Asthma
Is a Serious Lung Disease
Your Asthma Can Be
Controlled With Proper Care
How To Take Care of Your
Asthma
How To Work With
Your Doctor
Is Your Ashma Under Control?
Taking the Right Medicines
at the Right Times
Asthma Medicines: Brand
and Generic Names
How to Use Your Metered-Dose
Inhaler the Right Way
Asthma
Action Plan - Printable form
How to Use Your Peak Flow Meter
How to Control Things That
Make Your Asthma Worse
For More Information
If you have asthma, you are not alone.
More than 14 million people in the United States
have this lung disease. Of these, almost 5 million
are children. Asthma is a problem among all races.
But the asthma death rate and hospitalization rate
for blacks are three times the rate of whites. Proper
asthma care could prevent these problems for all.
 This
booklet can help you learn how to control your asthma
or help a friend or family member with asthma. Asthma
Asthma
Is a Serious Lung Disease
Asthma makes the sides of the airways in your lungs
inflamed or swollen all the time. See the drawing
below. Your airways react to things like smoke,
dust, pollen, or other things. Your airways narrow
or become smaller and you get common symptoms like
those listed in the box. Asthma that is not well
controlled can cause many problems. People miss
work or school, go to the hospital, or even die
because of their asthma. But you do not have to
put up with the problems asthma can cause.
Your
Asthma Can Be Controlled With Proper Care
With your doctor’s help, you can control your asthma
and become free of symptoms most of the time. But
your asthma does NOT go away when your symptoms
go away. You need to keep taking care of your asthma.
Your asthma cannot
be cured—having asthma is a part of your life. So
you need to make taking care of your asthma a part
of your life. This is true even if your asthma is
mild.
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How
To Take Care of Your Asthma
How
To Work With Your Doctor
- Agree on clear treatment goals with your doctor.
Your goal is to be able to say "no”
to all the questions in the box on section titled,
"Is Your Asthma
Under Control?”
- Agree on what things you need to do. Then
do them.
- Ask questions until you feel you know what
your doctor wants you to do, when you should
do it, and why. Tell your doctor if you think
you will have trouble doing what is asked. You
can work together to find a treatment plan that
is right for you.
- Write down the things you are supposed to
do before you leave the doctor's office, or
soon after.
- Put up reminders to yourself to take your
medicine on time. Put these notes in places
where you will see them.
- See your doctor at least every 6 months to
check your asthma and review your treatment.
Call for an appointment if you need one.
Prepare a day or two before
each doctor's visit:
- Answer the questions in "Is
Your Asthma Under Control?". Talk to
your doctor about your answers. Also, talk about
any changes in your home or work that may have
made your asthma worse.
- Write down questions and concerns to discuss
with your doctor. Include ALL of your concerns,
even those you think are not a big deal.
- Bring your medicines and written action plan
to each visit. If you use a peak flow meter,
bring it to each visit.
“The doctor would ask me at each
visit how little Jimmy’s asthma was. I always forgot
to mention some symptoms or other problems. Now
it’s different. Before we visit the doctor, I write
down when Jimmy had symptoms in the past 2 weeks.
I also write down all the questions I have. Now
when I leave the doctor’s office, I feel happy that
I got all my issues addressed.”
- Deborah, mother of a child with
asthma
Is
Your Ashma Under Control?
Answer these questions by checking "yes" or
"no." Do this just before each doctor's visit.
In the past 2 weeks |
| 1. Have you coughed, wheezed,
felt short of breath, or had chest tightness:
|
| -
During the day? |
_______ Yes |
_______ No |
| - At
night, causing you to wake up? |
_______ Yes |
_______ No |
| - During
or soon after exercise? |
_______ Yes |
_______ No |
| 2. Have you needed more "quick-relief"
medicine than usual? |
_______ Yes |
_______ No |
| 3. Has your asthma kept you from doing anything
you wanted to do? |
_______ Yes |
_______ No |
| If yes,
what was it? |
|
|
| ____________________________________________________________ |
| ____________________________________________________________ |
| 4. Have you asthma medicines caused you
any problems, like shakiness, sore throat,
or upset stomach? |
_______ Yes |
_______ No |
| In the past few months: |
|
|
| 5. Have you missed school or work because
of you asthma? |
_______ Yes |
_______ No |
| 6. Have you gone to the emergency room or
hospital because of your asthma? |
_______ Yes |
_______ No |
|
| What Your Answers mean |
|
|
- All "no" asnwers?
