When You Have Asthma ,,

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WHENYOUHAVEASTHMA

It's important to:

Take your asthma seriously.

Take your asthma medicines for asthma.

When asthma symptoms don't improve, get help.

KNOWYOURASTHMASYMPTOMS

"I cough a lot while I exercise or even when I restafter exercising."

"I have shortness of breath."

"I make a wheezing sound when I breathe."

"I feel a tightness in my chest."

Do you feel this way sometimes? Any one of these symptoms maymean that you have asthma. You can have one or more of thesesymptoms or even different ones. Symptoms are clues that let youknow that you are having an asthma attack.

FINDOUTWHATSTARTSYOURASTHMASYMPTOMS

Usually symptoms get started or "triggered" by something thatbothers your lungs. These things are called asthma triggers.

There are many kinds of triggers. They can range from viruses (suchas colds) to allergies, to gases and particles in the air.

Given this range, you may find it hard to figure out what starts yourasthma attacks. You may even think your attacks "just happen." Butthis is generally not true. Something usually triggers an attack.

SO WHAT'STHEGOODNEWSIN ALLOF THIS?

Once you find out your triggers, you can do something to preventyour asthma attacks. This gives you control. The result is that whenand if you have attacks, there's a good chance that they will be lesssevere and you won't have as many.

For example, do you get an asthma attack after you've exercised? If you do, you should tell your doctor. You can get help.You can still exercise when you have asthma, but you may need to

take rest breaks while you exercise. If you know that exercisetriggers your asthma, the doctor may tell you to take your asthmamedicine before you exercise. This way, you can still have funexercising without having an asthma attack.

There are other asthma triggers that you can get rid of or avoid.Good examples of these triggers are cold air, dust, feathers ormolds.

Cigarette smoking is another trigger that must be avoided. If yousmoke, you need to quit. Smoking cigarettes will make your asthmaworse, and if you breathe the smoke from someone else's cigarette,you may get an asthma attack.
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This is true for children, too. In fact, children are especially at riskwhen they breathe secondhand smoke. Studies show that children of smokers are more likely to suffer asthma attacks. Their asthma getsworse, too.

But you can do something about this. You can protect yourself (andif you're a parent with a child who has asthma, you can protect yourchild, too) when you know the risks of smoking cigarettes orbreathing secondhand smoke. The wisest and healthiest things youcan do are to live, work and play in places that are smoke free.

Remember:

Asthma symptoms and attacks usually get startedby triggers.

Talk to a doctor about these triggers.

Find ways to avoid them. Find ways to get rid of them.

Related links on the WebThese sites are not part of The American Lung Association web site,and we have no control over their content or availability.

Allergyasthma.com - Asthma: Destroying the Myths

alt.support.asthma FAQ

AN ASTHMAATTACK

Doctors are not exactly certain how you get asthma. But they do know that once youhave it, your lungs react to things that can start an asthma attack.

For instance, when you have asthma, you might get an asthma attack when youhave a cold (or some other kind of respiratory infection). Or, you might get an attackwhen you breathe something that bothers your lungs (such as cigarette smoke, dustor feathers).

When this happens, three changes take place in your lungs:

Cells in your air tubes make more mucus than normal. This mucus is very thick andsticky. It tends to clog up the tubes.

The air tubes tend to swell, just as skin swells when you get a scrape.

The muscles in your air tubes tighten.

These changes cause the air tubes to narrow. This makes it hard to breathe.

Asthma attacks may start suddenly. Or they may take a long time, even days, todevelop. Attack scan be severe, moderate or mild.

SEVEREATTACKS

When these happen, you may become breathless. As you're less and less able tobreathe, you may have trouble talking. Your neck muscles may become tight as youbreathe. Your lips and fingernails might have a grayish or bluish color. The skinaround the ribs of your chest might be sucked in.

In the case of a severe asthma attack:

Take your asthma medicine and get emergency medical help right away!

You can get into trouble if you wait too long to get help. This is how people die from

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too. They can include sprays, pills, powders, liquids and shots. The doctor choosesthe medicine and form that will work best for you.

Let's take a closer look at how these medicines can help you.

Bronchodilators. These medicines give you relief during an asthma attack.

Bronchodilators work to relax the muscles in your air tubes. As this happens, your airtubes open up, making it easier for you to breathe.

Anti-inflammatories, on the other hand, work to keep your air tubes open all of thetime so that you don't have an asthma attack in the first place. These medicinesreduce the swelling in your air tubes and decrease the mucus.

Cromolyn and nedocromil are two examples of anti-inflammatory medicines. Anotherexample is corticosteroids.

When you hear the word "steroid" you might think of the steroids used by athletes.This may worry you if you have heard about the problems and side effects athleteshave when taking steroids. But corticosteroids are not the steroids used by athletes. Those steroids are called "anabolic steroids."

