INFORMATION CENTRE

http://www.lungusa.org/site/c.dvLUK9O0E/b.22581/

http://www.mayoclinic.com/health/exercise-induced-asthma/DS01040

Facts about Asthma
Controlling Asthma
What Is Asthma?
Asthma Attacks
When You Have Asthma
Know Your Asthma Symptoms
Find Out What Starts Your Asthma Symptoms
So What's The Good News In All Of This?
The Asthma Profiler™ - Help With Treatment Decisions
CONTROLLING ASTHMA
Asthma can be controlled. You can do it! When you know how to control asthma, it no longer controls you.
WHAT IS ASTHMA?
Asthma is a lung disease. It can be life threatening.
Asthma is chronic. In other words, you live with it every day.
Asthma causes breathing problems.
These breathing problems are called attacks or episodes of asthma.
WHEN YOU HAVE ASTHMA
It's important to:
Take your asthma seriously.
Take your asthma medicines as directed.
When asthma symptoms don't improve, get help.
KNOW YOUR ASTHMA SYMPTOMS
"I cough a lot while I exercise or even when I rest after exercising."
"I have shortness of breath."
"I make a wheezing sound when I breathe."
"I feel a tightness in my chest."
Do you feel this way sometimes? Any one of these symptoms may mean that you have asthma. You can have one or more of these symptoms or even different ones. Symptoms are clues that let you know that you are having an asthma attack.
FIND OUT WHAT STARTS YOUR ASTHMA SYMPTOMS
Often symptoms get started or "triggered" by something that bothers your lungs. These things are called asthma triggers.
There are many kinds of triggers. They can range from viruses (such as colds) to allergies, to gases and particles in the air.
Given this range, you may find it hard to figure out what starts your asthma attacks.
SO WHAT'S THE GOOD NEWS IN ALL OF THIS?
Once you find out your triggers, you can do something to prevent your asthma attacks. This gives you control. The result is that when and if you have attacks, there's a good chance that they will be less severe and you won't have as many.
For example, do you get an asthma attack after you've exercised? If you do, you should tell your doctor. You can get help.
You can still exercise when you have asthma, but you may need to take rest breaks while you exercise. If you know that exercise triggers your asthma, the doctor may tell you to take your asthma medicine before you exercise. This way, you can still have fun exercising without having an asthma attack.
There are other asthma triggers that you can get rid of or avoid. Good examples of these triggers are cold air, dust, feathers or molds.
Cigarette smoking is another trigger that must be avoided. If you smoke, you need to quit. Smoking cigarettes will make your asthma worse, and if you breathe the smoke from someone else's cigarette, you may get an asthma attack.
This is true for children, too. In fact, children are especially at risk when they breathe secondhand smoke. Studies show that children of smokers are more likely to suffer asthma attacks. Their asthma gets worse, too.
But you can do something about this. You can protect yourself (and if you're a parent with a child who has asthma, you can protect your child, too) when you know the risks of smoking cigarettes or breathing secondhand smoke. The wisest and healthiest things you can do are to live, work and play in places that are smoke free.
Remember:
Asthma symptoms and attacks usually get started by triggers.
Talk to a doctor about these triggers.
Find ways to avoid them. Find ways to get rid of them.
Asthma Attacks
October 2007
An Asthma Attack
Severe Attacks
Moderate and Mild Attacks
The Second Wave
AN ASTHMA ATTACK
Doctors are not exactly certain how you get asthma. But they do know that once you have it, your lungs overreact to things and can cause an asthma attack.
For instance, you might get an asthma attack when you have a cold (or some other kind of respiratory infection). Or, you might get an attack when you breathe something that bothers your lungs (such as cigarette smoke, dust or feathers).
When this happens, three changes take place in your lungs:
Cells in your air tubes make more mucus than normal. This mucus is very thick and sticky. It tends to clog up the tubes.
The air tubes tend to swell, just as skin swells when you get a scrape.
The muscles in your air tubes tighten.
These changes cause the air tubes to narrow. This makes it hard to breathe.
Asthma attacks may start suddenly. Or they may take a long time, even days, to develop. Attacks can be severe, moderate or mild.

SEVERE ATTACKS
When these happen, you may become breathless. As you're less and less able to breathe, you may have trouble talking. Your neck muscles may become tight as you breathe. Your lips and fingernails might turn a grayish or bluish color. The skin around the ribs of your chest might be sucked in; this happens most often in children. If you are using a peak flow meter you will drop below 50% of your personal best.
In the case of a severe asthma attack:
Take your asthma medicine prescribed for an attack and get emergency medical help right away!
You can get into trouble if you wait too long to get help. This is how people die from asthma.
Go quickly to your health care provider's office or an emergency room. The sooner you see a health care provider, the faster you get the help you need.
MODERATE AND MILD ATTACKS
These attacks are more common. You may start to feel tight in your chest. You might start coughing or spit up mucus. You may feel restless or have trouble sleeping. You might make a wheezing or whistling sound when you breathe. This can happen as you breathe air in and out of your narrowed air tubes.
What should you do in the case of a moderate or mild asthma attack? Take your asthma medicine prescribed for an attack. Usually then the air tubes in your lungs open up in minutes. Sometimes, though, it can take several hours. Ask your health care provider how long it takes for the medicine to work.
If your medicine does not work in the time it is supposed to, call your health care provider.
THE SECOND WAVE
In some cases, your asthma attack may seem to ease up. However, changes may take place in your air tubes that cause another attack or second wave. This can be more severe and more dangerous than the first attack.
In the second wave, the air tubes continue to swell. This may happen even when you're not having asthma symptoms. At this time, you might find it harder to breathe.
The second wave may last for days or even weeks after the first attack. Your lungs become more sensitive to other irritants. This can trigger more attacks.
During the second wave, you may have to be admitted to a hospital. Health care providers need to take care of your asthma and give you medicines that will reduce the swelling in your air tubes and relax the tightened muscles.
In any kind of asthma attack:
Don't take cough medicine. This will not help your asthma.
Take only the asthma medicines that a health care provider gives you.

