Is your asthma severe? Is it under control?

The following post was originally published at healthcentral.com/asthma on June 6, 2011

Asthma control versus severity:  what you need to know

How severe is your asthma?  Is it under control?  Does it matter?  It seems the new recommendation is that asthma severity is out and asthma control is in.  So what does that me for me and you?

To help us decide I think a few definitions from The National Heart, Blood and Lung Institute’s Asthma Guidelines are in order here:

Asthma Severity: This is basically how bad your asthma is BEFORE you are on any asthma medicines, or how bad your asthma would be if you quit taking your asthma controller medicine.

The level of severity is best assessed when you are first diagnosed with asthma, and it helps your doctor determine the future course of therapy that will work best for you. This is generally measured to initiate asthma therapy.

The levels of severity are generally classified as: 

• Intermittent


• Mild persistent


• Moderate persistent


• Severe persistent

The problem most doctors have with diagnosing severity is most patients are already on asthma medicine before they are seen, so determining severity by the above definition is pretty much a guessing game. 

If you’re like me you’d love to know how severe your asthma is, yet you won’t want to quit taking your athma controller medicine to find out. 

Asthma Control:  This is basically a measure of how normal your life is compared to other people your age. It’s measured once you are on asthma controller medicine and measures of how well your asthma therapy reduces asthma symptoms and impairments.

Control is generally measured to adjust your asthma regime. By measuring this at your doctor visits your doctor may tweak your medicine regime and/ or yourasthma action plan, or keep things as they are.

It’s measured by: 

• The degree your symptoms are minimized (short of breath, wheezing, etc.)


• The degree your impairments are minimized (ability to exercise, walk, live a normal, active life)


• The degree to which your goals of therapy are met (I’m able to exercise without limitations.  No school or work days missed.)

According to the Global Initiative For Asthma (GINA) asthma guidelines, the classifications of asthma control are:

• Controlled


• Partly controlled


• Uncontrolled

To learn how to tell if your asthma is controlled click here, or you can click hereto download a neat pocket guide created by GINA that defines controlled, partly controlled and uncontrolled asthma.

So it’s neat to know how severe your asthma is, yet experts have learned that monitoring level of control is a better way of monitoring your asthma status and adjusting your asthma meds as needed.

Still, regardless of how severe your asthma is, by being asthma smart most asthmatics can obtain good asthma control.

What"s the difference between asthma control and severity?

The following is from healthcentral.com/asthma.

“Asthma Control vs. Asthma Severity:  What You Need to Know” (originally published 6/6/11)

How severe is your asthma?  Is it under control?  Does it matter?  It seems the new recommendation is that asthma severity is out and asthma control is in.  So what does that me for me and you?

To help us decide I think a few definitions from The National Heart, Blood and Lung Institute’s Asthma Guidelines are in order here:

Asthma Severity: This is basically how bad your asthma is BEFORE you are on any asthma medicines, or how bad your asthma would be if you quit taking your asthma controller medicine.

The level of severity is best assessed when you are first diagnosed with asthma, and it helps your doctor determine the future course of therapy that will work best for you. This is generally measured to initiate asthma therapy.

The levels of severity are generally classified as:

• Intermittent


• Mild persistent


• Moderate persistent


• Severe persistent

The problem most doctors have with diagnosing severity is most patients are already on asthma medicine before they are seen, so determining severity by the above definition is pretty much a guessing game.

If you’re like me you’d love to know how severe your asthma is, yet you won’t want to quit taking your athma controller medicine to find out.

Asthma Control:  This is basically a measure of how normal your life is compared to other people your age. It’s measured once you are on asthma controller medicine and measures of how well your asthma therapy reduces asthma symptoms and impairments.

Control is generally measured to adjust your asthma regime. By measuring this at your doctor visits your doctor may tweak your medicine regime and/ or your asthma action plan, or keep things as they are.

It’s measured by:

• The degree your symptoms are minimized (short of breath, wheezing, etc.)