Remember that corticosteroids are used to help prevent asthma attacks fromstarting. When you take this medicine in a spray form, the risk of serious side effectsis very little.

The chance of serious side effects increases when these medicines are taken in a pillor liquid form over a long period. In that case, you need to get regular check-ups bya doctor to make sure that the medicine works the best way for you.

Let's talk about side effects for a moment. Every kind of medicine, even aspirin, canhave some side effects. But a doctor can help you by finding ways to control side

effects.

When it comes to asthma medicines, it is important to check regularly witha doctor to make sure that these medicines are helping you.

Sometimes you may have some side effects, such as a sore throat, nervousness,nausea, rapid heartbeat, loss of appetite, or staying awake. Tell a doctor if you feelthis way. The doctor may want to change your dose, or try a different asthmamedicine.

The purpose of asthma medicines is to help you feel better and control your asthma so that you can do what you want to do without asthma getting inyour way.

One final note on medicines. There is another kind of treatment that may be helpfulto you if your asthma attacks get started by allergies. This treatment is calledhyposensitization therapy or allergy shots. These shots may be helpful to you inpreventing your asthma attacks. Not all experts agree about the usefulness of allergyshots.

On the other hand, the kinds of things that you do are just as important as the kindsof medicines that you take. You can help yourself when you try to avoid or get rid of the things that make you allergic, such as dust, feathers or animal fur. By doing this,you really take control and make it possible for your asthma medicines to worksuccessfully.

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ASTHMAANDALLERGY"TRIGGERS"

If you or someone you know have allergic symptoms or asthma, you are sensitive to"triggers," including particles carried in the air. These "triggers" can set off a reactionin your lungs and other parts of your body. Triggers can be found indoors oroutdoors. They can be simple things like:

Cold air.

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Tobacco smoke and wood smoke.

Perfume, paint, hair spray, or any strong odors or fumes.

Allergens (particles that cause allergies) such as dust mites, pollen,molds, pollution, and animal dander - tiny scales or particles that fall

off hair, feathers or skin - and saliva from any pets.

Common cold, influenza, and other respiratory illnesses.

You may be able to add more triggers to this list. Other things may also trigger yourasthma or allergies. It's important to learn which triggers are a problem for you. Askyour doctor to help. Your doctor my suggest:

Keeping an asthma diary.

Skin testing to test for allergies.

Finding triggers isn't always easy. If you do know your triggers, cutting downexposure to them may help avoid asthma and allergy attacks.

If you don't know your triggers, try to limit your exposure to one suspected triggerat a time. Watch to see if you get better. This may show you if the trigger was aproblem for you.

OUTDOORAIR, INDOORAIR ANDAIR-CONDITIONINGControlling your exposure to triggers outdoors is hard. You may have to avoidoutdoor air pollution, pollen, and mold spores. Any time air pollution and pollenlevels are high, it's a good idea to stay indoors.

The air at home is easier to control. Some people with asthma and allergies noticethat their symptoms get worse at night. Trigger controls in the bedroom or whereveryou sleep need the most care.

Air-conditioning can help. It allows windows and doors to stay closed. This keepssome pollen and mold spores outside. It also lowers indoor humidity. Low humidityhelps to control mold and dust mites.

Avoid too much air-conditioning or too much heat. Room air temperature should becomfortable for someone with allergies or asthma. Some people can't tolerate a bigchange in temperature, particularly from warm to cold air.

There are some devices that effectively remove particles from air. Their usefulness inreducing allergy symptoms is under study.

TRIGGERCONTROLS

Here are some common triggers and some ways to help control them at home:

Tobacco Smoke

Smoke should not be allowed in the home of someone with asthma orallergies. Ask family members and friends to smoke outdoors. Suggestthat they quit smoking. Your local American Lung Association can help.Ask your Lung Association how you can help a family member or friendquit smoking.

Wood Smoke

Wood smoke is a problem for children and adults with asthma andallergies. Avoid wood stoves and fireplaces.

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Pets

Almost all pets can cause allergies, including dogs, cats and especiallysmall animals like birds, hamsters and guinea pigs. All pets should beremoved from the home if pets trigger asthma and allergy symptoms.

Pet allergen may stay in the home for months after the pet is gonebecause it remains in house dust. Allergy and asthma symptoms maytake some time to get better.

If the pet stays in the home, keep it out of the bedroom of anyonewith asthma or allergies. Weekly pet baths may help cut down theamount of pet saliva and dander in the home.

Sometimes you hear that certain cats or dogs are "non-allergenic."There really is no such thing as a "non-allergenic" cat or dog,especially if the pet leaves dander and saliva in the home. Goldfish andother tropical fish may be a good substitute.

Cockroaches

Even cockroaches can cause problems, so it's important to get rid of roaches in your home. Small pieces of dead roaches and roachdroppings settle in house dust and can end up in the air you breathe.

