Asthma Information

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 booklet can help you learn how to control your asthma or help a friend or family member with asthma.
What Is Asthma?
Asthma is a chronic lung disease that lasts a long time. It cannot be cured– only controlled.

Airways are inflamed

Airways narrow and breathing becomes hard to do. This narrowing gets better, sometimes by itself, sometimes with treatment.

Airways are super sensitive. They react to many things, such as cigarette smoke, pollen, or cold air. Coughing, wheezing, tight chest, difficult breathing, or an asthma episode may result.

What Happens During an Episode of Asthma?
Asthma affects the airways in your lungs. During an episode of asthma:

The lining of the airways becomes swollen (inflamed).

The airways produce a thick mucus.

The muscles around the airways tighten and make the airways narrower (bronchoconstriction).

These changes in the airways block the flow of air, making it hard to breathe.
You need to know the ways that asthma affects the airways so you can understand why it often takes more than one medicine to treat the disease. Very simply, some medicines relax the airways and others reduce (and even prevent) the swelling and mucous.
What Causes Asthma Episodes?
People with asthma have airways that are super sensitive to things that do not bother people who do not have asthma. These things are called triggers because when you are near or come in contact with them, they may start an asthma episode. Your airways may become swollen, produce too much mucus, and tighten up. Common triggers for asthma episodes include the following:

Dander (or flakes) from the skin, hair, or feathers of all warm-blooded pets (including dogs, cats, birds and small rodents)

House dust mites

Cockroaches

Pollens from grass, trees and mold

Molds (indoor and outdoor)

Cigarette smoke; wood smoke; scented products such as hair spray, cosmetics, and cleaning products; strong odors from fresh paint or cooking; automobile fumes; and air pollution

Infections in the upper airway, such as colds (A common trigger for both children & adults)

Exercise

Showing strong feelings (crying, laughing)

Changes in weather & temperature

Is There a Cure for Asthma?
Asthma cannot be cured–having asthma is a part of your life. So you need to make taking care of your asthma a part of your life.
Your Asthma Can Be Controlled With Proper Care.
Your airways react to things like smoke, dust, pollen, or other things. Your airways narrow or become smaller and you get common symptoms like the following:

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.
With your 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.
What Can a Patient with Asthma Expect From Treatment?
With proper treatment most people with asthma will be able to:

Be active without having asthma symptoms. This includes participating in exercise and sports.

Sleep through the night without having asthma symptoms.

Prevent asthma episodes (attacks).

Have the best possible peak flow number– lungs that work well.

Avoid side effects from asthma medicines.

How To Take Care of Your Asthma

Work with your doctor and see him or her at least every 6 months.

Take your asthma medicines exactly as your doctor tells you.

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

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.

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 6 months to:

Check your asthma and review your treatment.

Write down questions and concerns to discuss with your doctor.

Bring your medicines and written action plan to each visit.

What You Need to Know About Medicines for Asthma.
What Medicines Are Used to Treat Asthma? There are two kinds of medicines:

Bronchodilators (quick-relief) are medicines that relax muscles that have tightened around the airways. They will relieve your asthma symptoms. Beta2-agonists, theophylline and ipratropium are bronchodilators.

Anti-inflammatory medicines (long-term control) are medicines that reduce or reverse the swelling in the airways that caused your asthma symptoms. These medicines also prevent the swelling from starting–which keeps asthma episodes from starting. Cromolyn sodium, inhaled corticosteroids and oral corticosteroids are anti-inflammatory medicines.