About Asthma Medicines
July 2005
Asthma medicines keep the air tubes in your lungs open. There are two groups of asthma medicines:
Bronchodilators are medicines that help to stop asthma attacks after they've started and can help prevent expected attacks, as from exercise.
Anti-inflammatories are medicines that help to control the airway inflammation and prevent asthma attacks from starting.
These medicines are sold under many brand names. They come in different forms, too. They can include sprays, pills, powders, liquids and shots. The doctor chooses the medicine and form that will work best for you.
Let's take a closer look at how these medicines can help you.
Bronchodilators give you relief during an asthma attack. These medicines work to relax the muscles in your air tubes. As this happens, your air tubes open up, making it easier for you to breathe.
Anti-inflammatories, on the other hand, work to keep your air tubes open all of the time so that you don't have an asthma attack in the first place. These medicines reduce the swelling in your air tubes and decrease the mucus. Cromolyn and nedocromil are two examples of anti-inflammatory medicines.
Another example is corticosteroids. When you hear the word "steroid" you might think of the steroids used by athletes. This may worry you if you have heard about the problems and side effects athletes have when taking steroids. But corticosteroids are not the steroids used by athletes. Those steroids are called "anabolic steroids."
Remember that corticosteroids are used to help prevent asthma attacks from starting. When you take this medicine in a spray form, the risk of serious side effects is very little.
The chance of serious side effects increases when these medicines are taken in a pill or liquid form over a long period. In that case, you need to get regular check-ups by a doctor to make sure that the medicine works the best way for you.
Let's talk about side effects for a moment. Every kind of medicine, even aspirin, can have some side effects. But a doctor can help you by finding ways to control side effects.
When it comes to asthma medicines, it is important to check regularly with a doctor to make sure that these medicines are helping you.
Sometimes you may have some side effects, such as a sore throat, nervousness, nausea, rapid heartbeat, loss of appetite, or staying awake. Tell a doctor if you feel this way. The doctor may want to change your dose, or try a different asthma medicine.
The purpose of asthma medicines is to help you feel better and control your asthma so that you can do what you want to do without asthma getting in your way.
One final note on medicines. There is another kind of treatment that may be helpful to you if your asthma attacks get started by allergies. This treatment is called hyposensitization therapy or allergy shots. These shots may be helpful to you in preventing your asthma attacks. Not all experts agree about the usefulness of allergy shots. On the other hand, the kinds of things that you do are just as important as the kinds of medicines that you take. You can help yourself when you try to avoid or get rid of the things that make you allergic, such as dust, feathers or animal fur. By doing this, you really take control and make it possible for your asthma medicines to work successfully.

Asthma Medications Chart
December 2007
Long-Term Control Medications

Type of Medicine

Generic Name

Brand Name
Possible Side Effects to report to your health care provider (not a complete list)

Short-Acting Beta2-Agonists (SABA): Inhaled or Oral Bronchodilator
albuterol

albuterol sulfate
Accuneb®
Proventil
HFA®
Ventolin
HFA ®
ProAir HFA ®
Proventil Repetabs® (tablet)
VoSpire ER®
increased heart rate
palpitations
nausea
vomiting
nervousness
headache
sleeplessness
tremor, shaking feeling
pirbuterol acetate
Maxair®

Terbutaline Sulfate
Brethine® (tabs only)

Levalbuterol hydrochloride
Xopenex®

Levalbuterol tartrate
Xopenex HFA®

Anticholinergics, Inhaled Bronchodilator
Ipratropium bromide
Atrovent®
dry mouth
rapid heart rate
Inhaled Corticosteroids:
Potent anti-inflammatory
beclomethasone
diaproprionate
QVAR® 40mg
QVAR® 80mg
creamy white, curd-like patches in mouth
cough
Side Effects that usually do not require medical attention unless they persist:
dry mouth
cough
hoarseness
headache
nose bleeds (nasal steroids only)
throat irritation
budesonide
Pulmicort Respules®
Pulmicort Turbuhaler®

flunisolide
AeroBid®
Aerospan HFA

fluticasone proprionate
Flovent®
Flovent Diskus®
(50 mg; 100 mg; 250mg)
Flovent HFA®

mometasone furoate

Asthmanex®

triamcinolone
Azmacort®

Long-Acting Beta2-Agonists (LABA): Inhaled or Oral Bronchodilator
To be used only with inhaled corticosteroids
formoterol fumarate
Foradil Aerolizer®
increased heart rate
palpitations
nervousness
sleeplessness
headache
nausea
vomiting
tremor, shaking feeling
salmeterol xinofate
Serevent Diskus®

