Chapter 4

Managing Asthma Long-Term

In This Chapter

Understanding what long-term asthma management involves

Identifying the four levels of asthma severity

Taking the stepwise approach to treatment

Evaluating your lungs

Figuring out self-management

Enhancing your life and overall health

R ather than letting your asthma control you, the key to controlling your asthma is to treat it on a consistent and preventive basis. Doing so means managing your asthma for the long term, rather than dealing with symptoms and episodes only temporarily. Developing and sticking to a long-term asthma management strategy is a priceless investment in your overall health and quality of life, especially if you have persistent asthma. The fundamental point is to address the root cause of your symptoms — the underlying airway inflammation that characterizes asthma.

In most cases, I find that after patients realize how much better they can feel by effectively managing their asthma on a long-term basis, they don’t put up with going back to the ineffective, short-term, crisis-management ways of dealing with their disease.

Seeing What a Long-Term Management Plan Includes

A comprehensive long-term management plan for persistent asthma should include the following elements:

Objective testing and monitoring of your lung functions to initially diagnose your condition and to continuously assess the effectiveness of your treatment (see Chapter 2 and the sections “Assessing Your Lungs” and “Taking Stock of Your Condition,” later in this chapter, for more information).

Avoiding and controlling exposures to asthma triggers and precipitating factors (see Chapter 5).

Developing a safe and effective pharmacotherapy program that results in minimal or no adverse side effects. The program includes taking appropriate long-term preventive medications on a routine basis to control your asthma and using appropriate short-term, quick-relief rescue medications if your symptoms suddenly get worse (see Chapter 16).

Initiating pharmacotherapy with a stepwise (step-up or step-down) approach. (See the “Using the Stepwise Approach” section, later in this chapter, for details.)

Consulting with an asthma specialist, such as an allergist or pulmonologist (lung doctor), when advisable (see Chapter 2).

Tailoring your asthma management plan to your specific circumstances and condition and continuing education for you and your family about asthma and your specific condition (see “Understanding Self-Management,” later in this chapter).

“Outgrowing” your asthma: Fact or fiction

Asthma isn’t something that you usually outgrow. Extensive studies over the past 15 years have shown that asthma is an ongoing physical condition that doesn’t just disappear forever when you feel better. Your asthma can vary in its symptoms and severity during your lifetime. However, just like the color of your eyes or your individual fingerprint pattern, when you have asthma, it remains as another of your distinctive, although unseen, physical characteristics.

When you have asthma, the airways of your lungs get bigger as you grow, so mild airway obstruction may not affect you as much as you get older. Also, as you mature, your sensitivities may not be sufficient to cause clinical symptoms that you notice. However, people who feel that they “outgrew” their asthma as children or teenagers commonly experience symptoms of the disease later in life, particularly in response to certain triggers (see Chapter 5 for more on asthma triggers).

Focusing on the Four Levels of Asthma Severity

Experts from different fields of medicine have classified the severity of asthma — whether allergic or nonallergic — into four levels. These asthma severity levels provide the basis for the stepwise management of the disease.

Bear in mind, however, that these levels of severity aren’t permanent or static. Asthma is a condition that can change throughout your life. The primary goal of the stepwise approach that I describe in this chapter is to get your asthma to the lowest classification possible. Therefore, effectively treating your condition is crucial: Otherwise, your asthma severity may move up the classification scale to the point where you could potentially suffer from severe, relentless symptoms that adversely affect your quality of life.

As described in the National Institutes of Health (NIH) Guidelines for the Diagnosis and Management of Asthma, the four levels of asthma severity are

Mild intermittent. Symptoms occur no more than twice a week during the day and no more than twice a month at night. Lung-function testing (see Chapter 2) shows 80 percent or greater of the predicted normal value, compared to reference values based on your age, height, sex, and race, as established by the American Thoracic Society. In addition, your peak expiratory flow rate (PEFR; see Chapter 2) shouldn’t vary by more than 20 percent during episodes and from the morning to the evening. Between episodes, you may be asymptomatic (not have noticeable symptoms), and your PEFR should be normal. If your asthma is at this level, a worsening of symptoms is usually brief, lasting a few hours to a few days, with variations of intensity.

