Asthma in Adults

Here are details and information about Asthma in adults:

Doctor Visit

When to See the Doctor

Some adults go many years with breathing difficulties without realizing they have asthma. Talk to your doctor if you are:

  • Wheezing.
  • Having difficulty breathing.
  • Feeling tightness in the chest.

IF YOU ARE GASPING FOR AIR, GET TO AN EMERGENCY ROOM.

If you have already been diagnosed with asthma, your doctor will schedule regular appointments with you, usually once or twice a year. More often if you are starting a new treatment.

Ask Your Doctor About…

  • The seriousness of your asthma.
  • The best therapy for your asthma.
  • How often you should take your asthma medication and how much.
  • Proper use of your inhaler and spacer.
  • If you smoke, the importance of stopping smoking.
  • The goals and expectations of your asthma.
  • How to deal with worsening symptoms.
  • The need for tests of your lung function.
  • Whether you may have allergies and whether you need to be allergy tested.
  • How your asthma may be aggravated by allergies and how you can avoid exposure to allergens.
  • The use of a peak flow meter.
  • Whether you should see a specialist or when hospital admission may be needed.
  • How you should use your medicines before you exercise to prevent attacks.
  • Your medicines for other conditions such as for headaches, arthritis or high blood pressure.

Hospitalization by Your Doctor

Your doctor may recommend admitting you to a hospital if:

  • You have been on oral corticosteroids for a full day and are not any better.
  • You have used the rescue inhaler eight times a day or more for the last two days.
  • You have another serious medical condition, such as heart failure or diabetes, and you are not better even when using your inhaler often.
  • You have a lung infection, like pneumonia.
  • You are unable to perform normal daily activities.

Treatment

Medical Evaluation

Asthma is graded according to how often you have symptoms and how severe those symptoms are. Your grade level can change, and treatment will improve your grade.

Number Of Days You Have Symptoms

Number Of Nights You Awaken From Asthma

Severity And Grade Of Your Asthma

Less than 2 days per week Less than 2 per month Mild, Intermittent
(Grade 1)
More than 2 per week, but less than 1 per day More than 2 per month Mild, Persistent
(Grade 2)
Every day, and you are using your rescue medicine everyday. More than 1 per week Moderate,Persistent
(Grade 3)
Every day, and your physical activity is limited. Frequent Severe, Persistent
(Grade 4)

Notes on classifying severity

  • Patients should be assigned to the most severe step in which any feature occurs.
  • Patients at any level of severity can have mild, moderate, or severe exacerbations.
  • Patients with two or more asthma exacerbations per week (that is, progressively worsening symptoms that may last hours or days) tend to have moderate-to-severe persistent asthma.

Your Treatment Plan

Asthma Severity Grade Best Treatment How Often You Should See Your Doctor
Mild, Intermittent (Grade 1) Use of a rescue inhaler (that is, a quick onset reliever such as albuterol) each time you have symptoms.

Avoid the things that trigger attacks, or pre-treat yourself before the trigger occurs.

Every 6 Months
Mild, Persistent (Grade 2) Use of a rescue inhaler (that is, a quick onset reliever such as albuterol) each time you have symptoms.

Avoid the things that trigger attacks, or pre-treat yourself before the trigger occurs.

Use a corticosteroid inhaler everyday.

Also:

– Your doctor may consider using a newer drug called a leukotriene inhibitor.

– If your triggers are associated with allergens (that is pets, dust, pollen), your doctor should consider referring you to an allergist.

– Your doctor may consider a medicine called a mast cell inhibitor.

Every 3 Months
Moderate/ Persistent (Grade 3) Check your peak flow every morning and evening before taking your medicine.

Avoid the things that trigger attacks, or pre-treat before the trigger occurs.

Use your rescue inhaler (that is, a quick onset reliever such as albuterol) each time you have symptoms.

Use a corticosteroid inhaler every day.

Also:

-Your doctor should consider prescribing a slow-onset, long-acting reliever at night.

-Your doctor may consider using a newer drug called a leukotriene inhibitor.

-Your doctor should refer you to an asthma specialist if these interventions do not improve your asthma in 2-3 weeks.

Every 6 Weeks
Severe, Persistent (Grade 4) Check your peak flow every morning and evening before taking your medicine.

Avoid the things that trigger attacks, or pre-treat before the trigger occurs.

Use your rescue inhaler (that is, a quick onset reliever such as albuterol) each time you have symptoms (12 puffs at most in a day).

Use a corticosteroid inhaler everyday.

Also:

-Your doctor may consider prescribing a slow-onset, long-acting reliever at night.

-Your doctor may consider using a newer drug called a leukotriene inhibitor, or prescribing another inhaler that acts longer than your usual albuterol-rescue inhaler.

-Your doctor may prescribe a course of corticosteroid tablets by mouth every day.

-Your doctor should consider the use of theophylline.

-Your doctor should refer you to an asthma specialist.

Every 4 Weeks

Self Care

Make sure that you:

  • Follow the treatment plan exactly as prescribed by your doctor.
  • Try to quit smoking, if you are a smoker.
  • Write down the results of your peak flows.
  • Write down the use of your rescue medicine.
  • Avoid any things at home or work that may bring on your asthma or make it worse.

Using your inhaler

How to correctly use your metered-dose inhaler plus spacer device:

Step 1. Remove the cap and place your metered dose inhaler in the spacer.

Step 2. Shake well.

Step 3. Exhale slowly with the spacer in your mouth.

Step 4. Press down on the canister once as you start inhaling.

Step 5. Inhale slowly and deeply.

Step 6. Hold your breath for 10 seconds, if you can. If not, try to hold your breath for at least four to five seconds.

Step 7. Exhale slowly through your nose or pursed lips.

Step 8. Wait 30 to 60 seconds and shake the inhaler well again for the next puff.

Action Plan at Home

IF you do not need to take another puff of the rescue inhaler for the next 4 hours and you have less wheezing or shortness of breath
Then You Have Had A
GOOD RESPONSEYou should…
continue your rescue inhaler every 3-4 hours for the next 1-2 days and call your doctor for follow up instructions.
IF you need to repeat your rescue medicine more than every 4 hours or your wheezing, shortness of breath or night time waking up due to your asthma continues
Then You Have Had An
INCOMPLETE RESPONSEYou should…
Start prednisone (oral corticosteroid) at the dose of __mg* per day, continue using your rescue inhaler as needed and call your doctor IMMEDIATELY for instructions.
IF you need your rescue inhaler (albuterol) every hour or more or you have more wheezing, shortness of breath, or can not sleep through the night
Then You Have Had A
BAD RESPONSEYou should…
Take prednisone (oral corticosteroid) ____mg* and Call your doctor IMMEDIATELY and go to the nearest Emergency Room or call 911.

* Your doctor should complete this.

Lifestyle Changes You Should Consider

  • If you are smoking, you should talk to your doctor about treatments that are available to help you quit.
  • If possible, avoid or remove asthma “triggers” from your home or work environment.