Combined Medication: Inhaled Bronchodilator and Steroid
Budesonide + formeterol
fumerate
Symbicort®
Refer to Side Effects of each component

flucticasone propionate + salmeterol xinofate
Advair Diskus®

Leukotriene Modifiers: Oral Anti-inflammatory
zafirlukast
Accolate®
headache
nausea
diarrhea
infection
zileuton
Zyflo®

montelukast
Singulair®

Methylxanthine: Oral Bronchodilators
Relax and open airways; stimulate diaphragm and breathing
theophylline
Aerolate® III
Aerolate® JR
Aerolate® SR
Choledyl® SA
Elixophyllin®
Quibron® - T
Quibron® - T/SR
Slo-bid®
Slo-Phyllin®
Theo-24®
Theochron®
Theo-Dur®
Theolair®
Theolair® SR
T-Phyl®
Uni-Dur®
Uniphyl®
stomach upset
nausea & vomiting
restlessness
rapid heart rate
wakefulness
irritability
dizziness
palpitations
Mast Cell Stabilizers: Inhaled Anti-inflammatory
May be used before exposure to known trigger
cromolyn sodium
Intal®
increased coughing
wheezing or shortness of breath
Side Effects that usually do not require medical attention unless they persist:
coughing
skin rash/itching
headache
sore throat
nausea
abdominal pain
nedocromil sodium
Tilade®

Corticosteroids: Oral Anti-inflammatory
Most potent
dexamethasone
Decadron®
Deltasone®
decreased or blurred vision
frequent urination
skin rash
increased thirst
mood changes
poorly controlled hypertension and diabetes
long-term use predisposes to fractures, cataracts, and GI ulcers
Side Effects that usually do not require medical attention unless they persist (may appear and then
go away during treatment):
increase in appetite
insomnia
nervousness
restlessness
Prednisone
Orasone®

Subcutaneous Injection
Monoclonal Antibody
Blocks IgE, a major mediator of allergic reactions
Omalizumab
Xolair
The most common side effects in patients who received XOLAIR in clinical studies are listed below. This is not a complete list of all side effects reported with XOLAIR.
Injection-site reaction
Viral infections
Upper respiratory tract infection
Sinusitis
Headache
Sore throat
Possible Side Effects listed for each medication is not complete (i.e. does not list every possible side effect), check with your Doctor or Pharmacist.

Asthma Tip Sheet
June 2001
Espanol
If you or someone you love sometimes has trouble breathing because of asthma, you may feel powerless to prevent the wheezing, coughing, or gasping symptoms that can appear to "come out of nowhere."

Limit Exposure to Triggers
Fortunately, because asthma symptoms are usually caused, or triggered, by a specific factor or combination of factors, you can help control asthma by understanding these triggers and limiting exposure to them.
Allergies to pollens, mold, pets, and other things in your environment
Air pollution such as tobacco smoke, high ozone levels, and traffic fumes
Emotions, including fear, crying, and laughing
Exercise, especially when it leads to overexertion or in cold weather
Household irritants, including dust, cleaning products, and perfume
Illnesses such as a cold or respiratory infection
Medications, including some over-the-counter pain relievers
Weather, particularly wind and cold air
Triggers vary widely among people with asthma, but there are a number of common ones.Talk to your doctor about the possible triggers listed above, and any others you think might be making your (or your loved one's) asthma worse.
For more comprehensive information about asthma triggers, visit the Asthma Index on this web site.
Important Information About Pain Relievers
Because some pain relievers can trigger asthma symptoms, it's important for someone with asthma to talk to a doctor before selecting an over-the-counter product for common aches, pains, and fever. The two major types of over-the-counter pain relievers are:
Nonsteroidal anti-inflammatory drugs, also called NSAIDs, including aspirin, ibuprofen, and naproxen sodium
Acetaminophen, the medicine in TYLENOL®.
There still remains much to be researched about the link between asthma and all pain relievers. Studies have shown that up to 20% of people with asthma may be sensitive to aspirin and other NSAIDs. Asthma guidelines from the National Heart, Lung, and Blood Institute recommend that people with asthma use acetaminophen, as directed, instead of NSAIDs, such as aspirin. But when deciding which over-the-counter pain reliever is right for you, talk to your doctor.
Brought to you by McNeil Consumer Healthcare, the maker of TYLENOL ®. The American Lung Association® and McNeil Consumer Healthcare are working together to promote asthma education. The American Lung Association does not endorse products.

