What is asthma

Asthma is a disease that causes the airways of the lungs to swell (inflammation) and narrow. Normally, when someone breathes in, air goes in through the nose or mouth, down the windpipe (trachea), and into the airways (bronchioles) of the lungs. When people breathe out, air exits the body in the opposite direction. With asthma, air has a harder time passing through. Airways swell and fill with mucus. The muscles around the airways tighten, making airways narrower. It leads to wheezing, shortness of breath, chest tightness, and coughing.

According to data from the National Health Interview Survey, the prevalence of asthma in the United States in 2014 was 7.7% in all ages, with 44.7% of persons with asthma reporting having had one or more asthma attacks. Nearly 9 million of them are children. Children have smaller airways than adults, which makes asthma especially serious for them. Children with asthma may experience wheezing, coughing, chest tightness, and trouble breathing, especially early in the morning or at night. In 2011, there were 1.8 million emergency department visits for asthma and in 2012 there were 10.5 million physician office visits with asthma as the primary diagnosis (Centers for Disease Control) ¹⁾. Given the prevalence of this disease, the impact on patients and caregivers, and the health care resources it demands, clinical guidelines are critical to standardizing and improving care throughout health care systems.

What is Asthma Attack ?

Asthma can flare-ups are when asthma symptoms get worse. They happen when airways get more irritated and inflamed (swollen) than usual.

During an asthma attack (flare-up), you might have:

• trouble breathing
• a tight chest
• a whistling sound while breathing (wheezing)
• a cough
• a fast heartbeat

Some flare-ups are serious, but others are mild. Flare-ups can happen suddenly or build up over time, especially if people don’t take their asthma medicines as directed.

Things that bring on a flare-up are called triggers. Triggers vary from person to person, but common ones include:

• allergies to things like pollen, mold, and pet dander
• irritants and pollutants in the air
• respiratory infections, like colds or flu
• weather conditions
• exercise (some kids only have asthma symptoms during or after exercise)
• gastroesophageal reflux

An important part of managing asthma is avoiding triggers. Your child’s doctor will work with you to create a care plan that helps prevent flare-ups as much as possible.

Signs of an asthma attack

If you do not know if you have asthma, these 4 symptoms could be signs that you do:

1. Coughing that sometimes wakes you up at night.
2. Wheezing, or a whistling sound when you breathe. You may hear it more when you breathe out. It can start as a low-sounding whistle and get higher.
3. Breathing problems that include having shortness of breath, feeling like you are out of breath, gasping for air, having trouble breathing out, or breathing faster than normal. When breathing gets very difficult, the skin of your chest and neck may suck inward.
4. Chest tightness

Other Warning Signs

Other early warning signs of an asthma attack are:

• An itchy neck
• Dark bags under your eyes
• Fatigue
• Being short-tempered or irritable
• Feeling nervous or edgy

Danger Signs

Call your local emergency number right away if you have any of the following symptoms. These are signs of a serious medical emergency.

• You are having trouble walking or talking because it is so hard to breathe.
• You are hunching over.
• Your lips or fingernails are blue or gray.
• You are confused or less responsive than usual.

If your child has asthma, the child’s caregivers must know to call 911 if your child has any of these symptoms. This includes teachers, babysitters, and others who take care of your child.

Exercise induced asthma

Sometimes exercise triggers asthma symptoms. This is called exercise-induced asthma ²⁾.

The symptoms of exercise induced asthma are coughing, wheezing, a feeling of tightness in your chest, or shortness of breath. Most times, these symptoms start soon after you stop exercising. Some people may have symptoms after they start exercising.

Be Careful Where and When you Exercise

Having asthma symptoms when you exercise does not mean you cannot or should not exercise. But be aware of your exercise induced asthma triggers.

Cold or dry air may trigger your asthma symptoms. If you do exercise in cold or dry air ³⁾:

• Breathe through your nose.
• Wear a scarf or mask over your mouth.
• DO NOT exercise when the air is polluted.
• DO NOT exercise near fields or lawns that have just been mowed.

Warm up before you exercise, and cool down afterward:

• To warm up, walk or do your exercise activity slowly before you speed up.
• The longer you warm up, the better.
• To cool down, walk or do your exercise activity slowly for several minutes.

