Finding Your Asthma Management Plan

Nearly 20 million people in the United States have asthma, with symptoms that range from mild to severe. Their onset of symptoms may be slow or rapid, and symptoms may occur occasionally or every day.

If you have asthma, you have inflamed airways -- the bronchial tubes that carry air in and out of your lungs. This inflammation, or swelling, makes the airways sensitive to substances that irritate them, according to the National Heart, Lung and Blood Institute (NHLBI). When the airways react to an allergen or irritant, they get narrower, which cuts down on the amount of air flowing in and out of your lungs. This makes it difficult to breathe. Cells in the airways also may make more mucus than normal, further narrowing the airways.

Asthma can't be cured, but you can control it to reduce the amount and severity of your symptoms. Your health care provider can help you learn to manage your condition and live an active, normal life.

Treatment plan

According to guidelines established by the NHLBI, asthma treatment involves monitoring air flow by a peak flow meter, taking medications to control symptoms and avoiding triggers.

Treatment is tailored to the severity of your asthma. Asthma is typically divided into four levels, says Christopher C. Randolph, M.D., a fellow of the American Academy of Allergy, Asthma and Immunology:

1. Mild intermittent. Daytime symptoms occur twice a week or less; nighttime symptoms, twice a month or less.

2. Mild persistent. Daytime symptoms occur more than twice a week but less than once a day; nighttime symptoms, more than twice a month.

3. Moderate persistent. Daytime symptoms occur every day; nighttime symptoms, more than once a week.

4. Severe persistent. Daytime symptoms occur constantly and likely limit daily activities; nighttime symptoms occur frequently.

How medicines help

Medications are considered the cornerstone of asthma management. Depending on your particular symptoms, your doctor most likely will prescribe one or both of these types:

• A quick-relief medication, such as a short-acting bronchodilator, which relaxes muscles around the airways during an asthma attack. Breathing it in through an inhaler helps ease symptoms rapidly. But, this medication doesn't prevent future attacks. That's why most people with asthma need another type of medication, too.

• Long-term control medications, which are anti-inflammatory medications that work over time to help keep airways clear. Even when you aren't having symptoms, you take this medicine every day to help prevent future asthma attacks. Inhaled corticosteroids, which help reduce swelling, tend to be the first line of treatment. Other medications that reduce inflammation and improve long-term control include cromolyn sodium, zafirlukast and montelukast.

Once you start taking asthma medications, make sure that your doctor is aware of your symptoms and how you're reacting to the medicines.

Know your triggers

In addition to medication, you need to learn to recognize and avoid your specific asthma triggers. Many everyday irritants and activities can set off symptoms. Here's a list of some of the most common triggers and practical tips for avoiding them:

• Cigarette smoke. If you smoke, ask your doctor for help quitting. Explain to friends and family who smoke that it could lead to an asthma attack. Then, make sure that no one smokes in your home or around you.

• Pollen or air pollution. Use an air conditioner when possible. Avoid being outside if pollen counts are high or air quality is low.

• Cold air. Wear a scarf over your mouth and nose when you're outside on cold days.

• Mold. Clean bathrooms and other areas that tend to get damp often. Reduce the humidity in your home with a dehumidifier or an air conditioner.

• Animal dander or dust mites. Put your mattress in a washable dust-proof cover. Wash sheets once a week in hot water. Replace carpets with hard floors if possible. Keep pets out of the bedroom. And, make sure that your home is free of cockroaches.

• Sulfites. This preservative is in many foods and beverages, such as dried fruit and wine, so read labels before you buy.

• Medications. Some medicines, such as beta-blockers and aspirin, can lead to asthma attacks in people who are sensitive to them. Remember to tell your doctor about all the medications you take, even over-the-counter remedies, vitamins and dietary supplements.

• Exercise. For some, activity brings on symptoms. But, don't stop exercising altogether. Staying fit is good for your overall health. "Exercising three to four times a week also is one way to help control asthma," says Dr. Randolph. Be sure to talk with your doctor before starting an exercise program. And, ask about using your inhaler before a workout.

With appropriate management, asthma doesn't need to slow you down. "Many Olympic athletes have it," says Norman H. Edelman, M.D., chief medical officer for the American Lung Association. "So, you can have an active life with asthma, too."

Are you at risk?

Experts aren't sure why some people develop asthma while others don't.

"Nobody is born with asthma, but it can appear as early as age 1 year or as late as age 80," says Dr. Edelman. "You could be predisposed to asthma."

These are risk factors for asthma:

• A family history of asthma

• A family or personal history of hay fever or eczema

• Your mother smoked during her pregnancy or you were exposed to secondhand smoke early in life

• Infection with respiratory syncytial virus before you turned 2

Although asthma is more common in children, adults can develop it, too. So, if you start noticing symptoms associated with asthma, such as coughing, wheezing, shortness of breath or colds that "go to the chest," ask your doctor about it.