Home Control of Asthma & Allergies
November 2002

Air Particles We Breathe
Asthma and Allergy "triggers"
Outdoor Air, Indoor Air and Air-Conditioning
Trigger Controls
General Rules To Help
The Airborne Allergy Profiler™ - Help With Treatment Decisions
AIR PARTICLES WE BREATHE
Many particles of different types and sizes are carried in the air we breathe. Some large particles may settle on the walls and furniture in your home. Other large particles are removed by your nose and mouth when you inhale. Smaller particles are breathed deep into the lungs.
Asthma may be triggered by both the large and small particles. Some air particles come from the indoors. Others are carried in the outdoor air. Outdoor particles come into your home through windows, doors, and heating systems.
For most people, the indoor air particles cause no problems. But people with allergic symptoms including asthma can have problems, right in their own home.
Back To Top

ASTHMA AND ALLERGY "TRIGGERS"
If you or someone you know have allergic symptoms or asthma, you are sensitive to "triggers," including particles carried in the air. These "triggers" can set off a reaction in your lungs and other parts of your body. Triggers can be found indoors or outdoors. They can be simple things like:
Cold air.
Tobacco smoke and wood smoke.
Perfume, paint, hair spray, or any strong odors or fumes.
Allergens (particles that cause allergies) such as dust mites, pollen, molds, pollution, and animal dander - tiny scales or particles that fall off hair, feathers or skin - and saliva from any pets.
Common cold, influenza, and other respiratory illnesses.
You may be able to add more triggers to this list. Other things may also trigger your asthma or allergies. It's important to learn which triggers are a problem for you. Ask your doctor to help. Your doctor my suggest:
Keeping an asthma diary.
Skin testing to test for allergies.
Finding triggers isn't always easy. If you do know your triggers, cutting down exposure to them may help avoid asthma and allergy attacks.
If you don't know your triggers, try to limit your exposure to one suspected trigger at a time. Watch to see if you get better. This may show you if the trigger was a problem for you.
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OUTDOOR AIR, INDOOR AIR AND AIR-CONDITIONING
Controlling your exposure to triggers outdoors is hard. You may have to avoid outdoor air pollution, pollen, and mold spores. Any time air pollution and pollen levels are high, it's a good idea to stay indoors.
The air at home is easier to control. Some people with asthma and allergies notice tAhat their symptoms get worse at night. Trigger controls in the bedroom or wherever you sleep need the most care.
Air-conditioning can help. It allows windows and doors to stay closed. This keeps some pollen and mold spores outside. It also lowers indoor humidity. Low humidity helps to control mold and dust mites.
Avoid too much air-conditioning or too much heat. Room air temperature should be comfortable for someone with allergies or asthma. Some people can't tolerate a big change in temperature, particularly from warm to cold air.
There are some devices that effectively remove particles from air. Their usefulness in reducing allergy symptoms is under study.
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TRIGGER CONTROLS
Here are some common triggers and some ways to help control them at home:

Tobacco Smoke
Smoke should not be allowed in the home of someone with asthma or allergies. Ask family members and friends to smoke outdoors. Suggest that they quit smoking. Your local American Lung Association can help. Ask your Lung Association how you can help a family member or friend quit smoking.
Wood Smoke
Wood smoke is a problem for children and adults with asthma and allergies. Avoid wood stoves and fireplaces.
Pets
Almost all pets can cause allergies, including dogs, cats and especially small animals like birds, hamsters and guinea pigs. All pets should be removed from the home if pets trigger asthma and allergy symptoms.
Pet allergen may stay in the home for months after the pet is gone because it remains in house dust. Allergy and asthma symptoms may take some time to get better.
If the pet stays in the home, keep it out of the bedroom of anyone with asthma or allergies. Weekly pet baths may help cut down the amount of pet saliva and dander in the home.
Sometimes you hear that certain cats or dogs are "non-allergenic." There really is no such thing as a "non-allergenic" cat or dog, especially if the pet leaves dander and saliva in the home. Goldfish and other tropical fish may be a good substitute.
Cockroaches
Even cockroaches can cause problems, so it's important to get rid of roaches in your home. Small pieces of dead roaches and roach droppings settle in house dust and can end up in the air you breathe.
Like humans, roaches need food and water and a place to live. Help keep your home roach free by storing food in sealable containers and keeping crumbs, dirty dishes and other sources of food waste cleaned up; fixing leacks and wiping up standing water; and cleaning up clutter where roaches find shelter.
If you still have problems and you have to choose a pesticide, be sure to use it safely, and as directed on the label. Baits are less likely than sprays or foggers to harm your lungs.
Indoor Mold
When humidity is high, molds can be a problem in bathrooms, kitchens, and basements. Make sure these areas have good air circulation and are cleaned often. The basement in particular may need a dehumidifier. And remember, the water in the dehumidifier must be emptied and the container cleaned often to prevent forming mildew.
Molds may form on foam pillows when you perspire. To prevent mold, wash the pillow every week, dry thoroughly and make sure to change it every year.
Molds also form in houseplants, so check them often. You may have to keep all plants outdoors.
Strong Odors or Fumes
Perfume, room deodorizers, cleaning chemicals, paint, and talcum powder are examples of triggers that must be avoided or kept to very low levels.
Dust Mites
Dust mites are tiny, microscopic spiders usually found in house dust. Several thousand mites can be found in a pinch of dust. Mites are one of the major triggers for people with allergies and asthma. They need the most work to remove.
Following these rules can also help get rid of dust mites:
Put mattresses in allergen-impermeable covers. Tape over the length of the zipper.
Put pillows in allergen-permeable covers. Tape over the length of the zipper. Or wash the pillow every week.
Wash all bedding every week in water that is at least 130 degrees F. Removing the bedspread at night may help.
Don't sleep or lie down on upholstered (stuffed) furniture.
Remove carpeting in the bedroom.
Clean up surface dust as often as possible. Use a damp mop or damp cloth when you clean. Don't use aerosols or spray cleaners in the bedroom. And don't clean the room when someone with asthma or allergies is present.
Window coverings attract dust. Use window shades or curtains made of plastic or other washable material for easy cleaning.
Remove stuffed furniture and stuffed animals (unless the animals can be washed), and anything under the bed.
Closets need extra care. They should hold only needed clothing. Putting clothes pin a plastic garment bag may help. (Do not use the plastic bag that covers dry cleaning).
Dust mites like moisture and high humidity. Cutting down the humidity in your home can cut down the number of mites. A dehumidifier may help.
Air cleaning devices, including portable units and central filtration systems may be helpful in reducing some indoor air pollutants when used with effective source control and ventilation. Ask your doctor for advice about air cleaning devices. If you decide to use one, make sure it removes particles efficiently over an extended period of time and does not produce ozone.
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GENERAL RULES TO HELP CONTROL THE HOME ENVIRONMENT
Controlling the home environment is a very important part of asthma and allergy care. Some general rules for home control for all members of the family are:
Reduce or remove as many asthma and allergy triggers from your home as possible.
If possible, use air filters and air conditioners -- and properly maintain them -- to make your home cleaner and more comfortable.
Pay attention to the problem of dust mites. Work hard to control this problem in the bedroom.
Vacuum cleaners with poor filtration and design characteristics release and stir up dust and allergens.
Select a unit with high-efficiency filters such as micro filter or HEPA media, good suction, and sealed construction. Ask for test data from manufacturers to determine the quantity and size of dust particles captured (e.g., 96 % at 1.0 micron or 99.97% at 0.3 micron). Alternately, consider a central vacuum that exhausts particulate outside the home.
Anyone with asthma or allergies may want to avoid vacuuming.
Peak Flow Meters
August 2006
What Is A Peak Flow Meter?
Who Can Benefit From Using A Peak Flow Meter?
Why Should I Measure My Peak Flow Rate?
How Do You Use A Peak Flow Meter?
How Do I Chart My Peak Flow Rates?
What Is A "Normal" Peak Flow Rate?
When Should I Use My Peak Flow Meter?
How Can I Determine A "Normal" Peak Flow Rate For Me?
Management Plan Based On Peak Flow Readings
Does Using A Peak Flow Meter Have Any Side Effects?
Ideas To Review

