Asthma Control

Asthma control is about more than just treating a flare-up. It is about staying healthy every day so you can breathe easy and stay active. When asthma is well-controlled, you should sleep through the night and rarely need a quick-relief inhaler. Learn more about asthma control at ControlYourAsthma.org.

At a Glance: Asthma Control

  • Asthma is under control when you have few symptoms and can breathe well. You should be able to sleep through the night, exercise, and take part in school, work, and other daily activities without asthma getting in the way.
  • Know the signs that asthma may not be under control. Frequent symptoms, waking up at night, using your quick-relief inhaler often, missing activities, taking corticosteroid pills, or going to the ER may mean your asthma needs better treatment.
  • Track your asthma symptoms and breathing. Tools such as the Asthma Control Test (ACT) and a symptom diary can help you see how well your asthma is controlled. Share the results with your healthcare provider.
  • Know what can make asthma worse. Missed medicines, incorrect inhaler use, colds or the flu, stress, and changes in weather can make symptoms worse. Follow your Asthma Action Plan and take your medicines as prescribed.
  • Talk with your healthcare provider if your asthma is not controlled. Your treatment plan may need to change. Your provider may also recommend tests to learn more about you

What is Asthma Control?

Asthma control means you rarely have symptoms, your breathing is strong overall, and you can do everyday activities (including exercise) without feeling short of breath.

When asthma is well controlled, you should have fewer symptoms of coughing, wheezing, chest tightness, or trouble breathing. Good asthma control can also help prevent asthma attacks.

With the right treatment, healthy habits, and support from a healthcare provider, many people with asthma are able to stay active and live healthy lives.

How Do I Know If My Asthma is Under Control?

Your asthma is well-controlled if…

  • You have few or no asthma symptoms most days of a given week.
  • You sleep well through the night, and you rarely wake up at night due to coughing or trouble breathing.
  • Asthma does not limit your daily activities, including exercise, sports, school, work, or play.
  • You only need to use your quick-relief inhaler occasionally – not more than once a week.
  • You do not miss school, work, or other activities because of asthma symptoms.
  • Your peak flow readings indicate your asthma is under control.
  • You feel confident managing your asthma and are less worried about flare-ups or attacks.

If your asthma is NOT under control, work together with your healthcare provider to adjust your Asthma Action Plan and treatment plan. An Asthma Action Plan is a written plan created with a healthcare provider that tells you what medications to take every day, what to do when symptoms worsen, and when to seek emergency care.

How Can Asthma Get Out of Control?

For some people, asthma is like the weather. There may be good days and bad days. Even if you have a sound treatment plan, asthma can occur when you least expect it. Symptoms can get worse over time.

Common reasons why asthma can get out of control include:

  • Not taking medicine as prescribed
  • Poor inhaler technique
  • Using the wrong inhaler at the wrong time
  • Being around triggers like smoke, pollen, mold, pet dander or dust mites
  • Getting sick with a cold or the flu
  • Having stress or strong emotions
  • Sudden changes in temperature or breathing in cold, dry air

If your asthma is becoming harder to control, don’t blame yourself. Talk with your healthcare provider. There may be a reason for the change and additional treatment options that can help.

Children with asthma may have unique symptoms and triggers. They may have symptoms at school, at night, or while playing sports. Work together with your child’s pediatrician and school nurse to develop a plan to keep asthma under control.

What Are the Rules of Two®?

The Rules of Two® is a screening tool that helps you determine your level of asthma control using a series of questions.

Rules of Two
Rules of TWO®
When is quick relief for asthma NOT ENOUGH?
DO YOU….Illustration of a healthcare professional wearing glasses and a stethoscope, smiling and gesturing with one hand. The person has curly hair and is dressed in a white coat over a green shirt, suggesting a friendly and approachable demeanor.

✓ Take your quick relief inhaler more than TWO TIMES A WEEK?

✓ Awaken at night with asthma more than TWO TIMES A MONTH?

✓ Do you refill your quick-relief inhaler more than TWO TIMES A YEAR?

✓ Use prednisone TWO or more times a year for flares of asthma?

✓ Measure changes in peak flow with asthma symptoms of more than TWO TIMES 10 (20%)?

If you answer “yes” to any of them, talk to your doctor.
Rules of Two is a registered trademark of Baylor Health Care System
Download a printable pdf of Rules of Two®

Download and print out the Rules of Two® graphic for a quick and handy reminder to monitor your asthma control. Post it on your refrigerator or medicine cabinet for easy reference.

Two people stand against a patterned wall, each holding a smartphone. The person on the left, wearing a dark jacket, looks at the other's phone. The person on the right wears a colorful sweater and focuses on their screen.

What Tools Can Track Asthma Control?

These simple tools are available to help you monitor your asthma control over time.

