Management of Asthma

Treatment for asthma

Specific treatment for asthma will be determined by your health care provider based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

As of yet, there is no cure for asthma. However, asthma can often be controlled with prescription medicines that may help to prevent or relieve symptoms, and by learning ways to manage episodes.

Child looking out of a window

Managing asthma

People with asthma can learn to identify and avoid the things that trigger an episode, and educate themselves about medications and other asthma management strategies.

According to the most recent Guidelines for the Diagnosis and Management of Asthma, published by the National Heart, Lung, and Blood Institute:

  • Asthma is a chronic disease. It has to be cared for all the time–not just when symptoms are present.

    • The four parts of continually managing asthma are:

      • Identify and minimize contact with asthma triggers.

      • Understand and take medications as prescribed.

      • Monitor asthma to recognize signs when it is getting worse.

      • Know what to do when asthma gets worse.

  • Working with a health care professional is the best way to take care of asthma. There are specific guidelines for children from infants to 4 years old, 5 to 11 years old, and 12 and older.

  • The more information a person with asthma has, the better asthma can be controlled.

Four components of asthma treatment

  1. The use of objective measures of lung function, such as spirometry and peak flow expiratory flow rate, to access the severity of asthma, and to monitor the course of treatment.

  2. The use of medication therapy designed to reverse and prevent the airway inflammation component of asthma, as well as to treat the narrowing airway.

  3. The use of environmental control measures to avoid or eliminate factors that induce or trigger asthma flare-ups, including the consideration of immunotherapy.

  4. Patient education that includes a partnership among the patient, family members, and their health care providers.

How to avoid asthma triggers

Many things can trigger an asthma episode, including the following:

  • Upper respiratory infections

  • Allergies to dust mites, pollens, animal dander, mold and mildew, or cockroaches

  • Exercise

  • Foods

  • Irritants, such as cigarette and other forms of smoke, strong odors and perfumes, fumes from wood stoves or kerosene heaters, and air pollution

  • Weather changes

The following is a list of things you can do to limit your exposure to common triggers of asthma:

  • Allergies:

    • Dust. Dust is the most common year-round allergy. The allergy is caused by tiny insect-like creatures called dust mites. Dust mites are found in mattresses, carpets, and upholstered furniture. They thrive in warm, humid conditions and feed on the shed scales of human skin. The best way to prevent allergy symptoms caused by dust mites is to limit your exposure. Be sure to pay special attention to the bedroom where you spend the most amount of your time:

      • Beds. Every bed in your house should have a wooden or metal frame. Do not sleep on a couch, sofa, or hide-a-bed. If your child has asthma and sleeps in a bunk bed, he or she should sleep on the top bunk.

      • Mattress and box spring. Place all mattresses and box springs in a zippered, dust-proof cover and tape over the zippers with electrical or duct tape.

      • Pillows. Encase pillows in zippered, dust-proof covers. Pillows should be made of Dacron or other synthetic fiber. Do not use foam, feather, or "down" pillows.

      • Bedding. Avoid wool or down blankets. Wash all bedding (sheets, pillowcases, blankets) in hot water. Cold water will not kill the dust mites. Dry all clothes and bedding in the dryer to avoid pollen sticking to them when on a clothesline.

      • Floor coverings. If possible, remove wall-to-wall carpeting. If not, vacuum the carpet frequently (at least twice a week) or ask someone who does not have asthma to vacuum for you. If your child has asthma, vacuum only when your child is away and will not return to the room for several hours after you have finished. Substitute multilayered vacuum bags for regular single layer bags. Small, washable cotton rugs may be used if washed often. Wood, tile, or vinyl flooring without a rug is best, and should be mopped at least weekly.

      • Closets. Remove all stored toys, boxes, and other articles from closets. The closet should contain only clothing and should be as dust-free as the room. Keep all clothes in closets, never lying around the room.

      • Furnace (heating). Electric or gas heat is recommended. Do not use wood stoves or kerosene heaters. Change the air filters on the furnace every month. Cover all furnace outlets in the room with special filters or cover the outlets with ten thicknesses of cheesecloth or muslin. This will catch dust in the furnace air. Change the cheesecloth when it gets dusty underneath (about every two weeks).