How Are Asthma Medicines Prescribed?
Each patient's asthma is different. Each patient's airways react to different triggers at different times and with different symptoms. As a result, asthma medicines must be prescribed for each person's special needs. This involves close work with your doctor and may take some time to find out which medicines work best for you.
What Is a Medicine Plan?
A medicine plan tells you what medicine to take and when to take it. It will help you take medicines the right way. There are two kinds of medicines:
Bronchodilators to relieve symptoms.
Quick-Relief-taken only as needed: These medicines quickly relax and open your airways and relieve asthma symptoms. But it only helps for about 4 hours. Quick-relief medicine cannot keep 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 medicines.
Do not delay taking your quick-relief medicine when you have symptoms. This can keep you from having a really bad asthma attack.
Side effects include rapid heart beat, tremors, feeling anxious and nausea. These side effects tend to leave as the body adjusts to the medicine. Serious side effects are rare, but may include chest pain, fast or irregular heart beat, severe headache or feeling dizzy, very bad nausea, or vomiting.
If you have symptoms only every now and then (less than once or twice a week), a bronchodilator may be all you need to control asthma symptoms. If you have an asthma episode, your doctor may tell you to take more of your bronchodilator medicine. This may be enough to relieve your symptoms. However, a second medicine may be prescribed for serious episodes. Your asthma control plan will give you more information on medicines to take during asthma episodes.
Anti-inflammatory medicines to reverse and prevent the swelling that causes the symptoms of asthma. Long-term control-taken daily:
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 where you need it. This reduces the amount of medicine you need and the chance of any side effects.
Side effects may include possible yeast infection in the mouth or bother the upper airways and cause coughing. There are two things to do to keep these things from taking place. Use a spacer device (an attachment on the inhaler) and rinse out your mouth after you take the medicine.
Steroid tablets or liquids are used safely for short periods to quickly bring asthma under control. They are also used long term to control the most severe asthma. When oral steroids are used to treat serious asthma episodes, they take about 3 hours to start working and are most effective in 6 to 12 hours.
Side effects of oral steroids used for a short time may cause increased appetite, fluid retention, weight gain, rounding of the face, changes in mood, and high blood pressure. These will stop when you quit taking the medicine, but do not stop taking this medicine without first talking to your doctor.
Oral steroids used for a long time may have bad side effects such as high blood pressure, thinning of the bones, cataracts, muscle weakness, and slower growth in children. Because of these side effects, doctors should only use oral steroids for a long time if a patient's asthma is serious.
Cromolyn and nedocromil are anti-inflammatory medicines sometimes used 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.
If you have symptoms more than once or twice a week, you need an anti-inflammatory medicine. You need to take this medicine EVERY DAY. Remember: Your asthma medicine plan is not working if you still have symptoms with exercise, at rest, at night or early in the morning. You need to talk with your doctor about your medicine plan. Your doctor may need to change the dose or the type of your medicine.
Are Asthma Medicines Safe?
Asthma medicines are safe, if taken as directed. Some people are afraid that they will become addicted to their medicines. This is not true. Others are concerned that if medicine is taken all the time, it will no longer work. This problem occurs rarely and can be managed. Talk to your doctor if this happens.
What Should Be Done If Side Effects Occur?

Report all side effects to your doctor.

Do not stop the medicine completely until you talk to your doctor. This may cause your asthma to get worse.

Tips For Correct Use of Medicine.
Take your bronchodilator medicine at the earliest sign that your asthma is getting worse.
Watch out for early signs (a drop in your peak flow number or feeling symptoms such as cough, chest tightness, wheezing or being short of breath) so that asthma medicine can be started right away to relieve symptoms. An asthma episode is easier to stop if you take your medicine as soon as symptoms start. You won't have to take as much medicine that way either.
Remember: Bronchodilators relieve symptoms, but they cannot reduce or prevent the swelling that causes the symptoms. When you have to use a bronchodilator a lot, it may be a sign that the swelling in your airways is getting worse. If you use a beta2-agonist to relieve symptoms every day or if you use it more than three or four times in a single day, your asthma may be getting much worse. You probably need another kind of medicine. Discuss this with your doctor right away.
Take your anti-inflammatory medicines exactly the way your doctor recommends, even if you are not feeling symptoms. This will reduce airway swelling and will keep asthma episodes from starting. This medicine must be taken regularly for it to work well.
Warning Signs of Asthma Episode
Asthma episodes rarely occur without warning. Most people with asthma have warning signs (physical changes) that occur hours before symptoms appear. Warning signs are not the same for everyone. You may have different signs at different times. By knowing your warning signs and acting on them, you may be able to avoid a serious episode of asthma. Think back on your last asthma episode. Did you have any of the signs below? Check your warning sign(s). Show them to your doctor. Remember to follow your asthma control plan as soon as these signs appear.

