I thought I had outgrown my asthma, hadn't had it since I was a kid, but it came back.
Like the doctor said it might, I couldn't believe it.
I have to admit that I didn't do a good job of managing it at first.
I missed a lot of work and almost ended up losing my position.
I even had trouble sleeping at night.
I was afraid I would wake up and not be able to breathe.
But then I started working with a doctor and her staff and we developed a plan to manage
my asthma.
I learned that asthma is one of the most common chronic illnesses affecting nearly 12 million
people in the United States.
I know now that asthma is a real disease, but it can be managed if I work with my doctor
on a regular basis, not just when I have symptoms, and if I apply the asthma management plan
for controlling it.
I learned how to control the things that may lead to asthma symptoms called triggers, like
house dust.
And I started taking asthma medicine on a regular basis, even when I don't have symptoms.
I learned how to use a peak flow meter and what to do to keep asthma symptoms from getting
worse.
Controlling my asthma has allowed me to maintain normal activity levels.
I do whatever sports I want.
I just remember to follow the asthma management plan, take my medication, and get medical
help before my symptoms become severe.
It's pretty much under control now.
But at first, there were a lot of things I needed to learn about managing my asthma.
One of the first things I did to start managing my asthma was to establish a partnership with
a doctor I had confidence in and could communicate with.
No matter how much you learn about asthma, you can't do it alone.
Everyone with asthma needs to work with a health care team, not just for treatment of
symptoms, but on a regular basis for prevention of asthma symptoms.
I found that I was able to work with the doctor and the staff better after I clearly understood
both the role of the health care team and my own role in managing my asthma.
The role of my doctor was to diagnose my asthma by taking a medical history, including information
about my symptoms, activities and my environment, performing a physical examination, and lab
tests, including a breathing test to determine the severity of my asthma, an allergy test
because he thought my asthma might be allergy related.
For my part, I provided complete answers to his questions as best I could.
I even started a daily asthma diary to collect important information about symptoms and to
help identify what triggers might be affecting my asthma.
The doctor and I also worked together to develop a plan for managing my asthma.
It included using a peak flow meter, controlling triggers, and taking prescription medicine.
The doctor also taught me what I needed to know to be able to follow the plan.
My job was to learn as much as I could about asthma and the management plan, and of course,
to follow the plan.
I have some questions about the asthma management plan.
What are those?
This meant visiting my doctor on a regular basis and keeping him informed of any problems
I was having, such as difficulty breathing at night or being unable to do the things
I like to do, or signs that the medicine is not working.
The doctor used this information to adjust the management plan, including changing my
medication.
Another great aspect of this partnership is that the doctor or staff is available by telephone.
I don't make any unnecessary calls, but neither do I hesitate to call when I have a question
or need help.
Yes, doctor?
Well, my peak flow reading...
And when I do call, I'm prepared to tell the doctor or nurse what they need to know about
symptoms, peak flow numbers, and what medicine I've already taken, so they can more quickly
give me the help I need.
Well, you seem to be doing very well.
I think the management plan's working fine.
What do you think?
I think it's working.
I feel good knowing that I have health care providers that I can count on who will work
with me and help make sure that I get the quality medical care that I need to manage
my asthma.
A very important part of the asthma management plan is taking asthma medicine to keep your
airways open.
There are several types of asthma medicines available under many brand names.
I worked with my doctor and pharmacist until we found a combination that was effective
for me and that didn't cause too many side effects.
In the process, I learned a lot.
There are two main groups of asthma medicines.
One type of medicine called a bronchodilator is commonly used to provide relief from symptoms
after an episode has started.
Examples are beta-2 agonists and theophylline.
They work like this.
Each person with asthma has an exaggerated sensitivity in the lungs airways or bronchial
tubes.
When this sensitivity to such things as the common cold, cigarette smoke, dust, or animal
dander is triggered, the muscles around the airways contract.
This narrows the airways and makes it hard to get air in and out.
The wheezing that is often heard is usually the air being exhaled through the narrow tubes.
