BreatheEasy Asthma Program

Do you...

• wake up at night due to your asthma?
• limit your participation in exercise or sports due to asthma?
• use an inhaler, such as albuterol, every day to relieve your symptoms?
• wish you knew more about asthma and your medicines?

If you answer "yes" to any of the above questions, we invite you to review our asthma program, BreatheEasy.

The handouts used in this program will help you understand your asthma and how to better control it.

Asthma is...

• A chronic lung disease.
• It can be controlled, but not cured.
• Asthma is inflammation; swelling or edema of the airways, and constriction or narrowing of the airways.

The main symptoms of asthma are:

• Coughing
• Difficulty breathing
• Tightness in the chest
• Wheezing

The most frequent symptom of asthma is coughing, which is often the first symptom when asthma is out of control (asthma attack/flare-up):

• Coughing, especially at night
• Coughing during or after activity
• Coughing that continues after a cold is over

When you have asthma, your airways are very sensitive to things called triggers.

You can control your asthma if you:

• Control the inflammation in your airways by taking your anti-inflammatory medication regularly
• Know and avoid/control your triggers
• Obtain early treatment for a flare-up of your asthma.

Airway remodeling refers to the scarring of your airways, if the airway inflammation s not controllers. Over time, scar tissue replaces your normal airway tissue, and may not respond to treatment.

Asthma Episodes rarely occur without warning. Most people with asthma have warnin 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 to your last asthma episode. Did you have any of the signs below?

Check your warning sign(s). Show them to your doctor and family.

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
• Tightness or pain starting to occur in the chest
• Breathing faster than normal
• Gettin out of breath easily
• Becoming tired
• Eyes becoming itchy, watery, or glassy
• Throat becoming scratchy or sore
• Stroking chin or throat
• Sneezing
• Head congestion, "stopping up"
• Headache
• Fever
• Restlessness
• Runny nose
• Change in face color
• Dark circles under the eyes

• Patient education is the foundation for your asthma control.
• Control your airway inflammation and you control your asthma.
• Quick relief medicines are used only when symptoms begin, get worse, or before physical activity.
• Know your/your child’s warning signs and symptoms.
• Know your/your child’s allergic/non-allergic triggers and control or avoid them.
• Don’t forget to use your peak flow meter every day.
• Don’t ignore coughing; it may be the only symptom of asthma or flare-up of asthma.
• Use your written action plan when your asthma flares up. This will help prevent emergency room and hospital visits.
• See your doctor regularly, even when you’re not having problems, and bring all your medicines, spacer, peak flow meter, and questions.
• Don’t let asthma control you. You control your asthma!

Working together with your doctor you can control your asthma. Control of your asthma means:

• No wheezing and no coughing
• Doing activities, sports and exercise without having symptoms
• Sleeping through the night
• Being able to attend school/work daily

For you to control your asthma and not have your asthma control you, the following are important:

• Learn about asthma
• Learn about your asthma triggers, and how to avoid or control them
• Learn about the different asthma medicines and how to best use them

Controller Medicines that are used daily to control your asthma.

Anti-inflammatories:

• Steroid inhalers
• Nonsteroid inhalers
• Leukotriene modifiers

Long acting bronchodilators:

• Inhaled long acting
• Theophyllines

Quick Relief Medicines (Short acting bronchodilator, (e.g. albuterol) will relax your airways and only treat symptoms. They don’t control asthma.

Asthma severity levels provide the basis for treating your asthma. Below are 4 categories defind by the National Asthma Education and Prevention Program (NAEPP).

Severity Class	Daytime Symtoms	Nighttime Symtoms
intermittent	less than 2 times per week	less than 2 times per month
mild persistent	more than 2 times per week but less than 1 time per day	more than 2 times per month
moderate persistent	daily	more than 1 time per week
severe persistent	continuous (limited physical ability)	frequent

 

A peak flow meter measures how well air moves out of your lungs. During an asthma episode, the airways of the lungs begin to narrow slowly. The peak flow meter can be used to find out if there is a narrowing in the airways hours, or even days, before you have any symptoms. By taking your medicine early (before symptoms) you may be able to stop the episode quickly and avoid a serious episode. Peak flow meters are used to check your asthma the way that blood pressure cuffs are used to check high blood pressure.

