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THINGS YOU SHOULD KNOW ABOUT

ASTHMA

Asthma – It’s on the rise.* Asthma affects people of all ages. For most people, it starts in childhood. More than 23 million people in the United States have asthma. Of these, 7 million are children. More and more people are diagnosed with asthma each year. Having asthma doesn’t mean you have to stop doing all of the things you enjoy. With treatment, you can live a normal active life. The key is to keep your asthma controlled. To achieve this you need to: • • • • •

Work closely with your doctor or other health care providers to manage your asthma Identify the things (triggers) that bring on your asthma symptoms Control and avoid your asthma triggers Take your medicines as directed by your health care provider and learn to use an inhaler and spacer correctly Monitor your asthma and respond quickly to warning signs of an attack

The good news – you can learn to control your asthma instead of letting your asthma control you. * This brochure is meant to help you learn more about asthma. It doesn’t tell you everything. Talk with your health care provider about asthma and ways to manage it.

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What is asthma? Asthma is a chronic lung disease. Chronic means you have the disease for a long time, usually a lifetime. When you have asthma, your airways – the tubes that carry air in and out of your lungs – are very sensitive to things like dust, pollen, and viruses. When you are exposed to these things your airways overreact and become narrow. Several changes can take place when this happens: • The lining of your airways become swollen or inflamed making it hard for air to move in and out. • The muscles around your airways tighten up which cause them to narrow even more. This is called bronchospasm (BRONK-oh-spaz-em).

Normal Airway Muscle

Airway wall

Airway cross section

Airway With Asthma Symptoms

• The airways produce a thick mucus which builds up and blocks the airways.

Inflamed airway wall

When these things happen you may find it hard to breathe. You may also wheeze (make a whistling noise when you breathe) or have other symptoms of asthma. Some people with asthma develop ongoing inflammation. This makes the airways super sensitive. If not treated, each time you are exposed to your asthma triggers the inflammation gets worse. As a result, you are likely to get asthma symptoms. This is called bronchial hyperresponsiveness.

Tightened muscle

Mucus

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The signs and symptoms of asthma With asthma, your symptoms may come and go. Sometimes they can be mild and not bother you very much. You have no trouble breathing. At other times, your symptoms may get worse and lead to an asthma attack. How often you have symptoms can also vary. You may feel asthma symptoms weekly or even daily. Or you may have them only once in a while. The most common asthma symptoms are: • Coughing • Wheezing • Chest tightness • Shortness of breath • Breathing problems during or after exercise • Breathing problems during certain times of the year • Waking up during the night with asthma symptoms When symptoms start, there are warning signs that an asthma attack is coming on. When you know what your warning signs are, you can act on them quickly and can stop your symptoms before they get worse.

What is an asthma attack?

The signs and symptoms of an asthma attack can vary from person to person. Some may have several symptoms or just 1 or 2. However, most people with asthma describe their symptoms and attacks in a similar way: Little to No Symptoms: Feeling Good • No coughing, wheezing, or tightness in the chest • No shortness of breath during the day or at night • Able to do usual activities • Peak flow numbers are in the Green Zone Moderate Symptoms: Signs Asthma Is Getting Worse • Coughing, wheezing, chest tightness, shortness of breath • Waking up during the night with asthma symptoms • Usual activities are harder to do • Need more quick-relief medicine than usual • Peak flow numbers are in the Yellow Zone Severe Symptoms: Signs Medical Help Is Needed • Feeling very short of breath • Symptoms such as coughing, wheezing, or chest tightness are getting worse • Unable to do usual activities • Trouble sleeping due to breathing problems • Quick-relief medicines are not helping • Peak flow numbers are in the Red Zone Danger Signs: Immediate Help Is Needed • Pulse is very rapid • Lips or fingernails are turning a bluish color • Shortness of breath is making it hard to walk and talk 3

What causes asthma? The exact cause of asthma is still unclear. Usually it involves several factors. Family history or genetics does play a role. If someone in your family has allergies or asthma, your chances of getting it are higher than average. Factors in your environment may also play a part. For example, young children who are exposed to certain indoor allergens may be more likely to get asthma. These include dust mites, cockroach droppings, cat dander, and mold. Other factors that may play a role in causing asthma include: • Frequent respiratory infections such as colds or pneumonia • Tobacco smoke or secondhand smoke • Air pollution • Chemicals and irritants at work • Obesity Also, babies whose mothers smoked during pregnancy are at higher risk of getting asthma.

