Asthma Management and Control
Asthma is a lifelong condition that can change over time. Managing it isn’t just about treating symptoms when they appear, it’s about staying one step ahead. It means taking charge of your asthma every day to prevent symptoms before they can start. Preventing symptoms means fewer asthma emergencies and a healthier, more active life. You can learn more about asthma management and control at ControlYourAsthma.org.
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.
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What is an Asthma Action Plan?
An 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.
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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 Confusion webpage. 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.
Questions About My Asthma Care
Here are some questions you can print out or save on your phone to discuss with your healthcare provider:
- “Is my current inhaler only for quick relief, or does it also contain a daily controller medicine?”
- “I use my quick-relief inhaler more than twice a week. Does this mean my asthma may not be well controlled?”
- “I heard about a newer ‘2-in-1’ inhaler approach. Could this treatment be a good option for me?”
- “I recently had a serious asthma attack. What steps can we take to lower my risk of another one?”
- “When should I update my Asthma Action Plan?”
- “Do I need a breathing test, such as spirometry, to check how well my lungs are working right now?”
- “My symptoms don’t go away despite taking medicines daily. Is this severe asthma?”
- “Can herbal teas and other culturally-based remedies help with my asthma care?”
Tools to Track Your 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 the 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 Control Questionnaire (ACQ). This is a tool your healthcare provider may use to check your asthma control.
- 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.
- Peak flow meter. This small handheld device can help detect narrowing in your airways before symptoms occur.
- AsthmaTracker. This is a written document that allows you to track your asthma symptoms. It helps you to identify triggers and patterns in your asthma. Available from Allergy & Asthma Network.
- Learn More Breathe Better: Monitor Your Asthma Fact Sheet. This 4-page document includes a tool to help you track your symptoms. It is downloadable as a PDF from the National Institutes of Health. Also available in Spanish.
What is the September Asthma Peak?
September is often a challenging month for people with asthma, especially children. Asthma flare-ups and hospital visits tend to spike in the first few weeks of the month, reaching a peak in the third week. This is called the September Asthma Peak.
The fall asthma spike happens because:
- New triggers: Fall ragweed pollen and mold are common in September.
- Germs: Children are exposed to more respiratory illnesses (cold, the flu) at school.
- Indoor air: When September arrives, people start to spend more time inside, where they may be exposed to indoor air problems. Schools may have indoor mold, use cleaning chemicals or have air fresheners that can affect people with asthma. Classrooms may have open windows that allow exhaust fumes from idling school buses to enter.
- “Summer gap”: Some people may stop taking their daily controller medicines during the summer months. Why? Their symptoms may show signs of improvement, so they mistakenly think they do not need to take their daily controller inhaler. However, asthma inflammation can still be present even when you feel okay. A “summer gap” can lead to an asthma flare-up when exposed to triggers again in the fall.
- Tobacco smoke and vaping: Exposure to these common asthma triggers may increase for schoolchildren when they go back to school.
How to Prepare for the September Asthma Peak
Preparation is the key to staying healthy during the September Asthma Peak. Schedule a checkup with your doctor in August, or before school begins if your child has asthma. Find out if you need to update the Asthma Action Plan before September. It’s also a good idea to review inhaler technique.
For schoolchildren, schedule a meeting with the school nurse. If your child does not yet self-carry a quick-relief inhaler, find out where the school keeps its stock albuterol. Ask if one can be kept in the classroom. Review your child’s Asthma Action Plan with the school nurse and submit any additional healthcare paperwork. Many schools require Asthma Action Plans be kept on file.
Late summer and early fall are good times to schedule annual vaccinations against the flu, COVID-19, RSV and other viruses. This can provide an extra level of protection. Respiratory viruses are a major asthma trigger.
Download a FREE Copy of How to Avoid the September Asthma Peak
Mental Health and Living with Asthma
Living with asthma can be emotionally hard sometimes. Asthma symptoms like coughing, wheezing and trouble breathing can make you feel worried, stressed or upset. Some people may feel nervous about having an asthma attack at school, work, sports, or while sleeping.