Mild persistent. Symptoms occur more than twice a week during the day, but less than once a day, and more than twice a month at night. Lung-function testing shows 80 percent or greater of the predicted normal value. Your PEFR may vary between 20 and 30 percent. If your asthma is at this level of severity, then worsening of symptoms can begin to affect your activities.

Moderate persistent. Symptoms occur daily and more than once a week at night, requiring daily use of a short-acting bronchodilator. Lung-function testing shows a 60 to 80 percent range of the normal predicted value. Your PEFR can vary more than 30 percent. Symptoms can worsen at least twice a week, with episodes lasting for days and affecting your activities.

Severe persistent. Symptoms occur continuously during the day and frequently at night, limiting physical activity. Lung-function testing is 60 percent or less of the normal predicted value. Your PEFR may vary more than 30 percent, and frequent aggravations of your condition can develop.

When diagnosing your condition, your doctor should identify your asthma’s severity level. Check to see which of the severity levels your condition most resembles, based on the definitions that I list in this section. Your own symptoms and lung functions may not always fit neatly into one of these particular severity levels. Your doctor, therefore, should evaluate your individual condition and develop a treatment plan for you based on the specific characteristics of your asthma. Keep in mind, however, that based on symptom criteria and the results of lung-function testing, the vast majority of asthma patients have some form of persistent asthma — mild, moderate, or severe — requiring long-term control therapy.

If the symptoms you’re experiencing seem to indicate that you have persistent asthma, I strongly advise having your lung functions evaluated by spirometry if you haven’t already done so (see “Assessing Your Lungs,” later in this chapter). For a spirometry evaluation, you may need to ask your doctor for a referral to an asthma specialist, such as an allergist or pulmonologist, because in many cases, primary care physicians don’t have easy access to office spirometers.

Using the Stepwise Approach

Asthma severity levels are steps in the staircase to controlling asthma, as shown in Figure 4-1. The basic concept of stepwise management is to initially prescribe long-term and quick-relief medications, based on the severity level that’s one step higher than the severity level you’re experiencing (see Table 4-1). By using this approach, your doctor can usually help you gain rapid control over your symptoms. After your condition has been under control for a month (in most cases), your physician can reduce the level of your medications by one level (step down ).

Using the stepwise approach to asthma management means that you step up your medication therapy to gain control, and then step down your medical treatment to maintain control. Like waltzing, after you and your doctor master the steps, you can move around life’s dance floor with the ease and grace of Fred Astaire or Ginger Rogers. Regular monitoring of your PEFR and follow-up visits with your doctor, however, are vital to ensuring that you stay in step, as I explain in the next section.

Figure 4-1: The steps of asthma severity levels.

The information in Table 4-1 is based on the NIH Guidelines for the Diagnosis and Management of Asthma. Please remember that these are guidelines. Your doctor should always evaluate your own specific condition and prescribe individualized treatment accordingly.

Table 4-1 Stepwise Approach for Managing Asthma in Adults and Children Older Than 5

