Asthma

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 information can help you learn to control your asthma or help a friend or family member with asthma.

ASTHMA IS A SERIOUS LUNG DISEASE

Asthma makes the sides of the airways in your lung inflamed or swollen all the time.  Your airways react to things like smoke, dust, pollen, or other things.  Your airways narrow or become smaller and you get common symptoms like: Coughing Wheezing (a whistling noise when you breathe) Chest tightness (the feeling that someone is squeezing or sitting on your chest) Shortness of breath

You may have all of these symptoms, some of them or just one.  Symptoms can be mild or severe.

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 the 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 can not be cured - having asthma is part of your life.  So you need to make taking care of your asthma a part of your life.  This is true even is your asthma is mild.

HOW TO TAKE CARE OF YOUR ASTHMA

1. Work with your doctor and see him or her at least every six months.

2. Take your asthma medicines exactly as your doctor tells you.

3. Watch for signs that your asthma is getting worse and act quickly.

4. Stay away from or control things that make your asthma worse.

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 under "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 six 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 medications and written action plan to each visit.  If you use a peak flow meter, bring it to each visit.

IS YOUR ASTHMA UNDER CONTROL?
Answer these questions by checking "yes" or "no."  Do this just before each doctor's visit.

In the past two 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 your 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 your asthma?	[     ] Yes	[     ] No
6.  Have you gone to the emergency room or hospital because of your  asthma?	[     ] Yes	[     ] No

TAKING THE RIGHT MEDICINES AT THE RIGHT TIMES
There are two main kinds of medications 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.

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-term-control medicine a part of your daily routine - just like eating, sleeping, and brushing your teeth.

THE LONG-TERM-CONTROL MEDICINES
The most effective long-term-control medicines are those that reduce swelling in your airways (inflammation).  These medicines include inhaled steroids, cromolyn, and nedocromil.

• Inhaled steroids and steroid tablets 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 when 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 long-acting-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-term-control medicine.  Studies so far show that it is used mainly for mild asthma in patients 12 years of age or 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 four hours.  Quick-relief medicine cannot keeps symptoms from coming back - only long-term control 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 quick-relief medicine.

Do not delay taking your quick-relief 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 that usual.  This is often a sign that your long-term-control medicine needs to be changed or increased.

Adapted from: National Institutes of Health - National Heart, Lung, and Blood Institute

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