Learn To Use Your Inhaler
Asthma is a chronic (life-long) condition that makes it harder to breathe. This is because the airways in your lungs are more sensitive, and get filled with mucus or tighten up when you’re around triggers, making it harder for air to pass through. While asthma can’t be cured, with proper treatment, people with asthma can lead normal, healthy, active lives. Here, you’ll find important “need to knows” about asthma, including symptoms and treatment, and how to stay on top of your condition.
Different people have different asthma symptoms, but there are some common ones, including:
- Feeling short of breath (at rest or when exercising)
- Chest tightness
- Coughing
- Wheezing
If you have these symptoms, see your healthcare provider for a proper diagnosis as these symptoms can also be caused by other conditions.
Childhood vs. Adult Symptoms
Children and adults generally have similar symptoms. But, identifying asthma symptoms in children can be more difficult, especially in younger children who may not be able to tell you how they are feeling.
Here are some things to watch for in your child that could indicate asthma:
- Not being able to keep up with other children while running around
- Having a hard time catching their breath or breathing faster than other children who are doing the same thing
- Looks like they have a cold, which could actually be asthma
- Coughing, especially at night
- Coughing so hard that they vomit
- You may hear wheezing (high-pitched whistling sound)
If you notice any of these symptoms, make an appointment with your child’s healthcare provider to get a proper diagnosis.
Acute vs. Chronic
“Acute” is the medical term for short-term, while “chronic” means long-term. Although asthma is a chronic condition, you can have both chronic and acute symptoms. For example, if asthma is not properly controlled, you can have a cough that doesn’t seem to go away. On top of that, if you’re around a trigger (e.g., pollen) or have a cold, this can cause an acute worsening (shortness of breath). This is why it is critical to try to keep you or your child’s asthma well controlled, including using the treatment prescribed and having an asthma action plan.
Triggers are the things that can cause your asthma symptoms. Each person has their own set of asthma triggers. Triggers can exist at home or even your workplace. Workplace specific triggers are covered within our work related asthma section. Over time you can figure out what your asthma triggers are and take steps to reduce your exposure.
There are two types of asthma triggers:
- Allergens, which only affect you if you are allergic to them
- Irritants, which can bother anyone with asthma.
It is important to work with your healthcare provider to help identify your triggers, and come up with a plan to minimize your exposure.
Allergens
When you breathe in one of your allergens, your immune (defense) system reacts to it in order to remove it. It is this allergic reaction that causes inflammation, swelling, extra mucus, and a tightening of your airways. This blocks the flow of air into and out of your lungs, and causes your symptoms. The most common allergens include:
- Dust mites
- Pet allergens
- Mould
- Wheezing
- Cockroaches
- Food additives (e.g., sulphites)
Irritants
There are many possible irritants – both indoors and outdoors – that can trigger asthma symptoms. Here are some common ones:
Indoor Irritants
- Tobacco and wood smoke
- Strong odours and toxic chemicals
- Exposure to a cold or the flu
Outdoor irritants
- Air pollution (e.g., vehicles, factories)
- Cold air
- Hot, humid weather
- Smoke from wood burning, bonfires, etc.
A good thing to do regularly is check the Air Quality Health Index (AQHI).
The AQHI provides potential health risks associated with air pollution at a given time and recommends steps to take if you are in an “at risk” group, such as having asthma.
Medication Triggers
Certain medications can also trigger asthma symptoms. Let your healthcare providers know about all of the medications you take – including non-prescription and herbal treatments – and check with them before taking any new medication.
During an asthma flare-up or “attack”, your airways can get so blocked that your lungs may not be able to provide enough oxygen to your body. This can be dangerous if left untreated. Whether your asthma is mild, moderate or severe, you need to know how to recognize it and what to do if it happens.
