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.
Symptoms
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 your or your child’s asthma well controlled, including using the treatment prescribed and having an asthma action plan.
Triggers
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.
Let’s take a closer look at each:
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
- 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) at www.airqualityontario.com.
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.
It is important to work with your healthcare provider to help identify your triggers, and come up with a plan to minimize your exposure.
Asthma Attacks
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:
Mild 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.
Diagnosis
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. See 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 under 6 are usually not able to this type of testing, 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)
For more information please Call us at 1-888-344-LUNG (5864) Monday to Friday between 8:30am-4:30pm or email us your question anytime at info@lunghealth.ca.
Treatment
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: Alvesco, Arnuity, 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: Foradil, 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 and Accolate)
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, Breo, Symbicort and Zenhale)
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 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, Salbutamol, Bricanyl, and Airomir.
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.
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 Call us at 1-888-344-LUNG (5864) Monday to Friday between 8:30am-4:30pm or email us your question anytime at info@lunghealth.c
Frequently Asked Questions
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.
Asthma affects the airways (air tubes) inside your lungs. These airways bring oxygen to the rest of your body. If your asthma is getting out of control, these airways can get narrower, making it harder to get air in and out of your lungs. Keep your asthma under control, and your airways will be clear and open, allowing you to breathe easily.
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.
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.
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.
Pet Allergens Animals naturally shed hair, feathers, and dander (skin flakes). 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.
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.
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!
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.
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.
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 doctor or pharmacist. You can also call our toll-free Lung Health Line at 1-888-344-LUNG (5864) Monday to Friday between 8:30am-4:30pm or email us your question anytime at info@lunghealth.ca.
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.
Topic: Building a National Companion Diagnostics Testing Framework
While targeted therapies offer Canadian lung cancer patients hope of extended survival and improved quality of life compared to traditional cancer treatments, the testing needed to match lung cancer patients with therapies is not equitably accessible across Canada.
Triggers are the things that can cause your asthma symptoms. Each person has their own set of asthma triggers. 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
- Irritants
Allergens only affect you if you are allergic to them. Irritants can bother anyone with asthma.
Allergens
When you breathe in one of your allergens, your immune (defence) system is ready to react to it in order to remove it. It is this allergic reaction that causes inflammation, swelling, extra mucus, and a tightening of your airways (bronchoconstriction). 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
- Pollen
- Mould
- Cockroach
Although food is not a common trigger of asthma, additives such as sulphites may trigger asthma symptoms in some people.
Irritants
There are many possible irritants where people live, work, or go to school that can trigger asthma symptoms. You may notice that you get asthma symptoms from some of the following irritants.Indoor Irritants
Most people are aware of the risks from outdoor air pollution. However, indoor air pollution is often worse than outdoor air. We also generally spend a lot more time indoors than outdoors.The following are common indoor irritants that can trigger asthma symptoms.
- Tobacco and Wood Smoke
- Strong Odours and Toxic Chemicals
- A cold or the flu often leads to asthma symptoms.
Outdoor irritants
There are many outdoor irritants that can cause asthma symptoms. They include:
- Air pollution from vehicles, factories, power plants, etc.
- Cold air
- Hot, humid weather
- Smoke from wood burning, backyard burning, and forest fires
Air Quality Health Index (AQHI)
Current air pollution levels and forecast maximums can be found at www.airqualityontario.com. The Air Quality Health Index (AQHI) reports on the health risks associated with air pollution at a given time.The AQHI measures these three air pollutants that are known to be harmful:
- Ozone (O3)
- Particulate matter 2.5 microns (PM2.5) in diameter and less (1 micron is 1/1000 of a mm)
- Nitrogen dioxide (NO2)
The AQHI provides the combined overall general health risk from these three pollutants. Follow the AQHI reports and forecasts, and take steps to reduce your exposure. Adjust your outdoor activity accordingly.
Follow the recommended steps to take based on the AQHI levels and whether or not you are in an “at risk” group (e.g., asthma).
Sign up for air quality alert notifications through Air Quality Ontario.
