Control Asthma

If you suffer from asthma, a disease of the lungs, you're not alone. 26 million people in the U.S. are affected by asthma,[1] which is also the most common chronic disease in childhood.[2] With asthma, the airways in the lungs are narrowed, inflamed, or twitchy. The obstruction of the airways makes it difficult to breathe.[3] While there's no cure, you should see a doctor if you're concerned. Visit a general practitioner or a specialist (like a pulmonologist or allergist). You may notice fewer: symptoms, visits to the doctor/emergency room, hospital stays, health care costs, and missed days from work or school.[1]

Steps

Getting Medical Help

  1. Learn the symptoms of asthma. One of the most common symptoms of asthma is wheezing. It is a musical, high-pitched, whistling sound made when airflow is blocked in the lungs. Sometimes, the only symptom of asthma is coughing. The cough is usually non-productive, chronic, and mostly at night.[2] You may also notice shortness of breath/difficulty breathing or chest tightness and pain.
    • If you experience anxiety and hyperventilation (rapid breathing), it's usually associated with asthma attacks. It is not usually caused by a heart problem.[4]
  2. Know when to see your doctor. If you notice an increase in episodes, severity, or symptoms at night you should talk with your doctor. Also, if you're limiting your normal activities, missing a lot of work or school, or feel like you're not reaching your personal best on a regular basis you should see your doctor. A visit is also a good idea if your asthma medications don’t seem to work anymore or you're using quick-relief inhalers more than twice per week.[5]
    • You should also see your doctor at least once a year for new prescriptions for your medication.
  3. Seek emergency treatment when necessary. Asthma can create a serious, life-threatening condition very quickly, so you should seek immediate assistance if you have the following symptoms:
    • Severe difficulty breathing
    • Lips, fingers, or fingernails turning blue
    • Feeling as though you are about to pass out
    • Not being able to walk or talk in full sentences
  4. Understand testing and asthma classifications. Your doctor will perform tests on your lungs to see how they're functioning (known as Spirometry). Your lungs will be tested before and after taking certain medications. The improvement in your lung function after these medications will determine how the asthma is diagnosed.[6] Asthma may be classified as intermittent, mild persistent, moderate persistent, or severe persistent.[2]
    • Intermittent: symptoms happen less than once a week, brief episodes, night symptoms don't happen more than twice a month.
    • Mild persistent: symptoms more than once a week but less than once a day, episodes may affect activity and sleep, and night symptoms happen more than twice a month.
    • Moderate persistent: daily symptoms, episodes that may affect activity and sleep, night symptoms more than once a week, and daily use of an inhaled short-acting beta-agonist.
    • Severe persistent: daily symptoms, frequent episodes, frequent night symptoms, and limitation of physical activities.
  5. Recognize the treatment options for different types of asthma. The goal of asthma treatment is to control the symptoms and maintain lung function over time using quick-relief medicines and long-term control medicines, if needed. Quick-relief medicines are very useful for helping to open airways during a severe asthma attack, but don't affect airway inflammation. Long-term relief medicines reduce inflammation of the lungs and are used to decrease the frequency and severity of asthma attacks, but they are not useful during an acute asthma attack.[7] Long-term medicines also maintain lung function over time; uncontrolled asthma can lead to irreversible lung changes. The following are usually the treatments used for each classification of asthma:[6] Asthma may be classified as intermittent, mild persistent, moderate persistent, or severe persistent.[2]
    • Intermittent: Inhaled short-acting beta-agonist as needed. No long-term control medicine needed.
    • Mild persistent: Inhaled short-acting beta-agonist as needed. Low-dose inhaled corticosteroid. Other treatment options include cromolyn or leukotriene modifier.
    • Moderate persistent: Inhaled short-acting beta-agonist as needed. Low to medium-dose inhaled corticosteroid plus inhaled long-acting beta-agonist.
    • Severe persistent: Inhaled short-acting beta-agonist as needed. High-dose inhaled corticosteroid plus inhaled long-acting beta-agonist plus 1 more of the following, if needed: Theophylline, Leukotriene modifier, Oral long-acting beta-agonist, Oral corticosteroid.
  6. Use a metered-dose inhaler (MDI) with or without spacers. If you find yourself having an asthma attack, using an inhaler can help you inhale fast-acting medication that will open your airways. Inhalers work best with spacers. Spacers are pressurized canisters that make it easier to dispense the medication into your airways. Spacers work particularly well for kids or people that have trouble breathing but anyone can benefit from a spacer.[8] Spacers help the medicine get deep into the lungs, rather than into the back of the throat, which is especially important for inhaled corticosteroids. To use the inhaler:
    • Assemble the inhaler by opening and attaching the medicine container at the medicine port of the inhaler. Shake the inhaler well before use. This makes sure that the medicine in the bottle is properly mixed.
    • Exhale completely so that your lungs feel empty of air.
    • Put the mouthpiece in your mouth and secure it with your lips, forming a sealed connection. This way you won’t waste any medicine.
    • Press the medicine bottle and simultaneously inhale through your mouth while holding your breath for 2 seconds so that the medicine can be absorbed in the airway. Repeat this process as prescribed by your doctor.
    • If you are using a spacer, be sure to read the instructions that accompany the device. Using the spacer may change how you use your inhaler.
  7. Use a dry-powder inhaler (DPI). Certain medications come in powdered form which require you to use a different type of inhaler. If you have an asthma attack and need to use your DPI, you'll need to breathe in deeply and quickly.[8] You may not feel or taste the medication as you breathe in and this is normal. To use:
    • Load the prescribed dose of medication by following the instructions that come with the inhaler.
    • Breathe out normally, holding the inhaler away from your mouth. Hold your chin up.
    • Put the mouthpiece between your lips. Breathe in quickly and deeply through the inhaler. Remove the mouthpiece and hold your breath for a count of 10.
    • Breathe out slowly but not through the inhaler. Moisture from your breath can make the powder stick inside the inhaler.[6] Be sure to close the inhaler and store it in a dry place when you're finished using it.
  8. Try a nebulizer. Nebulizers work by administering asthma medications as a fine mist through a mouthpiece or mask. This can make it a good choice for children, the elderly, or those that have trouble using inhalers. If you get dizzy while using a nebulizer, pause for five minutes and then continue the treatment.[6] To use a nebulizer:
    • Wash your hands. Set the nebulizer on a sturdy platform and plug it in an electric socket. Attach the mouthpiece/mask and the nebulizer cup to the tubing. Attach the tubing through a port of the nebulizer.
    • Put the prescribed medication in your nebulizer cup and position the nebulizer upright so that the air flows more effectively.
    • Turn on the machine and breathe the aerosol slowly. Simultaneously hold your breath for two seconds to let the medicine absorb. Continue until the nebulizer cup is empty.[6]

