Asthma Management and Control
At a Glance: What This Guide Covers
Asthma management 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 quick-relief inhaler. This guide offers:
- Asthma Control Quiz and Tests. Simple questionnaires to know when your quick-relief medicine is not enough.
- How to check your control. Use the “Rules of Two” to see if your current treatment is working.
- Trigger avoidance. How to find and remove the things in your home or environment that can trigger your symptoms.
- Seeing an allergy or asthma specialist. The most common asthma specialists are allergists and pulmonologists.
Check your asthma control
Do you need your quick-relief (rescue) inhaler more than two times a week for your asthma? Do asthma symptoms wake you up more than two times a month? Do you need to take oral corticosteroid pills (such as prednisone) more than twice a year? If you answered yes to any of these questions, your asthma may not be well-controlled. Talk with an asthma specialist about your treatment plan. Taking the right steps today can help you feel better in the long-term.
How do I know if my asthma is controlled?
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 your healthcare provider, many people with asthma can stay active and live healthy lives.
What Does ‘Well-Controlled Asthma’ Mean?
Your asthma may be 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.
- 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.
5 Questions to Check if Your Asthma is Controlled
Here are five questions you can ask yourself – or your child – to determine if asthma is under control. These are based on the Rules of Two®, a screening tool to help measure asthma control.
- In the past month, have you used your quick-relief inhaler more than twice a week?
- In the past month, have you awakened at night with asthma symptoms?
- In the past month, have you had to slow down, change, or reduce your daily activities due to asthma symptoms?
- In the past 12 months, aside from inhaled corticosteroids, have you needed oral (tablet), liquid or injectable corticosteroids more than two times?
- In the past 12 months, have you been to the hospital, emergency department or urgent care for asthma symptoms?
If you answer “Yes” to any of these questions, talk to a healthcare provider about asthma control. You may need to adjust the Asthma Action Plan and treatment plan.
| Rules of Two |
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| Rules of TWO® When is quick relief for asthma NOT ENOUGH? DO YOU….  ✓ 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 |
Why Asthma Can 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 symptoms are getting worse, speak with your healthcare provider. Sometimes even small changes can help you get your asthma back in control.
How to Prevent Asthma Symptoms Before They Start
Take steps to stay ahead of asthma symptoms and flare-ups. Avoiding triggers, taking medications correctly, staying active, and following your treatment plan can help keep asthma under control.
Avoid Your Asthma Triggers
Knowing what triggers your asthma can help you prevent symptoms before they start. Common triggers include respiratory viruses, pollen, mold, dust mites, pet dander, smoke, strong odors and cold, dry air. Once you identify your triggers, you and your healthcare provider can create a plan to reduce exposure and improve asthma control.
Some simple lifestyle changes can make a difference in your breathing:
- Avoid tobacco smoke. Stay away from cigarettes, cigars, vaping, and pipe smoke. This includes secondhand smoke.
- Clean the bedroom. Keep pets out of the bedroom. Use dust-mite-proof covers on pillows and mattresses. Wash bedding weekly in hot water.
- Clear the air. Vacuum and dust regularly. Reduce mold and moisture. Don’t use strong fragrances, air fresheners, and harsh cleaning products that may irritate the lungs.
- Check pollen and air pollution. Stay indoors when pollen counts or outdoor pollution levels are high. Keep doors and windows closed during peak allergy seasons.
You cannot avoid every trigger, so medicines are often an essential part of your treatment plan. They can help keep your asthma under control even when you are exposed to a trigger.
Allergen immunotherapy (also called allergy shots) is another way to prevent asthma symptoms. It’s a long-term treatment that can help reduce your body’s reaction to asthma triggers. Talk to your healthcare provider about whether allergen immunotherapy is right for you.
Exercise and Asthma
Most people with asthma can safely exercise, play sports, and stay active. Regular physical activity is not only important for overall health, but also for healthy lungs. The benefits of exercise for people with asthma include improved lung function, stronger immune system, stress reduction and weight loss.
Before beginning exercise or playing sports, always make sure your asthma is well-controlled.
Some people have exercise-induced asthma (also called exercise-induced bronchoconstriction, or EIB). This causes coughing, wheezing, chest tightness, or shortness of breath during or after physical activity.
Your healthcare provider may advise you to pre-treat your airways with a quick-relief albuterol inhaler. Take it 15-20 minutes before exercise to help prevent symptoms. It’s also important to warm up properly and stay hydrated.
Inhaler Technique
Even the best asthma medicine will not work well if your inhaler technique is incorrect. This is one of the leading causes of uncontrolled asthma.
During an asthma checkup, ask your healthcare provider to watch how you use your inhaler. Small adjustments in timing, breathing, or positioning can make a difference. If you use a metered-dose inhaler, a valved holding chamber or spacer may help more medicine reach your lungs.