Medication triggers
Certain medications can trigger asthma symptoms in some people. Let your health-care providers know about all of the medications you take – including non-prescription and herbal treatments. Check with your health-care provider before you take any new medication.The following medications may cause asthma symptoms in some people:
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen—these are often used for cold/flu symptom relief and to relieve pain (e.g., for arthritis, headache, and muscle pain). If one NSAID triggers your asthma symptoms, other NSAIDs will also likely trigger your asthma symptoms
- Beta blockers used to treat high blood pressure, angina, glaucoma, and sometimes tremor
- ACE inhibitors (for high blood pressure and heart disease) can cause a dry cough
If you know that you react to a certain medication, here are some ways to protect yourself:
- If you take a medication and develop asthma symptoms, stop taking that medication and tell your health-care provider and pharmacist right away—ask them for advice on which medications to avoid
- Work with your health-care provider to find an alternate medication that you do not react to
- If you need to avoid certain medications, always check medication labels
- Managing your asthma
Exercise
Regular exercise is a very important part of a healthy lifestyle. If you manage your asthma well, you should be able to exercise. Most people who manage their asthma well should not need to take a reliever inhaler (usually a blue inhaler) before exercising. If you need to take your reliever inhaler more than three times a week (including before exercise) see your health-care provider to find out how to get your asthma under control.Benefits of regular exercise include:
- Helps you to maintain a normal weight
- Reduces your risk of:
- Osteoporosis
- Heart disease
- Diabetes
- Some cancers
- Improved mental health
- Better able to do your normal daily activities
- Prevent falls as you get older
- Longer life
Here are some tips that can help you stay active:
- Do not start exercising if you have any asthma symptoms
- Warm up by starting at a slower pace—increase the pace slowly
- If you need to take a reliever inhaler before exercising, it should be taken about 10-15 minutes before the activity
- If you develop asthma symptoms while exercising, stop immediately—use your reliever inhaler and do not start again unless your symptoms are completely gone.
- Consider exercising indoors when outdoor conditions may trigger your asthma (e.g., when there is high air pollution or pollen levels, cold air, or hot humid air)
- When exercising in cold weather, cover your nose and mouth with a scarf or cold weather mask
- If symptoms continue, your asthma may not be under control—work with your health-care provider to improve your asthma management
During an asthma flare-up, your airways can get so blocked that your lungs may not be able to provide enough oxygen to your body or remove enough carbon dioxide. This can be dangerous if left untreated. Whether your asthma is mild, moderate or severe, it needs to be taken seriously and managed properly.
WHAT TO DO WHEN YOUR ASTHMA GETS OUT OF CONTROL
- Mild Asthma Attack
- Continuous Coughing
- Trouble Breathing
- Chest Tightness
- Wheezing (whistling sound in chest)
- Person may also be restless, irritable and/or very tired
STEP 1: Immediately use fast-acting reliever inhaler (usually a blue inhaler). Use a spacer if provided.
STEP 2: Check symptoms. Only return to normal activity when all symptoms are gone. If symptoms get worse or do not improve within 10 minutes, this is an emergency – follow steps below.
ASTHMA EMERGENCY
If any of the following occur:
- 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
- Person may also be anxious, restless and/or very tired
STEP 1: Immediately use 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:
- Have person sit up with arms resting on a table (do not have person lie down unless it is an anaphylactic reaction).
- Do not have person breathe into a bag.
- Stay calm, reassure the person, and stay by his/her side.
- Notify emergency contact if known.
After you’ve had a worsening of your asthma or an asthma attack, make an appointment with your health-care provider. There may be a need to adjust the doses of your medications. You can also discuss possible reasons why your asthma got out of control and find ways to prevent this in the future.
Different people have different asthma symptoms, which can change over time or depending on the situation. Common asthma signs and symptoms include:
- Feeling short of breath (at rest or when exercising)
- Chest tightness
- Coughing
- Wheezing
These symptoms can also be caused by other conditions. If you have these symptoms or if you think you might have asthma, see your doctor for a proper diagnosis.
ASTHMA SYMPTOMS – CHILDHOOD VS. ADULT?
Childhood asthma symptoms are generally similar to adult asthma symptoms. However, determining asthma symptoms in children can be a bit more difficult. Adult asthma symptoms are easier to determine since an adult can tell you how they are feeling plus they know their body better. Although you can see and hear the coughing and shortness of breath (laboured breathing, faster breath rate) in younger children, they may not be able to let you know how they are feeling. Plus young children are not able to do a breathing test called spirometry.
