Important Questions About Asthma Care

Medications
Asthma Treatment Devices
Asthma Action Plan
Know and Control Your Asthma Triggers
Exercise and Asthma
What is Good Asthma Control?
When to Seek Emergency Help
Frequently Asked Questions

Asthma cannot be cured. If not kept in check, asthma can interfere with your sleep and daily activities. It can also result in the need to seek help at the emergency room, or be admitted to hospital. This, however, can be avoided by effectively controlling your asthma.

Effective control includes taking the proper medication, having an asthma action plan, and making certain lifestyle changes. The first step to good asthma control is taking the proper medication.

Medications

Medications can be very effective in keeping your asthma symptoms under control. There are two main types of asthma medication:

1. Anti-inflammatory medications decrease the bronchial tube inflammation, making the airways less sensitive to the irritants that trigger asthma symptoms. These medications are very effective in stopping the airways from tightening and cutting down the mucus build-up that makes breathing difficult.

Corticosteroids are the most common type of anti-inflammatory asthma medication. There are two types of corticosteroids - those that are inhaled as an aerosol mist or powder; and those that are taken orally.

Inhaled corticosteroids are used in the long-term control of asthma. They prevent asthma attacks happening, but do not relieve symptoms when you do have an asthma attack. Inhaled corticosteroids are taken on a daily basis, the dosage will differ from person to person.

Possible medication side effects inclued throat hoarseness and thrush (small whitish eruptions on the mouth, throat and tongue).

Examples of inhaled corticosteroids are beclomethasone, flunisolide, triamcinolone acetonide, fluticasone propionate, and budesonide.

Oral corticosteroids prevent moderate to severe asthma attacks from happening. This medication is also used to relieve symptoms once an asthma attack has happened. Low doses of these drugs are taken daily, or every other day. A doctor will usually prescribe an oral corticosteroid in order to get asthma symptoms quickly under control before starting long-term treatment, or to treat sudden asthma flare-ups.

Examples of oral corticosteroids are prednisone, prednisolone, and methylprednisolone.

Long-term use of this medication can result in the following side effects: upset stomach, mood changes, bone loss, slowing in growth, weight gain, high blood pressure, acne, and cataracts.

The goal is to take the least amount of corticosteroid that will control symptoms.

2. Bronchodilators are used to help relax the airway tube muscles when they tighten. These drugs also help clear mucus that clogs the airways.

Short acting bronchodilators (short acting beta2-agonist) are called "rescue medications" because they act quickly to relieve tight muscles and open airways, thus relieving syptoms. These medications quickly open up blocked airways helping you to breath easier. Contact your doctor if you find you are over-using (more than 4 times per week) short-acting beta2-agonists. The need for rescue medication indicates that you:

• have poor control of your asthma
• might need to use an inhaled corticosteroid (if you are not already using one), or
• if you are using an inhaled corticosteroid, the amount you are using might need to be increased

You and your doctor should discuss how to improve your asthma control.

Examples of short-acting beta2-agonists include albuterol, Ventolin, bitolterol, levabuterol, metaproterenol, pirbuterol, and terbutaline.

Long-acting bronchodilators (long-acting beta2-agonists) are used in combination with anti-inflammatory medications to prevent asthma symptoms. They are not used for symptom relief once an asthma attack has occurred. These drugs are sometimes used to prevent asthma symptoms that occur at night, or those that occur during exercise.

Examples of long-acting beta2-agonists are albuterol Proventil, formoterol, foradil, and salmeterol. This type of medication comes in the form of either a tablet or inhaler ("puffer") form. Side effects are throat irritation, rapid heartbeat, headache and dizziness, nausea, vomiting and diarrhea, anxiety and nervousness or tremors.

3. Leukotriene antagonists are a new class of non-steroid drugs that control airway inflammation (examples include Singulair and Accolate). These drugs are used for long-term prevention of asthma and for exercise induced asthma; they are not used to relieve an asthma attack once it has occured. These drugs are either prescribed alone or in combination with corticosteroids.

Your doctor will work with you to find the medications that work best for you. Only take the asthma medications that are prescribed for you. Take your medications exactly as you have been instructed. Ask your doctor to help you develop an Action Plan that clearly spells out when you should take your asthma medications.

Even if you are feeling better, do not stop taking the asthma control medication you have been told to take every day. This medication treats the airway inflammation that causes asthma. You will not become addicted to or dependent on your asthma medication. Taking asthma medications for a long time does not result in needing to take more medication (or higher doses) in order for it to be effective.