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How is asthma diagnosed? The only way to know if you have asthma is to get a complete checkup. This checkup should include: A physical exam to learn more about your health and check symptoms. A spirometry (speh-ROM-eh-tree) test. This test is used to check how well your lungs are working. A medical history. Your health care provider will ask you some questions about: • Any asthma symptoms you are having • When you are having symptoms and how often you have them • Things that cause your symptoms or make them worse • How often you get colds that “go to the chest” and how long you have them • Your family history of asthma and allergies • Time lost from school or work • Activities you can no longer do or have a hard time doing You may also need other tests to help your doctor decide if you have asthma or another health problem that is causing your symptoms. These include: • Allergy testing • A chest x-ray or electrocardiogram (ee-lek-tro-KAR-dee-o-gram) to check for heart disease or another lung condition • Tests to see if you have gastroesophageal (GAS-tro-ee-sofa-JEE-al) reflux disease (GERD) • A test to see how exercise affects your airways • A test for sinus disease During your visit, also tell your health care provider about any medicines you take for your symptoms or other health conditions. Include prescriptions, over-the-counter medicines, and supplements.

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Be a partner with your doctor When you have asthma it’s important that you work closely with your health care provider on an ongoing basis to keep your asthma under control. He or she should: • Work with you to come up with treatment goals • Teach you how to take your medicines correctly. For example, how to use an inhaler • Help you identify and avoid things that make your asthma worse • Describe early warning signs of an asthma attack and how you should respond to them • Explain how and when to use a peak flow meter if you need one to monitor your asthma • Address any concerns you have about your asthma or treatment • Answer all of your questions about asthma and how to manage it

Using an asthma action plan Managing asthma needs to be part of your daily routine. To help you, your doctor will work with you to develop an asthma action plan. This plan is your personal “how-to” guide for managing asthma. Having an action plan is very useful if you have moderate to severe asthma, or if your asthma is not in good control. Your asthma action plan should include: • Your doctor’s name and phone number • The phone number of a nearby hospital/emergency department • What symptoms and peak flow readings tell you your asthma is in control, getting worse, or very bad (severe) • How you should respond when your asthma is getting worse, such as what medicines you need to add or increase • When to call your doctor or seek emergency care right away

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Control things (triggers) that make your asthma worse Most asthma symptoms start when something bothers your airways. These things are your triggers. To control your symptoms, you need to learn what your triggers are. Then take steps to reduce or avoid them. Some common asthma triggers are: • Allergens such as dust mites, animal dander, mold, pollen, and cockroach droppings • Irritants such as tobacco smoke, air pollution, strong odors, and cold air • Respiratory infections such as colds, flu, and pneumonia • Physical activity and sports Other triggers may include vacuuming, strong emotions like crying, certain medicines, food and beverages with sulfites (shrimp, dried fruit, and red wine) and GERD.

Ways to control your triggers Here are some things you can do to control your triggers. Focus on the things that affect your asthma. Ask your family to help you. For more ideas, talk with your doctor or other health care provider. Animal Dander Cockroach Droppings Dust Mites

Indoor Mold Pollen & Outdoor Mold Tobacco Smoke Physical Activity

• • • • • • • • • • • • • • • • •

If you can, keep furry pets out of your home Never allow pets in your bedroom Keep garbage in closed containers Don’t leave food out or in open containers Use baits, powders, or traps to kill cockroaches Put your mattress and pillow in dust-proof covers Wash sheets and blankets each week in hot water (130° F) or use warm water with bleach Remove stuffed toys from your bedroom Fix leaky faucets and pipes Clean moldy surfaces with bleach Keep windows closed during allergy season If you can, stay indoors when mold and pollen counts are highest (usually in the middle of the day) If you or other family members smoke, try to quit. Ask your doctor for help Don’t let people smoke in your home or car Ask your doctor about using a quick-relief medicine before exercise and what types of physical activity are best for you Warm-up before you start. Slowly increase how hard you exercise If you have mild symptoms, don’t exercise as hard or as long

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Use your medicines to help control your asthma Most people with asthma need 2 kinds of medicines. They are: 1. Quick-relief medicines. These inhaled medicines are also called “rescue” medicines. They help stop asthma symptoms right away. Quick-relief medicine can also be used to prevent symptoms during exercise. The most common quick-relief medicine is a short-acting beta-agonist. It works fast to relax tightened muscles around your airways. This allows more air to flow through. All people with asthma should have a quick-relief medicine to use when needed. 2. Long-term control medicines. These medicines are taken every day. Even when you don’t have symptoms. They control swelling in your airways. This helps prevent asthma symptoms and attacks. They do not stop symptoms once they start. Inhaled corticosteroids are a common type of long-term control medicine. It is an anti-inflammatory medicine that works very well to treat asthma. Other long-term control medicines used to treat asthma include: • Inhaled long-acting beta-agonists • Leukotriene modifiers (loo-koh-TRY-een MAH-di-fy-ers) • Cromolyn (KROE-moe-lin) sodium • Theophylline (thee-AH-fil-leen) Which medicines you need and how often you need them will be based on your symptoms and other factors. If your asthma stays in good control, over time you may need less medicine to manage it.

How to take asthma medicines Many asthma medicines are taken with an inhaler. An inhaler is a hand-held device that delivers the medicine right into your airways. There are several types of inhalers. Using your inhaler correctly is very important. Ask your health care provider to show you how. Spacers and nebulizers can make it easier to take some inhaled medicines. These devices are helpful for young children and adults who have a hard time using inhalers.