- 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 typical childhood asthma symptoms, see your doctor to find out if it is due to asthma.
ASTHMA SYMPTOMS – ACUTE VS. CHRONIC
In medical related matters, “acute” simply means short term, and “chronic” means long term. Although asthma is a chronic disorder, since it usually lasts a long time (often a lifetime), you can have both chronic and acute asthma symptoms. If someone does not properly manage their asthma, they can have regular chronic symptoms for many weeks, months, or even years. For example, they could experience a regular cough that lasts a long time if not managed properly.
Then on top of the regular chronic cough, they may also sometimes experience an acute asthma worsening that leads to a symptom such as shortness of breath. This could perhaps be due to getting a cold, or exposure to pollen or air pollution.
When someone has asthma, it is very important to keep it well controlled so that there are no chronic asthma symptoms. You can’t avoid all asthma symptoms all the time, but in general the symptoms should be uncommon and mild.
It is also very important to monitor your asthma so that you notice when there are acute asthma symptoms starting and can take the necessary measures to get it under control before it leads to an asthma attack. A written asthma action plan from your doctor can be very helpful in guiding your treatment decisions.
For more information please Call us at 1-888-344-LUNG (5864) Monday to Friday between 8:30am-4:30pm or email us your question anytime at info@lunghealth.ca.
If you think you might have asthma, it is important to get a proper diagnosis. Once asthma is diagnosed, it is possible to manage it well so that you can live a full active life. There are many people who have asthma but do not know they have it. The diagnosis of asthma is based on many factors including:
- Medical history
- Physical examination
- Test results, such as a lung function test
MEDICAL HISTORY
- Your medical history includes any past and current health issues that could be related to your asthma. Your health-care provider will ask you about:
- Your medical history and your family medical history (e.g., allergies, eczema, hay fever)
WHAT SYMPTOMS YOU HAVE HAD AND FOR HOW LONG?
- Have you had a cough? Shortness of breath? Chest tightness? Wheeze?
- 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
A physical exam includes checking for signs that you might have asthma. Your health-care 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
Lung function tests (breathing tests) such as spirometry are an important part of diagnosing asthma.
- Spirometry testing involves taking in a deep breath and breathing out as hard and long as you can into a tube. Once all your air has been exhaled, you then inhale as fast and deep as you can until your lungs are totally full. This test measures important flows and volumes and compares them to normal values.
- Spirometry testing is often done before and after using a reliever inhaler (bronchodilator) to see if there is a change in your lung function
- People under six years of age are not usually able to do a spirometry test
If your spirometry test results are normal but your health-care 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.
ALLERGY TESTING
Your health-care provider may refer you to an allergist for an allergy assessment. This may include an allergy skin test that tests you for reactions to specific allergens (e.g., pets, dust mites, pollen, mould). This can help you find out what allergens may be causing your asthma symptoms.
An allergy skin test involves placing drops of allergens on your forearm or back and making small scratches in the skin where the drops are located. The amount of redness and swelling caused by these allergens will help to show if you have any allergies.
TRIAL OF ASTHMA MEDICATIONS
Your health-care provider may prescribe asthma medications for you to take to see if they improve your asthma symptoms. If asthma medications improve your symptoms, this increases the likelihood that you have asthma.
OTHER TESTS
- Chest x-rays are not very useful in the diagnosis of asthma, but they may help rule out other reasons for your symptoms.
- A blood test or sputum (phlegm, mucus) test may sometimes be ordered. Diagnosing Asthma in Young Children
DIAGNOSING ASTHMA IN A YOUNG CHILD CAN BE MORE CHALLENGING BECAUSE:
- Children under six years of age are not generally able to do a lung function test
- Symptoms such as cough and wheeze are fairly common in very young children who do not have asthma
However, a diagnosis of asthma can be made in a young child. Your health-care provider will assess:
- What symptoms does the child have?
- When do the symptoms occur (e.g., seasonal, during colds)?
- Is there a history of allergies or asthma in the family?
- Does the child have any signs of allergies (e.g., congested nose, eczema)
- Do the symptoms improve when taking asthma medications?