Like humans, roaches need food and water and a place to live. Helpkeep your home roach free by storing food in sealable containers andkeeping crumbs, dirty dishes and other sources of food waste cleanedup; fixing leacks and wiping up standing water; and cleaning up clutterwhere roaches find shelter.

If you still have problems and you have to choose a pesticide, be sureto use it safely, and as directed on the label. Baits are less likely thansprays or foggers to harm your lungs.

Indoor Mold

When humidity is high, molds can be a problem in bathrooms,kitchens, and basements. Make sure these areas have good aircirculation and are cleaned often. The basement in particular mayneed a dehumidifier. And remember, the water in the dehumidifiermust be emptied and the container cleaned often to prevent formingmildew.

Molds may form on foam pillows when you perspire. To prevent mold,wash the pillow every week, dry thoroughly and make sure to changeit every year.

Molds also form in houseplants, so check them often. You may have tokeep all plants outdoors.

Strong Odors or Fumes

Perfume, room deodorizers, cleaning chemicals, paint, and talcumpowder are examples of triggers that must be avoided or kept to very

low levels.Dust Mites

Dust mites are tiny, microscopic spiders usually found in house dust.Several thousand mites can be found in a pinch of dust. Mites are oneof the major triggers for people with allergies and asthma. They needthe most work to remove.

Following these rules can also help get rid of dust mites:

Put mattresses in allergen-impermeable covers. Tapeover the length of the zipper.

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Put pillows in allergen-permeable covers. Tape over thelength of the zipper. Or wash the pillow every week.

Wash all bedding every week in water that is at least130 degrees F. Removing the bedspread at night mayhelp.

Don't sleep or lie down on upholstered (stuffed)furniture.

Remove carpeting in the bedroom.

Clean up surface dust as often as possible. Use a dampmop or damp cloth when you clean. Don't use aerosolsor spray cleaners in the bedroom. And don't clean theroom when someone with asthma or allergies is present.

Window coverings attract dust. Use window shades orcurtains made of plastic or other washable material foreasy cleaning.

Remove stuffed furniture and stuffed animals (unlessthe animals can be washed), and anything under thebed.

Closets need extra care. They should hold only neededclothing. Putting clothes pin a plastic garment bag mayhelp. (Do not use the plastic bag that covers drycleaning).

Dust mites like moisture and high humidity. Cuttingdown the humidity in your home can cut down thenumber of mites. A dehumidifier may help.

Air cleaning devices, including portable units and centralfiltration systems may be helpful in reducing someindoor air pollutants when used with effective sourcecontrol and ventilation. Ask your doctor for advice aboutair cleaning devices. If you decide to use one, make sureit removes particles efficiently over an extended periodof time and does not produce ozone.

GENERALRULESTO HELPCONTROLTHE HOMEENVIRONMENT

Controlling the home environment is a very important part of asthma and allergycare. Some general rules for home control for all members of the family are:

Reduce or remove as many asthma and allergy triggers from your home as possible.

If possible, use air filters and air conditioners -- and properly maintain them -- tomake your home cleaner and more comfortable.

Pay attention to the problem of dust mites. Work hard to control this problem in the

bedroom.

Vacuum cleaners with poor filtration and design characteristics release and stir updust and allergens.Select a unit with high-efficiency filters such as micro filter or HEPA media, goodsuction, and sealed construction. Ask for test data from manufacturers to determinethe quantity and size of dust particles captured (e.g., 96 % at 1.0 micron or 99.97%at 0.3 micron). Alternately, consider a central vacuum that exhausts particulateoutside the home.Anyone with asthma or allergies may want to avoid vacuuming.

Related links on the WebThese sites are not part of The American Lung Association web site, and we have no control over their content or

availability.

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McKinley Health Center - CONTROLLING YOUR ASTHMA TRIGGERS

Health Oasis/Mayo Clinic - ASTHMA: Cause and triggers

Health Oasis/Mayo Clinic - ASTHMA CONTROL: A comprehensive guide

5 WHATIS A PEAKFLOWMETER?

A Peak Flow Meter is a portable, inexpensive, hand-held device used to measure howair flows from your lungs in one "fast blast." In other words, the Meter measuresyour ability to push air out of your lungs.

Peak Flow Meters may be provided in two ranges to measure the air pushed out of your lungs. A low range Peak Flow Meter is for small children, and a standard rangemeter is for older children, teenagers and adults. An adult has much larger airwaysthan a child and needs the larger range.

There are several types of Peak Flow Meters available. Talk to your doctor orpharmacist about which type to use.

WHOCANBENEFITFROMUSINGA PEAKFLOWMETER?

Many doctors believe that people who have asthma can benefit from the use of aPeak Flow Meter. If you need to adjust your daily medication for asthma, a Peak FlowMeter can be an important part of your asthma management plan.

Children as young as three years have been able to use a Meter to help manage theirasthma. In addition, some people with chronic bronchitis and emphysema may alsobenefit from the use of a Peak Flow Meter.