What is an Asthma Action Plan?
n Asthma Action Plan can help you keep your asthma under control. It’s a personal guide for maintaining your asthma and knowing what to do if symptoms get worse.
This written plan, created with your healthcare provider, tells you:
- What to do every day to stay well
- What to do when symptoms start
- When to call your healthcare provider or get emergency help
Most Asthma Action Plans use a simple “stoplight” system:
- Green: You feel good. Stay on your daily plan.
- Yellow: Symptoms are starting. Take action early.
- Red: This is an emergency. Get help right away.
Every person with asthma should have an Asthma Action Plan. Review it regularly with their healthcare provider.
Do You Have an Asthma Action Plan?
If not, work together with your healthcare provider to create one. It is one of the most important tools for maintaining asthma control and preventing asthma attacks. Check out sample Asthma Action Plans. Print one out and bring it to your next appointment with your healthcare provider.
Need help managing your asthma?
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When should I see an asthma specialist?
Asthma is an ever-changing condition that requires constant attention. If you have asthma symptoms that disrupt everyday activities, then a visit to an asthma specialist is in order.
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 at night coughing, 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 spirometryto measure the amount of air in your lungs. Or you need a FeNO (fractional exhaled nitric oxide) breath test to measure airway inflammation.
Quick-Relief (Rescue) vs. Controller Inhalers: What’s the Difference?
Using asthma medications as prescribed is a key part of asthma management and control.
When first diagnosed with asthma, you may be prescribed two inhalers: 1) quick-relief (rescue) inhaler, and 2) daily controller inhaler.
Quick-relief (rescue) inhalers are sometimes referred to as short-acting beta-agonists, or SABA. They contain albuterol or levalbuterol. Symptom relief starts almost immediately and lasts 3-6 hours. This is the asthma treatment to use if you experience a sudden onset of symptoms or an asthma attack.
Daily controller inhalers are typically anti-inflammatory medications. They often contain an inhaled corticosteroid. Controller inhalers treat and prevent airway inflammation. They can also reduce mucus. These medications usually need to be taken every day to prevent and control symptoms. They are also helpful with preventing asthma attacks.
Think of the two medications like this:
- Quick-relief (rescue) inhaler is like a fire extinguisher (for emergencies).
- Daily controller inhaler is like a smoke detector (for prevention).
Confused about the variety of asthma inhalers on the market? Unsure about which is best for you? Check out our Inhaler Confusionwebpage. Remember,using the right inhaler at the right time is essential for asthma control.
New ‘2-in-1’ Approach for Asthma Relief
New asthma treatment guidelines support a “2-in-1” approach for certain people with asthma. This uses a single inhaler that is a combination of two medicines. Instead of using separate inhalers for daily control and symptom relief, the same inhaler may be used for both.
This approach can help simplify asthma management and improve control of symptoms.
SMART Therapy
SMART stands for single maintenance and reliever therapy. It combines:
- a long-acting bronchodilator (formoterol) to quickly open the airways for relief from acute asthma symptoms
- an inhaled corticosteroid (ICS – budesonide or mometasone) to reduce airway inflammation
This allows people with asthma to use a SMART therapy inhaler as both an ICS controller medication and for quick relief of acute asthma symptoms.
SABA and ICS Combination
This “2-in-1” inhaler is intended for quick relief of asthma symptoms. It combines:
- a short-acting bronchodilator (albuterol) to quickly open the airways for relief from acute asthma symptoms
- an inhaled corticosteroid (budesonide) to reduce airway inflammation
This SABA and ICS combination can help reduce the risk of an asthma attack.
Remember: not every asthma treatment works the same for every person. Your age, asthma severity, symptoms, and medical history can play a role in choosing the best treatment plan. Talk with your healthcare provider about what inhaler approach may be right for you.
Resources from the National Heart, Lung, and Blood Institute of the NIH
Is Your Asthma Bad?
You may have eosinophilic asthma ➤
What is the September asthma peak?
September is often a challenging month for people with asthma, especially children. Studies show asthma flares and hospitalizations tend to spike in the first few weeks that children are back at school
- Why does this happen? Some factors include:
- fall ragweed pollen and mold (both are common asthma triggers)
- greater exposure to respiratory illnesses, including the common cold
- indoor allergens at school, such as mold, chalk dust and dander from school pets
- not following a treatment plan or taking prescribed medications during the summer (when symptoms are often less noticeable)
Preparation is the key to keeping your child healthy. Schedule wellness doctor appointments before school begins, make sure your child continues to take asthma medications as prescribed and review your child’s Asthma Action Plan and inhaler technique. Many schools require Asthma Action Plans be kept on file.
Download a FREE Copy of How to Avoid the September Asthma Peak
Some people mistakenly call quick relief medications “rescue” medications but this is a life-threatening misunderstanding.
Quick-relief bronchodilators should be used to relieve breathing at the first sign of symptoms – the earlier you use the medication, the less you are likely to need.