Do not take cold medicines to relieve your asthma symptoms - they do not work - you need to take your asthma medications.

Speak with your doctor before using any over-the-counter asthma medications (Primatene Mist or Bronkaid). These medications do not control or prevent asthma symptoms. Never use over-the-counter asthma medications if you have high blood pressure, diabetes, a thyroid disease or heart disease.

Always speak with your doctor if you have medication side-effects that bother you. Never stop taking your medications without first discussing it with your doctor. Never skip a dose, even if you are feeling better.

Have your doctor, pharmacist, or asthma nurse educator check that you are using your inhaler properly.

Remember that the medications do not cure asthma; they only help keep your symptoms in check. If you stop taking your medications, the frequency and severity of your symptoms will worsen.

Asthma Treatment Devices

If you have asthma, you will need to use the following devices:

• Peak Flow Meter. People with asthma rarely feel any changes that are happening in their airways because the changes happen so gradually. A peak flow meter is a small (but very important) portable device that you use to check your lung function. This device measures how fast you can blow air out of your lungs (this is called your peak expiratory flow rate). A drop in your peak expiratory flow is an early warning signal of an asthma attack - by having this information you can take step to prevent the asthma attack.
• Inhaler ("puffer"). This device delivers asthma medication directly into your lungs, where it's needed. People with asthma need two inhalers - one that delivers asthma medication used on a daily basis to prevent airway swelling, and one that delivers rescue medication.
• Spacers (holding chambers). This device is used when a person cannot use an inhaler. A spacer is a cylinder with a mouthpiece at one end and a space at the other end that is fitted with an inhaler. A person holds the mouthpiece between their lips. When the inhaler is activated, asthma medication is released into the cylinder and remains suspended in the air inside the cylinder; the person then inhales the medication by breathing as they normally would. This device is often used by children, can be used by the very young.

Asthma Action Plan

Asthma cannot be cured. You need to take care of your symptoms on a daily basis. You also need to prevent long-term damage to your airways caused by inflammation. People who know how to keep their asthma in check are less likely to end up in the emergency department, hospital, and/or miss days from work or school.

You should have your own written Action Plan on how to keep your (or your child's) asthma under control. Work with your doctor to develop an Action Plan that clearly spells out:

• What medicines you need to take depending on whether your asthma is under control, changing, or getting worse.
• When you need to see your doctor about your symptoms.
• When you should call 9-1-1 or go directly to your nearest hospital emergency room.

• Asthma symptoms. This will help you identify the early warning signs that you are about to have an asthma attack
• Lung capacity. Ask your doctor about using a peak flow metre. This device measures the greatest amount of air you can breathe in and out of your lungs. This is an easy test that will alert you to when you are starting to have breathing problems that will turn into an asthma attack.
• Irritants in your environment that trigger your asthma (and should be avoided).

Know and Control Your Asthma Triggers

In order to keep your asthma in check you need to keep away from irritants that trigger your asthma. The following is a list of common "triggers", and some tips on how to control them.

Lead a smoke free life: Stop smoking and eliminate exposure to second hand smoke. For smoking cessation information, see Resources under To Stop Smoking.

Pollen: Tree, grass and weed pollen is a common seasonal allergen. Pollen counts are usually at their highest in the morning, so if you can, try to stay indoors during this time. You may also find it helpful to keep your windows closed and the air conditioning on. If you feel that you need relief for your symptoms, talk to your doctor about prescribing an antihistamine or corticosteroid nasal spray.

Dust: Dust mites are a common asthma trigger. To cut down on the amount of dust around you, place your pillows, mattress and box spring in airtight covers. Wash your bedding and your child's stuffed animals weekly in very hot water (water must be at least 54.4 degrees C, 130 degrees F) in order to destroy the dust mites.

Try not to sleep on upholstered furniture as the material traps dust. Rugs are a major source of dust mites, so consider having bare floor where possible. Rooms should be vacuumed once or twice a week. Try not to take on the job of vacuuming - if this is not possible use a vacuum cleaner with an ultra heavy (HEPA) filter, use a micro filter vacuum cleaner bag, or wear a dust mask when cleaning.

Mold: Molds are a common asthma trigger. Mold can be avoided by keeping damp areas of your house such as the bathroom, kitchen and basement clean and well ventilated. Moldy surfaces should be cleaned regularly with a cleanser that has chlorine bleach in it.