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WHAT IS A PEAK FLOW METER?
A peak flow meter is a portable, inexpensive, hand-held device used to measure how air flows from your lungs in one "fast blast." In other words, the Meter measures your ability to push air out of your lungs.
Peak flow meters may be provided in two ranges to measure the air pushed out of your lungs. A low range peak flow meter is for small children, and a standard range meter is for older children, teenagers and adults. An adult has much larger airways than a child and needs the larger range.
There are several types of peak flow meters available. Talk to your doctor or pharmacist about which type to use.

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WHO CAN BENEFIT FROM USING A PEAK FLOW METER?
Many doctors believe that people who have asthma can benefit from the use of a peak flow meter. If you need to adjust your daily medication for asthma, a peak flow meter can be an important part of your asthma management plan.
Children as young as three years have been able to use a meter to help manage their asthma. In addition, some people with chronic bronchitis and emphysema may also benefit from the use of a peak flow meter.
Not all physicians use peak flow meters in their management of children and adults with asthma. Many doctors believe a peak flow meter may be of most help for people with moderate and severe asthma. If your asthma is mild or you do not use daily medication, a peak flow meter may not be useful for asthma management.

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WHY SHOULD I MEASURE MY PEAK FLOW RATE?
Measurements with a peak flow meter can help you and your doctor monitor your asthma. These measurements can be important and help your doctor prescribe medicines to keep your asthma in control.
A peak flow meter can show you that you may need to change the way you are using your medicines. For example, peak flow readings may help be a signal for you to implement the medication plan you and your doctor have developed for worsening asthma.
On the other hand, if you are doing well, then measuring your peak flow may be helpful as you and your doctor try to lower the level of your medicines.
A peak flow meter can help you when your asthma is getting worse. Asthma sometimes changes gradually. Your peak flow may show changes before you feel them. It can allow your doctor to adjust your treatment to prevent urgent calls to the doctor, emergency room visits or hospitalizations.
A peak flow meter may help you and your doctor identify causes of your asthma at work, home or play. It may help parents to determine what might be triggering their child's asthma.
A peak flow meter can also be used during an asthma episode. It can help you determine the severity of the episode; decide when to use your rescue medication; and decide when to seek emergency care.
Knowing your "personal" peak flow Rate allows you to elevate your readings. Being at your "best" can provide reassurance and make you feel more self-confident.