What To Do When You Have A Mild Asthma Attack:
Symptoms:
- Coughing that doesn’t stop
- Trouble breathing
- Chest tightness
- Wheezing (whistling sound in chest)
- Feel restless, irritable and/or very tired
What to do:
STEP 1: Immediately use a fast-acting reliever inhaler (usually a blue inhaler). Use a spacer if provided.
STEP 2: Check your symptoms. If they are gone, you can go back to your normal activities. If they symptoms get worse or do not improve within 10 minutes, this is an emergency. Follow the steps below.
Asthma Emergency:
Symptoms:
- Breathing is difficult and fast
- Cannot speak in full sentences
- Lips or nail beds are blue or gray
- Skin on neck or chest sucked in with each breath
- Feel anxious, restless and/or very tired
What to do:
STEP 1: Immediately use a fast-acting reliever inhaler (usually a blue inhaler). Use a spacer if provided. CALL 911 for an ambulance.
STEP 2: If symptoms continue, use reliever inhaler every 5-15 minutes until medical help arrives.
While waiting for medical help to arrive:
- Sit up with arms resting on a table (do not lie down unless it is an anaphylactic reaction)
- Do not breathe into a bag
- Try to stay calm
- Ask for help if someone is nearby
If you have an asthma attack, make an appointment with your healthcare provider soon after. You may need to adjust your medications or take steps to better manage your triggers.
Download our Managing Asthma Attacks poster.
If you think you might have asthma, it is important to get a proper diagnosis. You can then get the treatment you need to live a full, active life. Click the Symptoms tab to learn more about common symptoms.
There are generally 3 main parts of an asthma diagnosis: medical history, physical examination and testing. Let’s take a closer look.
Medical History
This includes any past and current health issues that could be related to your asthma. Your healthcare provider will ask you about:
- Your medical history and your family medical history, especially relating to allergies
- What symptoms you have had and for how long, For example:
- Have you had a cough? Shortness of breath? Chest tightness? Wheezing?
- Do you have these symptoms at night or in the early morning hours?
- Do you get symptoms when you exercise, have a cold, or are exposed to cold air?
Physical Examination
This includes checking for signs that you might have asthma. Your healthcare provider will:
- Examine your chest and breathing rate
- Use a stethoscope to listen to your lungs for unusual sounds while you breathe
- Examine your nasal passages for signs of allergies
- Examine your skin for signs of eczema
Lung Function Tests
The most common lung function (breathing) test is called spirometry. It measures how well your lungs are working. Children 6 and under may not be able to perform this test, so your healthcare provider will use other examinations to make a diagnosis
If your spirometry test results are normal but your healthcare provider still thinks you might have asthma, you may be sent for further testing. A “challenge test” using either methacholine or histamine can also help diagnose asthma.
Some additional tests your healthcare provider might recommend are:
- Allergy testing to find out what allergens may be causing your asthma symptoms
- Chest x-rays
- Blood test
- Sputum test (looks at phlegm and mucus)
- FeNO (fractional exhaled nitric oxide)
For more information please email us at patientsupport@lunghealth.ca or call us at 1-888-344-LUNG (5864).
The good news about living with asthma is that there are many effective medications that can help you get your asthma under control and live a full, active life. Know that you are not alone – millions of Canadians live with asthma.
There are two types of asthma medications: controllers and relievers.
Asthma Controllers
Controller medications are daily inhalers that control inflammation. They help prevent asthma symptoms and asthma attacks. They should be taken every day, even if you feel well. However, they DO NOT help quickly during an asthma attack. Types of controller medications include:
- Inhaled steroids (corticosteroids) (Examples: Aermony, Alvesco, Arnuity, Asmanex, Flovent, Pulmicort, and Qvar)
The most common type of controller medication, and generally the most effective for controlling asthma long-term.
- Long-acting bronchodilators (Examples: Onbrez, Oxeze and Serevent)
Open up your lungs by relaxing the tiny bands of muscles that surround the airways. Since they can take longer to work than reliever medications, they are not to be used to quickly relieve symptoms (e.g., an asthma attack).
