• Asthma is a chronic, inflammatory disorder of the airways. A person with asthma may not feel symptoms all the time.

• The most common symptoms are difficulty breathing, wheezing, chest tightness, and coughing. Even if you have only one of these signs -- like chronic coughing -- it may be due to asthma. Other symptoms, like sweating or rapid heart rate, may be present.

• During an asthma attack, the lining of the airways becomes inflamed, the airways constrict tighter and tighter, and excess mucus builds up inside the airway passages. It becomes very hard for air to pass through the airways.

• Asthma can be triggered by most of the same things that trigger allergies (dust mites, mold, animal dander, cockroaches, etc). A key step in controlling asthma is to identify which of these triggers make your asthma worse, and then work to eliminate or avoid them. It also can be triggered by cold air, exercise, respiratory viruses, and other factors.

• People with asthma have very sensitive airways that are constantly on the verge of over-reacting to asthma triggers. Asthma is "reversible" -- in other words, it can be treated with medication to keep the symptoms under control.

• There are four levels of asthma severity. Asthma is classified based on how often symptoms occur during the day, how often symptoms occur at night, and spirometry results. The severity of your asthma impacts the treatment strategy.

• Almost anyone with asthma should be able to prevent most asthma attacks, sleep at night without being wakened by asthma, prevent most trips to the hospital, prevent missed work or school because of asthma symptoms, exercise normally like anyone else, and find an asthma treatment plan that has minimal side effects.

• Consider seeing an asthma specialist if these goals are not being met. For those with severe persistent asthma, it may take up to 6 months to get your asthma under control.

• All people with asthma should continue to visit their doctor at least twice a year to make sure that they are still achieving optimal control.

• There are two major types of asthma medication. The first type asthma medicine is called a long-term control drug, which may be used on a daily basis to PREVENT asthma attacks. Inhaled steroids, which prevent inflammation, are generally a doctor's first choice for daily control. For moderate-to-severe asthma, steroids are even more effective when combined with long-acting beta agonists.

• The second type of asthma medication is called a quick-relief drug. These medicines are used DURING an asthma attack to bring fast relief. Short acting beta-agonists are the most effective and most widely used drugs for treating asthma attacks. They also can be used just before exercising to help prevent exercise-induced symptoms. They work by relaxing the muscles that tighten around the bronchial tubes during an attack. Albuterol is the most commonly used short-acting beta-agonist.

• There are several ways to get an asthma drug into your lungs. The most common methods are metered dose inhalers (MDIs), dry powder inhalers, and nebulizers. Spacers work with your MDI to deliver medication more easily and effectively, and can reduce side effects. The appropriate method depends on personal preference, age, ability to use MDIs, and the drugs you have been prescribed.

• You should ask for a written action plan that explains how to take your medicines and control your asthma.

• Checking your peak flow is one of the best ways to empower yourself and gain control over your asthma. It can help you make sure your asthma is not getting worse and can bring you peace of mind. Peak flow is measured at home with a small, inexpensive plastic meter.

• Asthma can be managed by a pediatrician, family doctor, or primary care provider. Allergists, pulmonolgists, and some other physician respiratory specialists have specific training in the care of asthma and in some cases may be more familiar with current clinical guidelines, such as the National Institutes of Health asthma guidelines. Some patients may wish to go to an allergist or other specialist for a second opinion or to get the initial treatment plan established.

References

National Asthma Education and Prevention Program Expert Panel Report: guidelines for the diagnosis and management of asthma update on selected topics -- 2002. J Allergy Clin Immunol. 2002 Nov;110(Suppl 5):S141-219.

National Asthma Education and Prevention Program Expert Panel Report 2: guidelines for the diagnosis and management of asthma. Bethesda (MD): U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung and Blood Institute; 1997 Jul. NIH Publications 97-4051.

Williams SG, Schmidt DK, Redd SC, Storms W. Key clinical activities for quality asthma care: recommendations of the National Asthma Education and Prevention Program. MMWR Recomm Rep. 2003 Mar 28;52(RR-6):1-8.