• The degree your impairments are minimized (ability to exercise, walk, live a normal, active life)


• The degree to which your goals of therapy are met (I’m able to exercise without limitations.  No school or work days missed.)

According to the Global Initiative For Asthma (GINA) asthma guidelines, the classifications of asthma control are:

• Controlled


• Partly controlled


• Uncontrolled

To learn how to tell if your asthma is controlled click here, or you can click here to download a neat pocket guide created by GINA that defines controlled, partly controlled and uncontrolled asthma.

So it’s neat to know how severe your asthma is, yet experts have learned that monitoring level of control is a better way of monitoring your asthma status and adjusting your asthma meds as needed.

Still, regardless of how severe your asthma is, by being asthma smart most asthmatics can obtain good asthma control.

How do I know if my asthma is under control? Lifestyle Management

General Tools – Asthma Action Plan
An Action Plan is a written, customized plan to help you take action to manage your asthma. If you know what to watch for and what steps to take, you will be able to make timely and appropriate decisions about managing your condition help prevent your asthma from getting worse. The Action Plan is based on changes in respiratory symptoms and peak flow numbers, and it specifically will:
Give you and your family information about when and how to use daily medications, emergency medications and your peak flow meter.
Help you decide when to call your healthcare provider and when to seek emergency medical care.
Serve as an easy place to keep your crisis intervention plan, self-management instructions or written guidelines.

Components of an Asthma Action Plan
Action Plans should be individualized. Your healthcare provider will develop an Action Plan specifically for you, and your action plan should include the following information:
1. Peak Flow Numbers and Peak Flow Zones
Peak flow numbers measure how well you are breathing. If your peak flow number drops, it means you are having trouble breathing. Peak flow zones can be used to signal you when your peak flow drops a certain percentage. Your healthcare provider will consider certain characteristics of your asthma and help you determine your zones.
2. Asthma Symptoms
Your action plan should tell you what to do when you experience asthma symptoms and when you need to increase treatments to manage asthma symptoms. Your plan will be based on the severity or seriousness of these symptoms.
3. Asthma Medications
Together with your healthcare provider, you will develop instructions about when to take asthma medications.
4. Emergency Telephone Numbers and Locations of Emergency Care
Your written action plan should include information about who to call and where to get emergency care. Your healthcare provider will be able to give you telephone numbers and locations for emergency care during the day or night. You should also include numbers of relatives, friends and other people who can help you in an emergency.
Specific Points to Clarify with Your Healthcare Provider
These are five points that your healthcare provider should specifically clarify for you for inclusion in your Action Plan.
• When should you call your healthcare provider?
• When should you seek emergency care?
• When is quick relief medicine not enough?
• When or if you should increase inhaled steroids?
• When or if you should start taking oral steroids?

Making Your Asthma Action Plan Work for You
Your Action Plan can help you manage your asthma symptoms. Here are tips to make sure it’s available and update for you to use:
Photocopy your written plan and give it to those who can assist you in using the plan, including your spouse or significant other, relatives and work personnel.
Keep a current action plan with you at all times for use in an emergency.
Review your action plan with your healthcare provider at least once a year. Changes in your personal best or baseline peak flow number or medications may mean your action plan also needs to be changed.
If you ever have questions or concerns about your Action Plan, please discuss them with your healthcare provider.

General Tools – Peak Flow Meter
A peak flow meter is a small, easy-to-use instrument that reveals how well your lungs are working. It does this by measuring your peak expiratory flow, which tells you how fast you can blow out air after a maximum inhalation. You use the peak flow meter to help you identify lung performance patterns, which give you information to prevent asthma episodes and develop your asthma management plan.
How it Works
First, you establish your “personal best,” or the highest number you regularly blow. This helps you see when you have changes with your asthma, because it gives you something to measure against. Once you know you personal best, you and your doctor establish treatment rules or “zones.”. You establish your personal best by recording the peak flow values for two weeks first thing in the morning before taking any medications and late afternoon when your asthma is under control..
If your peak flow is less than 80% of your personal best, you take your rescue medication, then wait 20 to 30 minutes and check your peak flow again.
If your peak flow is not back above 80%, report this to your doctor.
If your peak flow is back above 80%, recheck your peak flow about every 4 hours for a day or so. Call your doctor if you continue to need rescue medicine
If your peak flow is less than 60% consider this an emergency: Take your rescue medicine, and call your doctor or go to the emergency room right away.

