What is it?

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 makes the primary airways—known as the bronchi—in the lungs swollen and inflamed all of the time. People who have asthma are more sensitive than other people to things inhaled from the environment, known as triggers. These triggers make the muscles in an asthma sufferer's lungs tighten, constricting the air passages and making breathing difficult. In addition, cells in the lungs produce more mucus in response to a trigger. The mucus clogs up the bronchial tubes, which contributes to breathing problems. The airways also swell and become inflamed with white blood cells. When the lungs react to a trigger, what's known as an "asthma attack" occurs. Wheezing, coughing and/or tightness in the chest and shortness of breath are all hallmark symptoms of a classic asthma attack. This lifelong condition can't be cured, but it can be controlled with the proper diagnosis and treatment.

The National Center for Health Statistics (a division of the U.S. Centers for Disease Control and Prevention, or CDC) reported that 16.1 million American adults and 6.8 million children suffered from asthma in 2006. 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 more likely than men to die from asthma, according to the Asthma and Allergy Foundation of America.

Researchers aren't sure why some people's airways are more sensitive to things in the environment. Asthma sufferers may have allergies to certain substances, known as allergens, which can trigger an attack. But, not all asthma sufferers have defined allergies.

Common Asthma Triggers

Common allergens include: dust mites, mold, pollen, cockroaches, and certain foods or chemicals commonly used in food processing. Contrary to popular belief, dog and cat fur don't cause allergies. Rather, a protein found in the pet's saliva, dander and urine causes allergies in some individuals, according to the American Academy of Allergy, Asthma, and Immunology (AAAI). Other things can irritate the already-sensitive air passages of asthma or allergy sufferers. Common irritants include cigarette smoke, stress, cold air, exercise and pollution.

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. New medications are available, and older methods are being improved. 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

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 from time to time. Asthma symptoms are sometimes mistaken for an infection.

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 how serious they are 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

• 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

• waking up at night short of breath

Common asthma triggers include the following:

• dust mites

• pollens

• molds

• food allergies

• pet dander (protein in pet fur, saliva and urine)

• cockroaches

• respiratory infections

• certain medications, such as aspirin and other nonsteroidal anti-inflammatories, and beta blockers

• exercise

• stress

• menstrual cycles in some women

• irritants (tobacco smoke and some scented products and chemicals)

If you are experiencing one or more of the symptoms associated with asthma and have never received treatment or medication for it, make an appointment with a health care professional soon. 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. 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 estimated that about 74 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.

According to the Asthma and Allergy Foundation of America, more than 50 percent of people with moderate to severe asthma also have chronic sinusitis, and many patients with asthma won't improve unless their sinusitis is treated. Additionally, many only get asthma when their sinusitis is worse. Thus, a complete assessment of asthma always requires a review of the sinuses.

Tests that measure your airflow are a primary tool in the diagnosis of asthma. Some health care professionals might use a spirometer, which is a machine that measures how much air you blow out each second. Another test used for the same purpose employs a peak flow meter to measure how much air you can breathe out in a fast 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.

Other tests may be administered to assess your sensitivity to specific allergens that may be triggering your asthma. Health care professionals often use skin tests to determine the exact nature of an allergy. The doctor will inject diluted extracts from allergens-particular foods, pollens, dust mites, etc.-under your skin or into a tiny scratch or puncture on your arm or back. If you have a positive reaction (meaning your are indeed 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.

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.

Treatment

Treatment

Asthma requires continuous medical care. Asthma treatment today is focused on opening airways by reducing inflammation and swelling of the bronchial tubes—the lung structures affected by asthma. Once inflammation and swelling are reduced, the lungs may become less sensitive to environmental triggers. Many medications are now 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.

Two groups of asthma medications are available: Reliever medications and controller medications. They are available under many brand names and in a variety of forms: sprays, pills, powder, liquids and shots. Some are short acting and are administered directly to the lining of the lungs to immediately relieve symptoms; controller medications are meant to have longer-term effects—preventing attacks from occurring. "The longer-acting medications take awhile to help symptoms subside. Some asthma

Asthma medications called bronchodilators are typically designed to be short-acting—they 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 reliever medications—or "rescue medications"—category. Coughing, wheezing and breathing difficulties are quickly relieved. The most commonly used bronchodilator in the United States is albuterol (Ventolin, Proventil, ProAir, generic albuterol), and the preferred method of taking bronchodilators is through inhalation with a metered dose inhaler.