- Leukotriene-receptor antagonists (Examples: include Singulair)
These are daily pills that help control inflammation in the airways. They may be used on their own or in combination with inhaled steroids.
- Combination medications (Examples: Advair, Atectura, Breo, Enerzair, Symbicort, Trelegy, Zenhale, and Wixela).
Combination medications have two medications in one inhaler: an inhaled steroid and a long-acting bronchodilator. They are used when inhaled steroids alone do not fully control your symptoms.
- Biologics (Examples: Cinqair, Dupixent, Fasenra, Nucala, Tezspire and Xolair)
Biologics are a newer type of asthma medication designed to inhibit certain components of the immune system that trigger inflammation, which causes many symptoms of asthma.
Asthma Relievers (Fast-acting Bronchodilators)
These are usually only taken when you need quick relief or during an asthma attack. They can also be used for less severe symptoms or before you exercise. They help open up your lungs by relaxing the muscles that surround the airways. Examples include Ventolin and Salbutamol.
Reliever medications are sometimes called “rescue” medications, since they start working quickly (usually within a few minutes). They are not useful for long-term control of asthma since they do not control the inflammation in your lungs. If you need this medication more than three times a week, talk to your healthcare provider. Some changes in you asthma management may be needed.
Asthma Relievers (Anti-inflammatory reliever)
Symbicort is a combination medication that has a quick and long-acting bronchodilator and inhaled steroid in one device. You may be prescribed to use Symbicort as a controller and reliever by your healthcare provider. If you are needing your Symbicort as a reliever more than 3 times per week, consult your healthcare provider.
To learn more, our healthcare provider, pharmacist, or Certified Respiratory Educator can:
- Explain how each of your asthma medications work
- Discuss any concerns about potential side effects
- Show you how to use your medication inhalation advice
For more information please email us at patientsupport@lunghealth.ca or call us at 1-888-344-LUNG (5864).
How did I get asthma?
Asthma and allergies often run in families and may be passed on in genes. That means you have a higher chance of having asthma and allergies if one or both of your parents has them. However, many people have asthma when nobody else in the family does.
How does my healthcare provider know if I have asthma?
To find out if you have asthma, your doctor will ask you how you’ve been feeling and whether you have any regular coughing or difficulty breathing. Your doctor will also listen to your breathing with a stethoscope. You might be asked to take a breathing test called spirometry, which will help with the asthma diagnosis. Your doctor will ask you and your parents if asthma or allergies run in your family and may prescribe asthma medicines to see if you get better with them. If you do get better after a few weeks of taking these medicines, then you likely have asthma. If you had eczema or food allergies as a child, then there’s a higher chance that you will also have asthma.
Why does asthma make it hard for me to breathe sometimes?
Asthma affects the lower airways (air tubes) inside your lungs. These airways bring oxygen to the rest of your body. If your asthma is flaring up, these airways can get narrower, making it harder to get air in and out of your lungs. Keep your asthma under control by taking your medications as prescribed to help reduce inflammation to keep your airways open, allowing you to breathe easily.
Will I ever outgrow my asthma?
For some people, asthma goes away and never comes back. For others, asthma goes away during childhood or the teen years, only to come back later in adulthood. Unfortunately, some people will always have asthma. Keep your asthma under control and you’ll still be able to what anyone else does, even if asthma stays with you forever.
Why do we use inhalers for asthma?
You take most medicines in pill form, so it might seem strange to take asthma medicine with an inhaler. Asthma medicine often comes in an inhaler because it directs the medicine quickly to where it is needed – your lungs – so you’ll need less medicine as a result.
What’s the best medicine for asthma?
Are my asthma medicines safe for me?
Asthma medicines are generally very safe. Your healthcare provider will try to find the lowest amount of medicine that keeps your asthma under control. Keeping your lungs healthy and being able to exercise normally is important. Inhaled steroids are the most common medicines for treating asthma long-term. Although people have many misconceptions about inhaled steroids, these medicines have great benefits, are generally safe in prescribed doses, and tend to be the most effective asthma medicine.