Step	Long-Term Control	Quick Relief
Step 1: Mild	No daily medication	Short-acting bronchodilator:
intermittent	needed	Inhaled beta2-adrenergics as
		needed for symptoms. Intensity
		of treatment may vary depend
		ing on the severity of your
		symptoms. (If you’re using a
		short-acting inhaled beta2-
		adrenergics more than twice a
		week, you may need to initiate
		long-term control therapy.
		Consult your doctor in this
		case.)
Step 2: Mild	One daily medication:	Short-acting bronchodilator:
persistent	Anti-inflammatory medic-	Inhaled beta2-adrenergics as
	ation, either inhaled corti-	needed for symptoms. Intensity
	costeroid (low dose) or	of treatment may vary depend
	mast cell stabilizers, such	ing on the severity of your
	as cromolyn or nedocromil.	symptoms. (If you’re using a
	Your doctor may also con-	short-acting inhaled beta2-
	sider anti-leukotriene mod-	adrenergics more than twice a
	ifiers such as zafirlukast	week, you may need additional
	and montelukast. Your	long-term control therapy.
	physician may also con-	Consult your doctor in
	sider a methylxanthine	this case.)
	product such as sustained-
	release theophylline as an
	alternative treatment, but
	not as preferred therapy.
Step 3*: Moderate	Daily medication: Anti-	Short-acting bronchodilator:
persistent	inflammatory medication,	Inhaled beta2-adrenergics as
	inhaled corticosteroid	needed for symptoms.
	(medium dose), or inhaled cor-	Intensity of treatment may vary
	ticosteroid (low to medium	depending on the severity of
	dose), adding a long-acting	your symptoms. (If you’re using
	bronchodilator, especially for	a short-acting inhaled beta2-
	nighttime symptoms — either	adrenergic more than twice a
	long-acting inhaled beta2-	week, you may need additional
	adrenergics, sustained	long-term control therapy.
	release theophylline, or long-	Consult your doctor in this
	acting beta2-adrenergic	case.)
	tablets.
	If needed: Anti-inflammatory
	medication, inhaled corticos-
	teroid (medium-high dose),
	and long-acting bronchodila-
	tor, especially for nighttime
	symptoms — either long-
	acting inhaled beta2-
	adrenergics, sustained
	release theophylline, or long-
	acting beta2-adrenergic tablets.
Step 4*: Severe	Daily medication: Anti-	Short-acting bronchodilator:
persistent	inflammatory medication,	Inhaled beta2-adrenergics as
	inhaled corticosteroid (high	needed for symptoms. Intensity
	dose), and long-acting bron-	of treatment may vary depend
	chodilator — either long-	ing on the severity of your
	acting inhaled beta2-	symptoms. (If you’re using a
	adrenergics, sustained	short-acting inhaled beta2-
	release theophylline, or long-	adrenergic more than twice a
	acting beta2-adrenergic	week, you may need additional
	tablets; and if required, long-	long-term control therapy.
	term use of corticosteroid	Consult your doctor in this
	tablets or syrup.	case.)

*If your asthma severity is at Step 3 or Step 4, consult an asthma specialist, such as an allergist or pulmonologist (lung doctor), to achieve better control of your condition.

Stepping down

If you’re on long-term maintenance control at any level, your doctor should review your treatment every one to six months. A gradual stepwise reduction in treatment may be possible after your symptoms are under good control, meaning that you feel good, have maintained improved lung function, and experience no asthma symptoms.

The goal of the stepwise approach is to use early and aggressive treatment to gain rapid control over your asthma symptoms, thus allowing your doctor to reduce your medication to the lowest level required to maintain control of your condition.

Stepping up

If you find yourself frequently resorting to your quick-relief medications, your symptoms aren’t under control, and your doctor should consider increasing your treatment by one step. In assessing whether to step up your therapy, your doctor will probably evaluate the following aspects of your current treatment step:

Your inhaler technique. (See “Evaluating your inhaler technique,” later in this chapter.)

Your level of adherence in taking the medications that your doctor prescribes.

Taking your prescriptions as your doctor instructs is vital. If you’re having trouble with a product (because of potential side effects) or you don’t understand your doctor’s instructions, tell your physician so that he can take appropriate measures.

Your exposure level to asthma triggers, such as allergens and irritants and precipitating factors, such as viral infections and other medical conditions. Control your exposure to asthma triggers and precipitating factors as much as possible, no matter what step of treatment you’re receiving. (See Chapter 5 for information on controlling asthma triggers.)