Drop in peak flow reading

Chronic cough, especially at night

Difficulty breathing

Chest starts to get tight or hurts

Breathing faster than normal

Getting out of breath easily

Tired

Itchy, watery or glassy eyes

Itchy, scratchy or sore throat

Stroking chin or throat

Sneezing

Head stopped up

Headache

Fever

Restless

Runny nose

Change in face color

Dark circles under eyes

Other:______________

Summary of Steps To Manage Asthma Episodes
Know your warning signs and peak flow zones so you can begin treatment early.
Take the correct amount of medicine at the times the doctor has stated. If the asthma control plan includes increased dosage or a second medicine to be used during episodes, take it as prescribed. Always call your doctor if you need to take more medicine than the doctor ordered.
Remove yourself or the child from the trigger if you know what it is. Treatment does not work as well if the patient stays around the trigger.
Keep calm and relaxed. Family members must stay calm and relaxed too.
Rest.
Observe yourself or the child by noting changes in body signs such as wheezing, coughing, trouble breathing and posture. If you have a peak flow meter, measure peak flow number 5 to 10 minutes after each treatment to see if peak flow is improving.
Review the list below for signs to seek emergency medical care for asthma. They include:

Your wheeze, cough, or shortness of breath gets worse, even after the medicine has been given and had time to work. Most inhaled bronchodilator medicines produce an effect within 5 to 10 minutes. Discuss the time your medicines take to work with your doctor.

Your peak flow number goes down, or does not improve after treatment with bronchodilators or drops to 50 percent or less of personal best. Discuss this peak flow level with you doctor.

Your breathing gets difficult. Signs of this are:

Your chest and neck are pulled or sucked in with each breath.

You are hunching over.

You are struggling to breathe.

You have trouble walking or talking.

You stop playing or working and cannot start again.

Your lips or fingernails are gray or blue. If this happens, Go to the Emergency Room Now!

Keep your important information for seeking emergency care handy.
Call a family member, friend or neighbor to help if needed.
Immediately call a clinic, doctor's office or hospital for help if needed.
Do Not Do the Following:

Do not drink a lot of water. Just drink normal amounts.

Do not breathe warm moist air from a shower.

Do not rebreathe into a paper bag held over the nose.

Do not use over-the-counter cold remedies without first calling the doctor.

How To Control Things That Make Your Asthma Worse
You can help prevent asthma attacks by staying away from things that make your asthma worse. This guide suggests many ways to help you do this.
You need to find out what makes your asthma worse. Some things that make asthma worse for some people are not a problem for others. You do not need to do all of the things listed in this guide.
Look at the things listed below and check for those things which you know make your asthma worse. Ask your doctor to help you find out what else makes your asthma worse. Then, decide with your doctor what steps you will take. Start with the things in your bedroom that bother your asthma. Try something simple first.
Tobacco Smoke

If you smoke, ask your doctor for ways to help you quit. Ask family members to quit smoking, too.

Do not allow smoking in your home or around you.

Be sure no one smokes at a child's day care center.

Use an indoor air-cleaning device (for smoke, mold and dander).

Dust Mites
Many people with asthma are allergic to dust mites. Dust mites are like tiny "bugs" you cannot see that live in cloth or carpet.
Things that will help the most:

Encase your mattress in a special dust-proof cover.

Encase your pillow in a special dust-proof cover or wash the pillow each week in hot water. Water must be hotter than 130 degrees Fahrenheit to kill the mites.

Wash the sheets and blankets on your bed each week in hot water.

Other things that can help:

Reduce indoor humidity to less than 50 percent. Dehumidifiers or central air conditioners can do this.

Try not to sleep or lie on cloth-covered cushions or furniture.

Remove carpets from your bedroom and those laid on concrete, if you can.

Keep stuffed toys out of the bed or wash the toys weekly in hot water.

