What Is Asthma?

Asthma is a chronic (long-term) disease of the airways in the lungs. It can’t be spread to others, and it has nothing to do with how you were raised or your relationships. Asthma is often hereditary, meaning it is passed through families. Sometimes, more than one person in the same family has asthma.Understanding how your lungs work will help you understand more about asthma.

When You Have Asthma?

NORMAL

When asthma is under control, the linings of the airways (bronchial tubes) are smooth, clear, and air fl ows easily in and out.

INFLAMED AIRWAYS
With asthma, your airways are super sensitive. When asthma is not controlled, the airways become infl amed and swollen. The airways then are made smaller, but air can still fl ow. When this happens, you may have a cough, chest tightness, wheezing,shortness of breath, or you may feel tired.
DURING AN ATTACK
During an attack, the airways swell up even more and make extra mucus (phlegm). Also,the muscles around the airways become tight, and air gets trapped in the alveoli (the small sacs at the end of the bronchial tubes).All of this makes it very hard for air to pass through your airways and can even block them. You may wheeze, cough, and have trouble breathing.

Why Does Asthma Happen?

Sensitive airways can become affected by many things. These are called asthma triggers.The first important step in controlling your asthma is to discover what allergens trigger your asthma, and stay away from them!
If you can control your triggers, you can help keep your airways from becoming inflamed and swollen.

Common Allergens That Trigger Asthma
Dust mites are tiny insects found in house dust in almost all parts of the United States. They live on human dander (skin flakes shed by all people), and they increase with moisture in the air. Dust mites are plentiful on mattresses, pillows, carpets, bed covers, and upholstered furniture.

S O L U T I O N •
You can control dust mites by washing the bed pillows, sheets, and covers every week in hot water (130o F). • Use a special allergy-proof mattress and pillow covers. • If possible, get rid of carpets, extra pillows, and upholstered furniture, especially in the bedroom. • Limit stuffed animals in children’s rooms, and wash them weekly in hot water (130o F). • Dust and vacuum often.
• Use a dehumidifier in damp areas, such as basements—dust mites need moist air to live.


Animals
All warm-blooded animals, including birds and small rodents, produce dander (shedded skin, fur, and
feathers), urine, saliva, and droppings to which you may be sensitive.
S O L U T I O N
• Don’t have furry pets in your home. Your pet will increase asthma symptoms, either immediately
or over time.
• If that’s not an option, keep pets out of your bedroom. Keep your bedroom door closed, and
consider using dense filters or tape double-thickness cheesecloth over forced-air outlets.
• Keep pets away from carpet and upholstered furniture as much as possible.



Molds
Molds can grow in many homes and apartments, especially if you have a damp environment.
S O L U T I O N
• Repair leaks and clean with fungicide or bleach and water solutions where mold is visible.
Keep humidity at less than 50%, using a dehumidifier if necessary, especially in basements.

Cockroach Droppings
You can breathe in the droppings of cockroaches and become sensitive to it. This is a concern in big
cities and areas of the country with cockroach problems.
S O L U T I O N
• Keep food in tight containers.
• Repair water leaks.
• Use traps and poison baits to control cockroaches.

Outdoor Triggers
Tree, grass, and weed pollens and outdoor mold can also be a problem. Air pollution, smoke,
and car exhaust can affect you as well.

S O L U T I O N
• Keep your doors and windows shut, when possible, during times when outdoor triggers
are present.
• Avoid outdoor activity during high pollen or ozone hours, or premedicate prior to activity.
• Shower and shampoo after being outside.

Common Irritants That Trigger Asthma
Strong Smells
Strong smells from painting, spraying, cleaning fluids, garden chemicals, perfumes, lotions,hair sprays, and deodorants can trigger asthma problems.

S O L U T I O N
• Stay away from the house or apartment when these chemicals and sprays are in use, and stay away until the smell clears.

Smoking
Cigarette, pipe, and cigar smoke are triggers that can affect asthma severely. Children in homes with adults who smoke are far more likely to have asthma problems and ear infections.

S O L U T I O N
• If possible, smokers in families with asthma should quit.
• Smokers should never smoke indoors, in cars, or around people with asthma.
• Smokers should wear a removable shirt or jacket while smoking that can be taken off upon returning inside.