The peak flow meter can also be used to help you and your doctor:

• Decide if your medicine plan is working well
• Decide when to add or stop medicine
• Decide when to seek emergency care
• Identify triggers, that is , what causes your asthma symptoms to increase
• Talk about your asthma with more knowledge

How to Use a Peak Flow Meter

1. Place the indicator at the base of the numbered scale
2. Stand up
3. Take a deep breath
4. Place the meter in your mouth and close your lips around the mouthpiece. Do not put your tongue inside the hole.
5. Blow out as hard and as fast as you can
6. Write down the number you get
7. Repeat the steps above two more times
8. Record the highest of the three numbers you got

Find Your Personal Best Peak Flow

Your "personal best" peak flow number is the highest peak flow number you can achieve when your asthma is under good control. Good control is when you feel good and do not have any asthma symptoms.

Your action plan needs to be based on your own personal best peak flow number.

Allergic Triggers

Pollen and Outdoor Molds

• Stay indoors late morning to early afternoon
• Never sleep with your windows open
• Use air conditioning whenever possible
• Stay away from wet leaves, standing water, gardens
• If allergic to grass pollen, don’t cut the grass

Dust Mites

• Wrap pillow, mattress, box spring in air-tight covers
• Wash bedding (pillow case and sheets) once a week in hot water (130 degrees F)
• Dust bedroom once a week; use a dust filtration mask
• Remove carpet from the bedroom, if you can
• Keep indoor humidity at less than 50%

Indoor Molds

• Keep indoor humidity at less than 50%
• Use a dehumidifier, but clean it regularly
• Do not use humidifier or vaporizer
• Keep your bathroom, kitchen and basement clean, dry, and well aired.

Animals

• You can be allergic to their dander, saliva and sometimes urine. Remove animals to better control your asthma/allergies.
• Avoid visits to places with pets; if you must visit, take your quick relief medicine before you go and also take with you, to use while you’re there.
• If allergic to feathers; no birds or feather pillows.

Irritant and Other Triggers

Cockroaches

• Use cockroach traps, boric acid or poison baits
• Avoid insect sprays in asthmatic homes
• Always keep food and garbage in closed containers

Irritants

• Do not smoke
• Do not allow smoking in your home or car
• Avoid wood burning stoves/furnaces/fireplaces
• Avoid kerosene heaters
• Avoid scented cosmetics, such as perfumes, hair sprays, soaps
• Avoid air fresheners
• Use exhaust fan in kitchen and bathroom
• Stay indoors if high air pollution or "ozone alert day"

Colds and Infections

• Talk to your doctor about getting a flu shot and pneumonia vaccine
• Do not use over the counter medicines unless you ask your doctor first
• Maintain a healthy lifestyle; eat a balanced diet, get plenty of rest, and exercise on a regular basis
• Avoid using antibiotics just for "colds"

Exercise

• Pre-treat with your quick relief medicine every time you exercise.
• Warm up at the beginning of your routine and cool down when you are done.
• Avoid exercising in very cold or hot weather.
• With cold air, always breathe through your nose
• Use a mask/scarf on cold or windy days
• If you have asthma symptoms when exercising or with activity, stop what you are doing. Contact your doctor about adjusting your medicines.

An asthma action plan tells you how to adjust your asthma medicines at home, based on symptoms and your peak flow meter readings.

This action plan can help you reduce or avoid urgent care/emergency department visits or hospitalizations for an asthma attack.

Your peak flow meter measures the amount of air that you are able to get out of your lungs quickly. The higher the number, the less your airways are obstructed.

Your personal best peak flow reading is the highest number you get when you are feeling your best.

Your action plan follows a traffic light system based on your peak flow meter readings:

Green

80-100% of your personal best
No symptoms
Continue using controller medicines

Yellow

80-60% of your personal best
Coughing/wheezing
May have night time symptoms
Temporary increase in medicines or addition of new medicines

Red

< 60% of personal best
Asthma attack is severe
Call doctor immediately
Oral steroids may be prescribed

Talk to your doctor about your asthma action plan.