How to Measure Your Expiratory Flow
Whenever you measure your flow, it is a good idea to write your peak flow numbers in a place where you can track them. Establish one central place to do this so you can more easily keep track of your numbers, such as in a peak flow sheet or Asthma Health Diary. Here’s how to regularly measure your expiratory flow:
Grab your peak flow recording sheet or health diary and a pen and record the date and time, along with any changes in how you feel, changes in your medicines, and/or anything you think may be making your asthma worse.
• Stand up or sit up straight.
• Slide the indicator to the base of the meter.
• Take in a deep breath.
• Place the mouthpiece in your mouth and seal your lips around it.
• Blow out as hard and fast as you can (one quick blow).
• Repeat that process 2 more times.
• Select the highest number of the 3 efforts.
• Record this number on your peak flow diary or on a graph.

When to Check Your Expiratory Flow
When the numbers do not change much from time to time: The peak flow number should be checked once a day (ideally in the morning when you wake up).
When you are doing well: Use the peak flow meter two times during the week and once on the weekend.
When you:
Begin to wake at night with asthma symptoms
Experience more daytime asthma symptoms
Have a respiratory infection (a cold)
You are sick or have asthma symptoms
Check your peak flow number at least twice a day (once in the morning and once in the evening)
When you need to use “rescue medicine”: This is medicine prescribed by your doctor to be used for quick relief of asthma symptoms. Check your peak flow before taking the rescue medicine, then check it again 20-30 minutes later.

Reporting Peak Flow Numbers to Your Doctor
Take your peak flow meter and your asthma health diary with you each time you visit with your doctor or nurse. If you have an Asthma Action Plan from your doctor, follow the plan for each peak flow zone, and compare your peak flow numbers to your personal best.

Signs Your Asthma is Getting Worse
Your peak flow meter is only an aide to you, so do not rely on your peak flow numbers alone when deciding whether to take your rescue medicine or call your doctor. In addition to measuring your peak flow on a daily basis, you should always look out for early warning signs of an asthma attack, which are:
• Runny, stuffy nose
• Fatigue
• Chin or throat itches
• Headache
• Moodiness
• Cough with activity or laughing
• Wheezing with activity
• Waking up at night or early morning with a cough or wheeze
• Faster breathing rate
• Irritability

General Tools – Peak Flow Zone Chart
The following shows an example of how these zones work. Your doctor can help you create a similar table for your own asthma.

Green: 80-100% of your personal best
• Your breathing is good.
• You do not have any early warning signs or asthma symptoms.
• Take all your medicines every day, as your doctor tells you.
• Take your inhaler before exercise, as your doctor tells you.

Yellow: Caution 60-80% of your personal best
• Runny, stuffy nose.
• Feel more tired.
• Chin or throat itches.
• Sneezing.
• Restless
• Red or pale face
• Coughing
• Dark circles under your eyes
• Use “rescue” medicine
• Recheck peak flows after 20-30 minutes
• Call your doctor, healthcare professional, or nurse care manager:
• if your peak flow is not back to the Green Zone
• if your peak flow drops into the Yellow Zone again in less that 4 hours.

Red: Danger Below 60% of your personal best
• Cough, more at night
• Wheezing
• Chest feels tight or hurts
• Breathing faster than normal
• Get out of breath easily
• Use your quick-relief medicine by inhaler or nebulizer right away!
• Call your doctor or 911 NOW

Article source: http://www.nationaljewish.org/healthinfo/conditions/asthma/lifestyle-management/tools/action-plan

Picture source: http://srxa.wordpress.com/2011/05/03/you-can-control-your-asthma-2

Modern inhalers may equal better asthma control

The neat thing about asthma is it can be controlled. At present, the most recommended medicine to control asthma is inhaled corticosteroids. Is it possible, depending on your asthma severity one inhaled corticosteroid might be better than another? Is it possible the new HFA inhalers are better than the old CFC ones?