  • Asthma Control Test (ACT). This is for adults and children. It consists of five questions that ask about asthma symptoms and their impact on daily activities over the past four weeks. Note: a score of 20-25 on the ACT suggests well-controlled asthma. A score of 19 or less on the ACT indicates poorly controlled asthma.
  • Asthma Impairment and Risk Questionnaire (AIRQ™). This is a 10-question test to measure your asthma control. The score should be shared with a healthcare provider.
  • Pediatric Asthma Impairment and Risk Questionnaire (Peds-AIRQ™). This 8-question test is for children ages 5-11 with asthma. It should be completed by parents or caregivers with input from their child. The score should be shared with a healthcare provider.

How do I track my asthma?

  • Learn More Breathe Better: Monitor Your Asthma Fact Sheet. This 4-page document includes an explanation of how to use a peak flow meter. The peak flow meter is a small handheld device you can use to see if your asthma is in control. Your peak flow may change before you actually have symptoms. It is downloadable as a PDF from the National Institutes of Health. Also available in Spanish.
  • AsthmaTracker. This is a written document to help you track your asthma symptoms. It also can help you identify triggers and patterns in your asthma. Available from Allergy & Asthma Network.

Remember, asthma control isn’t something you check once and forget about. It can change over time. Review asthma control regularly with your healthcare provider and after major changes, such as if you recently had an asthma attack.

How Can Asthma Testing Improve Your Asthma Control?

When you see a specialist for asthma, you may undergo tests to determine your level of asthma control. These tests can help determine if you have moderate to severe asthma. They can also help determine your treatment plan. Do you need to switch to a stronger inhaler or do you need advanced medications such as biologics?

Your doctor may use biomarker tests to learn more about your asthma. These tests look for signs in your breath or blood that show what is causing your symptoms. The three main biomarker tests are:

  • FeNO (Fractional Exhaled Nitric Oxide). This breathing test measures the amount of nitric oxide in your breath. High levels can be a sign of inflammation in your airways. The test can also show how well your daily controller ICS inhaler is working.
  • IgE blood test. This test measures IgE, an antibody linked to allergies. High IgE levels may mean allergies are causing or worsening your asthma. The results can help you and your doctor decide if allergen immunotherapy or biologics are treatment options.
  • Blood eosinophil test. This blood test measures your body’s level of eosinophils, a type of white blood cell. High eosinophil levels may mean you have a type of asthma that responds well to certain biologic treatments.

Your doctor will combine the test results with your symptoms and medication history. Then your doctor can recommend the treatment to help you control your asthma.

A woman with curly hair and a red polka dot dress stands against a white brick wall. She has a hand on her chest and an expression of an asthma attack.

What Should I Do If My Asthma is Not Controlled?

If screening and measurement tools like the Asthma Control Test and AIRQ test indicate your asthma is not well-controlled, what should you do next?

Talk with your healthcare provider. This is the first thing you should do. Your asthma treatment plan may need an update. Or you may need tests to learn more about what is causing your asthma symptoms. Maybe you are exposed to something new that is suddenly triggering your asthma? Your healthcare provider can also help find asthma triggers or other health problems that may be making your symptoms worse.

Review your Asthma Action Plan. Make sure you know which medications to take each day and what to do when your symptoms get worse. Your plan should also tell you when to call your healthcare provider or get emergency care.

Check your inhaler technique. Using your inhaler the wrong way can keep the medicine from reaching your lungs. Demonstrate your inhaler technique to your healthcare provider or pharmacist to make sure you’re using the device correctly.

Know when to get emergency help. Severe asthma symptoms can be life-threatening. Are your symptoms worsening? Quick-relief inhaler not helping? Struggling to breathe or your lips, face or fingernails look blue or gray? These are signs of an asthma emergency. Get emergency medical care right away by calling 911. Or go to the urgent care, ER or hospital. Most ERs are open 24 hours a day, seven days a week. (Consider doing a trial run for an asthma emergency so you know how long it takes to get to the nearest ER and where to go when you get there.)

When to See an Asthma Specialist

Asthma can change over time. Regular checkups can help make sure your treatment continues to meet your needs. (Note: asthma severity and asthma control are not the same thing. You can have mild asthma with poor control. You could have severe asthma with good control.) 

A doctor in a white coat gestures towards a woman who looks concerned, with her hand on her chest. They are in a medical office setting, and the doctor holds a blood pressure monitor.

Here are the signs to watch for that indicate you need to see find a specialist:

Other health problems make your asthma worse. You have other issues like constant sinus trouble, allergies, allergic asthma, or heartburn (gastroesophageal reflux disease, or GERD). These conditions can make your asthma harder to manage.

You had a scary asthma attack. You went to the hospital, urgent care clinic or emergency department in the past year.

Your asthma medicine isn’t working. You take your daily asthma medication as prescribed by your healthcare provider for 3 to 6 months, but you still don’t feel better.

You use your quick-relief inhaler often. You need to use your quick-relief inhaler more than two times a week because of your asthma symptoms.

You use corticosteroid pills to control your asthma. You take oral corticosteroids (pills or liquid) two or more times per year to reverse an asthma flare or attack. Repeat use of oral corticosteroids can increase the risk of serious side effects over time.