Make sure that your asthma management plan clearly explains at what point you should contact your physician if your symptoms worsen.

Treating severe episodes in stepwise management

Your doctor may consider prescribing a rescue course of oral corticosteroids at any step if you suddenly experience a severe asthma episode and your condition abruptly deteriorates. (Chapter 16 provides more information on oral corticosteroids.)

In some cases, severe episodes can occur even if your asthma is classified as intermittent. In many instances, patients with intermittent asthma may experience severe and potentially life-threatening episodes, often because of upper respiratory viral infections (such as the flu or colds), even though these patients may otherwise have long periods of normal or near-normal lung functions and few clinically perceptible asthma symptoms.

Assessing Your Lungs

Objective measurements of your lung functions are essential for monitoring your asthma’s severity. Just as you check the oil level in your car on a regular basis (rather than waiting for the flashing red warning light), you and your doctor should also regularly check your airways to determine whether you’re at the right step of asthma medication. In addition to recording your asthma symptoms in a daily symptom diary (see “Keeping symptom records,” later in this chapter), you should also obtain objective measurements of lung functions with spirometry and peak-flow monitoring.

What your doctor should do: Spirometry

A spirometer is a sophisticated machine that your doctor or asthma specialist, such as an allergist or pulmonologist, uses for measuring airflow from your large and small airways before and 15 minutes after you’ve inhaled a short-acting bronchodilator. The spirometer helps your asthma specialist diagnose whether you have asthma and also allows your physician to follow your asthma’s clinical course.

For adults and children older than age 4 or 5, spirometry currently provides the most accurate way of determining whether airway obstruction exists and whether it’s reversible. For information on other types of lung-function tests your doctor may recommend and to find out more about diagnosing asthma in children under age 4, see Chapter 2.

What you can do: Peak-flow monitoring

Peak-flow meters (see Figure 4-2) allow you to keep an eye on your lung functions at home. The readings from this handy tool can be vital in diagnosing asthma and its severity and can also help your doctor prescribe medications and monitor your treatment’s effectiveness. Peak-flow monitoring can also provide important early warning signs that an asthma episode is approaching.

Figure 4-2: A patient using a peak-flow meter.

Children older than 4 or 5 who have asthma generally can also use this small, hand-held device to measure their own PEFR. If your kids constantly question your judgment (as mine do about almost everything), using a peak-flow meter can help youngsters understand when their condition may require them to limit their activities. If your child understands that the PEFR — not just you or your doctor — is advising him or her not to go to soccer practice on that particular day because of worsening asthma symptoms and a resulting PEFR reduction, you may have more success in helping to control your child’s asthma.

Explaining and using peak-flow meters for children

I often advise parents to explain to their kids that when their peak-flow rate is down, it’s like having an injury in their lungs. You can reinforce this analogy by telling your child that although the underlying airway inflammation isn’t visible — unlike the injury to a sprained ankle, for example — the problem still needs proper treatment, just as a sprain needs to heal before resuming normal activities.

By the same token, when your child’s PEFR is between 80 to 100 percent of his or her personal best, you can breathe easier about encouraging sports and other physical activities that are vital aspects of improving their overall health and fitness, including their lung functions. Make sure, however, that you and your child know how to manage potential symptoms of exercise-induced asthma (EIA), as I explain in Chapter 18.

Using a peak-flow meter at home

Consider these basic instructions and tips for using most types of peak- flow meters (several different makes and models are currently available). Remember, however, to follow the instructions that come with your specific device. Ask your doctor for specific advice on the most effective way you can use your peak-flow meter to assess your condition.

