Asthma

Overview

What Is It?
Asthma is a lung condition that makes the primary airways—known as the bronchi—in the lungs swollen and inflamed all of the time.

Asthma is a lung condition that results in the large and small airways—known as the bronchi and bronchiole—in the lungs becoming swollen and inflamed. People with asthma can be more sensitive than other people to triggers, such as substances inhaled from the environment, odors, temperature changes and physical activity.

These triggers can cause airway obstruction or blockage where the lungs tighten, constricting the air passages and making breathing difficult. In addition, cells in the lungs can produce mucus in response to triggers. The mucus can clog the bronchial tubes, which contributes to breathing problems. The airways can swell as a result of inflammation made worse by an elevated number of a type of white blood cells known as eosinophils, which are markers for severe asthma.

When the lungs react severely to a trigger, what's known as an "asthma attack" may occur. Wheezing, coughing and/or tightness in the chest and shortness of breath are all hallmark symptoms of a classic asthma attack. Asthma can be controlled with the proper diagnosis and treatment.

It is very important to rule out cardiac arrest or other heart-related disease when these symptoms occur, because the symptoms can be similar.

The National Center for Health Statistics (a division of the U.S. Centers for Disease Control and Prevention, or CDC) reported that 18.45 million American adults and 6.2 million children suffered from asthma in 2015. The condition is becoming more common and more severe across all age, sex and racial groups.

Asthma typically develops during childhood. But many people develop the condition in adulthood, after age 20—known as adult onset asthma. Some individuals have their first asthma attack after age 50.

Who's at Risk?

Obesity significantly increases a person's risk of developing the condition. Heredity is also thought to play a role. Children of parents with asthma are at greater risk for developing the condition.

Pollution, poor air quality in urban environments, poverty and lack of patient education are also factors contributing to rising asthma and asthma-related complication rates. People who have allergies are at an increased risk of developing asthma, and those raised in environments where they were exposed to cigarette smoke also have a much higher incidence of the condition.

Women and Asthma

Women may first develop asthma during or after pregnancy, though the condition may also improve during pregnancy. There is some evidence that asthma may be affected by hormonal changes during a woman's cycle and can be triggered prior to or during the menstrual period. Women are also more likely than men to die from asthma.

Researchers aren't sure why some people's airways are more sensitive to things in the environment. Asthma sufferers may have allergies to certain proteins, known as allergens, which are usually airborne and can trigger an attack. But not all asthma sufferers have defined allergies. An estimated 60 percent of people with asthma have airborne allergies.

Common Asthma Triggers

Common allergens include: dust mites, mold, pollen, cockroaches, animal dander and certain foods. Contrary to popular belief, dog and cat fur don't cause allergies. Rather, a protein found in the pet's saliva, dander (skin) and urine can cause allergies in some individuals. Other things can irritate the already-sensitive air passages of asthma or allergy sufferers. Common irritants include cigarette smoke, cold air and pollution. Exercise and stress also can trigger an asthma attack.

Controlling asthma includes short-term relief of symptoms and long-term strategies to prevent attacks from occurring. Medications and behavioral approaches, such as avoiding asthma triggers, for example, are both important to managing asthma successfully. Another critical part of asthma management is education and close consultation with your health care team. Newer medications are available, and older methods are being improved or have been withdrawn from the market.

Asthma symptoms that recur frequently, even when medication is taken regularly, can be a sign that a reassessment with a health care professional is necessary.

Diagnosis

While primary care providers can diagnose and treat asthma, consultation with a specialist, such as an allergist or pulmonary or lung specialist, may be necessary. Asthma symptoms are sometimes mistaken for a bacterial infection. Antibiotics are not effective in controlling asthma. Pulmonary or lung function testing is essential to making the proper diagnosis. An elevated measurement of exhaled nitric oxide (called eNO) can indicate lung inflammation. An elevated measure can also let the health care provider know that the person may not be using their steroid inhaler as prescribed.

Moderate and mild asthma attacks are common for asthma sufferers. During these attacks an asthma sufferer may feel restless, feel her chest tighten, wheeze and/or cough up mucus. Severe attacks interrupt breathing, causing breathlessness, difficulty talking and eventually loss of consciousness, if not treated immediately. Asthma symptoms and their severity can vary greatly, but they should always be taken seriously.