You can probably go to school or work if you have any of these symptoms:

• Stuffy nose, but no wheezing
• A little wheezing that goes away after taking medicine
• Occasional mild cough
• Able to do usual daily activities
• No extra effort needed to breathe
• Peak flow number is in the green zone

You should probably stay home if you have any of these symptoms:

• Infection, sore throat, or swollen, painful neck glands
• Fever over 100 degrees F orally, or 101 degrees F rectally; face hot and flushed
• Wheezing or coughing that still bothers you 1 hour after taking the medicine
• Weakness or tiredness that makes it hard to take part in usual daily activities
• Breathing with difficulty or breathing very fast
• Peak flow below 65-70 percent of personal best number and no response to treatment

 

Inhaled steroids - controller medications - help you control your asthma by reducing the swelling and inflammation of your airways.

To control your asthma, so you have fewer symptoms, flare-ups, and sleep better, you must take this medicine every day.

This medicine will not work right away. It can take up to one week to see the benefits.

This medicine is not for quick relief. You must use a quick relief bronchodilator (eg. albuterol) for asthma flare-ups.

For most people with asthma, this medicine is safe. Common side effects include:

• Hoarseness
• Cough
• Yeast infection in throat

Use a spacer and rinse your mouth after using this medicine to prevent possible side effects.

Nebulized steroids, such as Pulmicort Respules, can be used in babies and young children unable to use inhalers.

Sometimes your doctor may use a combination of an inhaled steroid with another controller medication to better control your asthma.

Some Information about Steroids

• The regular use of inhaled steroids can reduce the need for oral steroids, which may cause serious side effects when used long-term.
• Both inhaled and oral steroids are used to treat asthma. They are completely different from anabolic steroids, which are male hormones sometimes used by body-builders.

As an anti-inflammatory, this medicine reduces, reverses or prevents congestion and swelling inside your airways.

Your doctor will prescribe this medicine to "head off" a severe asthma attack or prevent an attack from getting worse.

Oral steroids can help prevent an emergency department visit or even a hospitalization for asthma when used early in an asthma attack.

These medicines are usually used as a short course (5-10 days) to treat the asthma attack.

Possible side effects of a short course include:

• Increased appetite
• Fluid retention
• Stomach aches
• Mood changes
• Weight gain
• Leg cramps
• Worsening of chicken pox.
  (Please notify your doctor if you’ve been recently exposed.)

Remember that for most patients, the benefits of taking oral steroids outweigh the risks and side effects of asthma which is out of control.

Frequent or long term use of oral steroids can lead to serious side effects.

Some information about steroids:

• The regular use of inhaled steroids can reduce the need for oral steroids, which may cause serious side effects when used long term.
• Both inhaled and oral steroids are used to treat asthma. They are a completely different type of drug than anabolic steroids, which are male hormones sometimes used by body builders.

These medicines are nonsteroidal anti-inflammatories. They are not steroids.

They reduce or prevent inflammation of the airways

They must be used every day to control the inflammation and thus control your asthma

They will not give you immediate relief of symptoms and can take up to 8 weeks to work

They can also be used about 20-30 minutes before activity, sports, or animal contacts

These medicines are very safe. Possible side effects include:

• Bad taste
• Dry cough

Use of a spacer will prevent or minimize these side effects, and will improve the effectiveness of the medication.

These medicines are a long acting bronchodilators. You must also have a quick relief medication for asthma flare-ups, available at all times.

It will relax the muscles around your airways, making it easier to breathe.

Its effects last about 12 hours.

This medicine can be used twice daily to control your asthma and prevent night time symptoms.

It is useful in preventing exercise-induced asthma when taken 30 minutes before exercise.

Never use this medicine more frequently than every 12 hours, and never as a quick relief emergency medicine.

Side effects are not common, but if they occur are usually mild.