At the first sign of symptoms, the bronchodilators are used to relax airway muscles and open
up the air passages so that more air can flow through.
Another type of medicine, anti-inflammatory medicine, is often prescribed to help prevent
asthma flare-ups.
They come in different forms and brand names, chromalin and nidochromyl, and corticosteroids
are used as anti-inflammatories.
They work like this.
The airway sensitivity to triggers is related to inflammation of the airway lining.
When triggered, the airway swells on the inside and produces mucus, making breathing more
difficult.
Anti-inflammatory medicines taken every day, even when there are no symptoms, help control
inflammation, decreasing swelling and mucus production, thus reducing sensitivity to triggers
and leading to fewer or less severe asthma episodes.
These are the ones you'll take on a daily basis.
In my experience working with the doctor and pharmacist to find out which combination of
medicines works best for me, I learned that it's not enough to read the directions on
the label.
There's a lot to know about how to use the medicine correctly, and you need to be sure
to ask certain questions about the medication plan, such as, so is this a bronchodilator?
Yes, it is.
What is the name of the medicine, and what is it supposed to do?
Do I take two puffs of the anti-inflammatory each time I use it?
That's correct.
How and when is it taken?
Is it taken every day, or only when symptoms appear?
Some doctors prescribe three medicine schedules, green, yellow, and red.
The green schedule is for when you are not having symptoms, and yellow is for when you
are having mild symptoms.
If you are successfully managing your asthma, you will alternate between green and yellow.
The red schedule is for a severe attack.
Also, what if I miss a dose?
That's a good question.
Ask what should be done if a dose is missed.
What if the medicine doesn't work?
If the medication doesn't work.
What should be done if the medicine doesn't seem to be working?
Are there possible side effects?
If so, what are they, and what should be done if they occur?
How should the medicine be stored?
The medicine should always be stored.
How should the medicine be stored?
What other medicines, foods, or drinks should be avoided when taking the asthma medicine?
After a while, I learned to plan ahead so that I always have the asthma medicines that
I need.
I remember to refill prescriptions long before they run out.
And whenever my medicine has to be taken at work or other locations outside the home,
I get duplicate prescriptions or medicine split into two containers, and I never forget
my medicine when I go on vacation.
Some asthma medicines are given in powders or liquid, but many come in an aerosol spray
dispensed by a metered dose inhaler or MDI like this one.
It sprays out a fixed amount of medicine whenever you push it down.
The doctor taught me how to use it correctly.
Remove the cap and make sure the mouthpiece is free of foreign objects.
Shake the canister to mix up the medication, then tilt your head back.
Now blow out all the way.
Then holding the inhaler about one inch in front of your open mouth, begin to slowly
breathe in.
Depress the canister to release one puff of medication while continuing to slowly breathe
in.
Now hold your breath for five to ten seconds before slowly breathing out.
Good.
Now wait one minute before taking the second dose.
Your doctor may recommend the closed mouth technique.
Push your lips firmly around the mouthpiece and your tongue below the opening.
If you have trouble using the inhaler correctly, a holding chamber or spacer can be used to
make it easier to take the aerosol medication so that it reaches the lungs.
These devices can also help prevent coughing.
Both bronchodilator and anti-inflammatory medicines may be taken using an inhaler.
If you use an inhaled corticosteroid, a holding chamber is recommended.
And be sure to rinse your mouth after taking the medicine to prevent a buildup in the throat.
I also sometimes take medicine using a nebulizer, which is an air compressor that changes liquid
medicine into a vapor that I breathe in from a mask or tube.
Some medicines, such as theophylline and oral prednisone, come in tablets.
A medicine schedule that includes both tablets and two or more types of inhaled medicines
is not uncommon, especially when the asthma is severe.
Be sure you understand how to use each medicine.
And it's a good idea to keep an accurate record of the medicines you take along with dates
and times.
I work closely with my doctor to evaluate the medication plan, and we adjust it when
we need to.