Common symptoms of asthma include:

• dry cough, especially at night or as a response to certain "triggers" or allergens, such as dust or pets
• a feeling of tightness or pressure in your chest
• difficulty breathing
• wheezing—which sounds like a whistling sound—when you exhale
• shortness of breath after exercise
• colds that migrate to your chest or don't go away for 10 days or more, leading to an asthma flare up waking up at night with shortness of breath

Common asthma triggers include the following:

• dust mites
• pollens
• molds
• pet dander (protein in pet fur, saliva and urine)
• cockroaches
• viral respiratory infections
• certain medications, such as aspirin and other nonsteroidal anti-inflammatories and beta blockers in certain people with asthma
• exercise
• stress
• menstrual cycles in some women
• irritants (tobacco smoke, some scented products and chemicals)
• food allergies

If you are experiencing one or more of the symptoms associated with asthma and have never received treatment or medication for it, it is very important that you make an appointment with a health care professional. To accurately diagnose your condition, your health care professional will ask you questions about your symptoms, perform a physical exam and conduct lung function tests.

Asthma symptoms are often associated with other illnesses in older adults, such as chronic obstructive pulmonary disease (COPD), gastroesophageal reflux disease (GERD) and sinusitis. COPD is a persistent blockage of the air passages caused by emphysema or chronic bronchitis. Emphysema occurs when the walls of the alveoli—or tiny air sacs—in the lungs are damaged. This damage makes the aveoli less elastic and, therefore, less effective at passing oxygen into the blood and removing carbon dioxide from the blood, leading to shortness of breath. It is most common among people who have smoked the equivalent of one pack of cigarettes per day or more for 10 years or longer.

Chronic bronchitis, which produces a persistent cough not related to a cold or other medical condition, causes inflammation of the airways, which produces mucus and causes muscle spasms. It is most commonly associated with smoking.

It is estimated that more than 75 percent of people with asthma also experience GERD, which causes the stomach's digestive juices to back up or "reflux" into the esophagus—the passageway for food from the mouth to the stomach. Over time, the esophagus becomes inflamed or permanently damaged. Chronic heartburn, cough, snoring, wheezing and hoarseness are some symptoms of GERD.

Asthma and sinusitis frequently coexist, and many patients with asthma won't improve unless their sinusitis is treated. Additionally, many only get asthma when their sinusitis worsens, such as from an acute infection. Thus, a complete assessment of asthma always requires a review of the upper airway, including the sinuses.

Tests that measure your airflow are a primary tool in the diagnosis of asthma. Specialists and some primary health care professionals will use a spirometer, which is a machine that measures how much air you blow out each second. Another test employs a peak flow meter to measure how fast you can breathe out in a blast. These tests are simple and painless but offer revealing information about your airflow. Your health care professional might also measure your airflow before and after treatment with a bronchodilator, a medicine that relaxes tight muscles in the airways, to judge reversibility or improvement with a bronchodilator, the hallmark of asthma.

Other tests may be administered to assess your sensitivity to specific allergens that may be triggering your asthma. Often skin tests are used to determine which allergens you are allergic to. Diluted extracts from allergens such as particular foods, pollens, dust mites and molds are injected under your skin or into a tiny scratch or puncture on your arm or back. If you have a positive reaction (meaning you are allergic), a small, raised, reddened area with a surrounding flush will appear at the test site, indicating antibodies to that specific allergen are present in the skin. These reactions can be modest or very large depending on how allergic you are.

Your health care professional might also conduct a blood test, which is not as sensitive as a skin test, to look for allergies. Using a sample of your blood, the test looks for levels of antibodies to particular allergens present in the home and outdoors in various parts of the United States.

Treatment

Asthma requires continuous medical care and treatment. Asthma treatment focuses on opening airways by reducing inflammation and swelling of the bronchial tubes, both large and small—the lung structures affected by asthma. Once inflammation and swelling are reduced, the lungs may become less sensitive to triggers. Many medications are available to treat symptoms and prevent attacks from recurring. Nonmedical management strategies also are recommended: asthma sufferers are encouraged to identify triggers in their environment and avoid them, when possible, or at least be prepared for them by having and using medication, both control and reliever types.

