Complete Guide to Asthma Management

Asthma affects over 25 million Americans, but with proper management, most people with asthma can lead completely normal, active lives. As a family medicine physician, I help patients understand their asthma, control symptoms, and prevent dangerous attacks.

Understanding Asthma

Asthma is a chronic inflammatory condition that affects your airways. During an asthma episode:

• Airways become inflamed and swollen
• Muscles around airways tighten
• Airways produce excess mucus
• Breathing becomes difficult

Common Asthma Symptoms

Recognize these warning signs:

• Shortness of breath: Especially with activity or at night
• Wheezing: A whistling sound when breathing
• Chest tightness: Feeling of pressure or squeezing
• Coughing: Particularly at night or early morning
• Difficulty sleeping: Due to breathing problems
• Exercise intolerance: Getting winded easily during activity

The Two Types of Asthma Medications

1. Controller Medications (Daily Prevention)

These medications reduce airway inflammation and prevent symptoms. You take them EVERY DAY, even when feeling well:

• Inhaled corticosteroids (ICS): Most effective long-term control medications
  • Examples: Flovent, QVAR, Pulmicort
  • Reduce inflammation in airways
  • Prevent symptoms and attacks
• Combination inhalers (ICS + LABA): For moderate to severe asthma
  • Examples: Advair, Symbicort, Dulera
  • Control inflammation plus long-acting bronchodilator
• Leukotriene modifiers: Pills taken daily
  • Example: Singulair (montelukast)
  • Reduce inflammation and mucus production

2. Rescue Medications (Quick Relief)

Use these for immediate symptom relief during asthma flare-ups:

• Short-acting beta agonists (SABA):
  • Examples: Albuterol (ProAir, Ventolin, ProAir RespiClick)
  • Relaxes airway muscles within minutes
  • Provides relief for 4-6 hours
  • Should carry with you at all times

Proper Inhaler Technique

Up to 70% of people use inhalers incorrectly! Follow these steps for metered-dose inhalers (MDI):

1. Shake the inhaler 10-15 times
2. Breathe out completely to empty your lungs
3. Place inhaler in mouth or 1-2 inches away (better with spacer)
4. Start breathing in slowly through your mouth
5. Press inhaler down once at the beginning of inhalation
6. Continue breathing in slowly and deeply (like sipping hot soup)
7. Hold your breath for 10 seconds if possible
8. Wait 1 minute before second puff if prescribed
9. Rinse mouth with water after using corticosteroid inhalers

Identifying and Avoiding Asthma Triggers

Common triggers that worsen asthma:

Indoor Triggers

• Dust mites: Use allergen-proof mattress and pillow covers, wash bedding weekly in hot water
• Pet dander: Keep pets out of bedroom, bathe pets weekly
• Mold: Fix leaks, use dehumidifiers (keep humidity below 50%)
• Cockroaches: Keep kitchen clean, seal food containers, fix water leaks
• Strong odors: Perfumes, cleaning products, air fresheners—choose fragrance-free
• Tobacco smoke: No smoking indoors, avoid secondhand smoke

Outdoor Triggers

• Pollen: Check pollen counts, keep windows closed on high-pollen days
• Air pollution: Limit outdoor activity on poor air quality days
• Cold air: Wear a scarf over mouth/nose in winter
• Weather changes: Be prepared with medications during temperature fluctuations

Other Triggers

• Exercise: Use rescue inhaler 15-20 minutes before activity, warm up properly
• Respiratory infections: Get flu shot annually, wash hands frequently
• Stress and emotions: Practice relaxation techniques
• GERD (acid reflux): Treat reflux if present—it can worsen asthma
• Certain medications: Aspirin, NSAIDs (ibuprofen), beta-blockers—discuss with doctor

Monitoring Your Asthma

Peak Flow Meter

This simple device measures how fast you can blow air out of your lungs:

• Establish your "personal best" peak flow number
• Check peak flow daily, especially during flare-ups
• Use results to guide treatment decisions

Peak Flow Zones (Like a Traffic Light)

• Green Zone (80-100% of personal best): Asthma well controlled—continue current treatment
• Yellow Zone (50-80% of personal best): Caution—asthma worsening, follow your action plan
• Red Zone (Below 50% of personal best): Medical alert—use rescue medication and get help immediately

Creating an Asthma Action Plan

Every person with asthma needs a written action plan that includes:

• Your daily controller medications and doses
• How to recognize worsening asthma
• What to do when symptoms worsen (step-by-step instructions)
• When to call the doctor
• When to go to the emergency room
• Emergency contact numbers

When to Seek Emergency Care

Go to the ER or call 911 if you experience:

• Severe shortness of breath (can't speak full sentences)
• Rescue inhaler not helping or relief lasting less than 4 hours
• Peak flow in red zone
• Lips or fingernails turning blue
• Struggling to breathe (chest pulling in, using neck muscles)
• Extreme anxiety or agitation due to breathing difficulty

Living Well with Asthma

Exercise and Physical Activity

Exercise is important for overall health and can be done safely with asthma:

• Use rescue inhaler 15-20 minutes before exercise if prescribed
• Warm up for 10-15 minutes before intense activity
• Cool down gradually after exercise
• Breathe through your nose when possible
• Choose asthma-friendly activities (swimming, walking, yoga)
• Avoid exercising outdoors when air quality is poor

Pregnancy and Asthma

If you're pregnant or planning pregnancy:

• Continue asthma medications—uncontrolled asthma is riskier than medications
• Work closely with your OB and primary care doctor
• Monitor symptoms carefully—pregnancy can affect asthma control
• Most asthma medications are safe during pregnancy

Regular Follow-Up Care

Schedule appointments with your doctor:

• Well-controlled asthma: Every 6-12 months
• Not well-controlled: Every 2-6 weeks until controlled
• After ER visit or hospitalization: Within 3-5 days
• Annual flu shot: Reduces risk of asthma flare-ups

The Bottom Line

Well-controlled asthma means:

• Symptoms 2 days a week or less
• Nighttime awakenings 2 times a month or less
• Using rescue inhaler 2 days a week or less (except before exercise)
• No limitations on activities
• Normal lung function

If your asthma isn't meeting these goals, it's time to adjust your treatment plan. Don't accept frequent symptoms as normal—better asthma control is possible!