Keeping Asthma under Control

Written by Dr Robin Green
© Allergy Society of South Africa & SACAWG

Introduction Points allowing you to achieve the goals of management of Asthma 1. Take medication as prescribed 2. Have and use an action plan when symptoms change How an asthma plan works 3. Use a peak flow meter during troublesome periods 4. Understand your Asthma 5. Don't ignore your symptoms 6. Avoid trigger factors that aggravate your asthma 7. Keep in touch with your doctor

Introduction

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• Although asthma is a condition that usually causes symptoms over a prolonged period (i.e. chronic) it is not a condition that should alter the quality of life of people who have it
• In fact most guidelines for the treatment of asthma highlight effective control of asthma as the most important goal

• The South African Childhood Asthma Working Group that drew up guidelines for doctors managing patients with asthma have suggested that the goal of management is effective control of asthma, which strives to ensure that the asthmatic is able to lead a normal and physically active life
• For a normal life the aim is to:
  
  • Be completely free of any symptoms; i.e. cough, wheeze and breathlessness.
  • Attend school regularly and participate fully in all school activities, including sports.
  • Have restfull sleep free from night-time cough and/or wheeze.
  • Minimise the number of attacks of asthma.
  • Avoid hospital admissions.

• Yes, troublesome asthma can usually be controlled. But there is no magical instant cure. It takes time and effort to learn about asthma and to look after yourself

The following points allow you to achieve the goals of management of asthma. Return to the top

Summary (Text follows below)

1. Take medication as prescribed (understand your treatment and the devices you use).
2. Have and use an action plan when symptoms change.
3. Use a peak now meter during troublesome periods.
4. Understand your asthma.
5. Don't ignore symptoms.
6. Avoid trigger factors that aggravate your asthma.
7. Keep in touch with your doctor.

1. Take medication as prescribed

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• One of the most important concepts to understand about asthma is that for most asthmatics treatment will be prescribed regularly
• This 'preventative' approach allows your doctor to keep the inflammation in your lungs under control. Preventers work by reducing the swelling, mucus and muscle tightening around the airways (see "Asthma Medicines and How they Work").
• In addition, but not in place of preventers, your doctor will give you a reliever treatment to use when you need to. It is important to know that relying on relievers only is a poor way to control symptoms. In order that you understand and use your treatment correctly make sure your doctor answers these questions:
  • Which is my preventer and which is my reliever?
  • When should I take preventor?
  • When should I take my reliever?
  • How many doses or puffs should I use?
  • How soon call I expect the medicine to work?
  • Call I alter these doses if my asthma gets worse or better?
  • What should I do if it doesn't seem to be working?
  • Am I using my asthma pump properly?
  • How can I keep side effects of the drugs to a minimum?

• The commonest way in which asthma medicine is used is called a pressurised metered dose inhaler or an asthma pump. Proper use is essential and discussed in 'Inhaler Devices in Asthma"
• Wash out the plastic container of your inhaler about once a week. The drug is delivered through a very tiny hole in the plastic container, which can slowly block up and this will result in a reduced amount of drug being delivered
• If your child has problems using the inhaler, as detailed above, then talk to your doctor about using a 'spacer ' (large volume chamber that holds the mist from the inhaler until the child starts to breath in)
• To check the contents of the metered dose container - invert the canister next to your can several times - if its full you will hear and feel the liquid contents swishing back and forth. Alternatively keep a record of puffs used - most canisters contain 200 puffs
• Some children are using powder devices and the principles of usage are the same. In this case pressing the inhaler is not necessary and breathing in (after activation) is all that is required
• In the near future asthma pumps may be changed slightly to make them less damaging to the ozone layer of our atmosphere. These CFC-free devices will, however, contain the same asthma medications and you need not worry about changing over. Your doctor can give you more advice in this regard.

2. Have and use an action plan when symptoms change

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The National Asthma Education Programme has freely available, asthma management cards which your doctor can use to individualise a plan of action for a change in your symptoms or peak now

Ask your doctor to write in the various asthma medications and when to change.
This card is organised by the colours of a robot (traffic light)

• Green reflects good control when regular medicines are used
• Yellow indicates a deterioration in symptoms or peak flow and a treatment plan will be given
• Red reflects poor control in which case your doctor should be contacted

It is useful to put this card in a prominent place and to take it with you when visiting your doctor or hospital.

How an asthma plan works

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a. Well controlled asthma

• You have no wheeze or cough during the night
• You can exercise and/or do your usual activities
• You seldom need any reliever medicine
• Your peak now readings stay within the safe range as agreed in your Action Plan

This is what you do:

• Continue with your regular treatments (written down on your Action Plan chart as Regular Medicines).

b. Worsening asthma

• You need your reliever inhaler more often than usual -or -
• You are waking with asthma at night -or -
• You are getting a cold -or -
• You are more short of breath during activity -or -
• Your peak now readings are up and down showing wide swings, and are lower than the expected figures.