Three groups of asthma medications are available: quick-relief medications, long-term controller medications and medications for allergy-induced asthma. They are available under many brand names and in a variety of forms: sprays, pills, powder, liquids and injections. Some are short acting and are administered directly to the lining of the lungs by inhaling them to immediately relieve symptoms. Controller medications are meant to have longer-term effects—preventing attacks from occurring. The longer-acting medications take a while to help symptoms subside. Some asthma medications are meant to be taken daily, while others are intended only for symptom relief, as symptoms develop.

Quick-relief medications:

Quick relief (or "rescue") medications are used to provide short-term relief during an asthma attack or, for some people, before physical activity to prevent exercise-induced asthma or after exposure to a known allergen like cats or dust.

In a class of medications known as short-acting beta agonists, asthma medications called bronchodilators are typically designed to act quickly to stop an asthma attack once it has started by relaxing and opening—"dilating"—the bronchial tubes so more air is available. For this reason, they are in the quick-relief medications—or "rescue medications"—category. Coughing, wheezing and breathing difficulties are quickly relieved, and the effects of these medications last for several hours.

The most commonly used bronchodilator in the United States is albuterol (Proventil, ProAir), and the preferred method of taking bronchodilators is through inhalation with a metered dose inhaler. Anther short-acting beta agonist generally used for asthma is levalbuterol (Xopenex HFA). It is available in a solution form to be delivered by a nebulizer.

Another bronchodilator—ipratropium (Atrovent)—works to relax the airways and make breathing easier. Although it is primarily used for chronic bronchitis and emphysema, ipratropium is approved to treat asthma in adults and children.

Also in the rescue medications category, corticosteroids work to relieve airway inflammation caused by severe asthma. Corticosteroids are not the same type of steroids used by some athletes. These performance-enhancing drugs are called anabolic steroids.

In inhaled form in standard doses, there are fewer side effects from corticosteroids used to treat asthma, though the risk of side effects may increase if you take this medication orally (in liquid or pill form) over a long time. Oral steroids take hours to work—they do not work rapidly. Side effects may include hoarseness and thrush, a surface (throat) fungal infection, though rinsing the throat with water after inhaling reduces this risk. Prednisone and methylprednisolone are two of the most commonly prescribed oral steroid drugs. They are available as liquids or pills for short-term use. Side effects include weight gain, menstrual irregularities, increased appetite and loss of energy, among others. Long-term effects of the drug include decreased bone density, bone fractures, ulcers, cataracts, high blood pressure, elevated blood sugar and many other potential problems.

In their inhaled form, corticosteroids are also frequently prescribed for long-term asthma control, discussed below.

Long-term controller medications:

Most long-term controller medications for asthma need to be taken every day for asthma prevention.

Inhaled corticosteroids, including fluticasone (Flovent Diskus, Flovent HFA), mometasone (Asmanex), beclomethasone (Qvar), budesonide (Pulmicort Flexhaler), ciclesonide (Alvesco, Breo Ellipta) and others, are the most commonly prescribed long-term asthma remedy. Compared to oral corticosteroids, inhaled corticosteroids have a relatively low risk of side effects and are usually safe for long-term use in normal doses. It usually takes several weeks for these medications to start working and for improvement to be seen.

Salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer) are two bronchodilators in a class of medications known as long-acting beta agonists (LABAs). When used with an inhaled corticosteroid, these drugs help control asthma symptoms. There are also preparations available that contain both a LABA and an inhaled (anti-inflammatory) corticosteroid (Advair, Symbicort, Dulera). Recent studies have confirmed the safety of salmeterol and formoterol when used in combination with inhaled steroids.

Theophylline (Uniphyl), another type of slow-acting bronchodilator, is prepared in a slow-release form taken by mouth. Although not used as frequently as it used to be in the past, theophylline is sometimes used for persistent asthma symptoms, particularly nighttime asthma. Side effects can include nervousness, shakiness and a rapid heart rate. There also may be interaction with other medications or reduced effectiveness caused by other factors.

If you are using rescue bronchodilators more than three times a day, you should consider notifying your health care professional because your asthma may not be under adequate control or could be getting worse. If your bronchodilator contains salmeterol, you shouldn't use it more than two times a day or less than 12 hours apart. However, you may not be using your inhaler correctly for optimum relief. Although the majority of asthma patients use some type of inhaler, health care professionals say that some people who use them aren't using them correctly. Some use them once a day or every other day, for example.

