episodes taken daily — even on days when you feel fine.
or persistent asthma take at least two drugs. One is
for quick relief during an episode. It relaxes the
muscles of the airways. The other is for long term
control. It is taken daily to prevent inflammation
and mucus production.
You should know which medication is for which
purpose. You must take your daily long-term
medication to manage your asthma. But this will not
give relief during an episode. For that, you need a
quick-relief medication.
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Inhaled corticosteroids Leukotriene modifiers
Inhaled corticosteroids are the most potent and Leukotriene modifiers are another way to control
effective long-term drug. They reduce swelling asthma. Leukotrienes cause tightening of the bronchi
in the airways. They reduce asthma episodes and the and increase mucus. Zafirlukast (Accolate®) and
need to go to the hospital. They increase breathing montelukast (Singulair®) are oral drugs that block
test results. They reduce airway twitches. They may the actions of leukotrienes. They are used in adults
prevent damage to the airways. Regular daily use is key. and children. They can be used alone or with inhaled
It can take five to seven days before they begin to work. corticosteroids.
There are many kinds and strengths. The dose may vary
with the product used. Usually they are taken one to
two times per day.
One type of inhaled corticosteroid is a nebulized form.
It is called budesonide. The brand name is Inhaled corticosteroids
Pulmicort Respules®. It often helps children who
have persistent asthma.
Minor side effects from inhaled steroids may be • Beclomethasone dipropionate (QVAR®)
hoarseness and thrush. Thrush is a yeast infection in • Budesonide (Pulmicort Turbuhaler®,
the back of the throat and tongue. This can be reduced Pulmicort Respules®)
by using a spacer with the inhaler. It also helps to • Flunisolide (AeroBid®, AeroBid-M®)
rinse the mouth with water or gargle with mouthwash
• Fluticasone propionate (Flovent®, Advair®)
after use. Inhaled corticosteroids help many people
reduce their need for oral corticosteroids. These can • Triamcinolone acetonide (Azmacort®)
have more serious side effects, such as reduced growth, • Mometasone furoate (Asmanex)
osteoporosis, cataracts and glaucoma.
Long-acting beta agonists Long-acting beta agonists
Long-acting beta agonists can be inhaled or oral.
Inhaled salmeterol and formoterol fumarate (Foradil®)
can help you breathe better for about 12 hours.
They are usually used with an inhaled corticosteroid Inhaled
for long-term control. Inhaled beta agonists are the • Formoterol fumarate (Foradil®)
preferred type. They have fewer side effects. They last • Salmeterol (Serevent Diskus®)
longer than sustained-release albuterol tablets.
Oral
Inhaled steroids combined with • Extended-release albuterol (many brands)
long-acting beta agonists
Advair is a combination of fluticasone propionate
(Flovent®) and salmeterol (Serevent®). It comes in
three strengths: 100/50, 250/50, 500/50. Symbicort
is a combination of Budesonide and Formoterol.
It is available in 160/4.5 and 80/4.5. Dulera is a
combination of Monetasone and Formoterol.
It comes in two strengths: 200/5, 100/5.
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Cromolyn sodium and nedocromil Theophylline can interact with other drugs. Talk with
(mast cell stabilizers) your doctor or pharmacist before taking any other
Cromolyn sodium and nedocromil are called mast cell drugs — prescription or over-the-counter. Never adjust
stabilizers. Cromolyn sodium (Intal®) is inhaled. It your dose on your own. Taking less than the prescribed
keeps the airways from getting inflamed. It is used to dose or skipping doses can lead to an asthma episode.
control mild to moderate allergic asthma. It is taken Taking more than the prescribed dose can lead to
through an inhaler or nebulizer. It may be used all year serious side effects. These may include seizures.
or only in some seasons.