- Your asthma is under control.
-
One or more "yes" answers? - Something
needs to be done. Read the guide on how to
get your asthma under control and talk to
your doctor. |
|
|
Taking
the Right Medicines at the Right Times
There are two main kinds of medicines for asthma:
(1) those that help with the long-term control of
asthma and
(2) those that give short-term quick relief from
asthma symptoms. See
the list of brand and generic names for asthma medicines.
Long-Term-Control Medicines
Are Taken Every Day To Control Asthma
Long-term-control medicines will prevent symptoms
and control asthma. But it often takes a few weeks
before you feel the full effects of this medicine.
Ask your doctor about taking
daily long-term-control medicine if you:
- Have asthma symptoms three or more times a
week, or
- Have asthma symptoms at night three or more
times a month.
If you need a long-term-control medicine,
you will need to keep taking your medicine each
day, even when you feel well. This is the only way
you can keep your asthma under control. Make taking
your long-termcontrol medicine a part of your daily
routine-just like eating, sleeping, and brushing
your teeth.
The Long-Term-Control Medicines
The most effective long-termcontrol medicines are
those that reduce swelling in your airways (inflammation).
These medicines include inhaled steroids, cromolyn,
and nedocromil.
- Inhaled steroids and steroid tablets or liquids
are the strongest long-term-control medicines.
The steroids used for asthma are NOT the same
as the unsafe steroids some athletes take to
build muscles.
- Inhaled steroids are used to prevent
symptoms and control mild, moderate, and
severe asthma. Inhaled steroids are safe
when taken at recommended doses. This is
because the medicine goes right to your
lungs where you need it. This reduces the
amount of medicine you need and the chance
of any side effects.
- Steroid tablets or liquids are used safely
for short times to quickly bring asthma
under control. They are also used longer
term to control the most severe asthma.
- Cromolyn and nedocromil are often the choice
of medicine for children with mild asthma.
- Inhaled long-acting beta2- agonists are used
to help control moderate-to-severe asthma and
to prevent nighttime symptoms. Long-acting beta2-agonists
do not reduce inflammation. Therefore, patients
taking this medicine also need to take inhaled
steroids. Inhaled longacting beta2-agonists
should not be used for quick relief of asthma
attacks.
- Sustained-release theophylline or sustained-release
beta2- agonist tablets can help prevent nighttime
symptoms. These medicines are used with inhaled
steroids, nedocromil, or cromolyn. Theophylline
is sometimes used by itself to treat mild asthma.
The dose for theophylline must be checked over
time to prevent side effects.
- Zileuton and zafirlukast are a more recent
type of long-termcontrol medicine. Studies so
far show that it is used mainly for mild asthma
in patients 12 years of age and older.
Quick-Relief Medicines Are
Taken Only When Needed
Inhaled quick-relief medicine quickly relaxes and
opens your airways and relieves asthma symptoms.
But it only helps for about 4 hours. Quick-relief
medicine cannot keep symptoms from coming back—only
long-termcontrol medicines can do that.
Take quick-relief medicine when you
first begin to feel symptoms— like coughing, wheezing,
chest tightness, or shortness of breath. Your doctor
may tell you to use a peak flow meter to help you
know when to take your inhaled quickrelief medicines.
Do not delay taking your quickrelief medicine when
you have symptoms. This can keep you from having
a really bad asthma attack. Tell your doctor if
you notice you are using more of this medicine than
usual. This is often a sign that your long-term-control
medicine needs to be changed or increased.
Make an Action Plan With Your
Doctor
Ask your doctor to help you fill out the “Asthma
Action Plan”. Be sure you know when to take
your medicine and what to do when your asthma gets
worse.
“I always thought if you had asthma
you should expect to have asthma symptoms. My new
doctor disagreed. She told me to take an “inhaled
steroid” every day for my asthma. Well, I did not
feel anything at first. But after about 3 weeks,
my symptoms came less often. Now, after a few months
on this medicine, I can see my doctor was right.