Some kinds of exercise may be less likely to trigger asthma symptoms than others.

• Swimming is a good sport for people with exercise induced asthma. The warm, moist air helps keep asthma symptoms away.
• Football, baseball, and other sports with periods when you do not move fast are less likely to trigger your asthma symptoms.

Activities that keep you moving fast all the time are more likely to trigger asthma symptoms, such as running, basketball, or soccer.

Use Your Asthma Medicine Before you Exercise

Take your short-acting, or quick-relief, inhaled medicines before you exercise.

• Take them 10 to 15 minutes before exercise.
• They can help for up to 4 hours.

Long-acting, inhaled medicines may also help.

• Use them at least 30 minutes before exercise.
• They can help for up to 12 hours. Children can take this medicine before school, and it will help for the whole day.
• Be aware that using this kind of medicine every day before exercise will make it less effective over time.

Follow your doctor’s advice on which medicines to use and when.

When to see a Medical Professional

Call for an appointment with your provider if asthma symptoms develop.

See your provider or go to the emergency room if:

• An asthma attack requires more medicine than recommended
• Symptoms get worse or do not improve with treatment
• You have shortness of breath while talking
• Your peak flow measurement is 50% to 80% of your personal best

Go to the emergency room if these symptoms occur:

• Drowsiness or confusion
• Severe shortness of breath at rest
• A peak flow measurement of less than 50% of your personal best
• Severe chest pain
• Bluish color to the lips and face
• Extreme difficulty breathing
• Rapid pulse
• Severe anxiety due to shortness of breath.

Causes of asthma

Asthma is caused by swelling (inflammation) in the airways. When an asthma attack occurs, the lining of the air passages swells and the muscles surrounding the airways become tight. This reduces the amount of air that can pass through the airway.

No one knows exactly why some people develop asthma. Experts think it might be a combination of environmental factors and genes.

People with asthma may have a parent or other close relative with asthma. Those who are overweight may be more likely to have it.

In people who have sensitive airways, asthma symptoms can be triggered by breathing in substances called allergens or triggers.

Common asthma triggers include:

• Animals (pet hair or dander)
• Dust mites
• Certain medicines e.g. aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS)
• Changes in weather (most often cold weather)
• Chemicals in the air or in food
• Exercise
• Mold
• Pollen
• Respiratory infections, such as the common cold
• Strong emotions (stress)
• Tobacco smoke

Substances in some workplaces can also trigger asthma symptoms, leading to occupational asthma. The most common triggers are wood dust, grain dust, animal dander, fungi, or chemicals.

Many people with asthma have a personal or family history of allergies, such as hay fever (allergic rhinitis) or eczema. Others have no history of allergies.

How Is Asthma Diagnosed ?

To diagnose asthma, doctors will ask questions about your health, problems with breathing, and family medical history. They’ll also ask about any allergies, illnesses, and exposure to things that may make your breathing worse.

You will have a physical exam and may have a lung function test. This usually involves testing breathing with a spirometer, a machine that analyzes airflow through the airways.

Asthma Prevention

You can reduce asthma symptoms by avoiding triggers and substances that irritate the airways.

• Cover bedding with allergy-proof casings to reduce exposure to dust mites.
• Remove carpets from bedrooms and vacuum regularly.
• Use only unscented detergents and cleaning materials in the home.
• Keep humidity levels low and fix leaks to reduce the growth of organisms such as mold.
• Keep the house clean and keep food in containers and out of bedrooms. This helps reduce the possibility of cockroaches. Body parts and droppings from cockroaches can trigger asthma attacks in some people.
• If someone is allergic to an animal that cannot be removed from the home, the animal should be kept out of the bedroom. Place filtering material over the heating outlets to trap animal dander. Change the filter in furnaces and air conditioners often.
• Eliminate tobacco smoke from the home. This is the single most important thing a family can do to help someone with asthma. Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair. This can trigger asthma symptoms. If you smoke, now is a good time to quit.
• Avoid air pollution, industrial dust, and irritating fumes as much as possible.