Not all physicians use Peak Flow Meters in their management of children and adultswith asthma. Many doctors believe a Peak Flow Meter may be of most help for peoplewith moderate and severe asthma. If your asthma is mild or you do not use dailymedication, a Peak Flow Meter may not be useful for asthma management.

WHYSHOULDI MEASUREMY PEAKFLOWRATE?

Measurements with a Peak Flow Meter can help you and your doctor monitor your

asthma. These measurements can be important and help your doctor prescribemedicines to keep your asthma in control.

A Peak Flow Meter can show you that you may need to change the way you are usingyour medicines. For example, Peak Flow readings may help be a signal for you toimplement the medication plan you and your doctor have developed for worseningasthma.

On the other hand, if you are doing well, then measuring your Peak Flow may behelpful as you and your doctor try to lower the level of your medicines.

A Peak Flow Meter can help you when your asthma is getting worse. Asthmasometimes changes gradually. Your Peak Flow may show changes before you feelthem. It can allow your doctor to adjust your treatment to prevent urgent calls to thedoctor, emergency room visits or hospitalizations.

A Peak Flow Meter may help you and your doctor identify causes of your asthma atwork, home or play. It may help parents to determine what might be triggering theirchild's asthma.

A Peak Flow Meter can also be used during an asthma episode. It can help youdetermine the severity of the episode; decide when to use your rescue medication;and decide when to seek emergency care.

Knowing your "personal" Peak Flow Rate allows you to elevate your readings. Being

at your "best" can provide reassurance and make you feel more self-confident.

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HOWDO YOUUSEA PEAKFLOWMETER?

Step 1: Before each use, make sure the sliding marker or arrow on the Peak FlowMeter is at the bottom of the numbered scale (zero or the lowest number on thescale).

Step 2: Stand up straight. Remove gum or any food from your mouth. Take a deepbreath (as deep as you can). Put the mouthpiece of the Peak Flow Meter into yourmouth. Close your lips tightly around the mouthpiece. Be sure to keep your tongueaway from the mouthpiece. In one breath blow out as hard and as quickly aspossible. Blow a "fast hard blast" rather than "slowly blowing" until you have emptiedout nearly all of the air from your lungs.

Step 3: The force of the air coming out of your lungs causes the marker to movealong the numbered scale. Note the number on a piece of paper.

Step 4: Repeat the entire routine three times. (You know you have done the routinecorrectly when the numbers from all three tries are very close together.)

Step 5: Record the highest of the three ratings. Do not calculate an average. This isvery important.

You can't breathe out too much when using your Peak Flow Meter but you canbreathe out too little. Record your highest reading.

Step 6: Measure your Peak Flow Rate close to the same time each day. You andyour doctor can determine the best times. One suggestion is to measure your PeakFlow Rate twice daily between 7and 9 a.m. and between 6 and 8 p.m.

You may want to measure your Peak Flow Rate before or after using your medicine.Some people measure Peak Flow both before and after taking medication. Try to doit the same way each time.

Step 7: Keep a chart of your Peak Flow Rates. Discuss the readings with yourdoctor.

HOWDO I CHARTMY PEAKFLOWRATES?

Chart the HIGHEST of the three readings. The chart could include the date at the topof the page with AM and PM listed. The left margin could list a scale, starting withzero (0) liters per minute (L/min) at the bottom of the page and ending with 600

L/min at the top.

You could leave room at the bottom of the page for notes to describe how you arefeeling or to list any other thoughts you may have.

WHATIS A "NORMAL"PEAKFLOWRATE?

A "normal" Peak Flow Rate is based on a person's age, height, sex and race. Astandardized "normal" may be obtained from a chart comparing the patient with apopulation without breathing problems.

A personal best normal may be obtained from measuring the patient's own PeakFlow Rate. Therefore, it is important for you and your doctor to discuss what isconsidered "normal" for you.

Once you have learned your usual and expected Peak Flow Rate, you will be able tobetter recognize changes or trends.

HOWCANI DETERMINEA "NORMAL"PEAKFLOWRATEFORME?

Three zones of measurement are commonly used to interpret Peak Flow Rates. It iseasy to relate the three zones to the traffic light colors: green, yellow, and red. Ingeneral, a normal Peak Flow Rate can vary as much as 20 percent.

Be aware of the following general guidelines. Keep in mind that recognizing changesfrom "normal" is important. Your doctor may suggest other zones to follow.

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Green Zone: 80 to 100 percent of your usual or "normal" Peak Flow Rate signals all clear. Areading in this zone means that your asthma is under reasonably good control. Itwould be advisable to continue your prescribed program of management.

Yellow Zone:

50 to 80 percent of your usual or "normal" Peak Flow Rate signals caution. It is atime for decisions. Your airways are narrowing and may require extra treatment.Your symptoms can get better or worse depending on what you do, or how and whenyou use your prescribed medication. You and your doctor should have a plan foryellow zone readings.