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HOW DO YOU USE A PEAK FLOW METER?
Step 1: Before each use, make sure the sliding marker or arrow on the Peak Flow Meter is at the bottom of the numbered scale (zero or the lowest number on the scale).
Step 2: Stand up straight. Remove gum or any food from your mouth. Take a deep breath (as deep as you can). Put the mouthpiece of the peak flow meter into your mouth. Close your lips tightly around the mouthpiece. Be sure to keep your tongue away from the mouthpiece. In one breath blow out as hard and as quickly as possible. Blow a "fast hard blast" rather than "slowly blowing" until you have emptied out nearly all of the air from your lungs.
Step 3: The force of the air coming out of your lungs causes the marker to move along the numbered scale. Note the number on a piece of paper.
Step 4: Repeat the entire routine three times. (You know you have done the routine correctly when the numbers from all three tries are very close together.)
Step 5: Record the highest of the three ratings. Do not calculate an average. This is very important.
You can't breathe out too much when using your peak flow meter but you can breathe out too little. Record your highest reading.
Step 6: Measure your peak flow rate close to the same time each day. You and your doctor can determine the best times. One suggestion is to measure your peak flow rate twice daily between 7and 9 a.m. and between 6 and 8 p.m.
You may want to measure your peak flow rate before or after using your medicine. Some people measure peak flow both before and after taking medication. Try to do it the same way each time.
Step 7: Keep a chart of your peak flow rates. Discuss the readings with your doctor.

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HOW DO I CHART MY PEAK FLOW RATES?
Chart the HIGHEST of the three readings. The chart could include the date at the top of the page with AM and PM listed. The left margin could list a scale, starting with zero (0) liters per minute (L/min) at the bottom of the page and ending with 600 L/min at the top.
You could leave room at the bottom of the page for notes to describe how you are feeling or to list any other thoughts you may have.

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WHAT IS A "NORMAL" PEAK FLOW RATE?
A "normal" peak flow rate is based on a person's age, height, sex and race. A standardized "normal" may be obtained from a chart comparing the patient with a population without breathing problems.
A personal best normal may be obtained from measuring the patient's own peak flow rate. Therefore, it is important for you and your doctor to discuss what is considered "normal" for you.
Once you have learned your usual and expected peak flow rate, you will be able to better recognize changes or trends.

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HOW CAN I DETERMINE A "NORMAL" PEAK FLOW RATE FOR ME?
Three zones of measurement are commonly used to interpret peak flow rates. It is easy to relate the three zones to the traffic light colors: green, yellow, and red. In general, a normal peak flow rate can vary as much as 20 percent.
Be aware of the following general guidelines. Keep in mind that recognizing changes from "normal" is important. Your doctor may suggest other zones to follow.
Green Zone:
80 to 100 percent of your usual or "normal" peak flow rate signals all clear. A reading in this zone means that your asthma is under reasonably good control. It would be advisable to continue your prescribed program of management.
Yellow Zone:
50 to 80 percent of your usual or "normal" peak flow rate signals caution. It is a time for decisions. Your airways are narrowing and may require extra treatment. Your symptoms can get better or worse depending on what you do, or how and when you use your prescribed medication. You and your doctor should have a plan for yellow zone readings.
Red Zone:
Less than 50 percent of your usual or "normal" peak flow rate signals a Medical Alert. Immediate decisions and actions need to be taken. Severe airway narrowing may be occurring. Take your rescue medications right away. Contact your doctor now and follow the plan he has given you for red zone readings.
Some doctors may suggest zones with a smaller range such as 90 to 100 percent. Always follow your doctor's suggestions about your peak flow rate.

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MANAGEMENT PLAN BASED ON PEAK FLOW READINGS
It is important to know your peak flow reading, but it is even more important to know what you will do based upon that reading. Work with your doctor to develop an asthma management plan that follows your green-yellow-red zone guidelines.
Record the peak flow readings that your doctor recommends for your green zone, yellow zone, and red zone. Then work out with your doctor what you plan to do when your peak flow falls in each of those zones.

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WHEN SHOULD I USE MY PEAK FLOW METER?
Use of the peak flow meter depends on a number of things. Its use should be discussed with your doctor.
If your asthma is well controlled and you know the "normal" rate for you, you may decide to measure your peak flow rate only when you sense that your asthma is getting worse. More severe asthma may require several measurements daily.
Don't forget that your peak flow meter needs care and cleaning. Dirt collected in the meter may make your peak flow measurements inaccurate. If you have a cold or other respiratory infection, germs or mucus may also collect in the meter.
Proper cleaning with mild detergent in hot water will keep your peak flow meter working accurately and may keep you healthier.

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DOES USING A PEAK FLOW METER HAVE ANY SIDE EFFECTS?
A peak flow meter is not a medicine. It has no major side effects. Sometimes pushing the air out of your lungs in a "fast blast" may cause you to cough or wheeze.
Check with your doctor before you start using a peak flow meter.
Using the meter is as simple as taking a deep breath and blowing out a candle. If used properly, it can only help.
You must realize that measuring peak flow is only one step in a program to manage asthma. Its importance must not be exaggerated or over-interpreted.
Using a peak flow meter is not a substitute for regular medical care. Ask your doctor to help you understand your peak flow measurements.

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IDEAS TO REVIEW
Now you are aware of some of the techniques for using and caring for peak flow meters. You also know how Meters may help manage asthma and other breathing problems.
Discuss the use of a peak flow meter with your doctor. Make measuring your peak flow rate a part of your personal asthma management program.

