Asthma in adults: Gain control

Managing asthma can be complicated. Make it easier with written action plans. Here's help getting started.

You can take charge of your asthma by carefully monitoring your symptoms to see if your asthma is under control — and when it isn't, knowing exactly what steps you need to take. You are the most important member of your asthma treatment team. When you have asthma, you have many responsibilities:

• You may need to take several medications to control your symptoms.
• You may need to take peak flow readings to monitor how well your lungs are working.
• You must be prepared for quick action at the first sign of an asthma attack.

How do you juggle these responsibilities? Get the instructions in writing. Having clear written plans can reduce anxiety and help you control your asthma symptoms — instead of your symptoms controlling you.

Monitoring your asthma with a written plan is important for anyone with asthma, but even more so if you have moderate to severe persistent asthma or you have had severe exacerbations. Written plans can help you:

• Identify triggers that cause your asthma to flare up — and how to avoid them
• Recognize early signs of worsening asthma
• Know what medications you need to use when
• Determine when you need to see a doctor or seek emergency treatment

The approach

To take control of your treatment, improve your lung function and avoid the emergency room, it is helpful to have two written plans:

• A daily self-management plan that lists the steps you need to take to treat and monitor your asthma
• An asthma action plan that tells you what to do if your asthma gets worse

The daily self-management plan

Consider the daily self-management plan a blueprint for managing your asthma. Although formats vary, most daily plans include:

• A list of treatment goals, such as freedom from severe symptoms, being able to participate in favorite activities and limited use of a rescue inhaler
• A list of daily medications, including when to take them and how much to take
• Directions for recording peak flow readings
• Directions for recording symptoms and medication use

As part of your daily self-management plan, your doctor may want you to record information so that you can track your asthma, including:

• Peak flow readings (peak expiratory flow, or PEF)
• Asthma signs and symptoms
• Any activities interrupted by asthma
• Medication use, including daily medications and the number of puffs taken from your quick-relief inhaler in a given day

Your doctor may suggest keeping the information about your asthma in a daily asthma diary. Bring this information with you whenever you visit your doctor.

The action plan

Your action plan should list:

• Peak flow readings (PEF) and symptoms that indicate that you need immediate care
• Emergency telephone numbers for the physician, emergency department, someone who can drive you, and a family member or friend for aid and support

The action plan tells you how to prevent and treat asthma attacks based on certain signs, symptoms and PEF levels. Although formats vary, most action plans include clear instructions to help you:

• Avoid your asthma triggers. The action plan will list your asthma triggers — such as pollen, dust mites, mold, exercise, pet dander, smoke and respiratory infections — and tips for avoiding or minimizing your exposure to them.
• Recognize early warning signs and symptoms. These may include a drop in your peak flow rate, or increased coughing, wheezing, shortness of breath or chest tightness. Worsening signs and symptoms may wake you at night or occur after laughing or minimal exertion.
• Adjust your medication. To prevent a severe attack, the action plan will indicate when to increase your dosage of inhaled corticosteroids or take additional medications, such as short-acting bronchodilators or oral corticosteroids. The plan will tell you how often to take these medications, how much to take and for how long.
• Know when to seek emergency help. Some severe asthma attacks require medical help. Your action plan should list the PEF levels and symptoms that indicate the need for immediate care and should include emergency telephone numbers for your doctor, emergency department, ambulance service, and family or friends you can call for aid and support.

Looking ahead

Once you and your doctor have developed your written asthma plans, keep them in a safe place. Share the plans with a family member or friend who can help you during an emergency. In addition, keep a copy in your wallet or purse in case an asthma attack occurs away from home.

Meet with your doctor periodically to review your action plans and revise them as needed. These checkups are also a good time to reassess self-management skills, such as using your medications correctly and monitoring peak flow.