Red Zone: Less than 50 percent of your usual or "normal" Peak Flow Rate signals a MedicalAlert. Immediate decisions and actions need to be taken. Severe airway narrowingmay be occurring. Take your rescue medications right away. Contact your doctornow and follow the plan he has given you for red zone readings.

Some doctors may suggest zones with a smaller range such as 90 to 100 percent.Always follow your doctor's suggestions about your Peak Flow Rate.

MANAGEMENTPLANBASEDON PEAKFLOWREADINGS

It is important to know your Peak Flow reading, but it is even more important toknow what you will do based upon that reading. Work with your doctor to develop anasthma management plan that follows your green-yellow-red zone guidelines.

Record the Peak Flow readings that your doctor recommends for your green zone,yellow zone, and red zone. Then work out with your doctor what you plan to do whenyour Peak Flow falls in each of those zones.

WHENSHOULDI USEMY PEAKFLOWMETER?

Use of the Peak Flow Meter depends on a number of things. Its use should bediscussed with your doctor.

If your asthma is well controlled and you know the "normal" rate for you, you maydecide to measure your Peak Flow Rate only when you sense that your asthma isgetting worse. More severe asthma may require several measurements daily - ortwice a day.

Don't forget that your Peak Flow Meter needs care and cleaning. Dirt collected in themeter may make your Peak Flow measurements inaccurate. If you have a cold or

other respiratory infection, germs or mucus may also collect in the meter.

Proper cleaning with mild detergent in hot water will keep your Peak Flow Meterworking accurately and may keep you healthier.

DOESUSINGA PEAKFLOWMETERHAVEANYSIDEEFFECTS?

A Peak Flow Meter is not a medicine. It has no major side effects. Sometimespushing the air out of your lungs in a "fast blast" may cause you to cough or wheeze.

Check with your doctor before you start using a Peak Flow Meter.

Using the meter is as simple as taking a deep breath and blowing out a candle. If used properly, it can only help.

You must realize that measuring Peak Flow is only one step in a program to manageasthma. Its importance must not be exaggerated or over-interpreted.

Using a Peak Flow Meter is not a substitute for regular medical care. Ask your doctorto help you understand your Peak Flow measurements.

IDEASTO REVIEW

Now you are aware of some of the techniques for using and caring for Peak FlowMeters. You also know how Meters may help manage asthma and other breathingproblems.

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Discuss the use of a Peak Flow Meter with your doctor. Make measuring your PeakFlow Rate a part of your personal asthma management program.

Related links on the WebThese sites are not part of The American Lung Association web site, and we have no control over their content oravailability.

Loyola University Chicago Stritch School of Medicine - Home Peak Flow Monitoring

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Sample Chart

Related links on the WebThese sites are not part of The American Lung Association web site, and we have no control over their content oravailability.

Loyola University Chicago Stritch School of Medicine - Home Peak Flow Monitoring

Colorado HealthNet - Peak Flow Charts

American Academy of Allergy, Asthma and Immunology - Tips to Remember: What is a peak flow meter?

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What Is Asthma?

Have you, or someone you know, been diagnosed with asthma? If so,you probably have lots of questions.

You may wonder, for example, just what asthma is. The medicaldefinition of asthma is simple, but the condition itself is quite complex.

Asthma is a chronic (long-term) inflammation of the airways thatcauses the following symptoms:

Shortness of breath

Tightness in the chest Coughing

Wheezing

Asthma has no set pattern. Its symptoms: Can be mild, moderate or severe

Can vary from person to person

Can flare up from time to time and then not appear for long periods

Can vary from one episode to the next

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The cause of asthma is not known, and currently there is no cure.However, there are many things you can do to control it.Breathing: Normal Airway Versus Asthma AirwayIn someone with normal lung function, air is inhaled through the noseand mouth. It passes through the trachea (also called the windpipe)

before moving into the bronchi (large airways), which are branchingtubes leading away from the trachea. The bronchi branch into smallerand smaller tubes, ending in many small sacs called alveoli. It's in thealveoli that oxygen, which the body needs, is passed to the blood,while carbon dioxide, which the body doesn't, is removed from it.

People with asthma often have trouble breathing when they're in thepresence of what are called " triggers ." When someone with asthmahas an asthma attack, it means that the flow of air is obstructed as itpasses in and out of the lungs. This happens because of one or both of the following:

The lining of the airways becomes inflamed (irritated, reddened and swollen), andmay produce more mucous.

The muscles that surround the airways become sensitive and start to twitch andtighten, causing the airways to narrow.

Both of these factors cause the airways to narrow, making it difficultfor air to pass in and out of them.

The airways of someone with asthma are inflamed, to some degree,the more inflammed the more sensitive the airway becomes. This leadsto an increase in breathing difficulty.