Asthma in adults: Gain control with a written plan
Managing asthma in adults can be complicated. Make it easier with a written action plan. Here's help getting started.
Take charge of your asthma by carefully monitoring your symptoms to see if your asthma is under control — and knowing exactly what steps to take when it isn't. Remember: Even though health professionals play a critical role in managing your asthma, you are the most important member of your "asthma team." The key to asthma control is daily monitoring and taking the right medication at the right time. When you have asthma:
You may need to take a number of medications at different times to control your symptoms
You may need to take peak flow readings to monitor how well your lungs are working
You must be prepared for quick action at the first sign of an asthma attack
How do you juggle these responsibilities? Get the instructions in writing. Having a clear written plan can reduce anxiety and help you control your asthma symptoms — instead of your symptoms controlling you.
What a written plan can do for you
Monitoring your asthma with a written plan is important for anyone with asthma, but even more so if you have moderate to severe persistent asthma or you have had serious asthma flare-ups (exacerbations). A written plan can help you:
Quickly recognize early warning signs of an asthma attack
Know when to adjust asthma medications
Keep tabs on how well treatment is working
Know when to call a doctor or seek emergency help
Creating an asthma action plan
Work with your doctor to develop a written asthma action plan, including step-by-step instructions for preventing and handling asthma attacks.
The action plan tells you how to prevent and treat asthma attacks based on certain signs, symptoms and measurements using a peak flow meter. Although formats vary, most action plans include clear instructions to help you:
Manage your medications. List your asthma medications and when to take them — including daily control medications and as-needed rescue medications. Make sure you know what medications you have on hand, where they are and how to use them. If you have a nebulizer to administer medication in mist form, the asthma action plan should include instructions for when to use it.
Take action based on symptoms and peak flow readings. A peak flow meter can help you monitor how well your lungs are working from day to day. If your peak flow rate drops, use the action plan to adjust your medication. Peak flow readings are a useful tool for quickly recognizing early signs of an asthma flare-up.
Recognize an asthma attack. When you're on the lookout for warning signs — such as coughing, wheezing or shortness of breath — you can take prompt action at the first sign of an attack. Follow the action plan's instructions for using quick-relief medications and other drugs meant for more serious attacks.
Know when to seek emergency care. Some attacks can't be managed at home. Use the action plan to recognize the signs of rapidly worsening asthma, such as lips and nails turning blue or difficulty speaking.
Organize contact information. List the doctor's phone number, emergency phone numbers and the location of the nearest emergency room.
Avoid your asthma triggers. The action plan also may have a place to list your asthma triggers — such as pollen, dust mites, mold, exercise, pet dander, smoke and respiratory infections — and tips for avoiding or minimizing your exposure to them.
Work with your doctor to tailor a plan based on your needs.
Sample Adult Asthma Action Plan (PDF file requiring Adobe Reader)
Looking ahead
Once you and your doctor have developed your written asthma plan, keep it in a safe place. Share your plan with a family member or friend who can help you during an emergency. In addition, keep a copy in your wallet or purse in case an asthma attack occurs away from home.
Meet with your doctor on a regular basis to review your action plan and revise it as needed, even if you aren't having any trouble managing your asthma. Although asthma can be controlled, symptoms change over time — requiring adjustments to treatment. Regular doctor visits can help make sure you're getting the treatment you need. These checkups are also a good time to reassess self-management skills, such as using your medications correctly and monitoring peak flow.
Think of the plan as a tool that can help you achieve the best asthma control possible. Following your plan is the best way to improve your lung function and stay out of the hospital — and in control of your asthma.
Asthma: 3 steps to better asthma control
By using a three-step approach to asthma management, you can keep your symptoms at bay, reduce flare-ups and prevent complications.
When it comes to controlling your asthma symptoms, one size does not fit all. Everyone with asthma suffers from inflammation and airway constriction, but symptoms are different for each person — and can change over time. Work with your doctor to master the three steps to better asthma control:
Track your symptoms. Keep an asthma symptom diary. At each visit, talk to your doctor about how severe your symptoms are and if they've changed since your last appointment.
Check your lung function. Use lung function tests to assess how well you can breathe.
Adjust your treatment. Based on your symptoms and lung function tests, you and your doctor can make changes to your treatment if needed.
Track your symptoms
our symptoms
Keep track of your asthma symptoms every day so that you and your doctor can review them at each appointment and adjust your treatment. Keep a written record of:
Increased shortness of breath or wheezing (a whistling sound produced during exhalation)
Disturbed sleep caused by shortness of breath, coughing or wheezing
Chest tightness or pain
Increased need to use a quick-relief inhaler containing a short-acting bronchodilator — a medication that opens airways by relaxing the surrounding muscles
Decreased productivity at work, school, or at home due to asthma symptoms
Increased asthma symptoms during exercise
To help control your asthma symptoms, you and your doctor may also use a common rating system based on the National Asthma Education and Prevention Program guidelines for grading asthma severity. This system uses four levels, based on two things that you can record in your asthma symptom diary:
How often and when you have symptoms
Your lung function test results
