Asthma Management

What is Asthma?

Asthma is a chronic (long-term) condition that affects the airways in the lungs. The airways are tubes that carry air in and out of your lungs. If you have asthma, the airways can become inflamed and narrowed at times. This makes it harder for air to flow out of your airways when you breathe out.

To learn more about asthma:


Make a pact to “ACT” to manage your asthma and allergies:

  • “A” means have an action plan for asthma or anaphylaxis.
  • “C” reminds you to carry emergency medicines and wear a medical ID to alert others of your condition.
  • “T” calls for having a treatment plan that includes when to take your medicines and what to do in an emergency.


What is an Asthma Action Plan?

All people with asthma should have an Asthma Action Plan. An Asthma Action Plan (also called a management plan) is a written plan to that you develop with your healthcare provider to help control your asthma. An Asthma Action Plan is tailored specifically for you, and lists all medications with instructions on when they should be taken. It is a simple plan that describes how to achieve long-term control and what to do when asthma symptoms arise.

Your asthma action plan should include:

  • Factors that make your asthma worse, "asthma triggers"
  • Medicines you take to treat your asthma with specific names of each medicine
  • Medicines to take based on your signs, symptoms or peak flow measurements (if used)
  • Symptoms or peak flow measurements (if used) that indicate the need for urgent medical attention
  • Telephone numbers for an emergency contact, your healthcare provider, and your local hospital

An asthma action plan is divided into three zones (green, yellow and red):

  • GREEN zone: where you want to be on a daily basis. In this zone, you have no asthma symptoms and you feel good. Continue to take your long-term control medicine(s) even if you're feeling well.
  • YELLOW zone: you are experiencing asthma symptoms. This is where you should slow down and follow the steps including the use of your quick-relief medicine to keep your asthma from getting worse.
  • RED zone: you are experiencing severe asthma symptoms or an asthma flare-up. Follow the steps in your asthma action plan and get immediate medical treatment if your symptoms do not improve.
You should work with your healthcare provider to determine your zones. Your asthma action plan can be based on peak flow rate or asthma symptoms.

To learn more about how to use an Asthma Action Plan:

4 Signs that Your Asthma Action Plan Needs an Update: 

Asthma Action Plan, blank template (English): 

Asthma Action Plan, blank template, 2 types (Chinese): 

https://portal.ct.gov/-/media/DPH/Asthma/AAPchinese.pdf

https://cumming.ucalgary.ca/sites/default/files/teams/41/cana-ap-chinese-2013.pdf


Asthma Action Plan, blank template (Spanish): 

Asthma Action Plan for Young Children and in Other Languages:
https://cumming.ucalgary.ca/research/icancontrolasthma/resources/downloads/asthma-action-plans


How to Monitor Asthma Control with a Peak Flow Meter

Your healthcare provider may want you to use peak flow monitoring, especially if you have moderate to severe asthma. Your peak flow rate can show if your asthma is getting worse, even before you feel symptoms. Your peak flow rate is measured with a peak flow meter. 
A peak flow meter is a portable, inexpensive, hand-held device that measures your ability to push air out of your lungs. Air flow is measured by the amount of air that you can blow out in one "fast blast." Measuring your peak flow can you help you:

  • Follow the steps on your asthma action plan, such as deciding when to use your quick-relief asthma medicine or deciding when to seek emergency care.
  • Identify where (location) and when (time of day) asthma symptoms start, so you make a plan to avoid your asthma triggers.

Asthma sometimes changes gradually. Your peak flow rates can show you if your asthma is getting worse, even before you feel symptoms. A peak flow meter may help you and your healthcare provider identify causes of your asthma at work, home, or play.

Also, peak flow readings can help your healthcare provider make decisions about your treatment and adjust your medicines as necessary.

How to Use a Peak Flow Meter


Step 1: Before each use, make sure the sliding marker or arrow on the Peak Flow Meter is at the bottom of the numbered scale (zero or the lowest number on the scale).

Step 2: Stand up straight. Remove gum or any food from your mouth. Take a deep breath (as deep as you can). Put the mouthpiece of the peak flow meter into your mouth. Close your lips tightly around the mouthpiece. Be sure to keep your tongue away from the mouthpiece. In one breath, blow out as hard and as quickly as possible (like you are blowing out candles on a birthday cake). Blow a "fast hard blast" rather than "slowly blowing" until you have emptied out nearly all the air from your lungs.

Step 3: The force of the air coming out of your lungs causes the marker to move along the numbered scale. Note the number on a piece of paper.

Step 4: Repeat the entire routine three times. (You know you have done the routine correctly when the numbers from all three tries are very close together.)

Step 5: Record the highest of the three ratings. Do not calculate an average. This is very important. You can't breathe out too much when using your peak flow meter, but you can breathe out too little. Record your highest reading.

Step 6: Measure your peak flow rate close to the same time each day. You and your healthcare provider can determine the best times. One suggestion is to measure your peak flow rate twice daily between 7 and 9 a.m. and between 6 and 8 p.m. You may want to measure your peak flow rate before or after using your medicine. Some people measure peak flow both before and after taking medication. Try to do it the same way each time.

Step 7: Keep a chart of your peak flow rates. Discuss the readings with your healthcare provider.

