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We have answers and all the info on your real life breathing situation.

The best way to stay on top of your asthma is to be armed with what

you know. It’s your breath, your health and your life so read up and

carry on. It’s a big wide world out there and you should be a part of

it all. If you take care of that asthma, you CAN be part of it all!



DISCLAIMER. This book provides general information about asthma and related issues. The information does not

constitute medical advice and is not intended to be used for the diagnosis or treatment of a health problem or as a

substitute for consulting with a licensed health professional. Consult with a qualiﬁed physician or health care practitioner

to discuss speciﬁc individual issues or health needs and to professionally address personal medical concerns.

Table of ConTenTs

The Basics of Breathing

2)

Asthma: Funny Word, Serious Condition

4)

What Are the Causes of Asthma?

6)

Types of Asthma

8)

Triggers

12)

Irritants

16)

Smoking and Asthma

18)

Medications

22)

Partners in Care

24)

Daily Medication Chart

26)

The Ins and Outs of Your Inhaler

27)

Operation Spacer

30)

Reaching Your Peak

34)

Early Warning Signs and Symptoms

38)

Your Asthma Action Plan

40)

Q & A

44)

Peak Flow Diary

45)

1

My Notes

50)

THE BASICS OF

BREATHING

AIRING IT OUT

Breathing brings fresh air into your lungs and gets rid of the bad

air. So it’s kind of important to be able to breathe clearly. Okay,

it’s really important. Each breath you take delivers essential

oxygen to your bloodstream. Here’s what happens each time

you breathe:

1. Fresh air comes into your body through your mouth or nose,

down your throat and into a large airway. Then it branches

into smaller and smaller tubes inside your lungs. Special

muscles relax and contract.

2. These small tubes lead into balloon-like pouches called

alveoli that expand and contract as you breathe. The oxygen

ﬁlls these balloons and then moves into the bloodstream.

3. Your heart pumps the oxygen-rich blood through your

arteries to all of your organs.

4. Some of the stale old oxygen leaves the organs and is carried

by the blood.

5. When you exhale, the stale waste air leaves your body.

2

KEYS OF

WISDOM

InHaLiNg

means breathing in.

ExHaLiNg

means breathing out.

breathing.com/articles/basics.htm

3

ASTHMA:

Funny Word,

Serious Condition

PREPARING FOR THE ATTACK

SENSITIVE TUBES

Remember those breathing tubes and airways we just mentioned? Asthma is a disease that aﬀects those tubes

and makes breathing diﬃcult. People with asthma have sensitive breathing tubes. Sometimes everyday stuﬀ in

the air can irritate those tubes and bring on an asthma attack.

WHAT HAPPENS DURING AN ASTHMA ATTACK

• The breathing tubes in the lungs become swollen (INFLAMMATION)

• The muscles surrounding the airways get tighter (BRONCHOCONSTRICTION)

•

4

The smaller breathing tubes become clogged with excess mucus

LARGE AIRWAY (TRACHEA)

BRONCHIAL TUBE

SMALL AIRWAYS

(BRONCHI)

These changes slow down the ﬂow of air into and out of the lungs, making it hard to breathe. Have you ever

blown air through a garden hose? Have you ever blown air through a soda straw? Big diﬀerence in the amount

of air that passes through those diﬀerent sized tubes. An asthma attack can be like trying to blow through a

straw clogged with ice cream.



• The total length of the airways running through the lungs is 1,500 miles.

• The left lung has two lobes and is a little smaller than the right lung in

order to make room for the heart. The right lung has three lobes.

• The lungs are the only organs in the body than can ﬂoat on water.

• We’re born with pink lungs. They get darker as we breathe in polluted air.

• Every day you take about 22,000 breaths.

KEYS OF

WISDOM

SYMPTOMS OF AN ASTHMA ATTACK

• Wheezing or whistling sound

• Coughing, spitting up mucus

• Tightness in the chest

• Shortness of breath

It may feel like you can’t get enough fresh air into

your lungs, but during an attack, the breathing tubes

become too small to let out the stale air.

asthma.com

5

WHAT ARE THE CAUSES OF ASTHMA?

GOOD QUESTION.

NORMAL AIRWAY

THE SHORT ANSWER

We don’t really know the cause of asthma. Sorry.