Stay away from asthma triggers

It is important to know what things make your asthma worse. These are called asthma “triggers.” Avoiding them is your first step toward feeling better.

Your homes can be filled with asthma triggers, found within:

• The air we breathe
• Furniture and carpets
• Your pets

Stay Away From Smoking

If you smoke, ask your health care provider for help quitting. No one should smoke in your house. This includes you and your visitors.

Smokers should smoke outside and wear a coat. The coat will keep smoke particles from sticking to their clothes. They should leave the coat outside or away from your child.

Ask people who work at your child’s day care, preschool, school, and anyone else who takes care of your child, if they smoke. If they do, make sure they do not smoke near your child.

Stay away from restaurants and bars that allow smoking. Or ask for a table as far away from smokers as possible.

Pollen

When pollen levels are high:

• Stay indoors and keep doors and windows closed. Use an air conditioner if you have one.
• Save outside activities for late afternoon or after a heavy rain.
• Wear a facemask while you are doing outdoor activities.
• DO NOT dry clothes outdoors. Pollen will stick to them. Have someone who does not have asthma cut the grass, or wear a facemask if you must do it.

Dust Mites

You can take several steps to limit exposure to dust mites.

• Wrap mattresses, box springs, and pillows in mite-proof covers.
• Wash bedding and pillows once a week in hot water (130°F to 140°F [54°C to 60°C]).
• If you can, get rid of upholstered furniture. Use wooden, leather, or vinyl furniture instead.
• Keep indoor air dry. Try to keep the humidity level lower than 50%.
• Wipe away dust with a damp cloth and vacuum once a week. Use a vacuum cleaner with a HEPA (high-efficiency particulate arrestor) filter.
• Replace wall-to-wall carpet with wood or other hard flooring.
• Keep stuffed toys off the beds, and wash them weekly.
• Replace slatted blinds and cloth draperies with pull-down shades. They will not collect as much dust.
• Keep closets clean and closet doors closed.

Mold Spores

Keeping indoor humidity at less than 50% will keep mold spores down. To do so:

• Keep sinks and tubs dry and clean.
• Fix leaky pipes.
• Empty and wash refrigerator trays that collect water from the freezer.
• Defrost your refrigerator often.
• Use an exhaust fan in the bathroom when you are showering.
• DO NOT let damp clothes sit in a basket or hamper.
• Clean or replace shower curtains when you see mold on them.
• Check your basement for moisture and mold.
• Use a dehumidifier to keep the air dry.

Pets can Make Asthma Worse

Keep pets with fur or feathers outside, if possible. If pets stay inside, keep them out of bedrooms and off upholstered furniture and carpets.

Wash pets once a week if possible.

If you have a central air conditioning system, use a HEPA filter to remove pet allergens from indoor air. Use a vacuum cleaner with HEPA filters.

Wash your hands and change your clothes after playing with your pet.

Roaches and Rodents

Keep kitchen counters clean and free of food crumbs. DO NOT leave dirty dishes in the sink. Keep food in closed containers.

DO NOT let trash pile up inside. This includes bags, newspapers, and cardboard boxes.

Use roach traps. Wear a dust mask and gloves if you touch or are near rodents.

Other Triggers to Watch Out for

DO NOT use wood-burning fireplaces. If you need to burn wood, use an airtight wood-burning stove.

DO NOT use perfumes or scented cleaning sprays. Use trigger sprays instead of aerosols.

Discuss any other possible triggers with your health care provider and how to avoid them.

Asthma Action Plan

Early treatment is the most effective strategy for managing asthma exacerbations.

An asthma action plan is a care plan that you’ll develop with your doctor. The plan gives detailed instructions on how to manage asthma, including:

• what medicines you need and when
• what you asthma triggers are and how to avoid them
• how to manage a flare-up
• when to get emergency medical care

Following the plan can help you do normal everyday activities without having asthma symptoms.

Keeping an asthma diary is another way to help manage asthma. Tracking you symptoms and medicines will help you know when you are more likely to have a flare-up.

A peak-flow meter can help too (see below how to use asthma peak flow meter). This handheld tool measures breathing ability. When peak flow readings drop, it’s a sign of narrowing airways.