How to Chart Peak Flow Rates

  • Chart the HIGHEST of the three readings. This is called, "your personal best." The chart could include the date at the top of the page with AM and PM listed. The left margin could list a scale, starting with zero (0) liters per minute (L/min) at the bottom of the page and ending with 600 L/min at the top.
  • You could leave room at the bottom of the page for notes to describe how you are feeling or to list any other thoughts you may have.


Determining a "Normal" Peak Flow Rate

Peak flow rates are commonly split into three zones (green, yellow, red) and used to monitor asthma control with your Asthma Action Plan: 

  • Green Zone: 80 to 100 percent of your usual or "normal" peak flow rate signals all clear. A reading in this zone means that your asthma is in good control. Keep using the medicines as directed.
  • Yellow Zone: 50 to 80 percent of your usual or "normal" peak flow rate signals caution. This zone indicates that your airways are narrowing, and you need to take action. Take the additional medicine(s) listed in the yellow zone of your asthma action plan. Call your doctor and let them know.
  • Red Zone: Less than 50 percent of your usual or "normal" peak flow rate signals a medical alert. This zone indicates that there is severe airway narrowing. Take your quick-relief medicine right away. Contact your healthcare provider right away and if symptoms don’t improve, call 911 or go the nearest emergency room.

Some healthcare providers may suggest zones with a smaller range, such as 90 to 100 percent. Always follow your healthcare provider's suggestions about your peak flow rate.

When Should I Use My Peak Flow Meter?

  • When your asthma is well-controlled. If your asthma is under control, you may decide to only use your peak flow meter when your symptoms increase or when you experience triggers, such as breathing in cold, dry air.
  • When you’re getting your asthma symptoms under control. If your asthma is not well-controlled, you might take peak flow readings at least once daily, at the same time each day. You may also benefit from taking readings several times per day, such as first thing in the morning and right before bed.
  • When symptoms happen. If your symptoms wake you up from sleeping or occur at specific times of the day, use your peak flow meter when symptoms occur.
  • If you have an acute respiratory illness. If you have a cold, flu, or other respiratory condition, you might use your peak flow meter more often.
  • With your medications. Your doctor may suggest using your meter right before and after you use medications, such as a rescue inhaler (inhaled albuterol).


To learn more about how to use a peak flow meter:

How to Monitor Asthma Control by Tracking Symptoms

Another way to monitor your asthma control is to track your symptoms. Common asthma symptoms that indicate a problem include:
  • Daytime symptoms (cough, wheeze or chest tightness)
  • Problems with activity level (working, exercising or playing)
  • Nighttime symptoms


What Causes or Triggers Asthma?

People with asthma have inflamed airways which are sensitive to things which may not bother other people. These things are “triggers.” Asthma triggers vary from person to person. Some people react to only a few while others react to many.

If you have asthma, it is important to keep track of the causes or triggers that you know provoke your asthma. Because the symptoms do not always occur right after exposure, this may take a bit of detective work. Delayed asthma episodes may occur depending on the type of trigger and how sensitive a person is to it.

The most common asthma triggers include:

1. Allergies  

Substances that cause allergies (allergens) can trigger asthma. If you inhale something you are allergic to, you may experience asthma symptoms. It is best to avoid or limit contact with known allergens to decrease or prevent asthma episodes.

Common allergens that cause allergic asthma include:
  • Dust mites
  • Cockroach
  • Pollen
  • Molds
  • Pet dander
  • Rodents

2. Irritants in the Air 

Irritants in the environment can also bring on an asthma episode. Although people are not allergic to these items, they can bother inflamed, sensitive airways:
  • Smoke from cigarettes
  • Air pollution, such as smog, ozone, and others
  • Wood fires
  • Charcoal grills
  • Strong fumes, vapors, or odors (such as paint, gasoline, perfumes, and scented soaps)
  • Dust and particles in the air
  • Chemicals
  • Other Health Conditions

3. Exercise

Exercise and other activities that make you breathe harder can affect your asthma. Exercise – especially in cold air – is a frequent asthma trigger. Exercise-induced bronchoconstriction (EIB) is a form of asthma that is triggered by physical activity. It is also known as exercise-induced asthma (EIA). Symptoms may not appear until after several minutes of sustained exercise. (If symptoms appear sooner than this, it usually means you need to adjust your treatment.) With proper treatment, you do not need to limit your physical activity.

4. Weather

Dry wind, cold air or sudden changes in weather can sometimes bring on an asthma episode.

Thunderstorm asthma can also affect people with asthma if a thunderstorm hits during high pollen and high humidity. The rain can hit pollen and break the grains into smaller pieces. Wind from the storm spreads these particles around, making it easier for people to inhale them.

5. Feeling and Expressing Strong Emotions

Anger
Fear
Excitement
Laughter
Yelling
Crying

When you feel strong emotions, your breathing changes – even if you don’t have asthma. It may cause wheezing or other asthma symptoms in someone with asthma.

6. Certain Medicines

Some medicines can also trigger asthma, such as Aspirin and NSAIDs (non-steroidal anti-inflammatory drugs), or medicines known as beta blockers – they can also make asthma harder to control. 

Talk to your health care provider about your asthma and your triggers. Be sure to discuss any changes in your asthma management.

To learn more about what causes or triggers asthma:


    To learn more about reducing asthma triggers: