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Keeping your asthma under control

Follow the steps to manage your asthma

There are seven steps to keeping your asthma under control. These include being aware of asthma symptoms, what triggers your asthma, understanding your asthma medicines and when to take them, monitoring your peak flow, following a self-management plan, and visiting your doctor regularly.

Is my asthma under control?

Asthma affects people in different ways. Some people have asthma symptoms most of the time and forget how it feels to be well. Others have episodes of asthma every few weeks.

If you experience any of the following symptoms regularly, then your asthma is not under control:

  • wheeziness
  • coughing 
  • having a tight chest
  • waking at night with coughing or wheezing
  • finding it hard to exercise or hurry because of asthma symptoms
  • using your blue inhaler (reliever) more than 3 to 4 times a week
  • tiredness.

Seven steps to asthma control

  • Step one: Know your symptoms and understand your asthma
  • Step two: Know how your asthma medicines work
  • Step three: Take your preventer and symptom controller every day
  • Step four: Know your triggers and avoid them where possible
  • Step five: Use a peak flow meter and/or a symptom diary 
  • Step six: Understand and follow a self-management plan
  • Step seven: Keep in touch with your doctor.

1: Know your symptoms and understand your asthma

Asthma can sneak up on you slowly. It is very important to recognise early symptoms so you can prevent an attack.

Some early warning signs:

  • you are more aware of your asthma during the day, or 
  • it is more difficult to exercise or maintain your daily activities, or 
  • you wake at night with coughing, wheezing, a tight chest, or 
  • you need your reliever inhaler more often, or 
  • your peak flow readings are up and down.

The longer you ignore your asthma, the harder it is to treat. If you treat your asthma early, you may be able to stop further swelling of your airways. Use your self-management plan to help guide your treatment.

2: Know how your asthma medicines work

Asthma medications include preventers, relievers, symptom controllers and steroid tablets.

Preventers: Your preventer is your most important medication, because it treats the inflammation inside your airways, and reduces the likelihood of an asthma attack. Preventers work slowly. It will take from two weeks to three months for you to appreciate the full benefit of the medicine. Your preventer will help control your asthma for the months ahead. You need to take it regularly, usually twice a day, every day to get this effect.

Relievers: A reliever brings short term relief to your asthma. It relaxes the tight bands of muscle around your airways. This helps air to flow in and out more freely. Take your reliever when you feel tight in the chest or you are coughing or wheezing. See your doctor or asthma nurse if you are using your reliever more than 3 to 4 times a week, as this indicates your asthma is not under control.

Symptom controllers: A symptom controller is a long acting reliever. It is taken twice a day to keep the airway muscle relaxed, and it lasts 12 hours. Symptom controllers are used in addition to the preventer inhaler. They do not replace preventers, which must be taken at the same time. Symptom controllers help people who wake with asthma at night or who have difficulty when exercising. They should not be used for immediate or emergency use. A reliever may still have to be used occasionally.

Combination inhalers: Combination inhalers contain both preventer and symptom controller medicine in the one device. They should be taken regularly as prescribed. The combination inhaler Symbicort may be used in an emergency situation.

Steroid tablets: Steroid tablets (usually prednisone) are used in severe episodes of asthma. They work slowly over several hours to reverse the swelling of the airways. Steroid tablets usually need to be continued for several days after your asthma symptoms settle, to make sure the swelling doesn't return. Also see: Steroid tablets

3: Take your preventer and symptom controller every day

If you are prescribed preventer medication, you must use your preventer inhaler every day, even if you feel fine and are not wheezing.

Take your preventer and symptom controller at the same time every day to help you remember. Some good reminders are:

  • before brushing your teeth, so that you can gargle with water afterwards, or
  • mealtime or tea and coffee breaks, or
  • when your alarm clock buzzes in the morning.

Always clean your teeth or rinse your mouth out after taking preventer medication.

4: Know your triggers and avoid them where possible

A trigger is something that makes your asthma worse. Asthma is easier to handle when you can identify your triggers and avoid them where possible.

Some common asthma triggers are:

  • cigarette smoke
  • colds and flu
  • weather changes 
  • strong emotions
  • allergies - to house dust mite, pets, pollens, etc 
  • exercise - people often have asthma when they exercise, especially if the air is dry, cold or they are unfit. However, when people are active they usually find they have less asthma and can control it better in time. Also see Asthma, breathing and exercise

Some triggers are easily avoided, while others require planning. Also see Asthma triggers

5: Use a peak flow meter and/or a symptom diary

A peak flow meter shows how fast you can blow air out of your lungs. When your airways are swollen you get a low peak flow reading. When your airways are not swollen, the reading increases.

You can use regularly recorded readings along with your symptoms to decide when to change your treatment. Your self management plan will guide you. Get to know your best peak flow rate and try to maintain it. You can get a peak flow meter free from your doctor.

6: Understand and follow a self-management plan

A self-management plan teaches you how to change your treatment to control your symptoms. Research shows that people who follow self management plans control their asthma better than people who don't.  

Preparing for a self management plan:

Before you use a self management plan you need to know your asthma well.  Keep a 2 to 3 week diary of your asthma symptoms and medicine use. Record your results in the morning and in the evening.

  • Record your symptoms and peak flow readings. You may begin to see a pattern:
    -what time of day is your peak flow reading lowest? - highest?
    -are your readings steady or do they change a lot?
    -do your readings change when you take your medicines?
  • Record your medicine use and any extra information, eg:
    -how many puffs per day? Any tablets?
    -how do you react to these medicines?

When you show your doctor or asthma nurse your diary, they will write a plan to maximise the benefits of your medicine.

7: Keep in touch with your doctor

Many people with asthma only visit the doctor when they are unwell. You should also visit your doctor when you are well, to discuss the pattern of your asthma, what triggers it, and how to keep it under control.

Other things you can review are:

  • what times should I take my medication?
  • how many puffs should I take?
  • can I alter these doses as I learn to control my asthma better?
  • might there be side effects?
  • is my self management plan up to date?
  • checking inhaler technique, even after years of use
  • using a spacer with your metered dose inhaler so that 50% more medicine will reach your lungs.

Work through the seven simple steps and take charge of your health.

Related topics

Also see: Puffers and other devices

Original material provided by the Asthma Foundation of New Zealand, June 2009. Edited by everybody, November 2010.


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