If these side effects become severe, contact your doctor:

• Feeling shaky
• Rapid heart beat
• Feeling anxious
• Headache
• Nausea/vomiting

Some long-acting bronchodilators have been associated with an increased risk of severe asthma exacerbations and asthma-related death. The U.S. Food and Drug Administration has asked companies that make products containing long-acting beta agonists to give special warnings to health care professionals and patients about these possible risks.

Please contact your physician if you have questions about these medications.

 

These drugs are bronchodilators that relax the muscles surrounding the airways.

Use them only as your doctor prescribes. Never double up on doses, since this may lead to serious problems.

Your doctor will need to check the level of this drug in your blood stream on a regular basis, and may need to adjust your doses to avoid serious side effects.

Possible side effects are:

• Nausea
• Irritability/Nervousness
• Sleeplessness
• Heartburn
• Overdose can cause life threatening side effects; palpitations, seizures, death. Keep this medication out of reach of children.

Possible drug interactions include:

• Cimetidine
• Erythromycin
• Ciprofloxacin
• Allopurinol
• Anti-epilepsy drugs
• Birth control pills

Note: Let your doctor know about all medicines you are taking, both prescription and over-the-counter, to avoid serious, life threatening drug interactions.

 

These anti-inflammatory medicines prevent and reduce swelling inside you airways. Bronchodilators relax the muscles around your airways.

This medicine is to be used daily to control your asthma.

This medicine is not a quick reliever and cannot stop an asthma attack.

Possible side effects include:

• Headache
• Stomach ache
• Unusual weakness
• Muscle aches, rash, or yellowing eyes or skin should be reported to your doctor immediately

Tell your doctor if you have a history of liver disease.

Use this medicine with caution if you are taking anti-seizure medications

Drug interactions can occur if you take some of these medicines with warfarin. Contact your doctor immediately if you are taking warfarin

Notify your doctor if you have phenylketonuria

Short-Acting Bronchodilators

This medicine is a quick-relief, bronchodilator and will relax the muscles around your airways to make it easier to breathe.

This medicine will not control inflammation (edema or swelling) or mucous production.

Use of a spacer will improve the effectiveness of this medicine.

This medicine can be used in 2 ways:

1. Every 4 hours as needed for quick relief of asthma symptoms.
2. About 10-15 minutes before physical activity, like exercise or sports to prevent symptoms.

Do not use this medicine more than 4 times a day, unless you have called your doctor

Daily or frequent need for this medicine (other than for pretreatment for physical activity) means your asthma is out of control and you must contact your doctor.

If you need to use this medicine 3-4 times a day to control your asthma symptoms for more than 1 or 2 days, call your doctor. You could be having a serious flare up of your asthma and not know it.

Side effects are not common, but if they occur, they are usually mild.

If these side effects become severe, be sure to contact your doctor:

• Feeling shaky
• Rapid heart beat
• Feeling anxious
• Headache
• Nausea/vomiting

 

Aurora Advanced Healthcare

e-mail: ahl@ah.com
web site: www.ah.com
phone: 1-888-709-2080

American Academy of Allergy, Asthma and Immunology (AAAAI)

e-mail: info@aaaai.org
web site: www.aaaai.org
phone: 1-800-822-2762

American Academy of Pediatrics (AAP)

e-mail: kidsdoc@aap.org
web site: www.aap.org
phone: 847-434-4000

American College of Allergy, Asthma and Immunology

e-mail: acaai@aol.com
web site: www.acaai.org
phone: 1-800-842-7777

Asthma and Allergy Foundation of America (AAFA)

web site: www.aafa.org
phone: 1-800-727-8462

National Asthma Education and Prevention Program

(Coordinated by the National Heart, Lung and Blood Institute)

e-mail: dcl@nih.gov
web sites:
www.nhlbi.nih.gov
www.immune.com/allergy/index.html (teaching guide)
phone: 301-496-7196

National Institute of Allergy and Infectious Diseases (NIAID)

web site: www.niaid.nih.gov
phone: 301-496-7196

National Allergy and Asthma Network/Mothers of Asthmatics Inc. (AAN/MA)

e-mail: aanma@aol.com
web site: www.aanma.org
phone: 1-800-878-4403