Molds thrive in damp and humid environments so fix any leaky faucets and pipes, and try not to use vaporizers or humidifiers. If you cannot live without your humidifier, keep the humidity level in your house below 50 per cent. If you have a dehumidifier or air conditioner use them (especially in your living room and bedroom).

Pet Dander (flakes of animal skin or dried saliva): If you must have a pet that has fur or feathers, then try to keep it outside (or at least outside the main living areas of your house, especially your bedroom). Carpets and upholstered furniture trap dander so try to keep these materials out of the rooms that your pets spend their time in - also use a high-efficiency particulate air filter in these rooms. You can also cut down the amount of dander in your house by bathing your cat or dog weekly.

Cockroach Droppings and Dead Carcasses: Have professional exterminators get rid of the cockroaches in your house. If you are going to undertake extermination yourself, stay out of the room until the poison spray odor has subsided. To help make sure that the cockroaches do not come back, keep all food out of your bedroom, and keep food and garbage in closed containers.

Changes in the Weather: Sudden weather changes or shifts in barometric pressure can cause your asthma to flare up. Check the weather reports regularly, and then use your medications in response to the changes as spelled out in your Action Plan. Cold or windy weather can aggravate asthma so you might find it helpful to place a scarf over your mouth and nose so that you don't breathe in cold air.

Alcohol: Talk to your doctor about your alcohol intake. Wine and beer can especially aggravate asthma because they contain sulfites. Don't drink when your asthma flares-up or when your lung capacity drops.

Foods: For some people, cheese, milk, soy, eggs, peanuts, wheat, dried fruit, fish and shellfish can trigger an asthma attack. Use your daily asthma diary to track whether there are certain types of foods are associated with your asthma flare-ups. Talk to your doctor if you think that certain types of foods are triggering your asthma. You should cut these foods out of your diet until you have confirmed with your doctor whether the foods are triggering your asthma symptoms.

Be sure to read food labels to make sure they do not contain substances that trigger your asthma. Ask your server to find out whether a restaurant dish contains ingredients that could aggravate your asthma symptoms.

Heartburn or acid reflux can be asthma triggers because the stomach acid of heartburn or acid reflux can irritate the airway muscles. To avoid this trigger, finish your dinner at least 3 hours before bedtime, don't eat a big or spicy meal near bedtime, and avoid high fat foods, caffeine, and anything acidic.

Latex rubber allergy: If you are in hospital, be sure to inform your doctor or nurse that you are allergic to latex rubber. Latex rubber is often found in things commonly used in hospitals, including catheters, anesthesia masks, blood pressure cuffs, tourniquets, and adhesive tape. In your daily life, use products made from a non-latex substitute.

Medicines: Keep track of your symptoms in your daily asthma diary, and speak to your doctor if you think the medication you are taking for high blood pressure, glaucoma, migraine headaches, or depression is triggering your asthma. Aspirin and non-steroidal anti-inflammatory medications can trigger asthma as well.

Strong Emotions: Anger, frustration, and elation are strong emotions that can cause asthma flare-ups. If strong emotions are one of your triggers, keep your rescue medication with you at all times. Needless to say, try to keep your emotions under control, and try to stay calm.

Asthma flare-ups due to strong emotions may be a sign that your asthma is not in check - speak to your doctor to find out if your airway inflammation is not well controlled.

Non-allergenic airborne irritants (smoke, fumes, strong odors, sprays): Perfume, talcum powder, hair spray and paints might be asthma triggers that some people should avoid. Smoke and fumes from wood-burning stoves, kerosene heaters and fireplaces should also be avoided if they trigger your asthma.

Get a flu shot: Colds, the flu or sinus infections can trigger an asthma attack and make your breathing more difficult. People with an egg allergy should talk to their doctor.

Exercise and Asthma

Exercise is one of the best things you can do for your health. Most experts feel that asthma should not stop you from participating in sports and exercise. Some experts feel that if you are in good physical condition, your asthma symptoms will be less severe.

All experts agree you should not participate in sports unless your asthma symptoms are well under control. If you are having a lot of symptoms - don't exercise.

