Is Your Asthma in Control?
The following questions are designed to assess how well your asthma is controlled.

Are you sleeping through the night without coughing, wheezing, or shortness of breath?

Nighttime symptoms of asthma are a clue that your asthma is not in good control. Nighttime symptoms that occur more than 2 times per month require a daily controller or a preventive medication. If you are on a daily controller medication, then you need to "step up" your therapy. Notify your provider. If you are waking from asthma symptoms more than once per week, you made need to see an allergist. Talk to your provider.

How often are you having to get up and use your bronchodilator at night?

Waking from asthma symptoms more than two times per month requires a daily controller medication. Usually a non-steroidal anti-inflammatory drug or a low-dose inhaled steroid medication would be prescribed. If your nighttime symptoms occur more than 2 times per week, you require a medium dose inhaled steroid. Any nighttime symptoms which occur more than 2 times per week require a high dose inhaled steroid. If this is a recurring problem not responding to inhaled steroid therapy, you may have a sinus infection or a condition known as gastroesophageal reflux disease (GERD). Your provider should always be notified if you are waking at night due to asthma symptoms.

Does your oral asthma medication seem to keep you up at night?

Oral theophylline may cause insomnia. Notify your provider if you are unable to sleep at night. Newer alternative medications to theophylline are now available.

How long does your rapid reliever inhaler usually last?

Any person with asthma should not use more than 2 canisters of rapid reliever medications in 1 year! Rapid reliever medications include Albuterol, Combivent, Maxair, Proventil, and Ventolin. If you are using your rapid reliever medication more than 2 times per week your asthma is not in good control. A "step up" in therapy is required. Notify your provider. If you need to use your rapid reliever medication daily, you may need to see an allergist. Talk to your provider.

Does your asthma prevent you from leaving your home or engaging in certain activities?

Your asthma should not prevent you from participating in any activity. If your asthma prevents you from leaving your home during the spring, summer or fall, or with the Winter heating season, you may have allergies. Discuss this with your healthcare provider. An allergy consult may be required.

Has your asthma kept you from attending work or school? Are your activities of daily living or ability to exercise affected by your asthma (stair climbing, housework, hobbies, gardening)?

You should be able to sleep through the night, and participate in sports activities without any symptoms of asthma. If you are not on a controller medication, you may need one. If you are on a controller and still having exercise symptoms, you may need an additive medication such as Singulair or Serevent. Notify your provider.

Are you using your inhaler correctly?

For Metered Dose Inhalers:

• Shake the inhaler before each use. Make sure the cap is removed prior to dispensing the medication. Make sure the inhaler mouthpiece is clean, and there are no foreign objects in the mouthpiece.
• Breathe out through the mouth to empty the lungs.
  • For open mouth technique: place the inhaler 1-2 inches away from your open mouth. Press firmly on the inhaler to dispense one puff.
  • For use with a chamber device: dispense one puff of medication into the chamber, with your mouth positioned on the mouthpiece. You should always use a chamber when using an inhaled steroid. The chamber allows 80 % of the medication to enter your airways. If a chamber is not used, only 20-30% of the medication will enter the airway.
• Take a slow, deep breath. Hold your breath for 10 seconds (a slow count to 10). This allows the medication to settle in your airway.
• Wait 30-60 seconds before taking any other prescribed puffs. This allows the medication to begin working, and allows the canister to recharge.

For Dry Powder Inhalers:

• Load your dose as instructed by your healthcare provider. It is not necessary to shake this type of inhaler.
• Breathe out through the mouth to empty the lungs. Be sure not to blow directly into the mouthpiece, as the medication may be displaced from the inhaler, delivering the wrong dose.
• Place the mouthpiece in your mouth and take a rapid, deep inhalation. Hold your breath for 10 seconds, slowly! This allows the medication to settle in your airway.
• Wait 20-60 seconds before taking any other prescribed puffs. This allows the medication to begin working.

For both:

• If you are taking an inhaled steroid, rinse your mouth and spit, or brush your teeth. This will prevent medication side effects such as oral yeast infection or voice change.

Your inhaler technique should be checked every time you visit your healthcare specialist or provider. Always bring your inhaler and chamber to your healthcare visits for inspection.

Care of Your Metered Dose Inhaler
It is always important to keep the caps of the mouthpiece closed on your inhaler. Once daily, remove the metal canister and clean the plastic casing by rinsing it in warm water. Allow the plastic casing to air dry, then re-insert the metal canister for future use.

Care of Your Chamber Device
You should soak your chamber once daily in warm water. First, remove the plastic case which holds the inhaler. After rinsing, allow the chamber to air dry over night. Once per week, the chamber should be soaked in warm, sudsy water. After soaking, rinse by soaking in warm water, then allow it to air dry over night.

How Do you Know There Is Medication in Your Inhaler?
The only reliable way to know how much medication is in your inhaler is to count puffs. Floating the inhaler in water is not reliable and may alter the medication. There are several ways to keep track of the amount of medication in the inhaler. You may make a "puff counter sheet" by writing down the number of puffs contained in your inhaler on a sheet of paper. Each time you take a puff, cross out a number on the puff counter sheet. There are also stickers for your inhalers that are available to help you keep track of your puffs. Another method is to calculate the number of puffs you take per day, and divide that number into the total number of puffs in the inhaler. This will give you the number of days before you need a new inhaler. Circle this date on your calendar. Most inhalers contain exactly 30 days of medication. However, dosage and dosage changes may cause you to use more than or less than one inhaler per month. Therefore, counting puffs used is required to ensure you are getting medication from the inhaler. You may notice that you may still be able to feel air in the container, or even dispense air from the container after this time. However, these are lubricants and propellants that allow the medication to come out of the inhaler. Use of your inhaler until it is empty may result in worsening asthma, or even bronchospasm from the chemicals left inside the inhaler. Please discuss a method that may work for you with your healthcare provider.

More About Asthma

National Organizations

American Academy of Allergy, Asthma, & Immunology
(800)822-2762

American College of Allergy, Asthma, & Immunology
(847)427-1200

Asthma and Allergy Foundation of America
(800) 7- ASTHMA/ (800)727-8462

National Asthma Education and Prevention Program
National Heart, Lung, and Blood Institute
Information Center
(Guidelines for the Diagnosis and Management of Asthma)

National Institute of Allergy and Infectious Diseases
National Institutes of Health
(301)402-1663

National Jewish Medical and Research Center
(800)222-LUNG

Local Organizations

American Lung Association of Michigan
(616)942-0513

Asthma Resource Center for Children
(616)732-8984

Pediatric Asthma Network of West Michigan

More About Puff Tracker Stickers
JLB Enterprises
(419) 882-8193

Information contained in this web site adapted from materials received from the American Academy of Allergy, Asthma , and Immunology, the Allergy and Asthma Foundation of America, and Glaxo pharmaceuticals.