Anti-IgE therapy
Cromolyn sodium also helps control asthma set off Anti-IgE therapy [with omalixumab (Xolair®)] has
by exercise or cold air. For these cases, it is taken just been approved by the Food and Drug Administration.
before exercise or exposure to cold air. This is an injection given every two to four weeks. It
decreases the amount of allergic antibody. It has been
Nedocromil (Tilade®) is a non-steroidal drug like
shown to reduce asthma flares and the need for other
cromolyn sodium. It is used with an inhaler for mild to
drugs. It also reduces allergic rhinitis (hay fever).
moderate persistent asthma. Both of these drugs can
take two to six weeks of use before they begin to work. Quick-relief medications
Epinephrine is often used in emergency rooms for
Theophylline
asthma attacks. (It is also called adrenalin.) It gives fast
Theophylline is a methylxanthine drug that keeps
relief by causing the airways to open, restoring a free
airways in the lungs relaxed and open. It can take up
flow of air. It is not recommended for regular use.
to several hours to work. It is not used for treating
It can increase the heart rate. It should only be given
episodes that are already under way. It is used less often
by a health care professional.
than inhaled corticosteroids.
Theophylline comes in a variety of forms and
strengths. Capsules are a convenient form for young
children. They can be opened and mixed with foods
such as yogurt.
Theophylline can produce side effects. These may
include headache, nausea, vomiting, stomach cramps,
diarrhea, insomnia, fast heartbeat and restlessness.
These can be a sign that your dose is too high. If you
have any of these, talk with your provider. He or she
may use a blood test to check your level of theophylline.
If it is too high, your doctor will adjust your dose or
change the product.
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Short-acting bronchodilators
Other drugs called bronchodilators work much like Commonly prescribed
epinephrine, but are safer. They also work by relaxing short-acting beta agonists
the muscles to let the airways open up and make it
easier to breathe.
Albuterol (Proventil®, Ventolin®)
Inhaled short-acting beta agonists are the most
Levalbuterol (Xopenex®)
common family of bronchodilators. They work fast and
are easy to use. They have few side effects and can be Metaproterenol sulfate (Alupent®)
targeted to the lungs. They are used to give fast relief Pirbuterol acetate (Maxair®)
during an asthma episode. They come in tablets, syrups,
metered-dose inhalers (MDIs) and nebulized solutions.
When used with an inhaler, the beta agonist goes right
into the airways to ease the spasm. Relief begins within Anticholinergics
5 to 15 minutes. It lasts for about 4 to 6 hours. Long- Anticholinergics are a type of cough suppressant. They
lasting beta agonists are not “rescue” inhalers. They block signals in the nervous system that tell the body to
should not be used for relief from an episode. cough. Ipratropium bromide (Atrovent®) is an inhaled
medication. It offers fast relief from acute episodes. It
MDIs can be carried in a pocket or purse for use when is most often used with a beta agonist to relieve coughs
coughing or wheezing starts. Beta agonists in syrup, or for dilation of the bronchi. It begins to work within
tablet and nebulizer forms can be used with young 30 minutes after it is taken. Combivent® inhaler and
children and for others who cannot use an inhaler. DuoNeb® nebulizing solution are combined beta
agonist and anticholinergic products.
The syrup and tablet forms work more slowly than the
inhaled. They can also have more side effects. Still, they
may be more convenient for those with few asthma
episodes.
Beta agonists may have side effects. Proper inhalation
is key to ensure that the medication gets to the lungs.
(See the section on inhalers later in this chapter.) In
most cases, inhalers should not be used more than
two puffs every four to six hours. If you need more
relief than this, talk with your doctor. You may need
a different drug. Overuse of beta agonists is a sign of
asthma that is not controlled. It increases the chance
for side effects. These may include fast heartbeat, jitters
or headache.
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Oral corticosteroids Other medications
Oral corticosteroids are the strongest asthma drugs. Inflammation and mucus in the sinuses, nasal passages
They are mainly used for those with severe asthma. and throat can affect the small airways in the lungs.