      • Air conditioners. Window unit or central air conditioning is ideal. Change or clean all filters every month. Electric fans or ceiling fans should not be used. Windows should be kept closed, especially in the summer.

      • Doors. Keep bedroom closet doors and bedroom doors closed as much as possible.

      • Walls. Paint walls or use washable wallpaper. Avoid pennants, pictures, wreaths, flower arrangements, or other dust catchers on the walls.

      • Window coverings. Avoid heavy curtains and Venetian or mini-blinds. Use window shades instead. If curtains are used, they should be washed monthly in hot water.

      • Humidifier. Avoid the use of humidifiers, dust mites grow best in high humidity. Use a dehumidifier to keep humidity in the home less than 50 percent.

      • Furniture. Remove all upholstered (stuffed) furniture and replace upholstered furniture with wooden or plastic furniture. Avoid open bookshelves, as they are great dust catchers.

      • Sleeping and napping. Sleeping and napping should take place only in your own bed. Your child should nap or sleep only in his or her own bed as well, which has been made dust-free. When you travel, take your own nonallergic pillow with you.

      • Playing. If your child has asthma, do not allow him or her to jump on furniture or beds or wrestle on carpeted floors. Your child's bedroom should not be used as a playroom. Avoid fabric toys or stuffed animals. If your child has stuffed animals, they should be machine washable and washed in hot water or placed in the freezer overnight at least weekly. Store toys in a closed toy chest.

    • Pollens. In many areas, pollens can be a problem from February through November each year. If you are allergic to pollen, during pollen season it is important that you keep all car and house windows closed and use the air conditioning.

    • Animal dander. Pets that have fur or feathers often cause allergy troubles. If you are allergic to animal dander (the "skin" of the animal), it is best not to have pets and not to visit homes where these types of pets are kept.

    • Mold and mildew. Mold and mildew grow in areas that are dark, humid, and have poor ventilation:

      • Outdoors. Avoid damp, shady areas. Remove fallen leaves and avoid cutting the grass.

      • Bathrooms and kitchens. Always use the exhaust fans when cooking or bathing. If you do see mold and/or mildew, clean the area with cleansers made with bleach.

      • In the house. Use the air conditioner. Avoid using humidifiers, as mold and mildew can grow in the water tank. If you must use a humidifier, clean it daily with a bleach and water solution. Reduce indoor humidity to less than 50 percent and use a dehumidifier, if needed. Empty and clean the dehumidifier daily

    • Cockroach droppings. Some people are very allergic to the substance that cockroaches leave behind. Cockroaches are very common in warm climates and in homes of people living in the city. However, even in climates with much cooler temperatures, the use of central heat allows the cockroaches to live. To avoid exposure to cockroaches, it is best to use insect sprays (air out the house after spraying, however) and roach traps.

  • Exercise. Even though exercise is a common asthma trigger, you should not limit your participation in sports or exercise, unless directed by a health care provider. Exercise is good for your health and lungs. Some forms of exercise, such as running long distances and playing basketball, may be harder for you to do. Activities such as swimming, golf, and karate are good choices for persons with asthma. However, persons with asthma should be able to participate in most physical activities. Always warm-up prior to exercise and cool down at the end of exercise. Using your quick reliever medicine 15-20 minutes before starting exercise can be very helpful, as directed by your health care provider. Talk with him or her about exercise and asthma if this is a problem for you.

  • Foods. Certain foods, such as milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish, and food additives can trigger asthma symptoms. It's best to avoid these foods if they trigger an asthma attack.

  • Irritants:

    • Smoke. Do not allow family and friends to smoke anywhere inside the house. Do not allow smoking in the car at any time. Smoke is very irritating in an enclosed area and its odor may be trapped in the car's upholstery for a long period of time and continue to trigger symptoms. When eating out, always sit in nonsmoking sections of restaurants. You should also have nonsmoking child care providers.

    • Strong perfumes and odors. Avoid things that have a strong smell, such as cleaning products, perfumes, hair spray, tar, fresh paint, gasoline, insect sprays, and room deodorizers.

  • Medications. Some medications can cause or worsen asthma. These medications include aspirin or other nonsteroidal anti-inflammatory drugs or beta blockers that are used to treat heart disease, high blood pressure, migraines, and glaucoma. Talk with your health care provider about your asthma history and use of these medications.