Animal Dander
Animal dander (or flakes–from the skin, hair, or feathers of all warm-blooded pets including dogs, cats, birds and rodents). The length of a pet's hair does not matter. The allergen is in the saliva, urine and dander.
The best thing to do:

Keep furred or feathered pets out of your home.

Choose a pet without fur or feathers (such as a fish or a snake).

If you can't keep the pet outdoors, then:

Keep the pet out of your bedroom and keep the bedroom door closed.

Cover the air vents in your bedroom with heavy material to filter the air.

Remove carpets and furniture covered with cloth from your home. If that is not possible, keep the pet out of the rooms where these are.

Wash the pet weekly.

Avoid visits to friends or relatives with pets.

Take asthma medicine before visiting homes or sites where animals are present.

Avoid products made with feathers such as pillows and comforters. Also avoid pillows, bedding and furniture stuffed with kapok (silky fibers from the seed pods of the silk-cotton tree).

Cockroach
Many people with asthma are allergic to the dried droppings and remains of cockroaches.

Keep all food out of your bedroom.

Keep food and garbage in closed containers (never leave food out).

Use poison baits, powders, gels or paste (for example, boric acid). You can also use traps.

If a spray is used to kill roaches, stay out of the room until the odor goes away.

Indoor Molds

Keep bathrooms, kitchens and basements well aired.
Clean bathrooms, kitchens and basements regularly with cleaner that has bleach in it.

Do not use humidifiers.

Use dehumidifiers for damp basement areas, with humidity level set for less than 50 percent but above 25 percent. Empty and clean unit regularly.

Fix leaky faucets, pipes or other sources of water.

Vacuum Cleaning

Try to get someone else to vacuum for you once or twice a week, if you can. Stay out of rooms while they are being vacuumed and for a short while afterward.

If you vacuum, use a dust mask, a double-layered or microfilter vacuum cleaner bag, or a vacuum cleaner with a HEPA filter.

Pollen and Outdoor Mold: what to do during your allergy season (when pollen or mold spore counts are high)

Try to keep your windows closed.

Stay indoors with windows closed during the midday and afternoon, if you can. Pollen and some mold spore counts are highest at that time.

Use air conditioning, if possible.

Avoid sources of molds (wet leaves, garden debris).

Smoke, Strong Odors and Sprays

If possible, do not use a wood-burning stove, kerosene heater or fireplace.

Try to stay away from strong odors and sprays, such as perfume, talcum powder, hair spray, paints and deodorizers.

Reduce strong cooking odors (especially frying) by using a fan and opening windows.

Use non-perfumed household cleaning products whenever possible.

Exercise, Sports, Work or Play

You should be able to be active without symptoms. See your doctor if you have asthma symptoms when you are active–like when you exercise, do sports, play or work hard.

Ask your doctor about taking medicine before you exercise to prevent symptoms.

Warm up for about 5 to 10 minutes before you exercise.

Try not to work or play hard outside when the air pollution or pollen levels (if you are allergic to the pollen) are high.

Colds and Infections

Avoid people with colds or the flu.

Get a flu shot.

Get rest, eat a balanced diet and exercise regularly.

Tell your doctor about all the medicines you take. Include cold medicines, aspirin and even eye drops.

Weather

Cover your nose and mouth with a scarf on cold or windy days.

Dress warmly in the winter or on windy days.

Other

Do not drink beer or wine or eat shrimp, dried fruit or processed potatoes if they cause asthma symptoms.

Remember: Making these changes will help keep asthma episodes from starting. An asthma trigger control plan is an important part of controlling asthma.
Use and Care of a Nebulizer
A nebulizer is a device driven by a compressed air machine. It allows you to take asthma medicine in the form of a mist (wet aerosol). It consists of a cup, a mouthpiece attached to a T-shaped part or a mask and thin, plastic tubing to connect to the compressed air machine. It is used mostly by three types of patients:

Young children under age 5

Patients who have problems using metered dose inhalers

Patients with severe asthma

A nebulizer helps make sure they get the right amount of medicine.
A routine for cleaning the nebulizer is important because an unclean nebulizer may cause an infection. A good cleaning routine keeps the nebulizer from clogging up and helps it last longer.
Directions for using the compressed air machine may vary (check the machine's directions), but generally the tubing has to be put into the outlet of the machine before it is turned on.
How to Use a Nebulizer

Measure the correct amount of normal saline solution using a clean dropper and put it into the cup. If your medicine is premixed, go to step 3.

