Controlling Asthma

What is asthma?

Asthma is a chronic disease of the airways characterized by inflammation of the bronchi, or the “tubes” that carry air to the lungs. Over time, the space that lets air pass becomes narrowed by things like inflammation and mucus.

This inflammation also causes the airways to become hyperreactive, which means they react excessively and abnormally to different stimuli. The bronchial tubes then contract, causing bronchospasms and breathing problems.

Asthma is a common health condition, as it affects more than 8% of Canadians over the age of 11. Asthma also tends to be more prevalent in children and is the main reason that children miss days from school.

Asthma symptoms

Someone with controlled asthma should feel no or few symptoms.

The most common symptoms of uncontrolled asthma are:

• cough
• shortness of breath
• chest pressure
• wheezing

An asthma attack occurs when you experience one or more of these symptoms. Attacks can be relieved with drugs that provide immediate relief and drugs that decrease inflammation. However, a severe asthma attack can endanger your life depending on your health condition and the severity of your symptoms. You may need emergency medical care in some situations.

What causes asthma?

The exact cause of asthma is unknown, but we do know that it has certain risk factors and triggers.

Risk factors

The following factors may make some people more at risk of having asthma:

• allergies (allergic rhinitis)
• family history of asthma or allergies
• exposure to cigarette smoke
• repeated exposure to irritants (e.g., workplace dust or chemicals)

Triggers

Other factors can also trigger or aggravate asthma. People with asthma must avoid these triggers as much as possible or take precautions when exposed to them. Here are a few examples of triggers:

• allergens (mould, dust mites, pollen)
• cigarette smoke
• strong odours
• pollutants
• viral respiratory infections
• certain medications (e.g., aspirin and ibuprofen)
• cold air
• exercise
• strong emotions
• stress

Asthma treatment and control

Asthma can’t be cured, but adopting good habits and taking your medication regularly can help you control it.

Take the test: Is your asthma under control?

Take this quick test to get an idea of how well you’re controlling your asthma. If you answer “yes” to one of the following questions, your asthma probably isn’t well controlled. Talk to your pharmacist or doctor.

• Do you feel symptoms during the day at least 4 times a week?
• Do you have any symptoms at night at least once a week?
• Are you limited in the physical activities that you can do?
• Have you had to take time off school or work because of your asthma?
• Do you need to use your rescue inhaler (e.g., Ventolin^TM, Bricanyl^TM or Symbicort^TM) 4 or more times a week?
• Are  your peak flow readings  more than 10% outside the values recommended by your doctor?

Develop your action plan 

Everyone with asthma needs an action plan to help you keep or regain control of your asthma. An action plan is a document prepared by your doctor or pharmacist that includes:

• The medication you need to take.
• The circumstances (or peak expiratory flow rate if you use a peak flow meter) when you need to modify your treatment or see your doctor.
• How much medication to take and when to take your medication  if your asthma gets worse.

Your action plan will help you better control your asthma, maximize the benefits of your treatment, and enjoy a better quality of life.

Control your triggers

To better control your asthma: 

• Don't smoke.
• Avoid second-hand smoke (don’t let anyone smoke in your house or car).
• Recognize and treat any associated health problems (including gastric reflux, sleep apnea, sinusitis and rhinitis).
• Use electric heating or hot water heating in your home instead of a wood heating system.
• Achieve or maintain a healthy weight.
• Get physical activity (only if your asthma is well controlled).
• Avoid all contact with known allergens.
• Regularly review how to use your inhalers.

Asthma treatment

There are two  major categories of asthma medication that let you manage your asthma symptoms: rescue medication and maintenance medication.

Rescue medication

Rescue medication provides immediate relief, e.g., during an asthma attack. These medications are short-acting bronchodilators that quickly open the bronchi to let air flow through. You “breathe” them in, which means that you have to inhale them with an inhalation device (also  called a “pump” or “inhaler”). Although you’ll quickly feel better after using them, they don’t decrease inflammation of the airways and don’t provide better asthma control. 

Short-acting bronchodilators should only be used as needed, i.e., at the onset of symptoms or before physical activity or exposure to cold air. A treatment goal should be to use them as little as possible, as more than 4 times per week is a sign of poorly controlled asthma. If you do use them more than 4 times a week, talk to your pharmacist or doctor.

Inhalers: Always check how to use them

Inhalers come in different forms and include dry powder inhalers (Diskus^TM, TurbuhalerTM) or metered-dose inhalers. Some contain a single drug while others come in drug combinations to reduce the number of pumps you have use. Each device is used in a particular way. Talk to your pharmacist to find out how to use them properly.

Maintenance medication

Unlike rescue medication, which immediately relieves symptoms, maintenance medications must be used on a regular basis to be effective. This category of drugs includes anti-inflammatories (also called corticosteroids) to reduce inflammation of the airways. Your doctor may adjust your prescribed  frequency and dose to help you cope with different situations (e.g., a cold or allergies).

Your doctor may add other maintenance medication, such as long-acting bronchodilators, if anti-inflammatories don't sufficiently control your asthma. Long-acting bronchodilators open the bronchi  over 12 to 24 hours.

These two medications are taken with inhalers. You must keep using them even if you feel better, as they prevent asthma attacks. Never stop using them without talking to your doctor or pharmacist first. You can also get a prescription for other maintenance medication in the form of tablets that are taken orally.

Your pharmacist can help you understand the role of each of your medications and is here to support you and answer your questions. Don’t hesitate to see your pharmacist for information!