But we do know many of the risk factors that can

cause an asthma attack. Allergies and family

history are two of the big ones.

ALLERGIES

The American Lung Association estimates that

at least 80 percent of children and 50 percent of

adults with asthma have allergies.

6

MISSION: DEFINITION

Allergy: An allergy is an abnormal reaction in the body

to an object (allergen) encountered through breathing,

eating, injecting or by skin contact. Allergies can produce

itchy eyes, runny nose, wheezing, skin rash or diarrhea.

MUSCLE SPASM

INFLAMED LINING

OF THE AIRWAY

EXCESS MUCUS

FAMILY HISTORY

If your parents have asthma, you are 40

percent more likely to develop it. Experts

have linked a strong family history of asthma

with its development.

KEYS OF

WISDOM

BY THE NUMBERS

Ten million U.S. children

under 18 have been

diagnosed with asthma at

some point in their life.

Asthma Statistics:

aaaai.org/about-aaaai/newsroom/asthma-statistics

7

TYPES OF ASTHMA

WHICH ONE DO YOU HAVE?

ALLERGIC ASTHMA

An allergen can be a common, everyday substance like dust, animal dander, plant pollen and

mold spores. These allergens can irritate people with allergies and cause harmful reactions.

One of these reactions can be an asthma ﬂare-up. A doctor can run tests to determine what

objects you’re allergic to.

Some common symptoms of allergies are:

• Itchy, watery eyes

• Sneezing

• Stuﬀy or runny nose

• Headache

• Dark circles under the eyes

MISSION: DEFINITION

Immunotherapy: A treatment or plan to reduce allergy

symptoms that often includes allergy shots or medication.

This treatment allows a person to gradually build up

immunity to the allergen.

?

8

SEASONAL ASTHMA

Sometimes changes in the weather can trigger an

asthma attack. It may be the microscopic pollen or

mold in the air during certain times of the year that

aﬀect people with seasonal asthma. For others,

it may be that they’re sensitive to the cold air in

winter or heat and humidity of summer. There are

certain asthma medications to take which prevent

allergies and attacks. Take them at the beginning

of the season that most aﬀects you and then

throughout the season, as your doctor prescribes.

NON-ALLERGIC ASTHMA

Some people have non-allergic asthma. No allergies. Cool, right? Nope.

They may suﬀer the same symptoms as allergic asthma but they’re

sensitive to other things, such as:

• Smoke

• Emotional stress

• Changes in the weather

• Respiratory (breathing) infections

Again, your doctor can run tests to ﬁnd out what triggers your asthma.

You can help by tracking the things you come in contact with and what

symptoms they produce. Make a list. Keep a chart. Figure it out.

9

EXERCISE-INDUCED ASTHMA

People with either allergic or non-allergic asthma may suﬀer from

exercise-induced asthma. When your body gets active, changes

in temperature and humidity can trigger attacks. The cold air that

enters your airway during exercise irritates the sensitive tubes.

Shortly after exercising, you might begin to feel the symptoms.



Having asthma is not an excuse to blow oﬀ exercising!

It’s still important for people with the disease to stay

active and physically ﬁt.

KEYS OF

WISDOM

Exercising regularly helps build strong bones and muscles, and ﬁghts oﬀ infection. Work with

your doctor to develop an exercise and treatment program. Here are some tips to remember

when exercising:

• You may need to take your asthma meds before engaging in physical activities.

• Don’t exercise on days when your asthma is not under control.

• Don’t exercise outside on high pollen count days or in high pollution conditions.

• Exercise at your own pace.

• Don’t exercise in extreme hot or cold weather.

• Warm up and cool down before and after you exercise.

• Try diﬀerent types of physical activities. You may have more success with

swimming than running.

10

NOCTURNAL ASTHMA

Nocturnal means “occurring at night,” so people with

this type of asthma feel the symptoms worsen late in

the day. Our bodies make certain hormones during the

day that protect against asthma. But at night, those

hormones turn oﬀ and you’re left without a bodyguard

against attacks. Other factors that can make asthma

symptoms more severe at night include:

• A runny nose or sinus infection

• Acid reﬂux from your stomach into your

esophagus

• Allergens in your bedroom

• A late reaction to something you were exposed

to earlier

• Cool nighttime air

If you notice you’re having more asthma symptoms at night than during the day, talk to your doctor. He or she can

adjust your medication and get you sleeping better.