This is what you do:

• Your Action Plan will show the peak flow reading at which you might expect to get these symptoms and need to take action
• Taking action at this early stage is very important
• Double the dose of your preventer or take it more frequently. (Your Action Plan will give you exact instructions from your doctor on this.) Continue the increased dose for 2 weeks
• Take extra doses of your reliever, your doctor will tell you the maximum number of extra doses that are safe for you
• If you are on other regular treatments - tablets, etc. - continue these as usual. Do not increase the dose of these without your doctor's instructions. Taking more than usual may result in dangerous side effects and will not help your asthma
• Measure your peak flow rate several times each day so you can check if the extra treatment is working. Remember, you are trying to get your readings back up to your best ones

c. Severe Asthma

• You are getting little relief from your reliever inhaler (or nebuliser) -or -
• You are more and more breathless despite increasing your preventer and reliever inhalers as in Step Two -or -
• Your peak now readings after using your reliever inhaler either stay the same or go down -or -
• Your peak now is below the level agreed on your Action Plan You need to use your reliever more than every 4 hours

This is what you do:

• Contact your doctor
• Your doctor may have given you a supply of tablets to take in this case and told you how many to take or will expect you to contact him or her when your symptoms or peak flow reading drop to the level agreed in your Action Plan.
• DON'T DELAY at this stage, as the tablets will take 4-6 hours to take effect. A short course of tablets (5-20 days) is safe with no long-term side effects. The tablets are necessary because they get rid of the swelling in the breathing tubes.
• After the first dose - which is taken as soon as needed - the total daily dose is taken in the morning. This dose should be continued until your peak flow readings are back to the normal levels shown in your Action Plan (Step One). Then the dose can be reduced as instructed providing your peak flow stays within the Step One readings on your Action Plan. Your peak flow readings will show you when the tablets have 'unblocked' your breathing tubes. If you reduce the tablets too soon you may find the asthma worsening again.

3. Use a peak flow meter during troublesome periods

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• Most people over the age of five will benefit from monitoring their asthma with a peak now meter
• It is also valuable to record these measurements on your diary so that your doctor can see what has happened
• The National Asthma Education Programme ( NAEP) has 2 types of diary available. For further explanation on using your peak flow meter see 'A Guide to Peak Flow in Childhood Asthma"
• It may only be necessary to use your peak flow meter during troublesome periods or at times when treatment is changed, however if you prefer daily record this too is acceptable.

4. Understand your Asthma

Understanding the process of asthma and what is happening in your lungs is a good start to taking control of your health. This problem is addressed fully in "What is asthma?". Remember that even though your doctor is there to help you, most of the day-to-day care of your asthma is your responsibility



5. Don't ignore your symptoms

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• Early treatment of asthma is an important part of good asthma care
• Asthma usually doesn't always come on suddenly but generally gets worse gradually
• You might become a little more aware of asthma during the daytime, particularly during exercise, or you may wake up at night with a cough or wheeze
• You may need your reliever inhaler more than usual and your peak now readings might go up and down
• It is easy to put up with asthma that creeps up on you like this, because you can still do most things, but don't ignore the warnings
• Delay allows swelling to build up and narrow the breathing tubes, making the asthma harder to control
• So start extra treatment early. See the Asthma Action Planpreviously in this pamphlet for details of what to do

6. Avoid trigger factors that aggravate your asthma

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• Good asthma care involves more than taking medicine
• Being aware of the factors in your environment that cause symptoms or make you feel worse, may help to keep you healthy and may even reduce the need for certain medicines
• Asthma triggers are dealt with in the "Allergy and Asthma", "Food Allergy", "Preservatives and Asthma" and "Indoor and Outdoor Pollution and Asthma" but common triggers are:
  
  • Viral colds and 'Flu"
  • Cigarette smoke and irritating fumes
  • Allergies to pets, pollens or dust
  • Changes in weather
  • Excessive exercise.



7. Keep in touch with your doctor

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• Because asthma is with you for some time, you need to see your doctor regularly, not just when the symptoms get really bad. This allows your doctor to know what is achievable in terms of asthma treatment and sort out a plan of action that suits you. Be sure to ask questions that are bothering you.
• Lastly it is important to know where you can get further help and information. Your doctor will help you in this regard but remember to have the contact number of the nearest hospital as well as that of the National Asthma Education Programme

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Copyright: Allergy Society of South Africa.
Written by Dr Robin Green
Endorsed by ALLSA.

ALLSA P.O. Box 88 Observatory, 7935 Cape Town, R.S.A.

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