Asthma Maintenance

• Mild intermittent asthmatics need only a rescue inhaler as needed for asthma symptoms – as long as asthma symptoms occur, on average, less than twice per week per week during the day and twice per month at night. If symptoms occur more than this, they are no longer a mild-intermittent asthmatic and need an anti-inflammatory medication.
  
  
• Mild, moderate and severe persistent asthmatics need to take one or more anti-inflammatory medications daily, even when asymptomatic. They should also have a rescue inhaler on hand to be used as needed for asthma symptoms. If asthma symptoms occur more than twice per week, this is an indication that airway inflammation is still present and anti-inflammatory medication needs to be increased.
  
  
• 90% of asthmatics have some worsening of symptoms during or following exercise. This is usually controlled by taking a short-acting broncodialator, such as 2 puffs of albuterol 20 minutes before exercise. Other medications such as long-acting bronchodilators and leukotriene modifiers have been shown to help exercise-induced asthma. Asthma should not limit your physical activity.
  
  
• Most asthmatics have an asthma flare-up during colds/infections. This can be controlled by starting or doubling the dose of an inhaled steroid at the first onset of cold symptoms, even before it has gone to the chest. This can prevent the infection from flaring up the inflammation within the airways and can often prevent the need for oral steroids. The inhaled steroid, or increased dose of inhaled steroid, should be continued for two weeks following an infection.
  
  
• Every asthmatic should see a doctor every 6 months. You should bring all of your inhalers and other asthma medications in case medication compliance or inhaler technique needs reviewing.
  Every asthmatic should have spirometry done every one to two years. Spirometry measures the lung volumes and is an important tool to gauge how your asthma is doing. The most important measurement is the FEVI, or the amount of air you can breath out in the first second. This correlates with the amount of obstruction in the airways.
  
  
• A peak flow meter is a tool that you can use at home to help assess how your asthma is doing. It measures the peak velocity of airflow and correlates with narrowing of the airways. You should memorize your personal best peak flow reading. If your asthma is stable, you do not need to use the peak flow meter. However, if you have a cold/infection or are having possible asthma symptoms, you should use your peak flow meter. A low reading is consistent with worsening asthma. Another way to help determine if your cough/shortness of breath/chest tightness is from asthma or from some other condition is to use your albuterol or other rescue inhaler during these symptoms. If albuterol helps, your symptoms are due to asthma.