Remember, the goal is to have a medication plan that works, is convenient, and has minimal
side effects and expense.
In addition to learning about medicine, I learned that there are many things that can
cause symptoms of asthma in a person with asthma.
These things are called triggers.
Common triggers of asthma include colds and flu, irritants in the air, like cigarettes,
smoke, or perfume, allergens, or things you're allergic to, like animal dander from cats
or dogs, exercise without pretreatment or warmup, changes in weather, especially cold
weather, also emotions such as laughing, crying, or getting angry, or any stressful situation
may play a role in making an asthma attack more severe.
What triggers my asthma is probably not the same as what triggers yours.
And even your own triggers may change somewhat over time.
But it is important to identify your own personal triggers so they can be controlled.
One way to help identify asthma triggers is to keep a diary of symptoms and exposures
to possible triggers, then review this information with the doctor.
Once a trigger has been identified, exposure to the trigger can usually be reduced or eliminated.
For example, the doctor and I noticed that whenever I caught a cold or got the flu, that
would usually trigger my asthma.
So I try extra hard to avoid colds and infections through frequent hand washing, keeping my
hands away from my nose and eyes, and by trying to stay clear of people when they have colds
or are sick.
I'm going to go to bed, I'm not feeling very well.
All right, well you'll let me know if you need anything, won't you?
Yeah.
Okay.
Good night.
Good night.
I got a shot to decrease my chances of getting pneumonia, and I also get a flu shot every
year.
Irritants in the air, especially cigarette smoke, including secondhand smoke, trigger
my asthma.
But I'm learning to control these irritants, and that is helping my asthma.
Fillies and meds, it's good.
Dan, would you mind not smoking?
Oh, sure.
All right, thanks.
We no longer paint in the house when I'm there, and I stay away from breathing hair sprays,
perfumes, and strong smelling cleaning solutions like ammonia.
And we keep the house well ventilated with filtered air from the outside whenever possible.
I even talked to my boss.
So they switched some things around on the plant so that I don't come into contact with
any fumes while on the job.
My allergic triggers are what I had to learn to control.
A skin test helped me discover some of the things that I'm allergic to.
Animal dander from animals with fur or feathers, pollen from trees, grass, or weeds, and house
dust all have allergens that will trigger my asthma unless I control them.
To control the house dust mites, we installed dust proof encasings on the mattress, box
spring, and pillows, and we removed the rug and other dust collecting objects from our
bedroom.
Because I'm allergic to feathers, we bought pillows filled with non-allergenic material
to replace the feather pillows, and we wash or replace them every six months.
We maintain a relatively dust free home environment by frequently vacuuming the carpets with a
machine equipped with a special HEPA filter.
I usually get someone else to vacuum, but if I do the vacuuming myself, I wear a HEPA
filter mask over my mouth and nose.
We change the vacuum bag outdoors to prevent spreading dust inside the house.
We also clean the curtains frequently and wash the bedclothes in very hot water every
week.
My husband makes sure the filters for heating and air conditioning are replaced regularly.
Yeah, you know how I love animals, but I'm afraid I'm allergic to your cats.
Why don't we eat at that new restaurant?
Because I'm allergic to animal dander, we found another home for our dog and thoroughly
cleaned up the areas of the house where he had been.
I also avoid visiting other homes where there are pets with dander.
A change in weather or temperature, especially breathing cold winter air, is one of the things
that triggers my asthma.
So when cold weather hits, a scarf or other cloth over my mouth and nose helps prevent
cold air from triggering my asthma.
It involves some work.
We even remove the carpet from our bedroom, but now that we've made our home as dust-free
as possible and have some of the other triggers under control, I feel much better and have
fewer asthma symptoms.
Other physical exercise is healthy and rarely needs to be avoided by anyone with asthma.
When I first got asthma, I stopped jogging because I almost always had symptoms afterwards.
Exercise induced asthma.
Now I jog and participate in any activity I like without fear of an asthma attack.
People with asthma who think they can't do anything active are probably only making things
worse, by avoiding activities they might otherwise enjoy.