In addition, cromolyn solution, an anti-inflammatory medication, is available for use with a nebulizer to help prevent asthma attacks in children.

Leukotriene modifiers are a form of anti-inflammatory medication that helps prevent asthma symptoms for up to 24 hours. Leukotrienes are chemicals produced by the cells in the lung lining and are part of the chain reaction that causes inflammation and constriction of the airways. Leukotriene modifiers fight this allergic response by blocking the receptors to leukotrienes and thereby decreasing inflammation. These medications are taken orally in pill form, rather than inhaled. Montelukast (Singulair) and zafirlukast (Accolate) are two examples of leukotriene modifiers. Rarely, leukotriene modifiers have been linked to depression, hallucinations, suicidal thoughts, aggression and agitation. If you experience one of these psychological side effects while taking a leukotriene modifier for your asthma, call your health care professional right away.

An injectable medication, omalizumab (Xolair), became the first biologic to be used for treating asthma when it was introduced in 2003. It is specifically for use in those age 6 and older with moderate to severe asthma symptoms, triggered by allergies whose symptoms are not adequately controlled with inhaled corticosteroids, long-acting bronchodilators or leukotriene receptor blockers. Omalizumab is a new class of allergic asthma therapy known as "anti-IgE" therapy, which targets an antibody called IgE that causes allergic reactions. The treatment binds to IgE and neutralizes it.

Three additional biologics are directed toward reducing severe exacerbations by reducing the number of inflammatory cells called eosinophils. Mepolizumab (Nucala) and benralizumab (Fasenra) are given by subcutaneous injection; mepolizumab is given monthly and benralizumab is given every eight weeks. Reslizumab (Cinqair) is given monthly by intravenous infusion.

Allergy-related medications:

If your asthma is the result of or worsened by allergies, you may benefit from one of the following allergy-related treatments.

Immunotherapy is a treatment option for individuals who cannot easily avoid allergy-related asthma triggers or find available asthma medications ineffective or unusable for some reason. Immunotherapy, also called allergy desensitization shots, involves injecting small amounts of the allergen to which you are allergic into your body. Gradually, the amount injected is increased, allowing your body to build immunity to the allergen. Following treatment, when you are exposed to the allergen, you may have only minor symptoms or none at all. According to the American Academy of Allergy, Asthma & Immunology (AAAAI), immunotherapy works best for allergic asthma, allergic rhinitis and conjunctivitis and stinging insect allergy. This is the only therapy that can induce long-term and perhaps permanent remission—when symptoms disappear and don't return.

Antihistamines and decongestants are medications available both by prescription and over the counter to treat allergy symptoms that could trigger an asthma attack. Antihistamines work against histamine, a chemical produced by the body in response to an allergen. Antihistamines relieve symptoms such as watery and itchy eyes, sneezing and other allergy symptoms. Side effects of older antihistamines include drowsiness and dehydration, among others. Antihistamines are available in pill, liquid and injection forms, and decongestants are available in pill, liquid and nasal spray forms. Oral decongestants must be obtained from behind the counter because of concerns about illicit drug abuse and manufacturing. A nasal spray is also available that is a combination of a nasal steroid and nasal antihistamine (Dymista).

Decongestants reestablish drainage of the nasal passages and relieve symptoms such as congestion, swelling, excess secretions and discomfort in the sinus areas. Decongestants may be pills, sprays or drops. Medications combining pain relievers and decongestants also are available. Side effects of decongestants include nervousness, sleeplessness and elevated blood pressure. Always check the labels on these and other medications for additional potential side effects.

Neither antihistamines nor decongestants are specifically indicated for use in asthma. However, leukotrienes, namely Singulair, are approved for both rhinitis and asthma.

Asthma and allergy sufferers should be cautious about herbal treatments for their conditions because of the potential for allergic responses. Any type of treatment should always be discussed with your health care professional before trying it.

Coping With Asthma While Pregnant

Although there is a slightly higher risk of complications in pregnant women with asthma compared to women without the condition, you can still have a safe and normal pregnancy as long as asthma symptoms are kept under control. Uncontrolled asthma in the mother can, however, cause oxygen levels to decrease in the blood and can impact how much oxygen the baby receives.