Infections
Viruses and infections of the sinuses can also make asthma worse. Viral infections are the most common triggers in young children and also cause attacks in adults.

S O L U T I O N
• Get your flu shot every year.
• See your provider for proper treatment. Often, you will need more of your regular asthma medicines until the infection clears.
• Ask your provider for asthma medicine prior to flu season to prevent an asthma attack if your child gets a viral infection every year.

Drainage From Colds and Sinus Problems
Drainage from colds and other sinus problems can make asthma worse.

S O L U T I O N
• Don’t ignore a drippy nose. Talk to your provider about medicines you can take
to reduce the drainage.
• Wash hands frequently.
• Don’t share toothbrushes or toothpaste when you have a cold.

Peak Flow Meter

A peak flow meter can be used at a clinic or at home to measure how well you are breathing. • Peak flow can be useful in identifying triggers.
• If a peak flow meter is used every day at home, you can find breathing problems even before you start to wheeze or cough.A drop in peak flow is a good way to recognize early signs of a coming asthma attack.
• Peak flow and the symptoms you are having help your provider decide if you are having an asthma flare.
• It helps to see how severely an asthma attack is affecting you.
• It helps the provider see how your asthma can be controlled over time.
There are many kinds of peak flow meters.

How To Use a Peak Flow Meter

Your asthma is not like anyone else’s, so you will need to discover your own personal best peak flow.

• Find your peak flow number in the morning and evening.
• Hold the meter next to the chart each time you blow to make
it easier to record the number.
• Circle the highest number of three blows. This is your peak flow.

STEP 1:
Slide the marker down as far as it will go.
This sets the meter at zero.

STEP 2:
Stand up. Take a deep breath in, and blow
all the way out as far as possible.
STEP 3:
Then take as deep a breath in as possible
with your mouth open.
STEP 4:
Place the meter in your mouth and close
your lips around it to form a seal. Your
tongue should be away from the hole.
Keep your fingers away from the markings.
Blow out once as hard and fast as you can.
STEP 5:
Don’t touch the marker, and write down
the number you get.
STEP 6:
Repeat twice. Reset the marker to zero each
time. Write down the number each time.
Your peak flow is the highest of these
three numbers.

• Find your peak flow number in the morning and evening.
• Hold the meter next to the chart each time you blow to make
it easier to record the number.
• Circle the highest number of three blows. This is your peak flow.

How To Establish Your Personal Best Peak Flow:
When your asthma is under control, record your peak flow twice daily for 2 weeks. Measure your peak flow at the same time of day, as peak flow is lowest in the early morning and highest between 12:00 noon and 5:00 PM. The highest number during those 2 weeks will be your personal best peak flow. Reestablish your personal best peak flow with new peak flow meters. Children need to reestablish their personal best peak flow every 6 months to allow for lung growth changes.

Long-term Control Medicines

If you regulate your triggers and use

long-term control medicines correctly,
your asthma can be very well controlled.

They reduce and help prevent the inflammation and swelling of your airways. If inflammation is controlled, your chances of having an asthma attack are low. Remember, managing your triggers, along with using long-term medicines, will give you good control of inflammation.

• Inhaled corticosteroids are the preferred medicine for persistent asthma (National Asthma Education and Prevention Program 2002).

• They must be used regularly to be effective, usually every day.

• You cannot become addicted to them, even if you use them for many years.

• Most will be inhaled, some are swallowed.

• With each new inhaler, especially the corticosteroid inhaler, check the number of doses in the canister. Count the number of doses you will be using each day and divide that number into the total number in the canister. This will tell you how long the medicine will last.
Write the date to call for a refill on the canister. DO NOT USE BEYOND THE NUMBER OF DOSES ON THE CANISTER.

• DO NOT DROP THE CANISTER INTO WATER.

Inhaled Corticosteroids
T H E S E A R E I N H A L E D

• Below are examples of the most common medicines used for controlling
inflammation and swelling of the airways.

• They are not the same as muscle-building steroids that are misused by athletes.

1.FLUTICASONE/SALMETEROL
(Flovent/Serevent) Combination Therapy (Advair Diskus)

2.FLUTICASONE
(Flovent)

3BUDESONIDE
( Turbuhaler)

P O S S I B L E S I D E E F F E C T S
• Oral thrush
(fungal infection in mouth)
• Dysphonia (hoarseness)
• Minimum growth delay in first
year of treatment with children.
Research shows these children
attain their normal height. Your
provider will keep your child on the
lowest maintenance dose possible.
Uncontrolled asthma may cause
more development problems than
long-term medicine.