Talk to your doctor about the following tips on participating in sports and exercise:

• About 15 minutes before you starting exercising, take a couple of puffs of a bronchodilator to prevent an asthma attack.
• If you feel an asthma warning sign, use your bronchodilator again. If you don't immediately start feeling better, take the medication again. If you still don't feel better, seek emergency care.
• Don't exercise in circumstances that trigger your asthma. For example, don't exercise outside during pollen season.
• Drink plenty of water - this will stop your airways from drying out.
• Don't exercise when you have a cold, the flu, or other respiratory infection.
• Don't exercise outside when the weather is hot and dry, when air pollution is high, or if pollen counts are high (and you are allergic to pollen).
• Sudden severe asthma attacks can occur even if a person has mild asthma. These asthma attacks can be life-threatening. If you experience a sudden severe asthma attack, seek emergency care immediately.

What is Good Asthma Control?

According to the Canadian Asthma Consensus Report (1999), your asthma is under control if:

• Daytime asthma symptoms such as coughing, wheezing, chest tightness or shortness of breath happen less than 4 days per week.
• Your asthma causes you to wake up at night no more than 1 night per week.
• You do not need to use more than 4 doses per week of your quick relief medication (this does not include 1 dose per day that is used to control symptoms during exercise).
• Your physical activity is normal.
• Your asthma attacks or flare-ups are mild and happen infrequently.
• You have not missed work or school because of your asthma symptoms.

Seek emergency help if:

• Your lips and fingernails are turning blue.
• You are struggling to breathe.
• You cannot finish a sentence in one breath.
• You do not feel any better 20 - 30 minutes after taking extra medicine and your peak flow is still in the red zone.

Frequently Asked Questions

What can I do to prevent the risk of my child developing asthma?
While there is no guaranteed way of preventing asthma, eliminating your child's exposure to tobacco smoke is probably one of the best things you can do. Tobacco smoke increases the probability that a child will develop asthma, and results in more severe asthma attacks among children who already have asthma. Research has also shown that mothers who smoke during pregnancy increase the risk that their newborn baby will experience wheezing.

Will my child outgrow asthma?
There is no definite answer to this question. Some children experience improvement in their teen years, whereas asthma symptoms worsen for others. Sometimes asthma symptoms will seem to have disappeared only to reappear when the person is in their twenties or thirties.

Can long-term use of inhaled corticosteroids affect bone growth?
Medical research had reported that inhaled and oral corticosteroids can cause bones to become thin, which can result in fractures and other bone problems. In order to keep bones strong, research recommends that children who take these medications should also take calcium and multivitamins (containing vitamin D) on a daily basis, and should also exercise regularly.

Can long-term use of inhaled corticosteroids slow my child's growth?
At higher doses they might slow a child's growth (especially in the early school years), but low doses are usually well tolerated. A child's growth rate will speed up again when the steroid dose is lowered. If your child does need high doses of inhaled corticosteroids, it is imporant to consider that severe asthma can affect the rate of growth in and of itself. In addition, without the medication it is unlikely that your child can live a normal life, attend school regularly, and enjoy sports and games with the other children. Always discuss medication dosage with the child's doctor, so you know what to expect - and what the alternatives may be.

Are there things I can do to help my child manage their asthma while at school?
Meet with your child's teachers and school nurse to go over your child's asthma action plan. Be sure to talk to them about the medications your child uses, and any restrictions on activity your child may have. Also inform the school staff about your child's asthma triggers and see what they can do to control or remove them from your child's environment. Ask the school to allow your child to keep their inhaler with them and encourage your child to use it when needed.

If your child has an asthma attack while at school, they should return to normal school activities as soon as they are feeling better. If they require their inhaler again in less than four hours, the parents should be notified and the child should be taken to see their physician.

Request that the school inform you every time your child has an asthma attack, and make a record of this in your child's asthma diary.

It is also important to inform school staff that they should call 9-1-1 if your child has a severe asthma attack that requires emergency help.

What is a peak flow meter?
This is a hand-held device that measures how quickly you can breathe air out of your lungs. Measuring your peak flow is a good way of telling when your airways have narrowed. Have your doctor or asthma educator teach you how to use a peak flow meter properly. You should keep your peak flow meter close by at all times. You should also have an Action Plan on what to do when your peak flow readings indicate your airways have narrowed.

Can I have a safe pregnancy if I have asthma?
If your asthma is kept under control and you are under medical supervision for your asthma, you will likely not experience any complications. However, if asthma is not under control it can affect both the mother and the fetus. Specifically, a mother may develop pre-eclampsia (very high blood pressure, swelling and protein in the urine) which rarely may lead to maternal death. For the baby, uncontrolled asthma may cause lower birth weight, growth retardation and sometimes even death.

Last Revised: December 17, 2007