Generally, you use a peak-flow meter by following these steps:

1. Move the sliding indicator at the base of the peak-flow meter to zero.

2. Stand up and take a deep breath to fully inflate your lungs.

3. Put the mouthpiece of the peak-flow meter into your mouth and close your lips tightly around it.

4. Blow as hard and as fast as possible, like you’re blowing out the candles on your birthday cake.

5. Read the dial where the red indicator stopped. The number opposite the indicator is your peak-flow rate.

6. Reset the indicator to zero and repeat the process twice more.

7. Record the highest number that you reach.

Finding your personal best peak-flow number

Your personal best peak-flow number is a measurement that reflects the highest number you can expect to achieve over a two- to three-week period after a course of aggressive treatment has produced good control of your asthma symptoms. Your best number is usually the result of step-up therapy.

To determine your personal best peak-flow number, take two peak-flow readings a day during an entire week when you’re doing well and record the best result. Take one reading prior to taking medication in the morning and another reading between noon and 2 p.m. after taking an inhaled short-acting bronchodilator. Compare your personal best peak-flow number with the measurement that your physician predicts, which is based on national studies for children or adults of particular heights, sexes, and ages. This number can help you determine how your measurements compare with the norm. When your asthma is well controlled, your PEFR should consistently read between 80 and 100 percent of your personal best.

If your peak-flow measurements fall below 80 percent, early and aggressive intervention with medications and strict avoidance of potential asthma triggers may be necessary to prevent worsening symptoms. Ignoring a declining peak-flow reading can lead to serious symptoms and may result in the need for emergency treatment.

Reading green, yellow, and red peak-flow color zones

The peak-flow zone system involves green, yellow, and red areas, which are similar to a traffic signal. Using your peak-flow meter on a regular basis enables you and your doctor to treat symptoms before your condition deteriorates further.

You or your doctor may want to place small pieces of colored tape next to the actual numbers on your peak-flow meter, corresponding with the green, yellow, and red zones that your doctor provides as a graph on your written asthma peak-flow diary. (See “Keeping symptom records,” later in the chapter, for more about asthma diaries.)

Table 4-2 explains how to read the peak-flow color zones.

Table 4-2 The Peak-Flow Color Zone System

Zone	Meaning	Points to Consider
Green zone	Readings in this area	When your reading falls into the
	are safe.	green zone, you’ve achieved 80 to
		100 percent of your personal best
		peak flow. No asthma symptoms
		are present, and your treatment
		plan is controlling your asthma. If
		your readings consistently remain
		in the green zone, you and your
		doctor may consider reducing
		daily medications.
Yellow zone	Readings in this area	When your readings fall into the
	indicate caution.	yellow zone, you’re achieving only
		50 to 80 percent of your personal
		best peak flow. An asthma attack
		may be present, and your symp
		toms may worsen. You may need
		to step up your medication
		temporarily.
Red zone	Readings in this area	Readings in the red zone mean
	mean medical alert.	that you’ve fallen below 50 percent
		of your personal best peak flow.
		These readings often signal the
		start of a moderate to severe
		asthma attack.

If your readings are often in the yellow zone, even after taking the appropriate quick-relief medication that your asthma management plan specifies, contact your doctor. If your readings are in the red zone, use your quick-relief bronchodilator and anti-inflammatory medications immediately (based on your specific and individualized asthma management plan) and contact your doctor if your PEFR doesn’t immediately return to and remain in the yellow or green zone.

Taking Stock of Your Condition

In addition to obtaining an objective measurement of your lung function with measuring devices, another important aspect of controlling your asthma is keeping track of a variety of other indicators. Your most valuable tracking device is usually a daily symptom diary. In fact, you should develop a rating system (in consultation with your doctor) for your diary that assesses your symptoms on a scale of 0 to 3, ranging from no symptoms to severe symptoms.