Salmeterol is a bronchodilator that is designed to be long acting. When used with an anti-inflammatory medication, it is used for controlling symptoms. There are also devices available that contain both a long-acting bronchodilator and an inhaled (anti-inflammatory) corticosteroid (Advair, Symbicort). Theophylline, another type of slow-acting bronchodilator, is prepared in a slow-release form taken by mouth. It is sometimes used for persistent asthma symptoms, particularly nighttime asthma. Side effects of bronchodilators can include nervousness, shakiness, and a rapid heart rate.

If you are using 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 insist that some people who use them aren't using the device correctly.

In August 2003 the FDA announced the addition of new safety information and warnings to the labeling for drug products that contain salmeterol, and then in May 2006, the FDA updated those warnings. The most recent labeling includes a boxed warning stating that products containing salmeterol "may increase the risk of asthma-related death." Data from a large placebo-controlled United States study compared the safety of salmeterol to a placebo and showed an increase in asthma-related deaths in patients receiving salmeterol. This warning is particularly important for African Americans, who seem be most affected.

Anti-inflammatory medications, which are in the category of controller medications, act to reduce inflammation and keep the airways open all of the time, thereby preventing an asthma attack from occurring. Cromolyn (Intal), nedocromil (Tilade) and corticosteroids are examples of anti-inflammatory medications currently available to treat asthma.

Once used only to manage acute symptoms, corticosteroid inhalants are now considered the best medications for long-term control of persistent asthma, according to the AAAAI. Corticosteroids are not the same type of steroids used by some athletes. These performance-enhancing drugs are called anabolic steroids. In inhaled form, there are few 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. Side effects of inhalants may include hoarseness and thrush, a surface (throat) fungal infection, though rinsing the throat with mouthwash after inhaling reduces this risk.

Prednisone is one of the most commonly prescribed oral steroid drugs; it is available as a liquid or a pill 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, ulcers, cataracts high blood pressure, elevated blood sugar, and many other potential problems.

Leukotriene modifiers are a new form of anti-inflammatory medication used to treat chronic asthma and may also be used as an alternative therapy for treating mild-to-moderate persistent asthma or as combination therapy in moderate asthma. 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 modifers fight this allergic response by blocking the lung's response 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.

Immunotherapy is another treatment option for individuals who cannot easily avoid allergy-related asthma triggers or find available asthma medications effective or usable 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 will have only minor symptoms, if any. According to 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, chemicals 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 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.

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.

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 be discussed with a health care professional before trying it.

A novel injectable medication, omalizumab (Xolair), is showing promise in treating both children and adults with moderate to severe asthma symptoms, triggered by allergies. Clinical trials have shown that the drug decreased the risk of serious asthma exacerbations, allowed asthma patients to reduce their reliance on steroid medication and improved allergy symptoms in those who were unresponsive to other treatments. Xolair targets an antibody called IgE that causes allergic reactions. The treatment binds to IgE and neutralizes it. The drug was approved for use in those 12 and older with moderate to severe asthma whose symptoms are not adequately controlled with inhaled corticosteroids in 2003.

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

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, if they occur

• 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.

• 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 degrees Fahrenheit) 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

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 necessary.

3. The rate of asthma is higher in children than in adults (7.3 percent of adults have asthma, compared to 9.4 percent of children).

4. The National Center for Health Statistics (a division of the CDC) reported that 16.1 million American adults and 6.8 million children suffered from asthma in 2006. Asthma cases have been increasing in number and severity since the early 1980s, spanning people of all ages, sex and racial groups.

5. According to the Asthma and Allergy Foundation of America, African Americans are three times as likely as Caucasians to be hospitalized from asthma and three times as 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 half of all adults with asthma have allergies that may trigger asthma symptoms, but not all asthma sufferers have allergies. 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. According to the CDC, asthma is the third-ranked cause of hospitalization in children younger than age 15.

10. Exercise can trigger an asthma attack; treatment before exercising can prevent exercise-induced asthma.

Questions to Ask

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

Key Q&A

1. What is asthma?

   Asthma is a lung condition that makes the primary airways—known as the bronchi—in the lungs swollen and inflamed. People who have asthma are more sensitive than other people to things in the environment, known as triggers. These triggers make themuscles in an asthma sufferer's lungs tighten or constrict making the air passages narrow and breathing difficult. In addition, cells in the lungs produce more mucus in response to a trigger. The mucus clogs the bronchial tubes, which contributes to breathing problems. When the lungs react to a trigger, what's known as an "asthma attack" occurs. Wheezing, coughing or tightness in the chest and shortness of breath are the hallmark symptoms of an asthma attack. This lifelong condition can't be cured, but it can be controlled with the proper diagnosis and treatment.

