Asthma: 10 Things You Need To Do To Keep It In Check
Medically reviewed on Apr 23, 2018 by C. Fookes, BPharm
1. Understand what your different inhalers are for
Knowing which inhaler does what is vital for keeping your asthma symptoms under control.
Most asthma inhalers can be grouped into those that relieve symptoms - these are known as "relievers" and those that need to be taken daily to keep symptoms under control - these are known as "controllers".
Traditionally, reliever inhalers are colored blue, an example is albuterol. Albuterol opens up the airways and helps you to breathe easier. Controller inhalers tend to come in many different colors, including brown, orange, purple, and red. However, this color-coding custom is not always followed so always check with your pharmacist if you are unsure. Examples of controllers include budesonide, flunisolide, and fluticasone; long-acting beta agonists (LABA) such as salmeterol, but there are many others.
If you find it difficult to distinguish between your inhalers, you could ask your doctor or Pharmacist to put an “R” or a “C” on the different types, or color code them with dots.
Your reliever medication needs to be used when you are short of breath or before exercise. Your controller medicine (if prescribed) needs to be used daily, usually twice a day, even when you feel fine. Controller medicines help keep your symptoms under control long-term, lessening the risk of an asthma attack.
LABAs help with breathing when used on a daily basis, but will not help symptoms of an acute attack. For more detailed information about asthma treatments, see our slideshow What is Asthma? Causes, Symptoms and Treatments.
2. Know your asthma triggers and keep track of your symptoms
Asthma attacks are usually brought on by triggers such as air pollution, animal dander, colds or the flu, chemical irritants, wood smoke, cockroach allergy, dust mites, or pollen. Exercise, fumes, changes of temperature, pre-menstrual and hormonal changes, or even moving house can worsen asthma symptoms. If you can identify these triggers, and avoid them if possible, you may have better asthma control.
Pay careful attention to the pattern of your asthma symptoms. Keep a diary and write down what you do, eat, and where you go each day. Mark the days where your breathing gets worse or when you have to step up your medication. Show your diary to your doctor and talk about how to manage possible triggers.
Blood tests or skin tests can also be used to determine if you are sensitive to a particular substance. Allergen immunotherapy is one option to consider if tests show a correlation between exposure to an allergen and your asthma symptoms.
3. Keep symptoms of hay fever under control
There is a strong link between hay fever and asthma and many experts now believe that hay fever could be the root cause of thousands of asthma-related hospitalizations and hundreds of asthma-related deaths each year.
Up to 80% of people with asthma also have hay fever. Discuss ways to manage your hay fever with your doctor before the pollen season starts. This may mean temporarily boosting your asthma medications or using a nasal corticosteroid for a few months in addition to your usual inhalers to help keep symptoms at bay.
4. Use your inhaler before exercising if your asthma is brought on by exercise
Physical activity is just as important in people with asthma as it is in people without asthma, so talk to your doctor if asthma limits you from doing exercise. Symptoms include coughing, wheezing, chest tightness or unexplained shortness of breath during exercise.
The most effective way to combat exercise-induced asthma is to use your inhaler before exercise. Relievers (short-acting bronchodilators) will prevent exercise-induced asthma in most people; however, some people may also need additional protective treatments, including long-term control medication. Warm-up periods and a scarf worn over the mouth if it is cold may also help prevent symptoms.
5. Create an asthma action plan with your doctor
Everybody needs an asthma action plan. If you don’t have one, talk with your doctor about completing one together so that you can keep it at home or in your wallet.
An action plan lists all the medications that you take for asthma along with simple instructions on when they should be taken. It provides a clear plan on what to do if your symptoms get worse. Action plans outline the medication you should take at the first sign of a cold, or following exposure to a known trigger, or if you develop a wheeze, cough, or tight chest.
Danger symptoms are also detailed. These include hard and fast breathing, difficulty talking, and feeling anxious. If your medication is not helping relieve these symptoms, then ring 9-1-1 or get to a hospital fast!
6. Take a copy of your child’s asthma action plan to their school
Most parents have enough to do at the start of the new school year, but parents of children with asthma have even more. If you haven’t already talked with the school or your child’s teacher about their asthma action plan, then make an appointment to do it as soon as you can. Provide the school with written instructions and review their policies so you are satisfied that your child’s specific needs will be addressed.
Although all 50 states and the District of Columbia have passed laws allowing students with asthma to carry their inhalers, there are still a range of local policies and practices in some schools that make it difficult for some children to freely access these potentially lifesaving medicines during the school day.