Asthma Can Affect AnyoneAsthma is a chronic condition, meaning it can last a lifetime.Anyone can get asthma, although it's usually first diagnosed in youngpeople. Currently, about three million Canadians have asthma.Living with AsthmaMost people with asthma live full, active lives. The trick is learning tokeep asthma under control. If you have asthma, you can control it:

By avoiding your asthma

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Common Asthma Triggers

About Inflammatory Triggers | About Symptom Triggers

Asthma attacks are often brought on by triggers. A trigger is any thingor condition that causes you to have an asthma episode.

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Your personal triggers can be very different from those of anotherperson with asthma. But in every case, it's important to avoid personaltriggers in order to keep airway inflammation to a minimum andreduce the symptoms.

Inflammatory TriggersInflammatory triggers can cause inflammation of the lungs' airways ortightening of the airways' muscles. Inflammatory triggers include:

Dust mites

Animals

Cockroaches

Moulds

Pollens

Viral infections

Certain air pollutantsSymptom TriggersSymptom triggers generally don't cause inflammation, but they canprovoke "twitchy" airways, especially if they're already inflamed.Symptom triggers include:

Smoke

Exercise

Cold air

Chemical fumes and other strong-smelling substances like perfumes

Certain food additives like sulfites

Certain air pollutants

Intense emotions

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When it comes to understanding all of the new asthma treatmentsavailable, it's natural to feel a little confused.

The important thing to remember is that asthma is a "variable"disease. In other words, the symptoms vary from person to person,and even the same person's condition may fluctuate throughout theyear.

If you have asthma, your doctor will:

Explain how you can keep your asthma under control by avoiding your personaltriggers

Prescribe medication that will help minimize your symptoms

Work with you so you have a written action plan

Recommend that you visit on a regular basis so that your symptoms can bemonitored and your treatments adjusted if necessary

In order to minimize possible side effects, your doctor will prescribe thelowest dose of medication needed to control your symptoms. It maytake some experimenting to find out what that dose is. You and yourdoctor might have to try a few different doses or a few different

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medications before you find what works best for you. Over time, yourmedication needs may change.Two Kinds of MedicationMost people with asthma take two kinds of medication. That's becauseeach asthma medication treats only one aspect of the condition:

Controllers, also called "preventers," reduce inflammation in the airways.Controllers should be taken every day, whether or not you're experiencingsymptoms.

Relievers are very good at helping to alleviate symptoms immediately. If you arecoughing, use a reliever medication to reduce symptoms. However, reliever medications do nothing for the underlying problem of inflammation. Relievers areonly a short-term solution to breathing problems and indicate that there isunderlying inflammation present that requires a different controller medication.

Relievers

Relievers are used to quickly alleviate asthma symptoms. They do this by relaxingthe bands of muscle that surround the airways. However, they do not reduceinflammation in the airways - to treat inflammation, you will need to take a controllermedication .

Relievers have a number of different names. You may hear them called:

Short-acting bronchodilators (bron-ko-di-la-tors)

Beta2-agonists

Rescuers or rescue medication

Examples of reliever medications include: Fenoterol (sold as Berotec)

Formoterol (sold as Foradil or Oxeze)

Ipratropium (sold as Atrovent)

Isoproterenol (sold as Isuprel)

Orciprenaline (sold as Alupent)

Salbutamol (sold as Ventolin, Apo-Salvent, Novo-Salmol or Alti-Salbutamol)

Terbutaline (sold as Bricanyl)

Relievers are safe but, as with any medication, you should never take more than youneed. Possible side effects of relievers include:

Increased heart rate

Restlessness

Tremor (i.e., shaky hands)

Only take your reliever medication when you're experiencing asthma symptoms or if prescribed, before you exercise. Since you can never be sure when symptoms willhappen, keep your reliever medication with you at all times. That way you won't becaught off-guard.

If you find you're using your reliever medication more than three times a week (notcounting before exercising), it means your asthma is not well-controlled. Talk to yourdoctor to see about a controller medication adjustment.

Controllers

Inhaled Steroids | Long-Acting Bronchodilators | Combination Medications | OtherMedicines

While relievers help you treat the symptoms of asthma, controller medications helpto treat the underlying inflammation of the airways in a person with asthma. Bycontrolling the inflammation, asthma symptoms can be decreased and flare-upsprevented from occurring.

When you start taking controller medications, you may not notice a difference rightaway. It may take a few weeks before the inflammation in your airways is reduced.

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Even if you don't feel better right away, don't stop taking your controller medicationunless your doctor tells you to.

Remember, controllers don't immediately relieve wheezing, coughing or chesttightness, and should not be used to treat a severe asthma attack. Make sure youunderstand the difference between your reliever medication, which provides quickrelief during an asthma episode, and your controller medication, which controls yourunderlying inflammation so that you're less likely to experience these symptoms inthe first place.