Asthma can really be controlled.”
| Asthma
Medicines: Brand and Generic Names, 1997*
|
| Asthma Long-Term Control
Medications |
| Generic Name |
Brand Name |
|
| Steroids: Inhaled |
|
| belomethasone |
Beclovent®
Vanceril®, Vanceril® Double |
| Strength |
|
| budesonide |
Pulmicort Turbuhalor® |
| flunisolide |
AeroBid®, AeroBid-M® |
| fluticasone |
Flovent® |
| triamcinolone |
Azmacort® |
|
| Cromolyn and Nedocromil:
Inhaled |
| cromolyn sodium |
Intal® |
| nedocromil sodium |
Tilade® |
|
| Leukotriene Modifiers:
Tablets |
| zafirlukast |
Accolate® |
| zileuton |
Zyflo® |
|
| Long-Acting Beta2-Agonists |
| salmeterol (inhaled) |
Serevent® |
| albuterol |
Volmax® |
| (extended release tablets) |
Proventil Repetabs ® |
|
| Theophylline: Tablets
or liquid |
|
Aerolate® III
Aerolate® JR
Aerolate® SR
Choledyl® SA
Elixophyllin®
Quibron®-T
Quibron®-T/SR
Slo-bid®
Slo-Phyllin®
Theo-24®
Theochron®
Theo-Dur®
Theolair®
Theolair®-SR
T-Phyl®
Uni-Dur®
Uniphyl® |
|
| Asthma Quick-Relief Medications |
| Generic Name |
Brand Name |
|
| Short-Acting Beta2-Agonists:
Inhaled |
| albuterol |
Airet®
Proventil®
Proventil HFA®
Ventolin®
Ventolin® Rotacaps |
| bitolterol |
Tornalate® |
| pirbuterol |
Maxair® |
| terbutaline |
Brethaire®
Brethine® (tablet only)
Bricanyl® (tablet only) |
|
| Anticholinergics: Inhaled |
| ipratropium bromide |
Atrovent® |
|
| Steroids: Tablets or liquids |
| methylprednisolone |
Medrol® |
| prednisone |
Prednisone
Deltasone®
Orasone®
Liquid Pred®
Prednisone Intensol® |
| prednisolone |
Prelone®
Pediapred® |
| |
|
| * This glossary is a complete
list of brand names associated with
the appropriate generic names of asthma
medications, as listed in the United
States Pharmacopeial Convention, Inc.,
Approved Drug Products and Legal Requirements,
Volume III, 17th edition, 1997, and
the USP DI Drug Information for Health
Care Professionals, Volume I, 17th edition,
1997. This list does not constitute
an endorsement of these products by
the National Heart, Lung, and Blood
Institute. |
|
| How
to Use Your Metered-Dose Inhaler the Right
Way |
Using
an inhaler seems simple, but most patients
do not use it the right way. When you use
your inhaler the wrong way, less medicine
gets to your lungs. (Your doctor may give
you other types of inhalers.)
For
the next 2 weeks, read these steps aloud as
you do them or ask someone to read them to
you. Ask your doctor or nurse to check how
well you are using your inhaler.
Use
your inhaler in one of the three ways pictured
below (A or B are best, but C can be used
if you have trouble with A and B). |
| Steps for Using Your
Inhaler |
|
Getting
Ready |
1. Take off the
cap and shake the inhaler.
2. Breathe out all the way.
3. Hold your inhaler the way your doctor said
(A, B, or C below). |
Breathe
in slowly |
4. As you start
breathing in slowly through your mouth, press
down on the inhaler one time. (If you use
a holding chamber, first press down on the
inhaler. Within 5 seconds, begin to breathe
in slowly.)
5. Keep breathing in slowly, as deeply as
you can. |
| Hold your breath |
6. Hold your breath
as you count to 10 slowly, if you can.
7. For inhaled quick-relief medicine (beta2-agonists),
wait about 1 minute between puffs. There is
no need to wait between puffs for other medicines. |
| A. Hold inhaler 1 to 2 inches
in front of your mouth (about the width of
two fingers). |
B. Use a spacer/holding
chamber. These come in
many shapes and can be useful to any patient. |
C. Put the inhaler in your
mouth. Do not use for steroids. |
|
|
|
Clean Your Inhaler
as Needed
Look at the hole where the medicine sprays
out from your inhaler. If you see “powder”
in or around the hole, clean the inhaler.
Remove the metal canister from the L-shaped
plastic mouthpiece. Rinse only the mouthpiece
and cap in warm water. Let them dry overnight.
