Three steps to better asthma control
Maintain optimal asthma control with a three-step approach
Asthma Day is an annual event organised by the Global Initiative
for Asthma (GINA) to improve asthma awareness and care around
the world. World Asthma Day 2008 will take place on Tuesday, May
6, 2008. The theme of this year’s event will be “You Can Control
When it comes to controlling your asthma symptoms, one size does
not fit all. Everyone with asthma suffers from inflammation and
airway constriction, but symptoms are different for each person
— and can change over time. Work with your doctor to master the
three steps to better asthma control:
1. Track your symptoms. Keep an asthma symptom diary. At each
visit, talk to your doctor about how severe your symptoms are
and if they’ve changed since your last appointment.
2. Check your lung function. Use lung function tests to assess
how well you can breathe.
3. Adjust your treatment. Based on your symptoms and lung
function tests, you and your doctor can make changes to your
treatment if needed.
Track your symptoms
Keep track of your asthma symptoms every day so that
you and your doctor can review them at each appointment and
adjust your treatment. Keep a written record of:
• Increased shortness of breath or wheezing (a whistling sound
produced during exhalation)
• Disturbed sleep caused by shortness of breath, coughing or
• Chest tightness or pain
• Increased need to use a quick-relief inhaler containing a
short-acting bronchodilator — a medication that opens airways by
relaxing the surrounding muscles
• Decreased productivity at work, school, or at home due to
• Increased asthma symptoms during exercise
To help control your asthma symptoms, you and your doctor may
also use a common rating system based on the National Asthma
Education and Prevention Programme guidelines for grading asthma
severity. This system uses four levels, based on two things that
you can record in your asthma symptom diary:
1. How often and when you have symptoms
2. Your lung function test results
Where you fall on the asthma rating scale may change over time
and with treatment. Assign yourself to the most severe category
in which you currently have symptoms. For example, even though
your symptoms may be generally mild, if you have serious
flare-ups, you may have a more severe rating.
Check your lung function
Lung function (pulmonary) tests can help you and your
doctor judge how well you are controlling your asthma and may
ward off flare-ups. One test you can use at home to keep track
of how well you can breathe. Another test you’ll have during
Peak flow meter: By learning how to use a peak flow meter, you
can help detect subtle changes in your airways before you notice
symptoms. Your doctor can give you instructions on how to deal
with low readings and prevent a flare up. A peak flow meter can
be used at home to measure how well you can force air out of
your lungs. It helps detect subtle narrowing of the airways
before you notice symptoms. If the readings are lower than
usual, it’s a sign your asthma may be about to flare up. Your
doctor can adjust your treatment based on the readings. Peak
expiratory flow (PEF) tells you the fastest rate at which you
force air out of your lungs.
A spirometer is used by a medical professional to measure
narrowing of your bronchial tubes. This device measures the
volume of air you can exhale after you’ve taken a deep breath. A
spirometer also shows how quickly you can get air out of your
lungs. This measurement is called forced expiratory volume-1
(FEV-1). Your doctor compares the result with the predicted
result for people of the same age, sex, race and height who
don’t have asthma. This comparison is expressed as a percentage.
Lower percentages indicate less lung power.
Here’s how lung function measurements correspond to different
grades of asthma severity:
By evaluating your symptoms and measuring your lung function,
your doctor can decide how well your treatment is working. Your
doctor may suggest a change in treatment if:
• Your current medications are not controlling your asthma as
well as possible
• Your medications are causing troublesome side effects
• You’re using a quick-relief inhaler (‘rescue’ medication) too
If you have persistent asthma, whether it’s mild, moderate or
severe, you’re likely to need long-term control medications.
Used properly, these medications can reduce or eliminate your
need to use a quick-relief inhaler. The most effective long-term
Inhaled corticosteroids:Examples include fluticasone (Flovent),
budesonide (Pulmicort) and triamcinolone (Azmacort).
• Inhaled, long-acting beta-2 agonists: Examples include
salmeterol (Serevent) or formoterol (Foradil).
• A combination of inhaled corticosteroids and long-acting
beta-2 agonists: This approach requires using two inhalers or a
combination inhaler such as Advair.
• Leukotriene modifiers: These drugs are taken in pill form,
either alone or in conjunction with an inhaled corticosteroid.
Examples include montelukast (Singulair) and zafirlukast (Accolate).
• Cromolyn (Intal) and nedocromil (Tilade): These medications,
taken by inhalation, are sometimes used to treat mild persistent
• Theophylline (Uniphyl): This drug is taken in pill form,
either alone or in conjunction with an inhaled corticosteroid.
Theophylline is rarely used in children.
• Oral corticosteroids: In some cases, severe asthma may require
additional treatment with an oral corticosteroid such as
prednisone or methylprednisolone.
Following is a summary of treatment recommendations for
different levels of asthma severity for people ages 6 through
adult. Younger children may need different treatment.
the three-step approach to asthma treatment
Track your symptoms, monitor your lung function and work with
your doctor to adjust your treatment as needed. For treatment to
work as well as possible, carefully follow your treatment plan.
Keep a daily, written record of symptoms, triggers and
medications. Go to every scheduled appointment, and talk with
your doctor about your asthma at every visit. Asthma cannot be
cured, but careful management can help you avoid asthma attacks
and keep symptoms under control.
“Each person with asthma reacts differently to medication, the
environment, triggers, and changing allergens that affect
symptoms,” says James Li, M.D., the lead author of National
Asthma Treatment Guidelines. “Assessing these factors requires
strong communication between you and your doctor on an ongoing
basis to determine whether changes in treatment should be made.”