Keeping symptom records

Besides serving as a record of your PEFR readings, your daily symptom diary should monitor and record the following:

Your signs and symptoms, as well as their severity

Any coughing that you experience

Any incidence of wheezing

Nasal congestion

Disturbances in your sleep, such as coughing and/or wheezing that awaken you

Any symptoms that affect your ability to function normally or reduce normal activities

Any time you miss school or work because of symptoms

Frequency of use of your short-acting beta ₂ -adrenergic bronchodilator (rescue medication)

Tracking serious symptoms

Your daily symptom diary is also the place to monitor occurrences of symptoms that are severe enough to make you seek unscheduled office visits, after-hours treatments, emergency room visits, and hospitalizations. Therefore, you also want to note the date and kind of treatment that you seek.

Be sure to record the following types of serious symptoms:

Breathlessness or panting while at rest

The need to remain in an upright position in order to breathe

Difficulty speaking

Agitation or confusion

An increased breathing rate of more than 30 breaths per minute

Loud wheezing while inhaling and/or exhaling

An elevated pulse rate of more than 120 heartbeats per minute

Furthermore, record exposures to triggers and/or precipitating factors that may have caused asthma flare-ups, including

Irritants, such as chemicals or cigarette or fireplace smoke

Allergens, such as plant pollen, household dust, molds, and animal fur

Air pollution

Exercise (Chapter 9 provides more information on exercise-induced asthma)

Sudden changes in the weather, particularly cold temperatures and chilly winds

Reactions to beta-blockers (such as Inderal or Timoptic), aspirin, and related products, including nonsteroidal anti-inflammatory drugs (NSAIDs) and food additives — particularly sulfites (see Chapter 5)

Other medical conditions, such as upper respiratory viral infections (colds and flu), gastroesophageal reflux disease (GERD), and sinusitis (see Chapter 5)

Monitoring your medication use

Recording all the side effects that you experience when taking your prescribed medication is also important. Various asthma medications include many levels of side effects that a person can potentially experience. However, in most cases, patients who understand their asthma management plan and take their medications according to instructions have few, if any, adverse side effects. The tables in Chapter 15 provide extensive details on asthma medication products.

I need to emphasize how important it is to know and remember the names of your medications, especially if you’re an older adult with multiple prescriptions. Patients telling me they’re using a “white inhaler” or taking a “yellow pill” aren’t providing the most helpful information in my quest to provide the best care possible and prevent potential adverse drug interactions with medications prescribed by another physician.

Evaluating your inhaler technique

Your doctor should show you the correct way to use your inhaler (see Chapter 15 for detailed instructions on using inhalers) and have you demonstrate your inhaler technique at each office visit. In the best of cases when using inhalers, only 10 to 20 percent of the topical inhaled drug gets into the areas of your lungs where it can really do some good. Because such small amounts of inhaler medications actually reach the airways of your lungs, understanding how to use your inhaler properly is vital to your treatment. Improper inhaler use is often the reason why some patients have difficulty controlling their asthma symptoms.

Understanding Self-Management

It takes two (at least) to treat asthma. You and your physician (as well as your other healthcare providers) are partners in controlling your asthma. Other members of your asthma partnership can include nurses, pharmacists, and other health professionals who treat you or assist you in understanding and finding out more about effectively managing your condition.

If you have asthma, your family also — in a sense — has the condition. Asthma isn’t contagious; rather, your family also has the condition because you all may need to deal with the various issues associated with your medical condition’s treatment. In fact, studies show that family support can be a major positive factor in the success of any asthma treatment plan. Particularly important to your asthma treatment is making sure that the people you live with (as well as co-workers, fellow students, or anyone you’re around much of the time) help you reduce your exposure to asthma triggers and to precipitating factors. I explain in detail the most common triggers and precipitating factors to avoid in Chapter 5.

If your child has asthma, you should also be a partner with your child’s doctor and other medical professionals in the management of your youngster’s condition. (Chapter 18 provides details on managing asthma in children.)

Working with your doctor

Participate in developing treatment goals with your doctor. Make sure that you understand how your asthma management plan works and that you can openly communicate with your doctor about the effects and results of your treatment.