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Monitor your asthma Monitoring your asthma will help you keep it in good control. Here are some things you can do:

Keep a record of your symptoms Write down any symptoms you have whenever you have them. This will help you be more aware of the things that cause your symptoms. When you share this information with your doctor, it can help him or her adjust your treatment as needed.

Use a peak flow meter A peak flow meter is a device you can use at home to check how well air is moving out of your lungs. It can detect small changes hours or even days before you feel symptoms. A peak flow meter can also be used during an asthma attack. The results can help you know how bad the attack is and if your medicines are working. To use a peak flow meter, your doctor will ask you to find your personal best peak flow number. Your personal best is the highest peak flow number you can get during a 2-week period when your asthma is under good control. Good control is when you feel good and have no asthma symptoms. When you know your personal best peak flow number, your doctor will use it to set up your peak flow zones. These zones help you know what actions to take when your peak flow number changes.

Peak Flow Zones Zone Green Zone Yellow Zone Red Zone

Percent (%) of Personal Best Action More than 80% All clear. Good control, no symptoms. Take medicines as usual. 50% to 80% Caution. Your asthma may be getting worse. Ask doctor if you should change or increase your medicines. Less than 50% Medical alert! Take quick-relief (rescue) medicine right away. Call your doctor or emergency room at once.

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To help you monitor your asthma and keep it in good control, it’s also important that you follow up with your doctor and get checkups on a regular basis. Here are some tips:

Follow up and get regular asthma checkups To be a partner with your doctor or other health care provider, you need to get regular asthma check-ups. Each visit gives you the chance to talk about your asthma and how you are managing it. Your doctor can also make sure you are using your inhaler and peak flow meter correctly. To make the most of your visits bring these items with you: • Records of your symptoms and peak flow numbers • Your inhaler (and spacer if you use one) • Other asthma medicines you take • Your peak flow meter

Seek emergency help when needed When you manage your asthma and stay in control, you should not have symptoms very often. However, there are times when an asthma attack will come on anyway. In some cases an asthma attack can be life-threatening. Your airways may become swollen and tighten up. Mucus can build up and clog your airways. Breathing becomes difficult. When these things happen, your lungs cannot work properly. Your organs do not get enough oxygen. This is a medical emergency. When your symptoms or peak flow numbers show you need to seek emergency help, do so. Do not wait. It can save your life.

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You can control your asthma and lead a normal life The good news is that you can be free of asthma symptoms most of the time. This means sleeping through the night. It also means you do not have to miss school or work because of your asthma. You can do the things you want to do, including physical activity and sports. And you can expect few trips to the emergency room, if any. How? In summary, you need to follow these steps: 1. Work closely with your doctor and other health care providers to manage your asthma. Follow your asthma action plan. Ask questions if you have any. 2. Take your medicines as directed. Know how to take them, when to take them, and how much you need to take. 3. Know what triggers make your asthma worse. Take steps to control or avoid them. 4. Monitor your asthma. Keep track of your symptoms, use a peak flow meter if needed, and see your doctor for regular checkups. Also, take care of your overall health. When you do, it can help improve your asthma and prevent other diseases. Talk with your doctor or other health care provider about ways to eat right, be physically active, and maintain a healthy weight. You can live an active life. Talk to your doctor. Control your asthma now.

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Search the Web for more information If you can get on the Internet, you might want to visit some of these Web sites for more information about asthma: 1. 2. 3. 4. 5.

National Heart, Lung, and Blood Institute: http://www.nhlbi.nih.gov Centers for Disease Control and Prevention: http://www.cdc.gov/health/asthma.htm American Academy of Family Physicians: http://familydoctor.org American Academy of Allergy Asthma and Immunology: http://www.aaaai.org American Lung Association: http://www.lungusa.org

References 1.

Centers for Disease Control and Prevention, National Center for Health Statistics, FastStats. Asthma. http://www. cdc.gov/nchs/faststats/asthma.htm. Accessed November 9, 2009.

2.

National Heart, Lung, and Blood Institute. So You Have Asthma. Rockville Md: National Institutes of Health, U.S. Department of Health and Human Services. NIH Publication No. 07-5248, March 2007. http://www.nhlbi.nih.gov/ health/public/lung/asthma/have_asthma.pdf. Accessed November 9, 2009

3.

National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program Expert Panel 3. Guidelines for the Diagnosis and Management of Asthma, Summary Report 2007. Rockville Md: National Institutes of Health, U.S. Department of Health and Human Services. NIH Publication No. 08-5846. http://www.nhlbi.nih. gov/guidelines/asthma/asthsumm.pdf. Accessed November 9, 2009.

4.

National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program Expert Panel 3. Guidelines for the Diagnosis and Management of Asthma, Full Report 2007. Rockville Md: National Institutes of Health, U.S. Department of Health and Human Services; Revised August 2007. NIH Publication No. 07-4051. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf. Accessed June 1, 2010.

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