By using these tools, taking medicines as prescribed and avoiding triggers, you’ll help keep yourself healthy and breathing well.

Figure 1. Asthma Action Plan

[Source ⁴⁾]

Management of Asthma Attacks (Flare-Ups)

Note: Algorithm for home management of acute asthma exacerbations. (PEF = peak expiratory flow.)

[Source ⁵⁾]

Signs and symptoms of asthma

Most people with asthma have attacks separated by symptom-free periods. Some people have long-term shortness of breath with episodes of increased shortness of breath. Either wheezing or a cough may be the main symptom.

Asthma attacks can last for minutes to days. Attacks can become dangerous if airflow is severely blocked.

Symptoms of asthma include:

• Cough with or without sputum (phlegm) production
• Pulling in of the skin between the ribs when breathing (intercostal retractions)
• Shortness of breath that gets worse with exercise or activity
• Wheezing

Emergency symptoms that need prompt medical help include:

• Bluish color to the lips and face
• Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack
• Extreme difficulty breathing
• Rapid pulse
• Severe anxiety due to shortness of breath
• Sweating

Other symptoms that may occur:

• Abnormal breathing pattern — breathing out takes more than twice as long as breathing in
• Breathing temporarily stops
• Chest pain
• Tightness in the chest

Exams and Tests for Asthma

The health care provider will use a stethoscope to listen to your lungs. Wheezing or other asthma-related sounds may be heard.

Tests that may be ordered include:

• Allergy testing — skin or a blood test to see if a person with asthma is allergic to certain substances
• Arterial blood gas (usually only done with people who are having a severe asthma attack)
• Chest x-ray
• Lung function tests, including peak flow measurements

Asthma treatment

The goals of treatment are ⁶⁾:

• Control airway swelling
• Stay away from substances that trigger your symptoms
• Help you to be able to do normal activities without asthma symptoms

You and your doctor should work as a team to manage your asthma. Follow your doctor’s instructions on taking medicines, eliminating asthma triggers, and monitoring symptoms.

Asthma medications

There are two kinds of medicines for treating asthma ⁷⁾:

• Control medicines to help prevent attacks
• Quick-relief (rescue) medicines for use during attacks.

Asthma Quick-Relief Asthma Medications

Asthma quick-relief medicines work fast to control asthma symptoms. You take them when you are coughing, wheezing, having trouble breathing, or having an asthma attack. They are also called rescue drugs.

These medicines are called “bronchodilators” because they open (dilate) and help relax the muscles of your airways (bronchi).

You and your doctor can make a plan for the quick-relief drugs that work for you. This plan will include when you should take them and how much you should take.

Plan ahead. Make sure you do not run out. Take enough with you when you travel.

Asthma Quick-Relief Asthma Medications are taken:

• For coughing, wheezing, trouble breathing, or an asthma attack
• Just before exercising to help prevent asthma symptoms caused by exercise

Tell your doctor if you are using quick-relief medicines twice a week or more. If so, your asthma may not be under control and your doctor may need to change your dose of daily control drugs.

Asthma Quick-relief medicines include:

• Short-acting inhaled bronchodilators
• Oral corticosteroids for when you have an asthma attack that is not going away

A severe asthma attack requires a checkup by a doctor. You may also need a hospital stay. There, you will likely be given oxygen, breathing assistance, and medicines given through a vein (IV).

Short-acting Beta-agonists Asthma Inhalers

Short-acting beta-agonists are the most common quick-relief drugs for treating asthma attacks.

They can be used just before exercising to help prevent asthma symptoms caused by exercise. They work by relaxing the muscles of your airways, and this lets you breathe better during an attack.

Tell your doctor if you are using quick-relief medicines twice a week or more to control your asthma symptoms. Your asthma may not be under control, and your doctor may need to change your dose of daily control drugs.

Some quick-relief asthma inhalers include:

• Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA)
• Levalbuterol (Xopenex HFA)
• Metaproterenol
• Terbutaline

Quick-relief asthma inhalers may cause these side effects:

• Anxiety.
• Tremor (your hand or another part of your body may shake).
• Restlessness.
• Headache.
• Fast and irregular heartbeats. Call your doctor right away if you have this side effect.