Organize for an in-date emergency supply to be kept in the nurse’s cabinet, just in case. Encourage your child to talk about their asthma to friends, classmates and teachers, and to let an adult know if they are experiencing any symptoms.
7. Check your inhaler technique with your doctor or pharmacist
The way you use your inhaler can make a huge difference to your asthma control. Even if you have had asthma for years, it’s not a bad idea to ask your doctor or pharmacist to check your technique next time you visit or pick up your supplies.
Some metered dose inhalers (MDIs) need to be shaken for at least five seconds before use. They must also be primed before first use, or after dropping, which involves spraying up to 4 puffs into the air. Breath-activated inhalers don't require shaking or priming. Ask your pharmacist if you are unsure which one you have.
Before putting the inhaler in your mouth, breathe out normally. Sit or stand upright and place the mouthpiece between your teeth and seal with your lips. Press down on the canister with your index finger to release the medication while breathing in deeply and slowly through the mouth. Hold your breath for about 5-10 seconds. Wait half a minute before repeating if you need more than 1 puff.
Ask your doctor or a pharmacist about a spacer if you have difficulty timing the spray with inhalation. These allow you to activate the MDI then inhale separately.
8. Clean your MDI inhaler once a week
Yes! Even inhalers get dirty and need a good scrub every now and then.
Hydrofluoroalkane (HFA) is the main propellant used to deliver medications in MDIs. HFAs were introduced in 2008 as a more environmentally friendly substitute for ozone-damaging chlorofluorocarbon (CFC)-propelled MDIs. HFAs taste different and feel warmer and softer in the mouth than CFC inhalers; and research has shown that they are just as effective at delivering medication. Because HFA is a stickier substance than CFC, residual spray is more likely to build up and clog up the mouthpiece of the inhaler.
Clean your inhaler weekly by removing the metal canister from the mouthpiece (never get the canister wet!). Rinse both the mouthpiece and cap under warm running water for 30 seconds, then allow to dry thoroughly before reassembling.
Clogged-up inhalers decrease the amount of medicine each puff delivers and can prevent you from receiving an accurate dose.
9. Work out when your inhaler is empty
Unfortunately, HFA canisters keep on spraying long after the medication has run out. This means you get a good dose of propellant but not much active drug.
While some brands have a dose counter on the side, others don’t, and it can be a challenge to work out when the canister is empty or close to empty.
Most corticosteroid inhalers deliver 120 doses and at two puffs twice a day, should last 30 days. It will help you to remember to change inhalers if you write the empty date with a sharpie on your inhaler the day you start it. It’s a bit trickier to work out the empty date with reliever inhalers and HFA canisters don’t float when empty like CFC ones use to which means the old “float test” doesn't work.
Get to know the feel of your canisters. If one feels under half full, it is a good idea to replace it with a new one. Hopefully, more inhaler manufacturers will bring out dose counters in the future!
10. Get the flu vaccine every year
Although people with asthma are not more likely to get the flu, the flu can be more serious in people with asthma, even if their asthma is mild or well controlled with medication.
Influenza further inflames the already swollen and sensitive airways of people who have asthma, exacerbating symptoms and triggering an asthma attack. People with asthma have a higher risk of developing pneumonia or other breathing disorders as a result of the flu. The risk of hospitalization is increased in people with asthma who catch the flu.
The best way to protect against the flu and pneumonia is with vaccination. Because influenza viruses are constantly changing, flu vaccination must be done yearly and is recommended for everybody with asthma over the age of 6 months. The pneumococcal vaccine does not need to be given each year.
Finished: Asthma - 10 Things You Need To Do To Keep It In Check
- Asthma overview. Reviewed Oct 2015. Asthma and Allergy Foundation of America. http://www.aafa.org/page/asthma.aspx
- Common Asthma Triggers. Updated Aug 2012. Centers for Disease Control and Prevention. http://www.cdc.gov/asthma/triggers.html
- Allergy facts. Updated Jan 2018. American College of Allergy, Asthma and Immunology. https://acaai.org/news/facts-statistics/allergies
- Exercise-Induced Bronchoconstriction (Asthma). Reviewed Oct 2015. Asthma and Allergy Foundation of America. http://www.aafa.org/page/exercise-induced-asthma.aspx
- Know How to Use Your Asthma Inhaler Updated Mar 2018. Centers for Disease Control and Prevention. http://www.cdc.gov/asthma/inhaler_video/
- Flu and People with Asthma. Reviewed Jan, 2017. Centers for Disease Control and Prevention. http://www.cdc.gov/flu/asthma/