Understanding and Managing Your Moderate to Severe Asthma

This article is for people who have moderate to severe asthma, or their care partners, as well as others who want to learn more about asthma. The goal is to educate patients on the importance of engaging with their doctor and healthcare team about the treatment and control of their asthma.

You will learn about:

• Asthma and its causes

• Symptoms of asthma

• What moderate to severe asthma is

• Asthma treatment

• Why asthma control is important and ways to help manage your symptoms

• Questions to ask your doctor

Asthma is a long-term (chronic) lung disease. It causes inflammation in your lungs, which narrows your airways and makes it difficult to breathe. Severe asthma can make it hard to talk or be active.

Not all asthma is the same -- the causes and types of inflammation can be different.

For some people, inflammation is triggered by allergens like pollen, mold, dust mites, and animal saliva and dander.

For others, asthma is autoimmune. This means there's a problem with the body's immune system and white blood cells (eosinophils). About half of people with severe asthma have raised levels of eosinophils in their bloodstream, which cause inflammation.

Asthma symptoms include coughing, wheezing, shortness of breath, and chest tightness.

Asthma severity depends on how often symptoms happen:

• Mild intermittent: symptoms occur less than 2 days a week and 2 nights a month

• Mild persistent: symptoms occur more than 2 days a week, but not every day

• Moderate persistent: symptoms occur daily and more than 1 night a week

• Severe persistent: symptoms are ongoing throughout the day on most days, and often at night

With moderate asthma, symptoms may disrupt your normal activities and make it difficult to sleep. Without treatment, your lungs function at only between 60% and 80% of normal.

Severe asthma is the least common type and occurs in about 10% of people. With severe asthma, it's difficult to control your symptoms, and they usually don't respond to standard treatment. This may limit your ability to do daily activities. Severe uncontrolled asthma can be debilitating. If left untreated, your lungs may work at less than 60% of normal.

Prevention and long-term control are main goals of treatment. Long-term asthma control medicines -- usually taken daily -- reduce airway inflammation and help prevent symptoms.

They include:

• Inhaled corticosteroids to prevent and ease airway swelling

• Leukotriene modifiers to block leukotrienes (substances in your body that trigger asthma)

• Long-acting beta agonist (or bronchodilator) inhalers to relax muscles surrounding your airways

• Combination inhalers with a corticosteroid and long-acting beta agonist

• Theophylline to open your airways and ease chest tightness

• Biologics for severe asthma that doesn't get better with other medicines

Quick-relief, or rescue, medicines are used as needed for short-term relief of symptoms during an asthma attack. They may also be used before exercise, if your doctor recommends it.

These medicines include:

• Short-acting beta agonist inhalers to relax muscles around your airways

• Anticholinergics (bronchodilators) in an inhaler or nebulizer to relax airways. Some may also be used to prevent asthma symptoms

• Corticosteroids (oral or intravenous) to ease swelling in your airways (for serious attacks)

For anyone with asthma -- especially severe asthma -- getting it under control is a main goal of treatment.

Asthma control is important for:

• Your current and future health

• Improved quality of life, including your physical, mental, and financial well-being

• Preventing permanent lung damage

Without proper treatment and control, you might need to make frequent visits to the emergency room, and even stay at the hospital, which can affect your home life and ability to work.

Asthma can often be controlled by taking medicine and avoiding triggers.

Ways to help manage your symptoms include:

• Take medicines as directed and use inhalers properly

• Quit smoking

• Avoid triggers by using air conditioning, reducing pet dander, and cleaning regularly

• Get proper exercise and maintain a healthy weight

• Pace yourself and avoid activities that make your symptoms worse

• Try breathing exercises and methods to cope with stress

Not using inhalers correctly and not taking controller medicines as directed are major causes of uncontrolled asthma.

You and your doctor can create an asthma action plan that includes when and how to take your medicines. It can also list your triggers and ways to avoid them.

Record your symptoms in a journal or diary to track how well your asthma is controlled. Also record how many inhaler puffs you use each week -- this can help determine if your long-term control medicines are working.

If your symptoms become severe and don't go away after you follow your action plan and use your medicines as directed, call your doctor or 911, or get emergency help.

See your doctor regularly to review your treatment. Take your asthma diary and action plan with you.

Questions to ask can include:

• What can I do to help control my asthma?

• Do I have asthma triggers? If so, what are they and how can I avoid them?

• What treatments are available and what are the side effects?

• Am I using inhalers correctly? What is the right way?

• How and when will my medicine need to be adjusted?

• What lifestyle changes should I make?

• What should I do if I start to feel stressed?

Congratulations!

You have successfully completed the program: Understanding and Managing Your Moderate to Severe Asthma