Taking care of your mental health is an important part of managing asthma. When these challenges are not addressed, asthma can become harder to control.
Stress and Anxiety
Stress, anxiety and strong emotions can sometimes trigger asthma symptoms. These feelings can cause your breathing to change. Your airway muscles may tighten. You may start to breathe faster or harder. This can lead to an asthma attack.
Asthma flare-ups and feeling shortness of breath can naturally cause long-term worry. Anxiety can lead to hyperventilation, which mimics or triggers an asthma attack. This can create a cycle of fear that is hard to break.
When you’re stressed or anxious, you may notice:
- More coughing or wheezing during stressful times
- Trouble sleeping
- Feeling nervous about asthma attacks
- Using your quick-relief inhaler more often
- Feeling sad, frustrated, or tired
If these things happen often, talk with a healthcare provider to find ways to manage both asthma and stress.
What You Can Do to Avoid Stress
Depression
Some people with asthma may experience depression. Depression is more than feeling sad for a short time. It can affect your thoughts, feelings, energy and daily life. Having both asthma and depression can limit your participation in activities, school or work.
Signs of depression may include:
- Feeling sad or hopeless often
- Losing interest in favorite activities
- Feeling tired most of the time
- Having trouble sleeping or sleeping too much
- Feeling alone or withdrawn from others
Depression can make it harder to manage asthma. You may skip asthma checkups or forget to take daily controller medication.
In addition, certain asthma medicines may include side effects for depression or suicide ideation. It is important to review the side effects with a healthcare provider and monitor mental health while on the medication.
Remember, asking for mental health support is okay. It isn’t a sign of weakness; it’s a part of your asthma care. If you feel signs of depression, talk with a healthcare provider, counselor, mental health specialist, support group or trusted adult.
When asthma and mental health are both cared for, patients often find they have fewer asthma symptoms. It can be easier to breathe, stay active, and enjoy everyday life.
How to Support Your Mental Health and Control Asthma
Simple daily habits can help you feel calmer and more in control of your asthma. In addition to taking asthma medication as directed and following the Asthma Action Plan, it’s important to…
- Get enough sleep each night.
- Stay active and/or get exercise (if your healthcare provider says it’s okay).
- Eat healthy foods and stay hydrated.
- Spend time with family and friends.
- Talk about your feelings with someone you trust.
Relaxation can help too. Some people feel better after:
- Taking slow, deep breaths
- Listening to music
- Stretching or doing light exercise
- Reading, drawing, or journaling
- Spending time outside in fresh air
How to Help Teens Self Manage their Asthma
When young children become teenagers, they naturally seek more independence from their parents. This is normal behavior. Part of this growing independence comes with taking greater responsibility for their health and asthma care.
Parents play an important role by helping teens with asthma gradually build skills and confidence to manage asthma safely and successfully. Encouraging teens to understand their symptoms, avoid triggers and take medications correctly can prepare them to take charge of their care over time.
This can have many benefits for teens. It may improve their physical and mental health, lower the risk of asthma attacks, and improve health outcomes. It can also help teens feel more in control of their daily lives.
Is Your Asthma Bad?
You may have eosinophilic asthma ➤
How do you manage severe asthma?
People with severe asthma have symptoms even while taking high-dose medicines or multiple asthma treatments. Severe asthma may cause frequent coughing, wheezing, shortness of breath, nighttime symptoms. Asthma attacks that can lead to emergency department visits or hospital stays.
Severe asthma can affect daily life more significantly. Some people may have trouble exercising, working, attending school, or sleeping well because of ongoing symptoms.
Avoiding your triggers and following your Asthma Action Plan are important for severe asthma. But many people with severe asthma require advanced medications such as biologics.
Work together with an asthma specialist to develop a treatment plan that helps you better manage severe symptoms and reduce the risk of serious asthma attacks.
Questions & Answers (Q&A) on Asthma Management and Control
Here are answers to common questions about asthma management. If you have a specific question that you’d like to see answered here, please email the editor
June 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).