Avoiding Triggers

  1. Avoid environmental triggers. Asthma triggers can be categorized as irritants, allergens, and other triggers. Irritants include smoke, smog, chemical fumes, and strong odors. You should know what kind of weather bothers your asthma and try to limit outdoor activity during these times. There are also other things you can do to decrease the effects of irritants within your immediate environment. These include:[6]
    • Asking for nonsmoking rental cars and hotel rooms
    • Sitting in the nonsmoking section when dining out
    • Avoiding fireplaces and wood stoves
    • Refraining from burning incense indoors
    • Checking air quality reports
    • Using home air conditioning instead of opening windows
    • Setting car air conditioning to recirculate
    • Using scent-free products
    • Avoiding the use of ammonia and bleach while cleaning
    • Using exhaust fans while cooking
    • Wearing a protective mask while doing tasks such as sanding, dusting, mowing, and sweeping
  2. Identify allergens that trigger your asthma. Allergens are substances that cause allergic reactions. Common outdoor allergens include pollens from grass, trees, and weeds. Common indoor allergens include dust mites, cockroaches, mold, and pets.[1] While it may not always be possible to avoid allergens, you can talk to your doctor about allergy treatments or medications. You can also try to decrease the effects of allergens on asthma by:[6]
    • Avoiding yard work, if possible
    • Tracking the pollen report, if available
    • Covering mattresses and pillows with hypoallergenic covers
    • Using HEPA air filters
    • Replacing carpet with wood or tile floors
    • Removing garbage from the home daily
    • Using bait stations or traps to control roaches (or calling an exterminator)
    • Cleaning damp areas weekly to prevent mold growth
    • Avoiding the use of vaporizers and humidifiers
    • Avoiding pets with fur or feathers
  3. Read food labels and be aware of what you are eating. Asthma often goes hand-in-hand with food allergies, especially to food additives. Some food additives include sulfites, metabisulfites, and sulfur dioxide. These are commonly found in wine, beer, and dried fruit. Check food labels and avoid food with these additives.
    • Talk to your doctor about avoiding, diagnosing, and managing food allergies. Some food allergies are quite severe and necessitate the use of an EpiPen for unexpected exposure.
  4. Watch for medicine or illness triggers. Colds, flu, and sinus infections are some upper respiratory illnesses that can irritate your airways and cause asthma attacks. To fight these illnesses, frequently wash your hands and get a flu shot every year.[6] If you think you have the flu or another illness that is causing your asthma to flare up, contact your doctor.
    • Note that some aspirin and anti-inflammatory medicines like ibuprofen and naproxen are responsible for some asthma flare-ups.
    • Check labels on over-the-counter and prescription medications to avoid these substances.
  5. Manage your emotions and stress. Emotions such as crying, laughing, or joy have been known to trigger asthma events. Practice slow breathing to relax and prevent asthma attacks.
    • Try exercising to manage stress. Don't avoid exercise if you have asthma. If you do have exercise-induced asthma, take a dose of a quick-relief inhaler 15 minutes before you start to exercise.
    • Be aware that overly intense exercise (or implementing a new exercise regimen too suddenly) can cause asthma to flare.