All About Inhaled Steroids

Doctors generally prescribe inhaled corticosteriods over oral (tablet or liquid)corticosteroids, because the inhaled medication is more targeted. In other words,when it's inhaled, more medication gets directly into the lungs where it's needed.Unlike oral medicines, inhaled steroids don't have to pass through other parts of thebody where they're not needed, and as a result are less likely to cause unwanted sideeffects.

If you are using a pressurized MDI (pMDI) inhaled steroid, then doctors recommendthe use of a spacer device . A spacer slows down the delivery of the aerosol dropletsthat carry the medicine, making delivery even better targeted to get into the airways.Remember, spacers should not be used with dry-powered devices such as theDiskus or Turbuhaler.

Frequently Asked Questions About SteroidsQ: What are steroids?A: Steroids are natural or man-made chemicals that make our bodies work in acertain way. The steroids that some athletes misuse to build their muscles are calledanabolic steroids, and they are potentially dangerous. Steroids that are used to treatasthma are called corticosteroids, and are very useful and quite safe when inhaled.

These two types of steroids should not be confused because they are very differentfrom each other. Corticosteroids do not build muscle or enhance performance; they

reduce inflammation and swelling.Q: Will corticosteroids used to treat asthma cause dangerous side effects?A: The corticosteroids that are inhaled to treat asthma today are considered safe.

This is because the medicine, which is breathed in through a puffer, goes directly intothe lungs where it reduces inflammation in the airways. A steroid pill that isswallowed has more side effects because a large amount goes into the blood streamand is carried to other parts of the body. Side effects from inhaled corticosteroids areminor when the proper amount is taken. A few people get a cough, hoarseness orhusky voice, sore throat or thrush (a yeast infection). Patients can protect againstthese discomforts by rinsing their mouth, gargling with water and spitting out, toremove any medicine left in the mouth.

Q: Are inhaled corticosteroids reserved for people with severe asthma?A: No. Inhaled corticosteroids are used in mild to moderate asthma as well as inmore severe cases. Canada's Asthma Control Guidelines, developed by Canada'sleading asthma doctors, strongly support the use of inhaled corticosteroids to reduceairway inflammation and get symptoms under control.

Q: How do I know that inhaled corticosteroids won't cause health problemsin the longer term?A: As with any medicine, doctors and patients must weigh the possible risks of takingmedicine against the effects of not taking the medicine to decide what is best. Lowamounts of inhaled steroids are considered to be quite safe. A growing number of doctors and patients are using them without hesitation to get asthma under control.

Q: I don't feel comfortable taking inhaled steroids every day. Can I stop?A: Inhaled steroids are generally considered to be the most effective medication forcontrolling asthma. What's more, they're generally considered to be safe if used asdirected. In most cases, the benefits of taking inhaled steroids outweigh the risks. It'sunderstandable that you should be concerned about the medications you take. Yourdoctor will work with you to ensure you're taking the smallest amount of medicinenecessary to control your asthma.

How to Use Your Inhaler

Metered Dose Inhaler (MDI or pMDI) | Spacers | Diskus | Turbuhaler | Diskhaler

About InhalersSeveral different kinds of asthma medicines are taken using an inhaler. Inhalers are

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popular devices because they deliver medication directly to the lungs, with very littleof it reaching other parts of the body where it's not needed. This means doctors canprescribe the smallest dose necessary to control asthma symptoms and, as a result,minimize the risk of side effects.

In order to get the full benefit of asthma medication delivered by an inhaler, youmust use your inhaler properly. Learning to do this can be a little tricky, but there arelots of places to get help. If you're just beginning to use an inhaler:

Follow the instructions that come with it.

Make sure a healthcare professional, like an asthma educator , a respiratory therapist, doctor or pharmacist, shows you how to use it and reviews its use with you from time to time - especiallywhen using your inhaler for the first time.

Refer to the guides on this Web site.

Inhalers fall into two categories: Pressurized inhalers use propellants to spray out medication into the lungs to breathe.

Dry-powder inhalers contain medication that is drawn into the lungs by a person breathing in.

Some people prefer dry-powder inhalers to pressurized inhalers because they find iteasier to co-ordinate breathing in medication from them. However, with some dry-powder inhalers, it's necessary to inhale more quickly to get the right dose than it iswith a pressurized inhaler. You may have to experiment with a number of differentdevices (under your doctor's supervision) before finding the one you're mostcomfortable with. An asthma educator can assist you in matching you with the bestdevice.Some inhaler devices come with built-in counters that monitor the number of doses aperson has taken and how many doses the device has left. If your inhaler doesn'thave a counter, ask your doctor or an asthma educator to show you how to monitoryour dose.

What to Expect if You Have AsthmaLearning to Live with AsthmaIf you've just been diagnosed with asthma, you may feel a little discouraged. But youshould know that with proper management and medication, most people with asthmalive perfectly normal, active lives.

