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Frequently Asked Questions

How can I prevent asthma attacks?
There are many things that you can do to prevent worsening of your asthma. Some of the most important are:

  • Minimize asthma triggers. People with asthma can take an active role in controlling their asthma by identifying those things that trigger their attacks and taking measures to minimize these triggers at home and at work or school. For example, if cats and dogs trigger your asthma, then not having a cat or dog or minimizing exposure to their dander will help to reduce the frequency and severity of asthma attacks. In situations where you cannot avoid the trigger, pretreatment with appropriate medications prescribed by your provider can prevent symptoms.
  • Take your medicine. Many people with chronic asthma take medications (usually an inhaled corticosteroid) that decreases the inflammation of the airways. Studies show that taking these drugs on a daily basis decreases your risk of having asthma attacks. If your provider puts you on a daily asthma medication, it's important that you take it as prescribed and DON'T MISS A DOSE!

What's the best way to determine what I'm allergic to?
If you suspect that you may have allergies as a trigger for your asthma, ask your provider to refer you to a board certified allergist who can perform skin testing or any other procedures needed to properly identify your allergies.

My asthma gets worse whenever I take pain medication. Why?
One possibility is that you are sensitive to aspirin and non-steroidal anti-inflammatory medications, such as ibuprofen. This is a serious asthma trigger and you should completely avoid all of these medications. Your provider should also see you so he can evaluate this problem. In many cases, acetaminophen may be safe to use for the treatment of pain and/or fever.

What are the side effects of my bronchodilator medicine?
Possible side effects of bronchodilators are:

  • Rapid heartbeat
  • Headache
  • Nervousness

These side effects tend to occur more with oral medications, such as pills and liquids that you swallow, rather than with inhaled forms. However, inhaled medications can also cause these effects. The side effects generally go away as your body adjusts to the medication. If the side effects bother you and continue to occur, you should contact your provider.

Can asthma drugs affect an unborn child?
It is normal for mothers-to-be to feel uneasy taking medications while pregnant. However, if a pregnant woman has asthma, it is especially important that her asthma is well-controlled not only for her own health but also for the health and development of her unborn child. If you are pregnant or thinking of becoming pregnant, discuss your asthma with your provider so your airways can be stabilized and appropriate medications prescribed. The risks of uncontrolled asthma in pregnancy are greater than the risks of necessary asthma medications.

How can I prevent coughing, wheezing, and chest tightness after exercise?
You shouldn't avoid exercise because of exercise-induced asthma. Inhaled medications taken prior to exercise can control and prevent exercise-induced asthma symptoms. The preferred medications are short-acting beta 2-agonists such as albuterol.

In addition to taking medications, warming up prior to exercising and cooling down afterwards can help prevent an attack. For those with known allergies, outside exercise should be limited during high pollen days. Outside exercise should also be limited when temperatures are very low or air pollution levels are high. The presence of viral infections, such as colds, can also increase symptoms, so it's best to restrict your exercise when you're sick.

I'm exposed to substances at work that worsen my asthma. What can I do to prevent this?
Generally, if symptoms are worse on days that you work, and improve when you are at home for any length of time, you may be suffering from occupational asthma. This may be allergy-related or a reaction to an irritant from exposure to triggers in your workplace. Identifying and avoiding these triggers and starting an appropriate medical treatment plan will help to stabilize your airways and decrease your symptoms. Your provider can refer you to a specialist to begin the correct treatment program.

I have heartburn. Can it make my asthma worse?
Heartburn is often a sign of a disease called GERD, which stands for gastroesophageal reflux disease. Although studies have shown a relationship between asthma and GERD, the exact relationship is not clear. GERD may worsen asthma symptoms and make asthma harder to treat. If you have coughing that is not completely resolved by taking your asthma medications then inform your provider. GERD may be one of the reasons that your cough persists.

My provider says I'm allergic to mites and mold. How do I avoid them?

Controlling and Avoiding Dust Mites

  • Encase pillows, mattresses and box springs with allergen-proof, zippered covers.
  • Wash all bedding in hot water once a week.
  • Non-carpeted flooring is best. If you cannot get rid of your carpeting, vacuum often with a multi-layer, allergen-proof vacuum bag. Wear a mask while vacuuming. If your child has asthma, do not vacuum while he or she is in the room. Products that eliminate dust mites from carpeting (such as Acarosan) can be purchased. Your asthma care provider can give you information about these products.
  • Avoid curtains and drapes. Use plain window shades instead of mini-blinds. Washable curtains should be washed in hot water every 2 to 4 weeks.
  • Dust all surfaces with a damp cloth often, including lampshades and windowsills.
  • Keep clutter under control. Toys and books should be stored in enclosed bookshelves, drawers or closets.
  • Replace traditional stuffed animals with washable stuffed animals.
  • Keep all clothing in drawers and closets. Keep drawers and closets closed.
  • Cover air ducts with filters or cheesecloth. Change these when soiled.
  • Pillows and bedding should not contain feathers.
  • Keep indoor humidity low (25-50%). Use a dehumidifier.
  • Regularly change filters on heaters and air conditioners.

Controlling and Avoiding Mold and Mildew

  • Air out damp, humid areas frequently. Run a dehumidifier to keep humidity between 25% and 50%.
  • Use air conditioners when possible.
  • Clean bathrooms regularly using products that kill and prevent mold. Use exhaust fans to vent steam. Do not carpet the bathroom.
  • Keep indoor plants out of bedrooms.
  • When painting, add mold inhibitor to paint to prevent mold from growing.
  • Avoid sources of outdoor molds, such as wet leaves or garden debris.