2. How prevalent is asthma among adults in the United States?

   The National Center for Health Statistics (a division of the U.S. CDC) reported that 16.1 million American adults and 6.8 million children suffered from asthma in 2006. Reported cases of asthma have been on the rise since the early 1980s among people of all ages, sex and racial groups. Many people develop asthma in childhood, but others develop the disease later in life—known as adult onset asthma. You can even first begin experiencing symptoms of the disease at age 50 or older.

3. Is there a cure for asthma?

   No, asthma is a chronic disease that cannot be cured, but it can be controlled with medication and lifestyle changes. There are a variety of medications in a variety of forms to treat symptoms of asthma. Lifestyle modifications, such as identifying and avoiding or minimizing asthma triggers, are also important to managing the disease.

4. Are women at greater risk for asthma compared with men?

   Women are more likely to die from asthma than are men. Studies have shown that asthma may be related to women's hormonal changes and could be triggered before or during the menstrual period. Some women first develop asthma during or after a pregnancy, but asthma symptoms may also subside during pregnancy or not be affected at all.

5. Are there certain groups of people who are at higher risk for asthma?

   The prevalence of asthma is definitely higher among children than adults and higher among African Americans and Hispanics than Caucasians. According to the Asthma and Allergy Foundation of America, African Americans are three times as likely as Caucasians to be hospitalized from asthma and three times as likely to die from the disease. Racial differences in asthma prevalence and mortality are believed to be highly related to poverty, urban air quality, indoor allergens, lack of patient education and inadequate medical care.

6. What are some common symptoms of asthma?

   Some of the more common symptoms of adult onset asthma include the following:

   • dry cough, especially at night or as a response to certain triggers or allergens

   • 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

   • waking up during the night

7. What type of health care professional treats asthma?

   Primary care health professionals typically diagnose and treat asthma, but consultation with an allergist or possibly a pulmonary (lung) specialist may be recommended to help develop an asthma management program.

8. Does it take a long time to diagnose asthma?

   Asthma can be hard to diagnose; therefore, its symptoms are sometimes misdiagnosed as respiratory infections or attributed to other conditions. Generally, with a thorough medical evaluation, which includes a physical, a medical history that includes evaluating your symptoms, different laboratory tests and respiratory-function tests, a diagnosis is quickly and accurately made. Once diagnosed, it can take some time for your health care team to determine which medications and dosages are right to best manage your symptoms.

9. What are my treatment options?

   There are many medications to help manage and minimize the effects of the asthma. Some medicines are preventive and are used for long-term control, while others are used as quick relievers for immediate action when an asthma episode (or attack) occurs.

10. I have asthma. Are my children at risk for developing this condition?

    Yes. Studies have shown that children of parents with asthma are at greater risk for developing the condition. It would be wise to discuss your children's health with their pediatrician.

Lifestyle Tips

Lifestyle Tips

1. Stamp out secondhand smoke

   Cigarette smoke triggers asthma attacks and makes 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, and 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 special "dust-free" covers. Wash bedcovers each week 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. Non-spray poisons or traps may be used to kill cockroaches. Avoid rooms sprayed for cockroaches until the smell goes away. Keep all food out of your bedroom, and put household food and garbage in closed containers. To deal with indoor mold, get rid of water leaks in your home, then clean moldy surfaces with a cleaner containing bleach.

3. Ask yourself these eight questions

   Asthma that doesn't get better, but instead sends you back to the ER with wheezes and coughs, can be very frustrating. Instead of getting discouraged, ask these questions: Is something in my home environment triggering asthma? In the workplace? 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? Enlist your doctor's help to answer these questions.

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, or change jobs. If you have asthma symptoms more than twice a week or wake up at night with symptoms more than twice a month, see your health care professional for better control.

5. Learn how to manage asthma flare-ups

   Learn which triggering factors to avoid, including allergens like dust mites, pollens, pet dander, cockroaches, or molds; or irritants such as chemical fumes and tobacco smoke. Increase your awareness of a flare-up by paying attention to symptoms and whether you're taking your quick-relief medication more often. 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 (peak flow in the green, yellow or red zones). If you're having a severe flare-up, don't wait for medical attention; go to the emergency room immediately.

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.

8. Know how to take a peak flow

   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.

9. Know how to use your peak flow meter

   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.