How do I know if my asthma inhaler is empty?
If you have a pressurized MDI (metered dose inhaler), the kind that sprays the asthma medicine out, then you can shake the inhaler near your ear to listen and feel for the liquid swishing around. Also, if you see that the puff of mist coming out of your inhaler is not as full as before, then it’s probably time to get a new asthma inhaler. You can also try counting the number of doses you use. This is easier if you take the same number of puffs every day. It’s much harder with inhalers that you only use once in a while. Some Turbuhalers have a counter on them. If your Turbuhaler doesn’t have a counter, a red mark will appear in the window on the side of the device when there are about 20 doses left. If you use a Diskus, it has a built-in counter.
If I’m feeling great, why do I need to keep taking my asthma medicine
Some asthma medicines only work if you take them every day. These are called “controller” medicines. They keep your lungs healthy, so if you stop taking them, your asthma can slowly start getting out of control, making it hard to breathe.
Do I need to stay away from sports and exercise if I have asthma?
Keep your asthma under control and you should be able to play sports and exercise just like everyone else. Doctors often recommend that people with asthma take their reliever inhaler (usually blue) before playing sports. A good warm-up before and a cool-down after exercising or playing sports also helps. If you do get short of breath during exercise, stop right away and take your asthma reliever inhaler. Only start again if your breathing is back to normal. If your asthma is not under control, you should not start any exercise.
Every winter I get colds that make my asthma worse. How do I stop getting colds?
It’s probably impossible to stop getting colds altogether, but here are a few things that can help:
- Wash your hands more (colds get passed from your hands to your mouth, nose or eyes).
- Try to stay away from people who have colds (especially in the first few days of a cold).
- Eat healthy foods and sleep enough.
- It’s also a good idea to get a flu shot every fall, to reduce the chances of getting the flu.
I am allergic to pollen. I know pollen comes from trees and plants, but what is it?
Pollen is a fine powder that comes from trees and plants. Trees and plants send pollen into the air to reproduce, and the pollen is carried by the wind. Unfortunately this means pollen can be inhaled into noses and lungs, triggering an allergic reaction.
Are there any dogs or cats that are okay for people who have asthma?
Allergic reactions can be triggered by animal dander, urine, and saliva. Since all furry animals produce dander and all birds have feathers, there are no pets with truly hypoallergenic fur or feathers. If you’re allergic to your pet, the optimal solution is rehoming it. If that’s not feasible, following steps to minimize pet allergens might provide some relief, although these measures are less effective.
Are there any foods that cause asthma symptoms?
Some people need to avoid certain foods that cause asthma symptoms and other allergic reactions. Foods don’t usually make asthma worse, but if you think it is a trigger, ask your doctor for advice.
Where are the best places to live with asthma?
Some people with asthma do benefit from moving to a different climate. For example, a person whose main asthma trigger is dust mites may improve if they move to a high-altitude area such as the Swiss Alps, the Rocky Mountains, or other low-humidity areas like the prairies. Or an outdoor worker with no allergies whose asthma symptoms are triggered mainly by cold air may do better in a warmer climate.
But people with asthma are usually sensitive to many asthma triggers, and the new climate may bring new triggers. For example, a warmer climate may have more air pollution and higher humidity.
To avoid replacing one asthma trigger with a different one when you move, it’s a good idea to spend a trial period of several weeks to months in the new location. Don’t move until you are sure there’s a real improvement in your asthma symptoms.
Consider also that your improvement might be due to leaving a pet at home, being away from the workplace trigger, or having less stress on holiday – nothing to do with climate at all!
Can I live without my asthma medications?