Oral Steroids

Your doctor might prescribe oral steroids when you have an asthma attack that is not going away. These are medicines that you take by mouth as pills, capsules, or liquids.

Oral steroids are not quick-relief medicines, but are often given for 7 to 14 days when your symptoms flare-up.

Oral steroids include:

• Prednisone
• Prednisolone
• Methylprednisolone.

Asthma Long-Term Asthma Medications

These are also called maintenance or control medicines. They are used to prevent symptoms in people with moderate to severe asthma. You must take them every day for them to work. Take them even when you feel OK.

Some long-term medicines are breathed in (inhaled), such as steroids and long-acting beta-agonists. Others are taken by mouth (orally). Your doctor will prescribe the right medicine for you.

Asthma – control drugs

Control medicines for asthma are drugs you take to control your asthma symptoms. You must take them every day for them to work. You and your doctor can make a plan for the medicines that work for you. This plan will include when you should take them and how much you should take.

You may need to take these medicines for at least a month before you start to feel better.

Take the medicines even when you feel OK. Take enough with you when you travel. Plan ahead. Make sure you do not run out.

Inhaled Corticosteroids

Inhaled corticosteroids prevent your airways from swelling in order to help keep your asthma symptoms away.

Inhaled steroids are used with a metered dose asthma inhaler (MDI) and spacer. Or they may be used with a dry powder inhaler.

You should use an inhaled steroid every day, even if you do not have symptoms.

After you use it, rinse your mouth with water, gargle, and spit it out.

If your child cannot use an inhaler, your doctor will give you a drug to use with a nebulizer. This machine turns liquid medicine into a spray so your child can breathe the medicine in.

Long-Acting Beta-agonist Asthma Inhalers

These medicines relax the muscles of your airways to help keep your asthma symptoms away.

Normally, you use these medicines only when you are using an inhaled steroid drug and you still have symptoms. DO NOT take these long-acting medicines alone.

Use this medicine every day, even if you do not have symptoms.

Combination Therapy

Your doctor may ask you to take both a steroid drug and a long-acting beta-agonist drug.

It may be easier to use an inhaler that has both drugs in them.

Leukotriene Modifiers

These medicines are used to prevent asthma symptoms. They come in tablet or pill form and can be used together with a steroid inhaler.

Cromolyn

Cromolyn is a medicine that may prevent asthma symptoms. It can be used in a nebulizer, so it may be easy for young children to take.

How to use asthma inhalers – without a spacer

Using a metered-dose asthma inhaler (MDI) seems simple. But many people do not use them the right way. If you use your metered-dose asthma inhaler (MDI) the wrong way, less medicine gets to your lungs and most remains in the back of your mouth ⁸⁾. If you have a spacer, use it. It helps get more medicine into your airways.

• The instructions below are not for dry powder inhalers. They have different instructions (see below).

Getting Ready

• Take off the cap and shake the inhaler hard.
• If you have not used the inhaler in a while, you may need to prime it. See the instructions that came with your inhaler for how to do this.
• Breathe out all the way.
• Hold the inhaler 1 to 2 inches (2.5 to 5 centimeters) in front of your mouth (about the width of 2 fingers).

Breathe in Slowly

• Start breathing in slowly through your mouth, then press down on the inhaler 1 time.
• Keep breathing in slowly, as deeply as you can.

Hold Your Breath

• If you can, hold your breath as you slowly count to 10. This lets the medicine reach deep into your lungs.
• If you are using inhaled, quick-relief medicine (beta-agonists), wait about 1 minute before you take your next puff. You do not need to wait a minute between puffs for other medicines.
• After using your asthma inhaler, rinse your mouth with water, gargle, and spit. This helps reduce side effects from your medicine.

Figure 2. Using asthma inhalers without a spacer

Keep Your Asthma Inhaler Clean

Look at the hole where the medicine sprays out of your inhaler. If you see powder in or around the hole, clean your inhaler.

• Remove the metal canister from the L-shaped plastic mouthpiece.
• Rinse only the mouthpiece and cap in warm water.
• Let them air dry overnight.
• In the morning, put the canister back inside. Put the cap on.
• DO NOT rinse any other parts.