In the morning, put the canister back inside.
Put the cap on. |
Know When To Replace
Your Inhaler
For medicines you take each day (an example):
Say your new canister has 200 puffs (number
of puffs is listed on canister) and you are
told to take 8 puffs per day.
So this canister will last 25 days. If you
started using this inhaler on May 1, replace
it on or before May 25.
You can write the date on your canister.
For quick-relief medicine take as needed
and count each puff.
Do not put your canister in water to see
if it is empty. This does not work. |
| How
to Use Your Peak Flow Meter |
A peak flow meter helps you
check how well your asthma is controlled.
Peak flow meters
are most helpful for people with moderate
or severe asthma.
This guide will tell you (1) how to find your
personal best peak flow number, (2) how to
use your personal best number to set your
peak flow zones, (3) how to take your peak
flow, and (4) when to take your peak flow
to check your asthma each day. |
| Starting
Out: Find Your Personal Best Peak Flow Number |
To find your personal best
peak flow number, take your peak flow each
day for 2 to 3 weeks. Your asthma should
be under good control during this time.
Take your peak flow as close to the times
listed below as you can. These times for
taking your peak flow are only for
finding your personal best peak flow.
- Between noon and 2:00 p.m. each day
- Each time you take your quickrelief
medicine to relieve symptoms (measure
your peak flow after you take your
medicine)
- Any other time your doctor suggests
Write down the number you get for each
peak flow reading. The highest peak flow
number you had during the 2 to 3 weeks is
your personal best.
Your personal best can change over time.
Ask your doctor when to check for a new
personal best.
To check your asthma each day, you will
take your peak flow in the morning. This
is discussed in the coming text. |
| Your Peak
Flow Zones |
Your peak flow zones are based
on your personal best peak flow number. The
zones will help you check your asthma and
take the right actions to keep it controlled.
The colors used with each zone come from the
traffic light. |
|
Green Zone (80 to 100
percent of your personal best) signals good
control. Take your usual daily long-term-control
medicines, if you take any. Keep taking these
medicines even when you are in the yellow
or red zones. |
|
Yellow Zone
(50 to 79 percent of your personal best) signals
caution: your asthma is getting worse. Add
quick-relief medicines. You might need to
increase other asthma medicines as directed
by your doctor. |
|
Red Zone (below 50 percent
of your personal best) signals medical alert!
Add or increase quick-relief medicines and
call your doctor now. |
Ask your doctor to
write an action
plan for you that tells you:
- The peak flow numbers for your green,
yellow, and red zones. Mark the zones
on your peak flow meter with colored tape
or a marker.
- The medicines you should take while
in each peak flow zone.
How To Take Your Peak Flow
- Move the marker to the bottom of the
numbered scale.
- Stand up or sit up straight.
- Take a deep breath. Fill your lungs
all the way.
- Hold your breath while you place the
mouthpiece in your mouth, between your
teeth. Close your lips around it. Do not
put your tongue inside the hole.
- Blow out as hard and fast as you can.
Your peak flow meter will measure how
fast you can blow out air.
- Write down the number you get. But if
you cough or make a mistake, do not write
down the number. Do it over again.
- Repeat steps 1 through 6 two more times.
Write down the highest of the three numbers.
This is your peak flow number.
- Check to see which peak flow zone
your peak flow number is in. Do the actions
your doctor told you to do while in that
zone.
Your doctor may ask you to write down your
peak flow numbers each day. You can do this
on a calendar or other paper. This will
help you and your doctor see how your asthma
is doing over time.
Checking Your Asthma: When To Use
Your Peak Flow Meter
- Every morning when you wake up, before
you take medicine. Make this part of your
daily routine.
- When you are having asthma symptoms
or an attack. And after taking medicine
for the attack. This can tell you how
bad your asthma attack is and whether
your medicine is working.
- Any other time your doctor suggests.
If you use more than one peak flow meter
(such as at home and at school), be sure
that both meters are the same brand.
Bring to Each of Your Doctor's
Visits:
- Your peak flow meter.
- Your peak flow numbers if you have written
them down each day.
Also, ask your doctor or nurse to check
how you use your peak flow meter—just to
be sure you are doing it right.
How
to Control Things That Make Your Asthma
Worse
You can help prevent asthma attacks by staying
away from things that make your asthma worse.