Recent evidence might suggest this true. While it has been proven that Flovent and Pulmicort work better than inhaled corticosteroids of old, such as Azmacort and Vanceril, mainly because they are stronger. Yet even more recent evidence suggests that a medicine called QVAR might work better if your asthma episodes involve the smaller airways as opposed to the larger airways.

As you may know, your lungs branch out like a tree (as you can see by the picture). You start out in the trachea, and from there air travels to the chorina where air can travel into your left lung or right lung. The chorina would be like the trunk of the tree.

Yet whichever way air travels (to the right or left lung), the next branch is the bronchioles. Air starts out in the large bronchioles, which would would be represented by the larger branches of a tree. As the bronchioles branch out, they get smaller and smaller. Thus, the small bronchioles would be represented by the sticks at the end of larger branches.

Now consider when you are a kid and have inflammation in your airways. This inflammation makes your lungs sensitive to your asthma triggers. When exposed to your triggers, this inflammation worsens, and this causes blockage of your airway that is the asthma attack.

In children and most asthmatics, the worsening inflammation will cause your peak flow readings to decrease. Yet, as you grow older and your airways become larger, the inflammation in your airways becomes smaller in comparison to your now larger airways. Thus, while your lungs grow, the inflammation stays the same.

So, in some asthmatics, some degree of shortness of breath can occur and this not effect the peak flow at all. This is because your peak flow readings represent what your large airways are doing. If inflammation in your large airways increases, your peak flow readings will go down. This is because air is trapped in your larger airways.

However, if your lower airways are blocked and the upper airways are not, your peak flow readings will remain the same. This, according to some asthma experts, might indicate that your asthma symptoms are the result of increased inflammation in your smaller airways.

So, while inhaled corticosteroids have been proven to benefit all asthmatics, what if you take inhaled steroids (like Flovent) and you still have asthma symptoms. Is it possible that there is an inhaled corticosteroid that does a better job of getting down to the smaller airways and reducing inflammation down there.

According to Sally M. Wenzel, MD, who is an asthma expert over at Medscapes.com, the answer to this question is yes, or probably. In answer to a question on this topic, she said, “The literature on particle deposition is actually pretty good for Qvar. It does get much better overall delivery to lungs, which means larger amounts to small airways (and alveoli). One small study (Annals Allergy) did show that adding Qvar to Flovent, as opposed to increasing the Flovent, produced slightly better symptom and lung function changes, particularly in measures of small airways. But, OBVIOUSLY each person’s disease is slightly different and there are no guarantees that this will work.”

Another neat thing I discovered is the following from a book I have called, “Asthma for Dummies,” by Dr. William E. Berger. He notes that the U.S. government forced the phaseout of CFC propellants for inhalers like Albuterol.

Berger writes, “As a result… Proventil HFA, Ventolin HFA, and QVAR-HFA are the first oxone-friendly products on the market with this propellant, which delivers medications to the lungs more effectively than CFC propellants developed in the 1950s.

“In most cases,” Berger continues, “because of a lower velocity propellant spray and smaller particle size, a non-CFC propelled product allows more of the medication to get into the smaller, more peripheral airways of your lungs.”

So this adds to the growing evidence that HFA inhalers, and not just QVAR, are able to get the medicine deeper into the lungs, and to the smaller air passages.

However, it should be noted that studies have been limited, and ongoing research is necessary. Still, it’s interesting to note there have indeed been some highly qualified asthma experts thinking along these lines.

So, perhaps, simply going to HFA inhalers may actually benefit chronic lungers using this medication, allowing for better overal asthma, COPD control.