Asthma stops you from doing things. You wake up coughing at night, find it difficult to breathe, or you have to slow down and do less during the day.

You have severe asthma. Your asthma is hard to control and symptoms persist most days and nights. In addition, your asthma does not get better with traditional medications such as quick-relief and controller inhalers.

You need special tests. You want to find out exactly what you are allergic to (skin or blood tests). You need advanced tests like spirometry to measure the amount of air in your lungs. Or you need a FeNO (fractional exhaled nitric oxide) breath test to measure airway inflammation.

Questions & Answers (Q&A) on Asthma Control

Here are answers to frequently asked questions about asthma control.

Asthma control requires daily management. Here’s what that looks like:

  • Take your medicines as prescribed.
  • Use your controller inhaler daily.
  • Take your quick-relief (rescue) inhaler when symptoms occur.
  • Follow your Asthma Action Plan.
  • Identify and avoid your triggers when possible.
  • Keep healthcare appointments.
  • Stay physically active.
  • Get recommended vaccines for asthma protection.
  • Monitor symptoms and lung function.
  • Have a plan for worsening symptoms.

Asthma medications are essential to controlling asthma. Taking your medicines as prescribed can help you prevent symptoms and asthma attacks. But asthma inhalers and advanced treatments are often expensive. Many are covered by insurance.

If you find that affording asthma medication is putting a strain on your finances, you have options:

  • Shop around for lower-cost medications at pharmacies and online.
  • Talk with your healthcare provider about generics or biosimilars.
  • Check out patient assistance programs, co-pay cards and other coupons from drug manufacturers.

Check out our “What If I Can’t Afford My Asthma Medication” webpage to learn more and get contract information and website for drug manufacturers.

Allergies can make asthma symptoms harder to control. The same allergens that trigger a stuffy or runny nose, sneezing, and itchy or watery eyes can trigger coughing, wheezing and shortness of breath. 

Common allergy triggers include pollen, mold, dust mites and pet dander. When you inhale an allergen, the airways may become inflamed and irritated, leading to symptoms. This is called allergic asthma.

Treating your allergies may help improve asthma control. Work with your healthcare provider to identify your triggers and develop a treatment plan. Taking your asthma medicines as prescribed and avoiding known triggers can help you prevent symptoms and breathe easier each day.

Some people may develop asthma symptoms – coughing, wheezing, shortness of breath – during or after physical activity. As a result, many people with asthma tend to avoid exercise. However, there are benefits from exercise that help with asthma control. These include:

  • Improved lung function – can build stamina
  • Stronger airway muscles – promotes blood flow to lungs and heart
  • Weight loss – reduces the risk of asthma flares
  • Improved immune system function – reduces the risk of getting respiratory infections
  • Stress reduction
  • Improved sense of well-being and quality of life

Talk with a healthcare provider about your level of physical activity, especially if you are starting to exercise after a long period of inactivity. You may need to use your quick-relief inhaler to pre-treat your asthma before exercise.

Asthma symptoms can be worse at night. This is called nocturnal asthma or nighttime asthma. Here’s how it can happen:

  • Your body undergoes physiological and hormonal changes when asleep. This can affect your lung function.
  • People with asthma may experience more mucus production and postnasal drip at night. This can trigger symptoms.
  • You may be exposed to dust mites, pet dander or other indoor allergens in your bedroom.
  • Comorbid conditions such as heartburn (GERD), obstructive sleep apnea and allergic rhinitis can make asthma worse at night.
  • Body position during sleep may affect lung function. Sleeping flat on your back can allow mucus to pool in breathing passages, triggering nocturnal asthma.

Nocturnal asthma can be very serious. It’s important to take daily controller medications as prescribed. You may want to keep a quick-relief inhaler at your bedside. Making lifestyle changes, such as dust mite-proof bedsheets and pillowcases, can also help.

If your asthma symptoms get worse, use your quick-relief inhaler to help open up your airways and improve your breathing. Then follow your Asthma Action Plan. This tells you:

  • What to do when symptoms start
  • When to use your quick-relief (rescue) inhaler
  • When to call your healthcare provider
  • When to seek emergency care

Stay calm and move away from anything that is triggering your asthma. This could be smoke, strong odors, or allergens.

Pay attention to warning signs such as coughing, wheezing, shortness of breath, or waking up at night because of asthma symptoms. Acting early can help you avoid a serious attack.

If your symptoms do not improve after using your quick-relief inhaler, or if your breathing becomes more difficult, seek medical help immediately.

Stress and anxiety can make breathing feel harder and cause chest tightness. It can also lead to faster or rapid breathing, which can worsen asthma symptoms. Learning to manage stress and anxiety and following your Asthma Action Plan can help keep symptoms under control.

October 2026
Reviewed by:
William E. Berger, MD, FACAAI, is a board-certified allergist and immunologist who serves as a media spokesperson and Chair of the Medical Advisory Council for Allergy & Asthma Network. He is a Distinguished Fellow and Past President (2002-03) of the American College of Allergy, Asthma & Immunology (ACAAI).