Replacing Your Asthma Inhaler

Most inhalers come with counters on the canister. Keep an eye on the counter and replace the inhaler before you run out of medicine.

DO NOT put your canister in water to see if it is empty. This does not work.

Bring your inhaler to your clinic appointments. Your doctor can make sure you are using it the right way.

Storing Your Inhaler

Store your inhaler at room temperature. It may not work well if it is too cold. The medicine in the canister is under pressure. So make sure you do not get it too hot or puncture it.

How to use asthma inhalers – with a spacer

Metered-dose asthma inhalers (MDIs) usually have 3 parts:

• A mouthpiece
• A cap that goes over the mouthpiece
• A canister full of medicine

If you use your asthma inhaler the wrong way, less medicine gets to your lungs. A spacer device will help. The spacer connects to the mouthpiece. The inhaled medicine goes into the spacer tube first. Then you take 2 deep breaths to get the medicine into your lungs. Using a spacer wastes a lot less medicine than spraying the medicine into your mouth.

Spacers come in different shapes and sizes. Ask your doctor which spacer is best for you or your child. Almost all children can use a spacer. You do not need a spacer for dry powder inhalers.

The steps below tell you how to take your medicine with a spacer ⁹⁾.

Getting Ready

• Take the cap off the inhaler and spacer.
• Shake the inhaler hard.
• Attach the spacer to the inhaler.
• If you have not used the inhaler in a while, you may need to prime it. See the instructions that came with your inhaler for how to do this.
• Breathe out gently to empty your lungs.

Breathe in Slowly

• Put the spacer between your teeth and close your lips tightly around it.
• Keep your chin up.
• Start breathing in slowly through your mouth.
• Spray 1 puff into the spacer by pressing down on the inhaler.
• Keep breathing in slowly. Breathe as deeply as you can.

Hold Your Breath

• Take the spacer out of your mouth.
• Hold your breath as you count to 10, if you can.
• Pucker your lips and slowly breathe out through your mouth.
• After using your inhaler, rinse your mouth with water, gargle, and spit. This helps reduce side effects from your medicine.

Figure 3. Using asthma inhaler with a spacer

Keep Your Asthma Inhaler Clean

Look at the hole where the medicine sprays out of your inhaler. If you see powder in or around the hole, clean your inhaler. First, remove the metal canister from the L-shaped plastic mouthpiece. Rinse only the mouthpiece and cap in warm water. Let them air dry overnight. In the morning, put the canister back inside. Put the cap on. DO NOT rinse any other parts.

Replacing Your Asthma Inhaler

Most inhalers come with counters on the canister. Keep an eye on the counter and replace the inhaler before you run out of medicine.

DO NOT put your canister in water to see if it is empty. This does not work.

Storing Your Asthma Inhaler

Store your inhaler at room temperature. It may not work well if it is too cold. The medicine in the canister is under pressure. So make sure not to get it too hot or puncture it.

How to use Dry Powder Asthma Inhalers

A dry powder asthma inhaler delivers pre-set doses of medicine in powder form. The medicine gets to your airways when you take a deep, fast breath in from the inhaler. To keep your asthma under control, it is important to take your medicine as prescribed by your doctor or other health care professional and to use the proper technique to deliver the medicine to your lungs. If you don’t use your asthma inhaler correctly, you won’t get the medicine you need.

Here are general steps for how to use and clean a dry powder inhaler. Be sure to read the instructions that come with your asthma inhaler. Ask your doctor, pharmacist, or other health care professional (such as nurse practitioner, physician assistant, nurse, respiratory therapist, or asthma educator) to show you how to use your inhaler. Review your technique at each follow-up visit.