For more information please Call us at 1-888-344-LUNG (5864) Monday to Friday between 8:30am-4:30pm or email us your question anytime at info@lunghealth.ca.
Medications are usually needed for asthma, even if it’s mild asthma. New asthma medications are continually being discovered and there are several effective asthma drugs in the market that help get asthma under control.
There are two types of asthma medications: controllers and relievers.
Asthma Controllers
These are usually taken every day, even if you feel well. They help prevent asthma symptoms and asthma attacks. However, they do NOT help quickly during an asthma attack. Types of controller medications are listed below:
1. Inhaled steroids (corticosteroids)
Controller medications are daily inhalers that control the inflammation in the airways of your lungs. This type of medication is generally the most effective for controlling asthma long term. Examples include Alvesco, Arnuity, Flovent, Pulmicort, and Qvar.
Possible side effects of inhaled steroids:
- Hoarseness and sore throat
- Thrush or yeast infection – looks like a whitish layer on your tongue. You can help prevent thrush by rinsing your mouth after taking the medication and by using a spacer when using a metered dose inhaler.
Your doctor will adjust your dose so you get the best asthma control using the least amount of medication. For a full list of side effects, see your doctor or pharmacist. In most cases, inhaled corticosteroids have few side effects with the dose needed to control asthma.
2. Long-acting bronchodilators
These inhalers open up your lungs by relaxing the tiny bands of muscle that surround the airways. Since they can take longer to work than the reliever medications, they are not to be used to quickly relieve symptoms, such as during an asthma attack. Examples include Foradil, Onbrez, Oxeze, and Serevent.
Possible side effects of long-acting bronchodilators:
- Increased heart rate
- Anxiety
- Tremors (shaking) in the hand
3. Leukotriene-receptor antagonists
Leukotriene-receptor antagonists are daily pills that help control inflammation in the airways. For people with mild asthma, doctors may prescribe leukotriene receptor antagonists alone, however they are generally not as effective as low dose inhaled corticosteroids. Doctors may also prescribe leukotriene receptor antagonists to people who are already taking inhaled corticosteroids to help further reduce symptoms or to help reduce the dose of corticosteroid. Examples include Singulair and Accolate.
Possible side effects of leukotriene-receptor antagonists:
- Headache
- Dizziness
- Heartburn
- Upset stomach
For a full list of side effects, see your doctor or pharmacist. In general, side effects from leukotriene receptor antagonists are uncommon.
4. Combination medications
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. Examples include Advair (Flovent + Serevent), Breo (Fluticasone + Vilanterol), Symbicort (Pulmicort + Oxeze), and Zenhale (Mometasone + Formoterol).
5. Biologics
Biological medications, often called biologics, are a relatively new type of medication for asthma. Compared to most medications that are made using chemical reactions, biologics are made using living systems (e.g., bacterial/viral cells, plant or animal cells). An example of a common biologic is the flu vaccine, which is usually grown in chicken eggs.
Biologics are designed to inhibit certain components of the immune system that trigger inflammation—and it is inflammation in the airways that cause a lot of the asthma symptoms.
Biologics for treating asthma now include Xolair® (available since 2005), Cinqair™, Nucala™ and Fasenra®.
Xolair®
Medication class: IgE-neutralizing antibody (Anti-IgE)
Immunoglobulin E (IgE) is a type of protein that our bodies naturally make in small amounts. In allergic asthma the IgE increases abnormally, causing swelling and tightening of the airways. Anti-IgE therapy reduces the ability of IgE to cause symptoms.
If you are following all the correct steps in managing your asthma but are still having a hard time getting your asthma under control, then your health-care provider may decide to send you for Xolair® injections. Xolair® may be prescribed to reduce the symptoms of asthma due to allergic triggers for individuals aged 12 and older.
If you are sent for Xolair® injections, you will receive them every two to four weeks. You need to continue using all of your asthma medication as prescribed by your health-care provider.
Possible side effects should be explained to you by your health-care provider.
Cinqair™, Nucala™
Medication class: Interleukin-5 (IL-5) inhibitor
Cinqair™ is given by intravenous infusion every four weeks.
Nucala™ is given by subcutaneous injection every four weeks.