Oral Corticosteroids
T H E S E A R E S W A L L O W E D

PREDNISONE
- Deltasone
- Prednisone

METHYLPREDNISOLONE
- Medrol
- Methylprednisolone

PREDNISOLONE
- Prelone Syrup
- Pediapred

P O S S I B L E S I D E E F F E C T S
You may notice after a few days:
• Fluid retention
• Increased appetite

You may experience after several
months of use:
• Adrenal suppression
(less able to handle stress)
• Decreased resistance
to infection
(get infections more easily)

You may experience after several
months or years of use:
• Moon face
• Cataracts
• Excess facial hair
• Osteoporosis

Non-Steroid Medicine
T H I S I S A L W A Y S I N H A L E D

• Protects the airways from some asthma triggers.
• Can help prevent asthma attacks due to exercise.
• Must take at least three times a day to be effective.

CROMOLYN SODIUM
(Intal)


P O S S I B L E S I D E E F F E C T
• Dry mouth

Quick-Relief Medicines

The long-term control medicines, on pages 20 to 24, are used to prevent asthma attacks from happening in the first place, but if asthma is severe, asthma attacks can still happen. Your provider will provide quick-relief medicines that usually relieve an asthma attack once it starts or keep it from getting worse. The medicines quickly relax the muscles around your airways so you can breathe easier. These medicines can also be used to prevent attacks if used before you exercise.

No matter what kind of quick-relief medicine you use, always carry it with you. Never leave home without it! Make sure you know how to use it the correct way. Check expiration dates regularly to make sure it is still effective.

B E C A R E F U L

You can use quick-relief medicines too often. They make you feel better for a little while, but will not help if you need to use them every day. You may need long-term control medicines if you:
• Need quick-relief medicine more than twice a week.
• Wake up at night more than twice a month with asth ma symptoms.
• Need a refill more than twice a year.
(Baylor’s Rules of Two®) With good control, you should not need quick-relief medicines very often.

Short-Acting Beta2-Agonists
T H E S E A R E I N H A L E D

P O S S I B L E S I D E E F F E C T S

• Racing heart

• Nervousness and tremors (shaking)

ALBUTEROL SULFATE

(Proventil)
Also available in nebulized form

Anticholinergics T H E S E A R E I N H A L E D

P O S S I B L E S I D E E F F E C T

• Dry mouth

IPRATROPIUM BROMIDE/ALBUTEROL
(Combivent) Combination Therapy

IPRATROPIUM BROMIDE
(Atrovent)

R E M E M B E R
• Set aside money for asthma medicine. Buy more before you run out.

• Ask your provider any questions you have about medicines. Asthma may get better or worse over the years. Your provider may need to change your medicines over time.

• Always check expiration dates.

Turbuhaler Technique and Tips

• Follow the manufacturer’s instructions to load your dose of medication.

• Hold inhaler upright after loading medicine.

• Hold the inhaler away from the mouth, take a deep breath in, and blow out slowly
and completely.

• Put your mouth around the mouthpiece and inhale deeply and forcefully.

• Hold your breath and count to 10.

• Breathe out slowly.

• Repeat these steps for the number of doses that your doctor has prescribed.

• Rinse your mouth with water, but don’t swallow.

• The red line appearing on the window of your turbuhaler indicates only 20 doses left.
Order refill at this time.

Diskus Technique and Tips

• Hold Diskus in left hand and place thumb on the thumb grip, pushing it forward away from
you as far as it will go.

• Holding the Diskus in a level horizontal position, push the lever forward away from you
until it clicks or as far as it can go.

• Holding the Diskus level but away from your mouth, take a deep breath, and blow out as deeply and completely as possible.

• Put the mouthpiece to your lips and breathe in steadily and deeply through your mouth.

• Remove the Diskus from your mouth.

• Hold your breath and count to 10.

• Breathe out slowly.

• To close Diskus, put your thumb on the thumb piece and slide the thumb grip back toward you
until it clicks shut. The lever will automatically return with the thumb grip and reset itself.

