Successful asthma treatment should not only reduce your current symptoms, but also help you limit your use of rescue medicines and maintain your normal activity levels such as attending work and school, exercising, and performing other physical activities.
The four main classifications of asthma severity (measured before starting medications) are:
- Intermittent asthma is the mildest form of asthma, with symptoms up to twice a week and normal or near-normal lung function.
- Mild persistent asthma is accompanied by symptoms more than twice a week, but no more than once in a single day. Lung function testing may be normal or mildly abnormal.
- Moderate persistent asthma symptoms occur once a day. Lung function is often significantly lower than normal.
- Severe persistent asthma is the most severe form, causing symptoms throughout the day on most days. Lung function is often far below the normal range and many patients with severe asthma have required hospitalization for severe asthma symptoms.
Your doctor will prescribe medication to help you control your asthma symptoms based on the combination of your asthma severity and its level of control. He or she may also help you develop an asthma action plan that describes how and when to take your medications, how to best avoid factors that worsen your asthma, how Your doctor will presc asthma control, how to respond to worsening asthma symptoms, and how to seek emergency care when needed.
People differ widely in their responsiveness to asthma treatments: What works for one person with asthma that is classified as "moderate persistent" may not work for someone else with the same symptoms. An important part of bringing your asthma symptoms under control is making regular follow-up trips to your doctor so he or she can assess how your treatments are working and adjust them accordingly.
You can help by charting your symptoms at home. Your doctor may prescribe a peak flow meter, a handheld lung function measurement device allows you to track your lung function at home. Based on symptoms, the doctor may switch your medication or increase the dosage of your current medication to help you gain better control over your symptoms; he or she may even reduce your dosage if your asthma seems to be well-controlled.
Once you start taking medications, your asthma symptoms should improve. But while some people experience total relief from their asthma symptoms after they start taking medications, many people will continue to experience some symptoms. So what does it mean if you still have asthma symptoms? How controlled is your asthma?
The Global Institute for Asthma (GINA) uses the following classification of how well-controlled your symptoms are with medications:
- Controlled asthma means there are no daytime or nighttime symptoms, infrequent need for quick-relief medicines (no more than twice a week) and your peak flow is normal with no asthma attacks (exacerbations).
- Partly controlled asthma involves daytime symptoms more than twice a week and sometimes at night with use of quick-relief medicine more than twice a week. Your peak flow rate is less than 80 percent of your normal and asthma attacks occur at least once a year but not weekly.
- Uncontrolled asthma is when you have three or more of the features of partially controlled asthma at least 3 times a week, and asthma attacks are occurring weekly.
Having asthma that is not controlled can be bothersome and sometimes downright scary. If you have to limit your activity to avoid asthma symptoms, then it's already reducing your quality of life. But uncontrolled asthma is more than just a nuisance. It can have a major impact on your ability to lead a happy, productive life and it carries a high risk of complications associated with the disease.
Effects of uncontrolled asthma include:
- Adults with poorly-controlled asthma miss three times more work than those whose asthma is well-controlled, and children with uncontrolled asthma tend to miss more school.
- Studies indicate that pregnant women whose asthma is uncontrolled risk exposing their fetus to periods of low oxygen which can cause low birth weight and increased risk of fetal death; pregnant women with well-controlled asthma do not face these same risks.
- Having uncontrolled asthma leads to loss of lung function that can persist for long periods of time.
- People with uncontrolled asthma face increased risk of emergency hospitalization and, unfortunately, death.
If you have any type of persistent asthma, the doctor will likely prescribe you two types of medications: fast-acting or "rescue" medications that may help relieve acute asthma symptoms and asthma attacks, and long-acting or "asthma control" medications that are taken daily to help control your everyday symptoms. Asthma control medications can help reduce your everyday symptoms as well as lessen the frequency of asthma attacks.
When you first start taking asthma control medication, you may notice a difference right away. These medications may take several weeks of regular use to achieve their full effect and even then they only work when they are taken consistently.
Ask your doctor about the specific medications you are prescribed, what to expect if it is working, and how long it usually takes to show improvement. If you have been taking the medications properly for a sufficient period but you are not experiencing any relief from your symptoms, your medications need to be adjusted by your doctor.
Some other signs that your asthma control medications may not be working include:
- Daytime asthma symptoms that occur more than twice a week.
- Needing to use your asthma rescue medication more than twice a week.
- Asthma symptoms that limit your usual activities or enjoyment of everyday life.
- Asthma symptoms that seem to be worsening.
- Waking up at night with asthma symptoms at least twice a month.
- Symptoms that occur during exercise.
- Having two or more asthma attacks in one year.
- Declining lung function (based on peak flow monitoring).
If you're taking asthma control medications, but you're still experiencing significant asthma symptoms, it may be time for you to talk to your doctor about how you can get better control over your asthma. Similarly, if you have asthma but you are only using fast acting inhalers to treat your symptoms instead of longer-acting control medication, you may also want to talk to your doctor about adjusting your medication.
If you and your doctor have already developed an asthma action plan (also called an asthma management or asthma control plan), guidelines may be included in the plan that tell you how and when to take more of your prescribed medications. But never take more medication than is specifically prescribed in an asthma action plan.
If you are still experiencing symptoms after following the asthma action plan, you should make an appointment with your doctor to make changes to the plan to help reduce your symptoms and the impact that they are having on your life. If your symptoms don't meet the criteria of "controlled" asthma, your doctor should be able to adjust your asthma action plan to try to help you get your symptoms under controlled.
One thing your doctor can do is change the schedule or dosage of your currently prescribed asthma control medications. Increasing how often you take your medications or how much you take each time may help better control your symptoms. Another option is to change the medications you are on, either by adding a new medication to your existing prescriptions or by substituting a new medication for one you are currently taking.
There are several types of asthma control medications, but the most frequently prescribed are:
- long-acting beta-2 agonists (LABAs)
- medications than contain both corticosteroids LABAs together
Corticosteroids help reduce inflammation in the lung airways and are commonly taken daily via an inhaler (note that this is not the same as the fast-acting rescue inhalers that are designed to be used only when you are experiencing symptoms). If you are prescribed one type of corticosteroid medication to control your asthma symptoms, your doctor might consider switching you to a different type of corticosteroid.
When you visit your doctor to talk about your uncontrolled asthma symptoms, it is a good idea to bring with you a list of your concerns.
How to do it: Chart your symptoms leading up to your appointment and then bring this information with you when you go. This can include your daily peak flow measures, information about when you experienced symptoms and how serious they were, whether your symptoms seem to be improving or worsening over time, how often you had to use your rescue inhaler, how much you have had to limit your daily activities or exercise, what triggers seem to be related to your symptoms, and information on any asthma attacks you may have had.
Once you have provided this information to your doctor, you can talk to him or her about making changes to your asthma action plan. If you don't already know, you can ask what types of medications you are currently prescribed. You can ask the doctor what the available options are for changing your medications: does he or she think you should increase the dose or frequency of your current medications, should you switch to a similar medication within the same class? You can ask the doctor to explain why they are recommending those particular changes and not something else.
You can also ask the doctor about changing other aspects of your asthma control plan: Should you be doing more to avoid factors that worsen your asthma? Are you doing enough to track your level of asthma control? Is it OK for you to increase the dose of one of your newly prescribed medications temporarily when your symptoms worsen? Finally, you can ask what the next step should be if the current changes you are making to your asthma action plan fail to bring your asthma symptoms under control.