What do I do if I have an asthma attack?
An asthma attack is a sudden worsening of asthma symptoms caused by the tightening of muscles around your airways. If you are experiencing an asthma attack, follow the "Red Zone" or emergency instructions in your asthma action plan immediately. If you have trouble walking or talking, or have blue lips and/or fingernails, call 911 immediately.

Why should I use a peak flow meter?
Readings from a peak flow meter can help you or your child recognize early changes that may be signs of worsening asthma. During an asthma attack, the muscles in the airways tighten and cause the airways to narrow. The peak flow meter alerts you to the tightening of the airways often hours or even days before you have any asthma symptoms. This allows you to know when to take your fast-acting asthma medicine. By taking these medications before you have symptoms, you may be able to stop the narrowing of the airways quickly, and avoid a severe asthma attack.

The peak flow meter can also be used to help you:

  • Learn what triggers your asthma
  • Decide if your asthma action plan is working
  • Decide when to add or adjust medications
  • Know when to seek emergency care
  • It is important to know that your peak flow meter only measures the amount of airflow out of the large airways of the lungs. Changes in airflow caused by the small airways (which also occur with asthma) will not be detected by a peak flow meter. Early warning signs, however, may be present. Therefore it is important for the patient to also be aware of their symptoms and early warning signs to best manage their asthma.

Who should use a peak flow meter?
Peak flow meters are very helpful if you or your child have moderate to severe asthma and require daily asthma medications. Even children ages 4 and up should be able to use them with good results. People with moderate-to-severe asthma should have a peak flow meter at home.

How do I use the peak flow meter?
A peak flow meter is simple to use. Here's what you do:

  • Stand up or sit up straight.
  • Make sure the indicator is at the bottom of the meter (zero).
  • Take a deep breath in, filling the lungs completely.
  • Place the mouthpiece in your mouth; lightly bite with your teeth and close your lips on it. Be sure your tongue is away from the mouthpiece.
  • Blast the air out as hard and as fast as possible in a single blow.
  • Remove the meter from your mouth.
  • Record the number that appears on the meter and then repeat two more times.
  • Record the highest of the three readings in an asthma diary. This reading is your peak expiratory flow (PEF).
  • To ensure the results of your peak flow meter are comparable, be sure to use your meter the same way each time you take a reading.

How often should I check my peak flow?
Peak flow values are best if they are checked at the same time each day, preferably once in the morning and again at night.

How do I determine my "personal best" peak flow number?
The "personal best" peak expiratory flow (PEF) is the highest peak flow number you or your child can achieve over a 2- to 3-week period when asthma is under good control. Good control means you feel good and do not have any symptoms.

Your personal best PEF is important because it is the number to which all of your other peak flow readings will be compared. Your treatment plan, developed along with your asthma provider, is based on this number.

To find your personal best peak flow number, take peak flow readings:

  • Twice a day for 2-3 weeks when asthma is in good control
  • At the same time in the morning and in the early evening
  • Before taking a short-acting beta 2-agonist (a bronchodilator) for quick relief (if you or your child takes this medication)
  • As instructed by your provider or asthma care provider
  • Once you have determined your or your child's personal best PEF, work with your asthma care provider to determine at what point you should start taking quick relief medicines to relieve an asthma attack or seek emergency medical attention. These are called your asthma peak flow zones. All of this information should be recorded in your personal asthma action plan.

Then, continue to take peak flow readings each morning. Daily readings will help you:

  • Recognize early drops in airflow
  • Know when your child's personal best improves naturally as he or she grows
  • If your morning PEF drops below 80% of your personal best, follow your asthma action plan and check PEF more frequently that day or as directed by your provider.

What should I do if I miss a dose of my inhaled steroid?
If you miss a scheduled dose of your inhaled steroids, you can take it if it has only been less than 4 hours from your usual time. Do not double up the next dose to make up for the missed dose.

Can my child grow out of asthma?
The underlying pathophysiology of asthma – what causes it – does not go away. However, clinical symptoms can change with time and with a change in environment. Asthma can get worse or better.

What are the side effects of inhaled steroids?
Generally, the severe side effects of systemic steroids (e.g. diabetes, cataracts, osteoporosis, hypertension) are not seen. There is evidence to suggest a possible decrease in height velocity, particularly in the initial three months of starting ICS. Controversy exists over change in final adult height (there are too many things that affect height). Poorly controlled asthma and repeated courses of oral steroids can affect growth. Local side effects such as oral thrush and sore throat can be mitigated with use of spacer. Rare cases of adrenal suppression have been reported.

Does a nebulizer work better than an inhaler?
Double blind placebo controlled study in the ER showed that there was no difference in hospitalization when comparing patients who received albuterol via inhaler vs. nebulizer. Sometimes during an asthma exacerbation, one may not be able to perform the ideal MDI/spacer technique. In that situation, consider a nebulizer or an increase in the number of puffs of MDI (e.g., give four to eight puffs if needed).

Should I use a spacer?
YES! There is 10 times less absorption of ICS in the oral mucosa, and four to 10 times the amount of medication that gets into the lungs. Even adults should use spacers.