Asthma can improve when an offending asthma allergen and/or asthma trigger has been identified and removed from the home or workplace. Sometimes however, asthma gets better for no apparent reason; children, for example, often outgrow their asthma – although it may return in adulthood. Given this, the amount of asthma medication needed for proper asthma control will change over time. However, asthma medication doses should only be adjusted by your doctor.
If you have had no asthma symptoms for a while, your doctor may advise you to reduce the dose of your asthma controller to see if you still have good asthma control. Under your doctor’s supervision, you may even be able to slowly taper off your asthma medications without recurrence of asthma symptoms. However, you should still carry an asthma reliever inhaler, just in case.
How will pregnancy affect my asthma?
For one-third of women, pregnancy has no affect on asthma symptoms; for another third, asthma symptoms improve; and for the remainder they worsen. Fortunately, whatever changes pregnancy brings to asthma can be usually managed with minor adjustments to medications. If you are pregnant do not stop your asthma medications – poorly controlled asthma can put the baby at risk with low oxygen levels in the blood. If you are pregnant or planning a pregnancy, consult your doctor. Once the baby is born, the level of severity of your asthma may return to what it was. If you’re breastfeeding, standard asthma medications appear to be safe. Once again, contact your doctor if you have any questions or concerns.
I have asthma, so will my child have asthma?
Asthma is sometimes due to heredity; that is, people may inherit the tendency to develop allergies and “twitchy”, or hyper responsive airways. However, most children whose parents have asthma do not develop asthma.
Most important in minimizing your child’s chances of developing asthma are environmental controls, including: not smoking (especially during pregnancy); not allowing smoking in the house when children are small; and avoiding allergens, such as pets and house dust mites.
Are there any asthma breathing exercises that can help my asthma control?
Although there may be many claims about asthma breathing exercises reducing asthma symptoms, or even curing asthma, these claims have not been backed up with adequate evidence. Exercise in general is great for the health of the lungs and heart. However there are no asthma breathing exercises that have been shown with proper studies to be of benefit for people with asthma.
I have more questions about asthma. Where can I get answers?
There is a lot to learn when you’re diagnosed with asthma. You’ll have to learn what asthma is, how it is treated, and how to use your asthma inhalers. So ask questions each time you visit your healthcare provider or pharmacist.
For more information please email us at patientsupport@lunghealth.ca or call us at 1-888-344-LUNG (5864).
Asthma Action Plan
An Asthma Action Plan is a set of written instructions from your healthcare provider that shows you what medicines you need to take, when you should take them, and how you should adjust them if your asthma starts to get out of control. It’s based on the traffic light system:
GREEN
Means your asthma is under control
YELLOW
Means your asthma is getting out of control
RED
is an emergency.
Download an Adult Asthma Action Plan or Pediatric Asthma Action Plan, and fill it out with the help of your healthcare provider.
Peak Flow Meter
Although using a peak flow meter is not necessary for everyone, your healthcare provider may suggest you use one to help track changes in your asthma. A peak flow meter is a hand-held device that you blow into to get a reading of how quickly you can breathe out the air from your lungs. This is known as your “peak flow rate.”
Using a peak flow meter is easy and should only take about a minute. Here is how to use a peak flow meter:
- Set the arrow to zero on the meter’s scale
- Sit up straight or stand for best results and slowly take in a big deep breath
- Place the mouthpiece in your mouth, sealing your lips tightly around it and blow out as hard and fast as possible for just a second
- Record the number
- Repeat the process two more times, recording the highest of your three values in your diary card (do not average the readings)
Use your asthma diary to keep a record of your peak flow rates in table format or plot them out on graph form. Doing a graph helps you see trends occurring over the day or over several days.
How often should you take peak flow measurements?
Peak flow readings can be taken on a regular basis or only at certain times. Regular monitoring may be useful when you are first diagnosed with asthma to determine your normal peak flow rates. Regular monitoring is also important when your asthma is unstable, or for those who do not notice symptoms when their asthma starts getting out of control. If your peak flow rate has dropped below your normal, you can act quickly to get control before it becomes serious.
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