Where you fall on the asthma rating scale may change over time and with treatment. Assign yourself to the most severe category in which you currently have symptoms. For example, even though your symptoms may be generally mild, if you have serious flare-ups, you may have a more severe rating.
Severity Frequency of general symptoms Frequency of symptoms at night Flare-ups (exacerbations)
Mild intermittent Two times a week or less Two times a month or less Brief (a few hours to a few days) with varying intensity
Mild persistent Two times a week or more — but less than one time each day More than two times a month May be severe enough to restrict physical activity
Moderate persistent Daily, often accompanied by daily use of rescue inhaler More than one time a week Twice a week or more, possibly severe enough to restrict physical activity
Severe persistent Continual, with limited physical activity Frequent Frequent
Check your lung function
Lung function (pulmonary) tests can help you and your doctor judge how well you are controlling your asthma and may ward off flare-ups. One test you can use at home to keep track of how well you can breath. Another test you'll have during doctor visits.
Peak flow meter. By learning how to use a peak flow meter, you can help detect subtle changes in your airways before you notice symptoms. Your doctor can give you instructions on how to deal with low readings and prevent a flare up.A peak flow meter can be used at home to measure how well you can force air out of your lungs. It helps detect subtle narrowing of the airways before you notice symptoms. If the readings are lower than usual, it's a sign your asthma may be about to flare up. Your doctor can adjust your treatment based on the readings. Peak expiratory flow (PEF) tells you the fastest rate at which you force air out of your lungs.
Spirometer. A spirometer is used by a medical professional to measure narrowing of your bronchial tubes. This device measures the volume of air you can exhale after you've taken a deep breath. A spirometer also shows how quickly you can get air out of your lungs. This measurement is called forced expiratory volume-1 (FEV-1). Your doctor compares the result with the predicted result for people of the same age, sex, race and height who don't have asthma. This comparison is expressed as a percentage. Lower percentages indicate less lung power.
Here's how lung function measurements correspond to different grades of asthma severity:
Level of severity Forced expiratory volume-1 (FEV-1) or peak expiratory flow (PEF)
Mild intermittent At least 80%
Mild persistent At least 80%
Moderate persistent 60% - 80%
Severe persistent 60% or less
Adjust your treatment
By evaluating your symptoms and measuring your lung function, your doctor can decide how well your treatment is working.
Your doctor may suggest a change in treatment if:
Your current medications are not controlling your asthma as well as possible
Your medications are causing troublesome side effects
You're using a quick-relief inhaler ("rescue" medication) too often
If you have persistent asthma, whether it's mild, moderate or severe, you're likely to need long-term control medications. Used properly, these medications can reduce or eliminate your need to use a quick-relief inhaler. These medications treat the underlying cause of asthma — inflammation — which leads to airway constriction that causes asthma signs and symptoms. The most effective long-term medications include:
Inhaled corticosteroids. Examples include fluticasone (Flovent), budesonide (Pulmicort) and triamcinolone (Azmacort).
Inhaled, long-acting beta-2 agonists. Examples include salmeterol (Serevent) or formoterol (Foradil).
A combination of inhaled corticosteroids and long-acting beta-2 agonists. This approach requires using two inhalers or a combination inhaler such as Advair.
Leukotriene modifiers. These drugs are taken in pill form, either alone or in conjunction with an inhaled corticosteroid. Examples include montelukast (Singulair) and zafirlukast (Accolate).
Cromolyn (Intal) and nedocromil (Tilade). These medications, taken by inhalation, are sometimes used to treat mild persistent asthma.
Theophylline (Uniphyl). This drug is taken in pill form, either alone or in conjunction with an inhaled corticosteroid. Although guidelines include it as an alternative to a long-acting beta-2 agonist in mild persistent and moderate persistent asthma, theophylline is rarely used in children.
Oral corticosteroids. In some cases, severe asthma may require additional treatment with an oral corticosteroid such as prednisone or methylprednisolone.
Following is a summary of treatment recommendations for different levels of asthma severity for people ages 6 through adult. Younger children may need different treatment.
Level of severity Preferred method Alternative method
Mild intermittent Short-acting bronchodilator as needed; no daily medication; for severe attacks, oral, injected or intravenous corticosteroids recommended None
Mild persistent Low-dose inhaled corticosteroids; short-acting bronchodilator as needed Cromolyn, leukotriene modifier, nedocromil, or sustained-release theophylline
Moderate persistent Medium-dose inhaled corticosteroids or low- to medium-dose inhaled corticosteroids plus long-acting beta-2 agonists; short-acting bronchodilator as needed Low- to medium-dose inhaled corticosteroids and either leukotriene modifier or theophylline
Severe persistent High-dose inhaled corticosteroids and long-acting beta-2 agonists plus (if needed) oral corticosteroids Omalizumab (Xolair) injections
Use the three-step approach to asthma treatment
Track your symptoms, monitor your lung function and work with your doctor to adjust your treatment as needed. For treatment to work as well as possible, carefully follow your treatment plan. Keep a daily, written record of symptoms, triggers and medications. Go to every scheduled appointment, and talk with your doctor about your asthma at every visit. Asthma cannot be cured, but careful management can help you avoid asthma attacks and keep symptoms under control.
"Each person with asthma reacts differently to medication, the environment, triggers, and changing allergens that affect symptoms," says James Li, M.D., an asthma and allergy specialist at Mayo Clinic in Rochester, Minn., and the lead author of national asthma treatment guidelines. "Assessing these factors requires strong communication between you and your doctor on an ongoing basis to determine whether changes in treatment should be made."