Sure, exercise can affect almost everyone with asthma, including myself, but that's
only when it's not being controlled.
For most people with exercise-induced asthma, the airway narrows a few minutes after the
strenuous activity starts, probably due to a loss of heat and water in the lungs.
Then five or ten minutes after the activity, the muscle constriction reaches a peak and
often resolves after another 20 or 30 minutes.
It's typical of exercise-induced asthma if it's not controlled.
It's been ten minutes since I stopped running and I feel fine.
How did I do it?
Prior to the exercise, I use the beta agonist medicine according to my doctor's directions.
I also make sure I warm up for 10 to 15 minutes beforehand.
The pre-medication may be helpful for up to several hours, but its effectiveness does
decrease with time.
That's why it's best to take it 15 minutes prior to the activity.
The other way I beat exercise-induced asthma is by staying in shape.
If you're not in shape, exerting yourself is more likely to trigger asthma.
But because I'm staying in good condition, it takes a lot of activity before my asthma
can be triggered.
So, choose an activity you enjoy, use the right medication just before you exercise,
and go for it!
Another part of the asthma management plan is watching for warning signs of an asthma
attack so that I can catch it early and take steps to prevent it from getting worse, such
as switching from my green medicine schedule to the yellow one.
A good way to know that an asthma attack may be starting is by using a peak flow meter
in the morning and evening and whenever symptoms begin to appear.
It can indicate changes in the lungs even before you notice any symptoms.
The peak flow meter measures how fast and how much air I can exhale.
When this ability to blow air out is decreased, it may be a warning sign of an oncoming asthma
attack.
I keep a chart of my peak flow readings with dates and times.
If my reading falls 20% or more below my personal best, that's a warning sign for me.
For others, the percent may be different.
Ask your doctor how to use a peak flow meter.
The warning signs of asthma are not the same for each person.
For me, coughing is usually the first sign that I'm going to have symptoms.
When that happens, I use the peak flow meter to check myself and see if I might need to
use the medicine the doctor prescribed for such occasions.
By recognizing early symptoms and warning signs before symptoms become severe, asthma
medicine can be used to control the symptoms.
In addition to cough, some of the possible warning signs are an itchy or sore throat
or a stuffy or runny nose.
Early symptoms may include light wheezing, restlessness while trying to sleep, fatigue
or being out of breath, and a chest that feels tight.
When an asthma attack does occur, it is important to stay calm.
First, I follow the medication plan.
Then I take steps to relax.
I sometimes read or watch TV.
My wife pampers me a little bit, and I just take it easy.
It's important to reduce stress when asthma rears its ugly head.
I also do breathing exercises as a form of relaxation on a regular basis.
Some people I know use meditation, muscle relaxation exercises, and biofeedback to reduce
stress and improve breathing on an ongoing basis.
There are many books and videotapes available that make it easy to learn these techniques,
but keep in mind that these methods are not a substitute for medical care.
My doctor says that if I'm having symptoms and am in doubt about what to do, that I should
call.
We set up guidelines concerning when to call the doctor and when to go to the emergency
room.
In general, I get emergency help if my symptoms do not respond or get worse after the bronchodilator,
if I am really having difficulty breathing, and my peak flow reading drops and does not
improve after treatment, or if it drops to 50% of my personal best.
And although this has never happened, if my lips or fingernails are gray or blue, I should
already be in the emergency room.
The important thing is, don't wait too long to get help.
I've worked with a doctor to develop an emergency plan.
If it ever does happen, I know where to go, how to get there, what to take with me, like
my peak flow meter and my asthma medication, and what to say when I get there, like I'm
having trouble breathing and I need help immediately.
Asthma does not have to be a crisis.
You should be able to live a normal life as you work in partnership with the health care
team, take the prescribed medications, identify and reduce asthma triggers, and learn to recognize
and respond to the warning signs of an attack.
It takes commitment and hard work, but the good health and peace of mind that come with
successfully managing your asthma will make it worth the effort.