Adjusting Your Lifestyle

  1. Follow the advice provided by your doctor. The first place you start should always be following the asthma plan that your doctor comes up with for you. Every case is different and your doctor will be able to give you specifics for you particular case and lifestyle.
    • Ask your doctor for a written asthma action plan. This can take the guess-work out during an attack and can be shared with others if you need assistance.
  2. Track your asthma using a peak flow meter. Your doctor can prescribe a peak flow meter which measures how fast you can push air out of the lungs. Decreases in peak flow meter results can signal an upcoming asthma attack, so it's important to keep track of your personal best when using a peak flow meter.[5] To use the meter:
    • Move the marker to 0, or to the lowest number on the scale. Stand up. If you can’t stand, sit up straight in a chair. Be sure you’re in the same position each time you do this test.
    • Take as deep a breath as you can. Put the mouthpiece of the meter between your teeth and close your lips tightly around it. Be sure your tongue does not block the opening.
    • Blow into the mouthpiece once, as hard and as fast as you can. Then take the meter out of your mouth. Check where the marker has moved to on the numbered scale and write this number down.
    • Move the marker back to 0. Repeat the test two more times, circling the highest of the three numbers. This is your peak flow number.[9]
  3. Know when you need to rest. It's important to recognize when you need to slow down and rest. Overexertion or fatigue can lead to asthma attacks. Know when too much activity is too much, so you can rest and catch your breath before an asthma attack happens. Establish a regular sleep schedule with at least 8 hours of sleep each night.[10]
  4. Drink more water. Drinking water will keep mucus moving in your lungs and prevent it from clogging up your airways, which can lead to shortness of breath.[11] Try to drink a small glass of water at least once every 2 hours while you're awake. [11]
  5. Maintain a healthy weight. Excess weight can increase the severity of asthma attacks. Gaining even as little as 5 pounds in a year can lead to decreased control of asthma, worse quality of life, and greater use of corticosteroid medicines.[12] The key to reaching a healthy weight is a nutritious diet and exercise.[13]
    • Cut back on fatty foods, sugar, and excess carbohydrates. For more information on how to create a healthy diet for yourself, learn how to eat healthy.
  6. Reduce your stress levels. Stress can cause you to have an asthma attack because your body can respond by restricting your airways. Try reducing your stress levels through yoga, deep breathing exercises, biofeedback, guided imagery, and meditation. These are all ways to relax and de-stress.[10]
    • Biofeedback trains you to control your breathing, muscle tension, heart rate, and blood pressure. It is very effective in treating conditions brought on by severe stress.[14] Guided imagery is a form of focused relaxation that helps create harmony between the mind and body.[15]
  7. Strengthen your lungs through moderate exercise. While strenuous exercise when your lungs are weak could lead to an asthma attack, moderate exercise can actually strengthen your lungs. Start with light or moderate exercises, like walking, and work your way into a more challenging workout regimen. Exercise most days of the week for a total of at least 30 minutes.[6] Talk with your doctor to tailor an exercise routine that fits the limitations of your asthma.[16]
    • Try aerobic activity in the form of one of the following: jogging, swimming, bicycling, or walking. Do strength training with weights or resistance to build muscle.
  8. Stop smoking. Smoking irritates the mucous linings of the airways which stimulates them to produce more mucus than normal. It also greatly increases your risk of other lung problems and cancer. If you have asthma, you should quit smoking to give your sensitive lungs a chance to recover.[17]
    • Avoid being around smoke in general. Second hand smoke can also wreak havoc on the linings of your airways so try to avoid being around cigarette smoke as much as possible.