It's possible that the severity of your asthma may change during pregnancy. For about one-third of pregnant women, asthma symptoms generally seem to worsen, while one-third may be lucky and see an improvement. Another third seem to have no change in the severity of their asthma.

Most medications prescribed to control asthma are safe for pregnant women to take, and the risks of uncontrolled asthma in pregnant women appear to be greater than the risks of necessary asthma medications. Medications administered with inhalers generally are considered better for pregnant women than oral medications because inhaled medications go straight to the lungs and are less likely to get passed along to the baby. In more serious cases, oral medications may be necessary to control symptoms of asthma. Ask your health care professional treating your asthma to consult with your obstetrician before developing a treatment plan for you.

Prevention

There is no way to prevent asthma from developing. You can learn to identify your asthma or allergy triggers and possibly avoid them. Developing an asthma management plan with your health care team can help you determine which medication works best for you and what other strategies you can use to improve your condition. Here are a few suggestions for avoiding triggers:

• Track your symptoms to identify what triggers your asthma attacks; once identified try to avoid them.
• Always be prepared to manage your attacks.
• Prevent symptoms before they occur, if possible.
• If you're allergic to cat or dog dander, use your asthma medications before visiting someone with these pets, and be sure and have a reliever type medication with you, such as albuterol.
• If necessary, find a new home for your pet or keep it out of your sleeping area.
• If you smoke, quit, and turn your home into a smoke-free zone.
• When pollen counts or ozone levels are high in the summer, try to stay indoors and in air conditioning; use air filters on your furnace and air conditioner.
• If cold air is a trigger for you, wear a scarf to cover your mouth and nose when you are outside in the winter.
• Wash all your bedding, including pillow cases, clothes and stuffed animal toys, once a week or more often in hot water (greater than 130° F) and dry at high heat to kill dust mites.
• Use a dehumidifier in damp areas such as bathrooms and basements to reduce mold build-up.
• Avoid close contact with anyone who has a cold or the flu, and wash your hands regularly.
• Get a flu shot in the fall.
• Work with your health care professional to come up with a medication regimen that will still allow you to exercise.
• Use your asthma medications before exercising in cold air.

Facts to Know

1. Asthma is a chronic lung condition caused by heightened sensitivity to various things in the environment, such as pollen, dust and smoke. Exposure to these "triggers" causes the air passages to become swollen and inflamed, causing the hallmark symptoms of an asthma "attack": increased mucous production, wheezing, coughing, chest tightness and difficulty breathing.
2. Asthma can't be cured, but it can be controlled with a variety of medications. If not well controlled, asthma can be life threatening. Lifelong management is usually necessary.
3. The rate of asthma is higher in children than in adults (7.6 percent of adults have asthma, compared to 8.4 percent of children).
4. The National Center for Health Statistics (a division of the CDC) reported that 18.4 million American adults and 6.2 million children suffered from asthma in 2015. Asthma cases span people of all ages, sex and racial groups.
5. According to the Asthma and Allergy Foundation of America, African Americans are more likely than Caucasians to be hospitalized from asthma, and they are also more likely to die from the disease. Racial differences in asthma prevalence and mortality are believed to be related to poverty, urban air quality, indoor allergens, lack of patient education and inadequate medical care. Women are more likely than men to die from asthma attacks.
6. About 60 percent of all adults with asthma have allergies that may trigger asthma symptoms. Identifying, avoiding or controlling triggers is an important part of asthma management.
7. Obesity is a major risk factor for developing asthma.
8. Asthma is believed to have a genetic component. Children of a parent or parents with asthma are at greater risk of developing the condition.
9. Three main groups of asthma medications are available: quick-relief medications, long-term controller medications and medications for allergy-induced asthma.
10. Exercise can trigger an asthma attack; treatment with an inhaled bronchodilator before exercising can prevent exercise-induced asthma.

Questions to Ask

Review the following Questions to Ask about asthma so you're prepared to discuss this important health issue with your health care professional.