They are also used to give fast relief from severe So drugs to relieve these symptoms can also help your
episodes. They begin to work within 8 to 12 hours of asthma. Allergic rhinitis (hay fever) causes congestion,
the first dose. They come in tablet or liquid forms. runny nose and other symptoms. Mild cases can be
They manage asthma very well for short periods when treated with antihistamines and decongestants.
other drugs do not work. Nasal corticosteroids may also be used. These are
similar to inhaled corticosteroids but are used as a
Side effects from short-term use (three to 10 days) are nasal spray. In severe cases, some of the asthma drugs
unusual. Side effects may include weight gain, fluid may be prescribed.
retention, mood changes, muscle pain, sleep issues
and stomach aches. Most symptoms go away when
the drugs are reduced or stopped. These drugs should
be taken with food to prevent an upset stomach. They Get the most from
should be used only with supervision by your health your medications
care provider.
Long-term use of oral corticosteroids is avoided due
to possible side effects. People who have severe asthma
}} Know what each medication you take is supposed
that cannot be controlled with other drugs may need to
to do. Know how much to take and how often.
take them for longer periods. This should be done only
with supervision by your provider. Your provider can }} Ask your doctor or pharmacist about side effects
give you a dose that lowers the risk of side effects. This and how to minimize them.
may mean taking the drugs every other morning. You }} Be sure to know if one medication should be
may need to take other steps to avoid any side effects. taken before another.
(For example, postmenopausal women may need to
}} Follow all instructions with care. Take the
take 1,000 to 1,500 mg of calcium and 400 units of
medicine as directed by your doctor.
vitamin D per day to prevent osteoporosis.)
}} Follow all directions for devices such as nebulizers
Oral corticosteroids used for asthma control are not the or inhalers with spacers.
same as anabolic steroids used by some athletes. Oral
}} Be prepared. Don’t run out of medications.
corticosteroids are synthetic replicas of the steroids
Always have an extra supply on hand.
made in the body by the adrenal gland. Anabolic
steroids are male hormones. They have a different }} Ask your provider if you should keep oral
effect in the body than oral steroids. corticosteroids on hand for severe episodes.
}} Asthma symptoms may change over time.
Tell your doctor about any changes. The doses
may need to be adjusted.
}} Ask your doctor or pharmacist to check all new
drugs for interactions with ones you are taking.
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Administering asthma medications Nebulizers.
You need special equipment for inhaled medications. Children too young to operate an inhaler are often
Sometimes this is the container in which the drug is treated with a nebulizer. This device is also ideal for
packaged. Other items, such as spacers or nebulizers, adults who have problems using MDIs. It is also used
may be needed. Below are the systems for delivering for those with severe and erratic asthma episodes.
inhaled drugs to the lungs.
Nebulizers use compressed air to turn liquid medication
into a fine mist that is breathed in through a mask
Inhalers or mouthpiece. It may be used for bronchodilators,
cromolyn sodium or the corticosteroid budesonide
Metered-dose inhalers (Pulmicort Respules®).
A metered-dose inhaler (MDI) is a small, portable
canister. It delivers a measured amount of medication. Nebulizers are usually used in doctors’ offices and
Proper technique and, in most cases, use of a spacer emergency rooms. They can also be purchased for home
are needed to ensure that medication gets to the use. A home nebulizer can help prevent a trip to the
lungs. The common errors people make when hospital. Many types of nebulizers are used. They range
using inhalers are: from small battery packs to units that plug into a
wall socket.
}} Poor timing between activation of the MDI and
inhalation. (An example is exhaling instead of When using a nebulizer at home, be sure to follow
inhaling at the moment the medication is released.) your doctor’s directions. Nebulizers should not be
overused or underused. The nebulizer cup and mask or
}} Inhaling too rapidly mouthpiece should be rinsed out and air-dried after
}} Not holding your breath briefly after inhaling. each use. Wash with soft water if possible.
}} Not keeping the inhaler clean New devices.
MDIs may not work properly if cold. If your MDI is Many new devices for asthma drugs have come out in
exposed to cold, warm it in your hands before using. the last 10 years or so. They continue to develop new
devices. The Turbuhaler® and Diskus® are among the
Be sure the inhaler has medicine in it before you use
most recent. These use inhaled powders. Your doctor
it. If you use the same dose every day, you can calculate
can tell you about more options if an MDI or nebulizer
how long it will last. A canister with 200 doses will last
does not meet your needs.
