Monday, March 25, 2013


An action plan for asthma

More than 23 million people have asthma in the United States, with nearly 9 million of them children, according to Medline Plus. In fact, it is the number one reason children are absent from school.

Flare-ups, or asthma attacks, are the most common cause of pediatric emergency department visits. But with the right asthma management plan —  and education —  asthmatics can learn to control their symptoms and flare-ups.  Asthma should not inhibit our daily activities.

Asthma is a lung condition that causes difficulty breathing. The symptoms include coughing, wheezing and shortness of breath. Although it may seem that an asthma flare-up happens without warning, the truth is the flare-up has been developing over time. It is caused by:

•  Swelling of the lining of the airways
•  Excess mucus that results in congestions and mucus “plugs” that get caught in the narrowed airways.
•  Tightening of the muscles surrounding the airways or bronchoconstriction.

When these three changes occur, it makes it difficult to take a deep breath. It feels like you are breathing through a straw. You may also experience coughing, wheezing, chest tightness, an increased heart rate, sweating and shortness of breath.

Asthma Triggers: Learn what triggers your asthma and eliminate these triggers.  Some common triggers can be allergies, airborne irritants or pollutants such as smoke, perfumes, strong odors from fresh paint or cleaning solutions, respiratory infections and even the weather.

Treatment: Asthma is treated based on its severity and triggers. Most asthma medications are inhaled, but some may be taken in pill or liquid form. Medications fall into two (2) categories: Rescue medications and controller medications. 

Controller Medications: Controller medications,  also called “preventative” or “maintenance” medications, manage asthma and prevent symptoms. Many people with asthma need to take a medication every day to treat the problem of airway inflammation. They work slowly, so it may take days or weeks for them to begin working. By taking a controller medication regularly, you may notice that you do not need to use your rescue inhaler as often.  Controller mediations are also prescribed to minimize any permanent lung damage associated with having asthma.

Rescue Medications: Rescue medications act quickly to stop the symptoms but are not long-lasting. Once they start working, they stop asthma symptoms — wheezing, coughing and shortness of breath.

Inhaler or Nebulizer? Asthma medications can be provided by two different types of devices – an inhaler or nebulizer. Most people use inhalers, but there are times when a nebulizer may be needed. Nebulizers are electric- or battery-powered machines that turn liquid asthma medication into a fine mist that is inhaled into the lungs.

An advantage of a nebulizer is that you can sit in one place and breathe in the mist. The disadvantage is that they take 5 to 10 minutes to deliver the medication, are noisy and not easy to carry around.

Inhalers, or metered dose inhalers, are portable hand-held devices that are small enough to carry in a pocket, purse or backpack. They deliver a premeasured puff of medication, and require the person to coordinate squeezing the inhaler and inhaling the medication into the lungs.

Sometimes when using an inhaler the medication will reach the back of the throat but not go down the lower airways --  where it needs to go to be effective.  Dr. Thinesh Dahanayake, a pulmonologist at Pulmonary Physicians of Norwich and member of the Backus Medical Staff, suggests most individuals use a device called a spacer when using an inhaler. According to Dr. Dahanayake, a spacer is easy to use and delivers the medication more effectively into the lungs, rather than in the mouth or throat.

Keep Your Inhaler Clean: Dr. Dahanayake also advises patients to keep their inhalers clean. If you see powder in or around the hole, clean it by removing the metal canister from the L-shaped plastic mouthpiece. Rinse the mouthpiece and cap in warm water, let it dry overnight and then put the canister back inside and replace the cap.

Asthma Action Plan: Your physician may provide you with an asthma action plan and peak flow meter. A peak flow meter is an easy-to-use handheld tool that measures breathing ability. If your peak flow readings are dropping, this is a sign of increasing airway inflammation, which can mean that you are not taking in a “normal” amount of air.

Your asthma action plan will have a green zone, yellow zone and red zone with a range for peak flow meter readings. Peak flow meter readings that fall in the green zone means the airways are open. A reading in the yellow zone means that there is a potential for an asthma flare-up and a reading in the red zone means the flare-up is serious and treatment is needed immediately, possibly a trip to your doctor or emergency department.

Controlling your asthma is as easy as 1…2…3…   1) Know what triggers your asthma; 2) take your medications as prescribed; 3) follow your action plan.

Lisa Cook is a community education nurse for the Backus Health System. To comment on this column or others, visit the Healthy Living blog at or e-mail Ms. Cook or any of the Healthy Living columnists at

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