1. Do you specialize in treating patients with asthma? Do I need to see a specialist—such as an allergist or pulmonologist—to get my asthma under control?
2. Do I really have asthma or are my symptoms caused by another illness? What tests can you give me to know for sure?
3. What are the warning signs of an asthma flare-up? How do I know if the flare-up is severe? What should I do if I have a severe flare-up?
4. Can I use long-term control medicines to help control my asthma? What kind of side effects do these medications have?
5. Is it safe for me to use short-acting asthma medicines for quick relief during an attack? If I'm taking one or more long-term controller medications, is it still safe?
6. I have a heart condition. Are there some asthma medications I should stay away from due to their tendency to increase heart rate?
7. What should I do if my asthma doesn't get better?
8. If I'm pregnant, what asthma medications are safe for me to take? Are there any that I shouldn't take?
9. Is it a good idea for me to get an annual flu shot if I have asthma? Can I make an appointment with you to get one?
10. Could there be something in my home making my asthma (or my child's asthma) worse? How do I get rid of it? Could my personal habits be contributing? Tell me what I can change.
11. What is a peak flow meter? How can I use it to monitor my asthma and see if it's getting worse?
12. Could you show me how to use my inhaler the right way? What should I do if I don't think my medication is working?
13. Do you measure lung function as part of your evaluation?

Key Q&A

Lifestyle Tips

1. Avoid secondhand smoke.
   Cigarette smoke can trigger asthma attacks and make them worse. It puts children at risk for asthma and damages their lungs for a lifetime. Don't smoke, and don't allow others to smoke in your home. Talk to family and friends before they visit. Offer them gum or mints to help them get by without smoking, or ask them to smoke outside. If you are visiting someone who smokes, explain in advance that you can't tolerate smoking. Be prepared to leave if necessary. Don't allow babysitters to smoke around your child, particularly where your child sleeps. Be very firm if necessary.
2. Rid your home of asthma triggers.
   • Combat dust mites by encasing your mattress and pillow in "dust-free" covers, such as microfiber covers.
   • Wash bedcovers weekly in water hotter than 130° F.
   • Keep stuffed toys out of your bed, and don't lie down or fall asleep on cloth-covered sofas or cushions.
   • Kill cockroaches with non-spray poisons or traps. Avoid rooms sprayed for cockroaches until the smell goes away.
   • Keep all food out of your bedroom.
   • Put household food and garbage in closed containers.
   • Get rid of indoor mold by repairing water leaks in your home and then cleaning moldy surfaces with a cleaner containing bleach.
3. Ask yourself these eight questions if your asthma isn't adequately controlled.
   • Is something in my home environment triggering asthma?
   • Is something in my workplace triggering attacks?
   • Am I taking my medicine exactly as my health care professional intended?
   • Am I using my inhaler the right way?
   • Am I taking the right medicines?
   • Should I learn more about managing asthma?
   • Should I use a mini-peak flow meter to keep track of my asthma?
   • Is my disease really asthma, or something with similar symptoms?
4. Take control of your asthma.
   Controller medication is intended to reduce airway inflammation and works only if you take it every day, as directed, even if you're not having a flare-up. Quick-relief medication should be taken when you're wheezing and coughing, or when your chest feels tight. Know the difference—ask if necessary! Avoid exposure to asthma triggers. Take action to get them out of your home and your working environment. If you have asthma symptoms more than twice a week or wake up at night with symptoms more than twice a month, talk with your health care professional for help in gaining better control.
5. Learn how to manage asthma flare-ups.
   Increase your awareness of a flare-up by paying attention to symptoms and whether you're taking your quick-relief medication more often than usual. Get a peak flow meter and take your peak flow. Ask your health care professional to give you a written action/medication plan for managing mild, moderate or severe asthma. If you're flare-up isn't responding to treatment, seek medical help immediately by calling 911 or going to your doctor's office or an emergency clinic.
6. Be sure you're taking your medication the right way.
   When you visit your health care professional, ask if you're inhaling your medication the right way (take your inhaler out and demonstrate). If you're not doing it correctly, the medication might not work. Take anti-inflammatory (controller) medication regularly, as directed by your health care professional, even if you don't have symptoms. Take bronchodilating (quick-relief) at the earliest signs of an asthma attack—don't wait. If you have to take bronchodilating medication more than three or four times a day, your airways may be too swollen for safety.
7. Learn how to use your metered-dose inhaler.
   Take off the cap and shake the inhaler three or four times. Breathe out all the way. Hold the inhaler 1 to 2 inches in front of your mouth (about the width of one or two fingers), or put the end in your mouth between your teeth and over your tongue with your lips closed tightly around it (but not if it's steroids). As you start breathing in, press down on the inhaler once. Breathe in over three to five seconds and hold your breath for a count of 10. You could also use a spacer/holding chamber; in that case, place the inhaler in your mouth in between your teeth and over your tongue with your lips closed tightly around it, press down once, then breathe in within five seconds. Take a slow breath in, holding for 10 seconds. If it's quick-relief medication, wait about one minute between puffs. Some are easy to use—you just click and breathe.
8. Know how to take a peak flow.
   Start by finding your best peak flow while your asthma is under control. Take your peak flow each day for two to three weeks first thing in the morning and last thing at night. The highest number is your personal best peak flow. Now you can establish your three zones: green (80 to 100 percent of best peak flow), yellow (50 to 79 percent) and red (below 50 percent), and what medicines to take (ask your health care professional). Check your peak flow every morning before you take your medication; during an asthma attack; and just after taking medication for an attack, to see if it's working.
9. Learn how to take an accurate peak flow measurement.
   Move the marker to the bottom of the numbered scale. Stand up straight, remove any food or gum from your mouth, and take a deep breath. Hold your breath and put the mouthpiece in your mouth and close your lips tightly around it. Don't block the mouthpiece with your tongue. In one breath, blow out as hard and fast as you can. Write down the number you get, but if you cough or otherwise make a mistake, start over; don't use that number as peak flow. Repeat the process two more times, then note the highest number out of three. (Do not calculate the average.) Check to see what zone your peak flow is in: green, yellow or red. Measure your peak flow rate close to the same time(s) each day; you and your doctor can determine the best time(s) for you.