This guide suggests many ways to help you
do this.
You need to find out what makes
your asthma worse. Some things that
make asthma worse for some people are not
a problem for others. You do not need to
do all of the things listed in this guide.
Look at the things listed in dark print
below. Put a check next to the ones that
you know make your asthma worse. Ask your
doctor to help you find out what else makes
your asthma worse. Then, decide with your
doctor what steps you will take. Start with
the things in your bedroom that bother
your asthma. Try something simple first.
Tobacco Smoke
- If you smoke, ask your doctor
for ways to help you quit. Ask family
members to quit smoking, too.
- Do not allow smoking in your home
or around you.
- Be sure no one smokes at a child’s
day care center.
Smoke, Strong Odors, and
Sprays
- If possible, do not use a wood-burning
stove, kerosene heater, or fireplace.
- Try to stay away from strong odors
and sprays, such as perfume, talcum
powder, hair spray, and paints.
Indoor Mold
- Fix leaky faucets, pipes, or other
sources of water.
- Clean moldy surfaces with a cleaner
that has bleach in it.
|
Dust Mites
Many people with asthma are allergic
to dust mites. Dust mites are like
tiny “bugs” you cannot see that live
in cloth or carpet.
Things that will help the most:
- Encase your mattress in a special
dust-proof cover.*
- Encase your pillow in a special
dust-proof cover* or wash the pillow
each week in hot water. Water must
be hotter than 1300F to kill the
mites.
- Wash the sheets and blankets on
your bed each week in hot water.
Other things that can help:
- Reduce indoor humidity to less
than 50 percent. Dehumidifiers or
central air conditioners can do
this.
- Try not to sleep or lie on cloth-covered
cushions or furniture.
- Remove carpets from your bedroom
and those laid on concrete, if you
can.
- Keep stuffed toys out of the bed
or wash the toys weekly in hot water.
|
Animal Dander
Some people are allergic to the flakes
of skin or dried saliva from animals
with fur or feathers.
The best thing to do:
- Keep furred or feathered pets
out of your home.
If you can't keep the pet outdoors,
then:
- Keep the pet out of your bedroom
and keep the bedroom door closed.
- Cover the air vents in your bedroom
with heavy material to filter the
air.*
- Remove carpets and furniture covered
with cloth from your home. If that
is not possible, keep the pet out
of the rooms where these are.
|
Cockroach
Many people with asthma are allergic
to the dried droppings and remains
of cockroaches.
- Keep all food out of your bedroom.
- Keep food and garbage in closed
containers (never leave food out).
- Use poison baits, powders, gels,
or paste (for example, boric acid).
You can also use traps.
- If a spray is used to kill roaches,
stay out of the room until the odor
goes away.
Vacuum Cleaning
- Try to get someone else to vacuum
for you once or twice a week, if
you can. Stay out of rooms while
they are being vacuumed and for
a short while afterward.
- If you vacuum, use a dust mask
(from a hardware store), a double-layered
or microfilter vacuum cleaner bag,*
or a vacuum cleaner with a HEPA
filter.*
|
Pollen and Outdoor Mold
What to do during your allergy season
(when pollen or mold spore counts
are high):
- Try to keep your windows closed.
- Stay indoors with windows closed
during the midday and afternoon,
if you can. Pollen and some mold
spore counts are highest at that
time.
- Ask your doctor whether you need
to take or increase anti-inflammatory
medicine before your allergy season
starts.
|
Exercise, Sports, Work,
or Play
- You should be able to be active
without symptoms. See your doctor
if you have asthma symptoms when
you are active—like when you exercise,
do sports, play, or work hard.
- Ask your doctor about taking medicine
before you exercise to prevent symptoms.
- Warm up for about 6 to 10 minutes
before you exercise.
- Try not to work or play hard outside
when the air pollution or pollen
levels (if you are allergic to the
pollen) are high.
|
Other Things
That Can Make Asthma Worse
- Flu: Get a flu shot.
- Sulfites in foods: Do not drink
beer or wine or eat shrimp, dried
fruit, or processed potatoes if
they cause asthma symptoms.
- Cold air: Cover your nose and
mouth with a scarf on cold or windy
days.
- Other medicines: Tell your doctor
about all the medicines you may
take. Include cold medicines, aspirin,
and even eye drops.
|
Contact
These Groups to Learn More About Asthma:
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