Draw up the correct amount of medicine using a clean eyedropper or syringe and put it into the cup with the saline solution. Once you know your number of drops, you can count them as a check on yourself.

Fasten the mouthpiece to the T-shaped part and then fasten this unit to the cup OR fasten the mask to the cup. For a child over the age of 2, use a mouth piece unit because it will deliver more medicine than a mask.

Put the mouthpiece in your mouth. Seal your lips tightly around it OR place the mask on your face.

Turn on the air compressor machine.

Take slow, deep breaths in through the mouth.

Hold each breath 1 to 2 seconds before breathing out.

Continue until the medicine is gone from the cup (approximately 10 minutes).

Store the medicine as directed after each use.

Cleaning the Nebulizer
Don't Forget: Cleaning and getting rid of germs prevents infection. Cleaning keeps the nebulizer from clogging up and helps it last longer.
After Each Use

Remove the mask or the mouthpiece and T-shaped part from the cup. Remove the tubing and set it aside. The tubing should not be washed or rinsed. Rinse the mask or mouthpiece and T-shaped part–as well as the eyedropper or syringe–in warm running water for 30 seconds. Use distilled or sterile water for rinsing, if possible.

Shake off excess water. Air dry on a clean cloth or paper towel.

Put the mask or the mouthpiece and T-shaped part, cup and tubing back together and connect the device to the compressed air machine. Run the machine for 10 to 20 seconds to dry the inside of the nebulizer.

Disconnect the tubing from the compressed air machine. Store the nebulizer in a ziploc plastic bag.

Place a cover over the compressed air machine.

Once Every Day

Remove the mask or the mouthpiece and T-shaped part from the cup. Remove the tubing and set it aside. The tubing should not be washed or rinsed.

Wash the mask or the mouthpiece and T-shaped part–as well as the eyedropper or syringe–with a mild dishwashing soap and warm water.

Rinse under a strong stream of water for 30 seconds. Use distilled (or sterile) water if possible.

Shake off excess water. Air dry on a clean cloth or paper towel.

Put the mask or the mouthpiece and T-shaped part, cup and tubing back together and connect the device to the compressed air machine. Run the machine for 10 to 20 seconds to dry the inside of the nebulizer.

Disconnect the tubing from the compressed air machine. Store the nebulizer in a ziploc plastic bag.

Place a cover over the compressed air machine.

Once or Twice a Week

Remove the mask or the mouthpiece and T-shaped part from the cup. Remove the tubing and set it aside. The tubing should not be washed or rinsed. Wash the mask or the mouthpiece and T-shaped part–as well as the eyedropper or syringe–with a mild dishwashing soap and warm water.

Rinse under a strong stream of water for 30 seconds.

Soak for 30 minutes in a solution that is one part distilled white vinegar and two parts distilled water. Throw out the vinegar water solution after use; do not reuse it.

Rinse the nebulizer parts and the eyedropper or syringe under warm running water for 1 minute. Use distilled or sterile water, if possible.

Shake off excess water. Air dry on a clean cloth or paper towel.

Put the mask or the mouthpiece and T-shaped part, cup and tubing back together and connect the device to the compressed air machine. Run the machine for 10 to 20 seconds to dry the inside of the nebulizer thoroughly.

Disconnect the tubing from the compressed air machine. Store the nebulizer in a ziploc plastic bag.

Clean the surface of the compressed air machine with a well-wrung, soapy cloth or sponge. You could also use an alcohol or disinfectant wipe. NEVER PUT THE COMPRESSED AIR MACHINE IN WATER.

Place a cover over the compressed air machine.