1. Remove cap and hold inhaler upright (like a rocket). If the inhaler is a Diskus®, hold it flat (like a flying saucer).
2. Load a dose of medicine according to manufacturer’s instructions (each brand of inhaler is different; you may have to prime the inhaler the first time you use it). Do not shake the inhaler.
3. Stand up or sit up straight.
4. Take a deep breath in and blow out completely to empty your lungs. Do NOT blow into the inhaler.
5. Place the mouthpiece of the inhaler in your mouth and close your lips around it to form a tight seal.
6. Take a fast, deep, forceful breath in through your mouth.
7. Hold your breath and count to 10.
8. Take the inhaler out of your mouth. Breathe out slowly, facing away from the inhaler.
9. If you are supposed to take more than 1 inhalation of medicine per dose, wait 1 minute and repeat steps 2 through 8.
10. When you finish, put the cover back on the inhaler or slide the cover closed. Store the inhaler in a cool, dry place (not in the bathroom).
11. If using an inhaled corticosteroid, rinse out your mouth with water and spit it out. Rinsing helps to prevent an infection in the mouth.

Keep Your Asthma Dry Powder Inhaler Clean

• Wipe the mouthpiece at least once a week with a dry cloth.
• Do NOT use water to clean the dry powder inhaler.

Figure 4. Asthma dry powder inhalers

How to use Asthma Nebulizer

A nebulizer is a machine that delivers medicine in a fine, steady mist. It is easy and pleasant to breathe the asthma medicine into your lungs this way. If you have asthma, you may not need to use a nebulizer. You may use an inhaler instead, which is usually just as effective. But a nebulizer can deliver medicine with less effort than an inhaler. You and your doctor can decide if a nebulizer is the best way to get the medicine you need. The choice of device may be based on whether you find a nebulizer easier to use and what type of medicine you take.

To keep your asthma under control, it is important to take your asthma medicine as prescribed by your doctor or other health care professional and to use the proper technique to deliver the medicine to your lungs. If you don’t use your asthma nebulizer correctly, you won’t get the medicine you need.

Most nebulizers are small, so they are easy to transport. Also, most nebulizers also work by using air compressors. A different kind, called an ultrasonic nebulizer, uses sound vibrations. This kind of nebulizer is quieter, but costs more.

Here are general steps for how to use and clean a asthma nebulizer. Be sure to read the instructions that come with your nebulizer. Ask your doctor, pharmacist, or other health care professional (such as nurse practitioner, physician assistant, nurse, respiratory therapist, or asthma educator) to show you how to use your nebulizer. Review your technique at each follow-up visit.

1. Wash hands well.
2. Put together the nebulizer machine, tubing, medicine cup, and mouthpiece or mask according to manufacturer’s instructions.
3. Put the prescribed amount of asthma medicine into the medicine cup. If your medicine comes in a pre-measured capsule or vial, empty it into the cup.
4. Place the mouthpiece in your mouth and close your lips around it to form a tight seal. If your child uses a mask, make sure it fits snugly over your child’s nose and mouth. Never hold the mouthpiece or mask away from the face.
5. Turn on the nebulizer machine. You should see a light mist coming from the back of the tube opposite the mouthpiece or from the mask.
6. Take normal breaths through the mouth while the machine is on. Continue treatment until the medicine cup is empty or the mist stops, about 10 minutes.
7. Take the mouthpiece out of your mouth (or remove mask) and turn off the machine.
8. If using an inhaled corticosteroid, rinse mouth with water and spit it out. If using a mask, also wash the face.

How To Clean and Store Asthma Nebulizer after each treatment:

• Wash hands well.
• Wash the medicine cup and mouthpiece or mask with warm water and mild soap. Do NOT wash the tubing.
• Rinse well and shake off excess water. Air dry parts on a paper towel.

Once a week:

Disinfect nebulizer parts to help kill any germs. Follow instructions for each nebulizer part listed in the package insert. Always remember:

• Do NOT wash or boil the tubing.
• Air dry parts on a paper towel.

Between uses:

• Store nebulizer parts in a dry, clean plastic storage bag. If the nebulizer is used by more than one person, keep each person’s medicine cup, mouthpiece or mask, and tubing in a separate, labeled bag to prevent the spread of germs.
• Wipe surface with a clean, damp cloth as needed. Cover nebulizer machine with a clean, dry cloth and store as manufacturer instructs.
• Replace medicine cup, mouthpiece, mask, tubing, filter, and other parts according to manufacturer’s instructions or when they appear worn or damaged.