• Repeat procedure for the number of doses the doctor has prescribed.

• If using inhaled corticosteroids, rinse your mouth with water, but don’t swallow.
Never wash the mouthpiece or any part of the Diskus device. It must always be kept dry.

Spacers and Holding Chambers

Some people, especially children, have trouble using an inhaler the right way. Using a spacer helps deliver more medicine to the lungs and helps decrease hoarseness that may occur with inhaled corticosteroids. Holding chambers allow you to breathe in and out more than once per puff of medicine. Wash the plastic spacer or chamber with soap and water when it is new to cut down on the electrostatic field that is inside the chamber.

STEP 1: The holding chamber or spacer attaches to the inhaler.

STEP 2:
Shake well.

STEP 3:
Breathe all the way out. Place the mouthpiece
in your mouth, then press the inhaler
button to release a puff of medicine into
the spacer or chamber.

STEP 4:
Breathe in slow and deep, keeping the
mouthpiece in place until finished.

STEP 5:
Hold your breath and count to 10, then
relax and breathe out.

STEP 6:
Young children may require a chamber
with a mask. It is necessary for the mask to
fit securely against the face for the child to
receive maximum dose.

• If you need more than one puff of medicine, wait at least a minute before using the spacer again.

• No matter what medicines you take and when, use your asthma diary and asthma action plan that you’ve created with your provider.
Always follow your plan, and your asthma can be controlled.

How To Take Asthma Medicines

Many asthma medicines come as sprays and powders
that are used in an inhaler. When you breathe in the
medicine through the inhaler, it goes right to the airways
in the lungs where it is needed. Ask your provider to
help you learn how to use an inhaler.



STEP 1:
Take off the cap, and shake the inhaler
with the metal canister inserted.

STEP 2:
Hold the inhaler like this—stand up, take
a deep breath, and breathe out as much as
you can. Tilt head back slightly.

STEP 3:
Hold the inhaler in your mouth or 2 fingers
away from your mouth (the best method).
As you start to breathe in, push down on
the top of the inhaler, and keep breathing
in slowly and deeply, keeping mouth open
until breathing is complete.

STEP 4:
Hold your breath for 5 to 10 seconds with
your mouth closed, then breathe out
slowly. If you use more than one puff,
wait 1 minute before inhaling again.

STEP 5:
If using inhaled corticosteroids, rinse your
mouth with water, but don’t swallow.
STEP 6:
Once a day, remove the cap and the canister
from plastic holder, and wash them with
mild soap and water. Rinse with running
water. Let dry.

Using a Nebulizer

• If using a face mask, the mask must fit properly (right size) and tightly over nose and mouth.
• If using a mouthpiece, it must be between the teeth with lips closed tightly around it.
• Waving the mouthpiece or mask in front of the mouth will NOT get the medicine into the lungs.

• Rinse out mouth after nebulizing Budesonide (Pulmicort Respules).
• Give infants a drink of water. • If a face mask was used, wash face with soap and water to avoid skin irritation.
• The cup, mouthpiece, or mask should be washed daily with mild soap and water, rinsed in a vinegar and water solution, and dried. Never wash the tubing.
• Change filter on nebulizer compressor according to manufacturer’s recommendations.

Asthma Attacks Can Be Dangerous

Know Your Signs and Symptoms

• Coughing, sneezing, itchy throat • Tight chest, wheeze • Shortness of breath • Wake up at night • Fast heartbeat and breathing • Headache
Take Action
• Work with your provider to develop an action plan.
• Learn what your warning signs are.
• When you feel an attack coming:

1. Get away from the trigger that started your attack.
2. Take a quick-relief medicine, up to 3 treatments of 2 to 4 puffs, 20 minutes apart. Check your peak flow first and before each additional dose.
3. If you still have wheezing and shortness of breath, get emergency help from your provider.

Follow Your Asthma Action Plan

Controlling your asthma may seem like a lot of work, but taking steps now can help you live a normal life.

• Find ways to control your asthma triggers.
• Keep your asthma diary up-to-date and follow your asthma action plan.
• Take your long-term control medicines daily or as prescribed.
• Always carry your quick-relief medicine with you.

All of these steps together can greatly reduce your chances of having asthma attacks. Prevention is the key. All it takes is good information
and a working partnership with your provider.