Ten Reasons Your Asthma May Not Be Well Controlled

Recent national health statistics reflect a significant drop in the number of people dying from asthma over the past 5 years. That is the only good news. Hospital admissions and emergency department visits have not decreased. Furthermore, death rates in African-Americans and Puerto Rican based Hispanics have not gone down.

Well controlled asthma is a major goal of asthma management.

Well controlled asthma means:

1) You need your reliever inhaler less than three times per week during the day (exercise preventive puffs are not counted)

2) You have chest symptoms in the middle of the night or before planning to get up in the morning less than three times per month

3) You have no limitations due to asthma at work, home or school

4) Shortness of breath occurs less than three times per week

5) Your lung function is normal (by Peak Flow Rate or Pulmonary Function Test)

The most common reasons for failure to maintain or achieve good control of asthma that I have observed are:

1) Lack of an adequate daily controller medication (Flovent, Qvar, Pulmicort, Asmonex and others)

2) Lack of consistent use of a prescribed controller (many doses missed over time)

3) Poor inhaler technique:

a) Forgetting to completely empty the lungs (blow out) before inhaling the drug.

b) Not holding the inhaled medication in the lung long enough (should be at least 10 seconds)

c) Not shaking aerosol metered dose inhalers before using them

4) Failing to properly prime aerosol inhalers (each inhaler has its own priming information)

5) Not periodically cleaning the aerosol inhalers.

6) Lack of an established action plan reviewed by the asthma specialist

7) Unmet goals in reducing exposure to environmental allergens and irritants (pets, dust mite, tobacco exposure, fragrances etc.)

8) Additional medical problems that may worsen or complicate asthma which are either not identified or inadequately treated (sinus infections, gastric reflux “GERD”, allergic nasal problems, sleep apnea and anxiety and/or depression).

9) Poor understanding of asthma triggers and how to avoid them

10) Fear of asthma medications especially if expected to be used over months to years.

What can be done?

First, recognize that your asthma is not well controlled. Could one or more of the issues mentioned above be the reason? New asthma guidelines focus on how health providers should assess severity and control of asthma.

Board certified allergists are skilled in managing asthma. Are you seeing one?

If you are one of my patients and do not feel your asthma is well controlled call the office and arrange for a follow-up visit. If you cannot get an appointment within 1 month send me an email at: allergyqa@aol.com

Please review my postings on: Inhaler technique (Are You a Failure With Your Inhaler-March 1, 2007),

New HFA Inhalers: What You Should Know- Feb. 2, 2008 and Asthma Checklist- March

 25th, 2007 (also Asthma Control Test- March 2nd 2007)