Organizations and Support

For information and support on coping with Asthma, please see the recommended organizations, books and Spanish-language resources listed below.

Allergy & Asthma Network Mothers of Asthmatics (AANMA)
Website: https://www.aanma.org
Address: 2751 Prosperity Ave, Suite 150
Fairfax, VA 22031
Hotline: 1-800-878-4403

American Academy of Allergy, Asthma & Immunology
Website: https://www.aaaai.org
Address: 555 East Wells Street, Suite 1100
Milwaukee, WI 53202
Phone: 414-272-6071
Email: info@aaaai.org

American Academy of Family Physicians (AAFP)
Website: https://www.aafp.org
Address: P.O. Box 11210
Shawnee Mission, KS 66207
Hotline: 800-274-2237
Phone: 913-906-6000

American College of Allergy, Asthma and Immunology (ACAAI)
Website: https://www.acaai.org/
Address: 85 West Algonquin Road, Suite 550
Arlington Heights, IL 60005
Hotline: 1-800-842-7777
Phone: 847-427-1200
Email: mail@acaai.org

American Lung Association (ALA)
Website: https://www.lungusa.org
Address: 61 Broadway, 6th Floor
New York, NY 10006
Hotline: 1-800-LUNG-USA (1-800-586-4872)
Phone: 212-315-8700

Asthma and Allergy Foundation of America
Website: https://www.aafa.org
Address: 1233 20th Street, NW, Suite 402
Washington, DC 20036
Hotline: 1-800-7-ASTHMA (1-800-727-8462)
Email: info@aafa.org

Books

ABC of Asthma, Allergies and Lupus: Eradicate Asthma - Now!
by F. Batmanghelidj

Allergies and Asthma For Dummies
by William E. Berger

Asthma Self-Care Book: How to Take Control of Your Asthma
by Geri Harrington

Asthma Sourcebook: Everything You Need to Know
by Francis V. Adams

My House Is Killing Me! The Home Guide for Families With Allergies and Asthma
by Jeffrey C. May

Spanish-language resources

American Lung Association (of San Diego and Imperial Counties)
Asthma Fact Sheets - English/Spanish
Website: https://www.lung.org/assets/documents/asthma/ALA-Asthma-Fact-Sheets-Spanish-R-1.pdf

American Academy of Allergy Asthma & Immunology
Website: https://www.aaaai.org/spanish-materials
Address: American Academy of Allergy, Asthma & Immunology
555 East Wells Street, Suite 1100
Milwaukee, WI 53202
Phone: 414-272-6071
Email: info@aaaai.org