IL-5 inhibitors are sometimes prescribed for the maintenance treatment of severe asthma in patients aged 18 years or older. It may be added when someone’s asthma is not under control despite using medium to high doses of inhaled corticosteroids plus another controller medication.
IL-5 inhibitors are only effective for people who have a certain level of eosinophil, a type of white blood cell in your blood. Your health-care provider will check your blood eosinophil level before prescribing the medication.
Possible side effects should be explained to you by your health-care provider.
Fasenra®
Medication class: Anti-eosinophil (anti-interleukin-5 receptor alpha monoclonal antibody)
Fasenra is used in addition to other asthma medicines for the maintenance treatment of adult patients with severe eosinophilic asthma, whose asthma is not controlled with their current asthma medicines. Severe eosinophilic asthma is a type of asthma where patients have increased eosinophils in the blood or lungs. Eosinophils are a type of white blood cell that are associated with inflammation of the airways that can cause your asthma to get worse or can increase the number of asthma attacks.
Fasenra works by reducing the number of eosinophils in the blood and lungs and helps reduce the number of asthma attacks that you experience.
Fasenra is given to you as an injection just under the skin (subcutaneously) by a healthcare professional. The injection is given every 4 weeks for the first 3 injections, and then every 8 weeks thereafter.
Possible side effects should be explained to you by your health-care provider.
Asthma Relievers (Fast-acting Bronchodilators)
These are usually only taken when needed for quick relief or for an asthma attack. They help open up your lungs by relaxing the muscles that surround the airways.
Reliever medications are sometimes called “rescue” medications or “quick relief” medications, since they start working quickly (usually within a few minutes). This is the inhaler you use when you have an asthma attack. It is also used for less severe symptoms, or before you exercise. These medications 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, see your doctor. Examples include Ventolin, Salbutamol, Bricanyl, and Airomir.
Possible side effects of reliever medications:
- Trembling
- Nervousness
- Flushing
- Increased heart rate
1. Spacer (Holding chamber)
This is a plastic device that is used with pressurized inhalers (the kind that spray the medication out) to better deliver medication to your lungs. It makes it easier to coordinate inhaling the medication from the inhaler. You get more medication in your lungs and less in your mouth and throat.
2. Corticosteroid Pills
Sometimes, the swelling in people’s airways is severe – this may be because they have a chest infection or for some other reason. In cases of severe airway swelling, the doctor may prescribe corticosteroid pills to reduce the swelling, redness, and mucus in the airways. Corticosteroid pills basically do the same thing as inhaled corticosteroids, but they are more powerful. Doctors often prescribe these pills for a short time to get the swelling under control. Examples of corticosteroid pills include Prednisone, Prednisolone (PediaPred®), and Dexamethasone (Decadron®).
For a full list of side effects, see your doctor or pharmacist. In the short term (e.g., 7-10 days) side effects of corticosteroid pills may include:
- Increased appetite
- Mood changes
- Water retention
- Hyperactivity in children
In the long-term (prescriptions that last many weeks or months) side effects of corticosteroid pills may include:
- Increased appetite
- Weight gain
- Stomach irritation
- Bone thinning
Dependency: your body can go into withdrawal if you stop taking prednisone all of a sudden. Your doctor may ask you to taper off your dose slowly.
Where to Learn More
Your doctor, 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
Ontario residents can reach our Certified Respiratory Educators through our toll-free Lung Health Information Line at 1-888-344-LUNG (5864).
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.
Asthma affects the airways (air tubes) inside your lungs. These airways bring oxygen to the rest of your body. If your asthma is getting out of control, these airways can get narrower, making it harder to get air in and out of your lungs. Keep your asthma under control, and your airways will be clear and open, allowing you to breathe easily.
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.
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.
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.
Pet Allergens Animals naturally shed hair, feathers, and dander (skin flakes). 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.
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.
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!
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.
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.
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 doctor or pharmacist. You can also call our toll-free Lung Health Line at 1-888-344-LUNG (5864) Monday to Friday between 8:30am-4:30pm or email us your question anytime at info@lunghealth.ca.
Click here to learn how to use your inhaler.
Asthma Action Plan
An Asthma Action Plan is a set of written instructions from your doctor 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 health care 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.