Figure 5. Asthma nebulizer with a mask (for young children)

Figure 6. Asthma nebulizer with a mouthpiece (for teens and adults)

How to use your peak flow meter for Asthma

A peak flow meter is a small device that helps you check how well your asthma is controlled. Peak flow meters are most helpful if you have moderate to severe persistent asthma.

Figure 7. Peak Flow Meter for Asthma

How to Measure Peak Flow

Measuring your peak flow can tell you and your health care provider how well you blow air out of your lungs. If your airways are narrowed and blocked due to asthma, your peak flow values drop.

You can check your peak flow at home. Here are the basic steps:

• Move the marker to the bottom of the numbered scale.
• Stand 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 against or inside the hole.
• Blow out as hard and fast as you can in a single blow. Your first burst of air is the most important. So blowing for a longer time will not affect your result.
• Write down the number you get. But, if you coughed or did not do the steps right, do not write down the number. Instead, do the steps over again.
• Move the marker back to the bottom and repeat all these steps 2 more times. The highest of the 3 numbers is your peak flow number. Write it down in your log chart.

Many children under age 5 cannot use a peak flow meter very well. But some are able to. Start using peak flow meters before age 5 to get your child used to them.

Find Your Personal Best

To find your personal best peak flow number, take your peak flow each day for 2 to 3 weeks. Your asthma should be under control during this time. To finding your personal best, take your peak flow as close to the following times of day as you can:

• Between noon and 2 p.m. each day
• Each time after you take your quick-relief medicine to relieve symptoms
• Any other time your provider tells you to

These times for taking your peak flow are only for finding your personal best.

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.

Ask your provider to help you fill out an asthma action plan. This plan should tell you when to call the doctor for help and when to use medicines if your peak flow drops to a certain level.

Your personal best can change over time. Ask your doctor when you should check for a new personal best.

Use Your Peak Flow Meter Every Day

Once you know your personal best, make taking your peak flow a habit. Take your peak flow:

• Every morning when you wake up, before you take medicine. Make this part of your daily morning routine.
• When you are having asthma symptoms or an attack.
• After you take medicine for an attack. This can tell you how bad your asthma attack is and if your medicine is working.
• Any other time your doctor tells you to.

Check to see which zone your peak flow number is in. Do what your provider told you to do when you are in that zone. This information should be in your action plan. If you use more than one peak flow meter (such as one at home and another one at school or work), be sure that all of them are the same brand.

Home remedies for asthma

• Know the asthma symptoms to watch for.
• Know how to take your peak flow reading and what it means.
• Know which triggers make your asthma worse and what to do when this happens.
• Know how to care for your asthma when you exercise.

Asthma action plans are written documents for managing asthma.

An asthma action plan should include:

• Instructions for taking asthma medicines when your condition is stable
• A list of asthma triggers and how to avoid them
• How to recognize when your asthma is getting worse, and when to call your provider

A peak flow meter is a simple device to measure how quickly you can move air out of your lungs.

• It can help you see if an attack is coming, sometimes even before symptoms appear. Peak flow measurements help let you know when you need to take medicine or other action.
• Peak flow values of 50% to 80% of your best results are a sign of a moderate asthma attack. Numbers below 50% are a sign of a severe attack.

Outlook (Prognosis) for Asthma

There is no cure for asthma, although symptoms sometimes improve over time. With proper self-management and medical treatment, most people with asthma can lead a normal life.

Possible Complications of Asthma

The complications of asthma can be severe, and may include:

• Death
• Decreased ability to exercise and take part in other activities
• Lack of sleep due to nighttime symptoms
• Permanent changes in the function of the lungs
• Persistent cough
• Trouble breathing that requires breathing assistance (ventilator).

Risk Factors for Asthma-Related Death

• Comorbidities (i.e., cardiovascular disease or other chronic lung disease)
• Difficulty perceiving airway obstruction or severity of exacerbation
• Illicit drug use
• Low socioeconomic status or inner-city residence
• Major psychosocial problems or psychiatric disorders
• Previous severe exacerbation (e.g., intubation or admission to intensive care unit for asthma)
• Two or more hospitalizations or three or more emergency department visits in the past year
• Two or more refills of short-acting beta2 agonists per month