Tips

  • Asthma can be difficult to diagnose, especially in children under 5. Regular physical checkups, including checking your lung function and checking for allergies, can help your doctor make the right diagnosis.
  • Asthma sufferers should also develop an asthma action plan with their medical team. The asthma action plan includes measures needed to get better control of asthma.
  • If you think your rescue inhaler isn't working, you may be using it incorrectly. The stream of medication should be pointed at the airway, not at the tongue or roof of the mouth. You must also inhale and hold the breath in your lungs for as long as possible to help the medication absorb. One puff is usually not enough and you might need to take two to four puffs every twenty minutes for up to an hour.[18] Using a spacer usually makes it easier to use an inhaler correctly and effectively. You can also take your medication to the doctor and have them watch you use it to ensure that you are using it correctly.
  • Quick-relief, or rescue, medicines are used as needed and include inhaled short-acting beta-agonists, anticholinergics, combination inhaled short-acting beta-agonist/anticholinergic, and oral corticosteroids. The most commonly used inhaled short-acting beta-agonist is albuterol, which works by relaxing the muscles tightening the airways.[6]
  • Anticholinergics suppress cough and can be used in combination with a short-acting beta-agonist for a severe attack. Ipratropium is the most commonly used anticholinergic asthma medicine. Oral corticosteroids may be used in burst therapy for severe asthma episodes. Examples of corticosteroids are prednisone, methylprednisolone, and prednisolone.[6]
  • Long-term relief medicines are taken daily and include long-acting beta-agonists, inhaled corticosteroids, combination inhaled long-acting beta-agonist/corticosteroid, leukotriene modifiers, mast cell stabilizers, and theophylline.[19]
  • The best way to keep track of symptoms is in a diary or journal.

Warnings

  • Respiratory infections are more serious in patients with asthma. These infections can often lead to pneumonia and acute respiratory disease.
  • Be sure to call or see your doctor if you have asthma and develop symptoms of a respiratory illness or the flu.
  • Adults and children with asthma are at high risk of developing complications after contracting the influenza virus. Unless you are unable, you should get a yearly influenza vaccine if you have asthma.

Related Articles

Sources and Citations

  1. ↑ 1.0 1.1 1.2 http://acaai.org/asthma/about
  2. ↑ 2.0 2.1 2.2 2.3 http://emedicine.medscape.com/article/296301-overview#aw2aab6b2b1aa
  3. ↑ https://www.oxhp.com/secure/materials/member/asthma.pdf
  4. ↑ http://www.webmd.com/asthma/guide/asthma-symptoms
  5. ↑ 5.0 5.1 http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/treatment
  6. ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 http://www.bcbsla.com/docs/krames/LivingWellWithAsthma.pdf
  7. ↑ http://www.cdc.gov/asthma/pdfs/asthma_brochure.pdf
  8. ↑ 8.0 8.1 http://www.webmd.com/asthma/guide/asthma-inhalers
  9. ↑ http://www.bcbsla.com/docs/krames/LivingWellWithAsthma.pdf
  10. ↑ 10.0 10.1 http://www.everydayhealth.com/asthma/how-stress-triggers-asthma.aspx
  11. ↑ 11.0 11.1 http://brown.edu/Student_Services/Health_Services/Health_Education/common_college_health_issues/asthma.php
  12. ↑ http://www.webmd.com/asthma/news/20071113/extra-weight-adds-asthma-tol
  13. ↑ Ernst, A & Herth, F (2012). Principles and Practice of Interventional Pulmonology
  14. ↑ http://www.medicalnewstoday.com/articles/265802.php
  15. ↑ http://my.clevelandclinic.org/services/wellness/integrative-medicine/treatments-services/guided-imagery
  16. ↑ http://www.asthma.org.uk/knowledge-bank-living-with-asthma-exercise
  17. ↑ Smeltzer, S. ET. Al.(2008). Brunner & Suddarth’s textbook of medical-surgical nursing.
  18. ↑ http://www.mayoclinic.org/diseases-conditions/asthma-attack/basics/treatment/con-20034148
  19. ↑ https://www.oxhp.com/secure/materials/member/asthma.pdf

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