25 days if you use four puffs twice a day. (200 doses ÷
8 puffs/day = 25 days.) Shaking the container is not a
good way to tell if any medicine is left. Aerosols may
be in the canister even after all the medicine is gone.
Always keep an extra inhaler handy so you are sure not
to run out.
You need to keep your inhaler clean. To prevent
clogging, rinse your inhaler daily. Keep the cap on
when not in use. Wash your inhaler (except Intal®
and Tilade®) once a week in warm water with a
mild dish detergent.
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Spacers
If you use an MDI, you will probably also need to How to use an inhaler
use a spacer. The spacer extends the space between
the inhaler and your mouth. Examples of spacers are
the AeroChamber®, InspirEase® or a plastic tube.
Spacers make using inhalants easier. They let more of To be sure you are using your metered-dose inhaler
the drug get deeper into the lungs. Without a spacer, correctly, stand in front of a mirror and follow the
inhaled drugs tend to spray to the back of the throat steps below. If at any time fog comes from the mouth
and go no farther. Spacers are important in preventing when inhaling or exhaling, the medication is not
thrush. Thrush is a yeast condition that can be caused reaching the lungs. It is also wise to demonstrate
by inhaled corticosteroids. If your inhaler makes you your inhaler technique to your health care provider
cough, talk with your doctor. regularly to be certain you are doing it properly.
1. Shake the container well before using.
Remove the cap, and hold the
container upright.
2. Place a spacer on the end of the inhaler.
If you don’t have one, roll up a piece of
paper to act as a spacer.
3. Breathe out normally. Then place the spacer
in your mouth and gently close your lips
around it.
4. Press down on the top of the inhaler to
release a puff of medication. Breathe in slowly
and deeply through your mouth.
5. Keep breathing in slowly for three to five
seconds until the lungs are full.
6. Hold your breath for 10 seconds to let the
medicine deposit in the lungs.
7. Usually
the next puff can be taken right away.
In some cases, a one to three minute wait is
advised before taking another puff.
8. Check with your doctor for directions for
your medications.
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Asthma medications
Quick-relief Medications
Class of Generic Names and Miscellaneous Information/
How Does It Work? Possible Side Effects
Medication Available Forms Handling Side Effects
Beta Agonists albuterol •R elaxes the smooth • Tremor, fast and/or • Side effects more common
(Proventil®, muscles of the airways, pounding heartbeat, and stronger with oral
Ventolin®) making it easier to nervousness and dizziness agents
Metered-dose inhaler breathe
(MDI), Solution for • Lasts 4-6 hours • If side effects are severe,
inhalation, Syrup, and last longer than one
Tablet hour, call your doctor
levalbuterol
(Xopenex®)
Solution for inhalation
metaproterenol
sulfate (Alupent®)
MDI, Solution
for inhalation
pirbuterol acetate
(Maxair®, Maxair®
Autohaler®) MDI
terbutaline Tablet
Anticholinergics ipratropium •R elaxes the smooth • Dry mouth, cough, rapid • Most often used in
bromide muscles of the airways by heartbeat, blurred vision, combination with a
MDI, Solution for inhibiting the action of headache and nervousness beta-agonist
inhalation acetylcholine
• Lasts 6-8 hours
Beta Agonists ipratropium • Relaxes the smooth • Dry mouth, cough, rapid
Combination bromide/albuterol muscles of the airways, heartbeat, blurred vision,
Anticholinergics/ sulfate making it easier headache, nervousness
(Combivent,® to breathe and tremor
Duoneb®) • Lasts 4-6 hours
MDI, Solution for
inhalation
Corticosteroids methylprednisolone •R
educes swelling, • Increased appetite, stomach • Take with food to avoid
(Medrol®) inflammation and mucus ache, mood changes, stomach ache
Tablet production in the airways muscle pain, fluid retention • Potential for side effects
and increased blood sugars is dose-related
prednisone • Long-term use may cause
(many brands) more severe side effects
Tablet, Syrup
prednisolone
(Prelone,®
Pediapred®)
Syrup
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