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Asthma treatment: 3 steps to better asthma controlBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/asthma-treatment/AS00011
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Asthma treatment: 3 steps to better asthma control
Follow this three-step approach to keep asthma symptoms under control and prevent asthma attacks.By Mayo Clinic staff
Effective asthma treatment requires routinely tracking symptoms and measuring how well your lungs are working. This information can then be used to adjust your asthma treatment according to the plan you made with your doctor. Taking an active role in managing your asthma treatment will help you maintain better long-term asthma control, prevent asthma attacks and avoid long-term problems.
Create a written asthma action plan with your doctor. This written plan will serve as an asthma treatment guide tailored to your specific needs. It will help you follow these three important steps, keeping a good handle on your asthma treatment:
1. Track your symptoms
Write down your symptoms in an asthma diary each day. Recording symptoms can help you recognize when you need to make treatment adjustments according to your asthma action plan. Use your asthma diary to record:
- Shortness of breath or whistling sounds when you exhale (wheezing)
- Disturbed sleep caused by shortness of breath, coughing or wheezing
- Chest tightness or pain
- Quick-relief (rescue) inhaler use — record when you need to use your quick-relief inhaler (such as albuterol) and write down how many puffs you take
- Disruptions to work, school, exercise or other day-to-day activities caused by asthma symptoms
- Asthma symptoms during exercise
- Changes in color of phlegm you cough up
- Hay fever symptoms such as sneezing and runny nose
- Anything that seems to trigger asthma flare-ups
2. Record how well your lungs are working
Your doctor may have you periodically record results of breathing tests (lung function tests). If your lungs aren't working as well as they should be, your asthma may not be under control. There are two main lung function tests:
- Peak flow. This test is done at home with a simple, hand-held device called a peak flow meter. A peak expiratory flow (PEF) measurement indicates how fast you can force air out of your lungs. Peak flow readings are sometimes gauged as a percentage of how your lungs work at their best. This is called your personal best peak flow.
- Spirometry. Spirometry tests can be done at your doctor's office with a machine called a spirometer. Some people use a hand-held spirometer to take measurements at home. Spirometry tests measure how much air your lungs can hold and how much air you can exhale in one second after you've taken a deep breath. This measurement is called forced expiratory volume (FEV1). Your FEV1 measurement is compared with the typical FEV1 for people who don't have asthma. As with your peak flow reading, this comparison is often expressed as a percentage.
3. Adjust treatment according to your asthma action plan
When your lungs aren't working as well as they should be, you may need to adjust your medications according to the plan you made with your doctor ahead of time. Your written asthma action plan will let you know exactly when and how to make adjustments.
The chart below can help you determine if you're doing a good job of keeping your asthma under control. A similar system should be included in your asthma action plan. Depending on where your asthma control falls on the chart, you may need to make adjustments to your medications.
Levels of asthma control in children over 12 and adults
|Poorly controlled |
|Very poorly controlled
|Symptoms such as coughing, wheezing or shortness of breath||Two days a week or fewer||More than two days a week||Daily and throughout the night|
|Nighttime awakenings||Two times a month or fewer||One to three times a week||Four times a week or more|
|Effect on daily activities||None||Some limits||Extremely limiting|
|Quick-relief inhaler use to control symptoms||Two days a week or fewer||More than two days a week||Several times a day|
|Lung test readings||More than 80% of your predicted personal best||60 to 80% of your predicted personal best||Less than 60% of your predicted personal best|
There are two main types of medications used to treat asthma:
- Long-term control medications such as inhaled corticosteroids are the most important medications used to keep asthma under control. These preventive medications treat the airway inflammation that leads to asthma symptoms. Used on a daily basis, these medications can reduce or eliminate asthma flare-ups.
- Quick-relief inhalers contain a fast-acting medication such as albuterol. These medications are sometimes called rescue inhalers. They're used as needed to quickly open your airways and make breathing easier. Knowing when to use these medications can help prevent an impending asthma attack.
Long-term control medications are the key to keeping your asthma in the green, or well-controlled, zone. If you frequently use a quick-relief inhaler to treat symptoms, your asthma isn't under control. See your doctor about making treatment changes.
Make sure you know how to use your asthma medications properly. They will only keep your asthma under control if you use them correctly.
Work with your doctor
Asthma symptoms and severity are always changing. Meet with your doctor on a regular basis to review your treatment. Take your asthma diary and asthma action plan with you when you go to the doctor. That way, you can review them together and make any needed changes to your treatment plan.
If you follow your asthma action plan but you're still having bothersome symptoms, make an appointment to see your doctor. You may need to increase or change your medications. On the other hand, if your asthma is well controlled all of the time, you may be able to reduce the amount of medication you take. If you have seasonal allergy triggers, your asthma medication may need to be increased at certain times of the year.
By taking these steps to keep your lungs functioning well every day, you'll help avoid asthma attacks and minimize the disruptions caused by asthma symptoms.
- Guidelines for the diagnosis and management of asthma: Summary report 2007. Bethesda, Md.: National Heart, Lung, Blood Institute. http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.pdf. Accessed Oct. 8, 2010.
- Peters S, et al. Treatment of moderate persistent asthma in adolescents and adults. http://www.uptodate.com/home/index.html. Accessed Sept. 27, 2010.
- Mangan JM, et al. What do patients need to know about their asthma? http://www.uptodate.com/home/index.html. Accessed Sept 27, 2010.