Making sure that your plan is tailored to your specific, individualized needs, as well as your family’s, is also very important. Doing so can include taking into account any cultural beliefs and practices that can have an impact on your perception of asthma and of medication therapy. Openly discuss any such issues with your physician, so that together, you can develop an approach to asthma management that empowers you to take control of your condition. Ensuring that your plan is tailored to fit you and your family results in a more motivated patient, which almost always means a healthier individual.

Evaluating for the long term

Successfully managing your asthma also means constantly assessing your asthma management plan to determine whether it provides you with the means to achieve your asthma management goals.

Always keep in mind that asthma is a variable, complex, multifaceted condition. Just as many other aspects of your life can change and vary over time, your asthma may also manifest in different ways throughout your life. Remember: Your goal is lifetime management of your condition.

Becoming an expert about your asthma

The education process concerning asthma and its treatment should begin as soon as you’re diagnosed. I believe that your doctor should make sure that you have a thorough understanding of all aspects of your condition. Ignorance is not bliss when it comes to managing your asthma effectively. Your process of education should include factors such as the following:

Knowing the basic facts about asthma.

Understanding the level of your asthma severity, how it affects you, and advisable treatment methods.

Teaching you all the elements of asthma self-management, including basic facts about the disease and your specific condition, proper use of various inhalers and nebulizers, self-monitoring skills, and effective ways of avoiding triggers and allergy-proofing your home.

Developing a written individualized daily and emergency self-management plan with your input (see Chapter 2).

Determining the level of support you receive from family and friends in treating your asthma. It’s also important for your doctor to help you identify an asthma partner from among your family members, relatives, or friends. This person should find out how asthma affects you and should understand your asthma management plan so that he or she can provide assistance (if necessary) if your condition suddenly worsens. I advise including your asthma partner in doctor visits when appropriate.

Asking your doctor and/or other members of your asthma management team for guidance in setting priorities when implementing your asthma management plan. If you need to make environmental changes in your life, such as allergy-proofing your home (which may include relocating a pet, taking up the carpets, installing air filtration devices, and many other steps that I explain in Chapter 5), you may want advice on which steps you need to take soonest and which steps can wait.

Improving Your Quality of Life

Taking asthma medication doesn’t mean that you can afford to ignore other aspects of your health. Effectively managing your asthma for the long term also requires being healthy overall. The better you take care of yourself, the more success you’ll have in treating your asthma and living a full, normal life.

Consider these important, common-sense guidelines when developing an asthma management plan:

Eating right. A healthy, well-balanced diet is especially important for people who have asthma. Include fresh fruits, meats, fish, grains, and vegetables in your diet.

Sleeping well. If you experience asthma symptoms during the night that disturb your sleep, tell your doctor. These types of symptoms should be treated, and they may indicate that you’re susceptible to precipitating factors, such as GERD, or asthma triggers such as dust mites in your bedroom (see Chapter 5).

Staying fit. When patients are in good physical condition, their asthma is often easier to control. You don’t have to sit on life’s sidelines just because you have asthma. Your doctor can prescribe medications that you can take preventively to control symptoms of EIA, thus enabling you to enjoy many types of exercise and sports activities in spite of your asthma. (Chapter 9 provides information on appropriate products for controlling EIA.)

Reducing stress. By effectively controlling your asthma, you’ll feel less anxious about your condition, thus reducing the overall levels of stress in your life and further helping you manage your asthma.

Expecting the Best

With effective, appropriate care from your doctor and your own motivated participation as a patient, your asthma management plan can enable you to lead a full and active life. However, if properly following your asthma management plan still doesn’t allow you to participate fully in the activities and pursuits that matter to you, openly communicate this to your physician so that she can adjust your plan and maximize the effectiveness of your treatment.

If, as sometimes happens, your doctor deals only with your asthma symptoms — instead of initiating the type of long-term approach that I discuss in this chapter — you may want to consider requesting a referral to an asthma specialist. Expect to effectively control your asthma, and your doctor should certainly help you achieve this goal.