The first step towards taking control of your health - and your life - is talking to yourdoctor. He or she will work with you to determine the best strategies and the propermedications for controlling your asthma so that its symptoms are minimized.

Your doctor will give you lots of useful advice, and possibly refer you to a specialist oran asthma educator .

In addition, your doctor may:

Suggest you use a peak flow meter to monitor your lung function. This allows you to note anychanges that might mean your asthma is not being controlled properly.

Prescribe medication that will help you keep asthma symptoms to a minimum. Your doctor will prescribe the smallest amount of medication to control your symptoms.

Suggest you keep a diary of the results of your peak flow monitor tests and your symptoms so thatyou and your doctor can use it to create a personalized action plan .

Peak Flow Monitoring at Home To monitor how well your asthma is controlled, your doctor may suggest you use a

peak flow meter. This simple device measures what's called your "peak expiratory flow," or PEF. Usingit, you can:

Determine whether your peak flows vary over time, or are affected by the presence of certaintriggers

Monitor how well your medication is working

Recognize whether you require immediate medical attention

Develop an asthma action plan

, a tool that helps you keep your asthma under control

Using a Peak Flow MeterUsing a peak flow meter is simple. Read the instructions that come with yourparticular model, and follow these steps:

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1. Attach the mouthpiece to the peak flow monitor.

2. Set the marker (indicator) to the level of zero on the scale.

3. Stand up or, if you can't stand, sit up straight.

4. Breathe in as deeply as you can.

5. Close your lips around the mouthpiece.

6. Blow out as hard and as fast as you can. (i.e., A "fast blast" of air)

7. Note the number next to the marker.

8. Repeat steps 2 through 7 two more times.

9. In a notebook or diary, record the highest of the three numbers. This number is your PEF for thatmorning or evening.

Making Sense of Your Results Your doctor or asthma educator will help you determine which of your PEF

measurements should be used as a "baseline" - that is, your personal best peak flow.Use your peak flow result with your written action plan to determine the actionneeded to be taken to manage your asthma.Once you know your personal best peak flow, you will be able to know if your asthmais well-controlled. If the result of a PEF test is 80 per cent or more of your personalbest number, your asthma is likely well controlled.If it is less than 80 per cent of your personal best you are not well controlled. Discussyour results with your doctor.Remember that a peak flow meter can be a useful tool, but monitoring yoursymptoms is the most important way to assess overall how well your asthma is beingmanaged.

What to Do if Your Asthma Worsens

When you have asthma, you know that your symptoms can vary from time to timeand situation to situation. It can be difficult to know when changes in your symptomsare normal, and when they might mean trouble.

That's why you should work with your doctor to create an asthma action plan. Youcan find an example of one here . Print it out and take it with you to your nextdoctor's appointment. Together, you can modify it as needed so that you alwaysknow when a change in your symptoms means something serious.

The Three Asthma Zones

The Green Zone When you're in the green zone, your symptoms are minimal. You're still able toparticipate in normal activities, including attending school or work regularly,exercising and sleeping.You are using your reliever medication less than four times aweek.

Being in the green zone means your asthma is well-controlled. Continue to take yourcontroller medications as directed by your doctor or discuss decreasing the dose if you are in the green zone regularly.

The Yellow ZoneMost asthma episodes aren't sudden, and can be treated with an increase or changein controller medication your doctor prescribes.

If you find that any of the following occur, you are in the yellow zone:

You have difficulty performing your regular activities or exercise.

Your asthma symptoms begin to disturb your sleep.

You get a cold or other chest infection.

You need to take your reliever medication more often than normal.(> 3/week)

You have to miss work or school due to asthma symptoms.

If you suspect you're in the yellow zone, ask your doctor about modifying yourcontroller medications.

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The Red ZoneIf you're experiencing severe asthma symptoms, you may be in the red zone.If so, you need to get medical attention immediately. Make sure you recognize redzone signs:

Excessive coughing

Excessive wheezing

Extreme tightness in the chest

Extremely laboured breathing

Sweating

Gasping voice

Pale or blue lips or fingernails

Anxiety or fear

Decreased activity level

Symptoms that don't respond to your regular reliever medication

Important Phone NumbersIf any of the above symptoms are present, call your local emergency serviceimmediately. Have the following written down and kept close at hand in case of anemergency:

Your doctor's name

Your doctor's phone number

The phone number of your local emergency service The phone number of your local ambulance service

At the Emergency DepartmentIf you have to go to the emergency department of a hospital, doctors and healthcareprofessionals will treat you by:

Giving you oral and/or inhaled corticosteroids

Giving you bronchodilator and oxygen therapy

Evaluating you with spirometry, peak flow monitoring and oximetry assessments

Remember, it's better to be safe than sorry. To delay getting medical help when

you're in the red zone can mean unnecessary suffering, even death. Always followyour action plan and your doctor's advice about how best to manage your asthma.
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Documents

When You Have Asthma ,,