WebMD: Exercise and Asthma:

webmd.com/asthma/guide/exercising-asthma

11

T

R

i

g

e

R

s

TRIGGER HAPPY

Sensitive airways. That’s the major malfunction for people with asthma.

Things that don’t aﬀect most people can cause real breathing problems for

those with asthma. These substances that cause breathing problems are

called triggers. And there are two kinds of asthma triggers:

ALLERGENS: Substances that can cause your allergies to kick in. They

trigger your breathing tubes to swell and excess mucus to build up and clog

the airways.

IRRITANTS: irritants are not allergens, but something that can bother your

breathing tubes and trigger asthma symptoms. More on irritants later.

CAUTION!

DANGER OUTSIDE!

POLLEN AND MOLD

You can’t see these ﬂoating in the air, but if you’re around trees, ﬂowers,

grass and weeds, chances are pollen and mold are there too. It’s just about

impossible to avoid these allergens entirely, but here are ways you can

reduce your exposure:

• Pay attention to local allergen reports. During a pollen alert,

when the pollen count in the air is high, stay inside, close doors

and windows and use the air conditioner.

• Stay away from sources of mold, like wet leaves, fallen wood

and puddles of water that won’t drain.

• Wear a breathing mask when doing yard work.

• Take a shower and wash your hair after outdoor activities.

12

DUST AND DUST MITES

Just when you thought it was safe to stay indoors,

there are more unseen problems lurking about.

House dust contains:

• Tiny pieces of fabric

• Particles of food

• Flakes of skin

• Protein from plants and animals

Dust mites feed oﬀ this stuﬀ in order to survive.

So, what’s a dust mite?

MISSION: DEFINITION

Dust mites: Microscopic bugs that live mainly on dead skin cells shed from humans

and their animal pets. Dust mites don’t carry diseases and they are usually harmless to

most people, but can cause allergic reactions in people with asthma.

Dust mite

You can minimize the threat of dust mites by washing bed linens weekly in hot water, using a wet mop or damp cloth to

keep your house dust-free, and by vacuuming once a week. Suck up those things and they won’t bother you anymore.

KEYS OF

WISDOM

WHAT CAN HOUSE DUST CONTAIN?

• cigarette ash

• ﬁbers

• wool

• cotton

• paper

• silk

• ﬁngernail ﬁlings

• food crumbs

• glass particles

• glue

• graphite

• human and animal hair

• insect fragments

• oil soot

• paint chips

• plant parts

• pollen

• polymer

• foam particles

• salt and sugar crystals

• skin scales

• soil

• spores

• stone particles

• tobacco

• wood shavings

13

•

OTHER INDOOR ALLERGENS

Animals

Pets such as dogs, cats, birds, hamsters or gerbils may be loyal and loving members of your family. But they may also

be the cause of your asthma attacks. Allergens in their fur or feathers, or proteins in their dander, saliva or urine could

act as triggers.

Solutions:

• Find a new home for your pet or keep it outdoors.

• Keep the pet out of your bedroom or areas where you hang out a lot.

• Bathe your pet once a week.

• Vacuum your ﬂoors regularly.

14

Cockroaches

The protein in cockroaches’ waste is the big problem for people

with asthma. Eliminate cockroaches and you can eliminate some

asthma attacks. Cockroaches love food and water left out, so

clean up crumbs, don’t leave old food sitting in your room and

dump water or other leftover drinks into the sink. They also love

humid air, so use your air conditioner in the summer to lower

humidity levels.

COCKROACH CANCELLATION CHECKLIST

Seal areas where cockroaches can enter your house.

Fix all leaky water faucets and pipes.

Hire an exterminator to spray your house, especially if you’re going away for a while.

Wash dishes immediately after eating.

Vacuum and sweep all ﬂoors.

Take out the garbage frequently.

INDOOR MOLDS AND MILDEW

Molds and mildew live and grow in areas of your house that are damp and humid. They release tiny spores into the air

that can irritate your airways and trigger an attack.

So…

• Get rid of the moisture in your home. Control water leakage and dampness.

• Use a dehumidiﬁer to keep indoor humidity to less than 50 percent.

• Clean bathtubs and sinks three to four times each week.

• Clean the drip pan under the fridge once a month.

• Clean out the garbage can with a mild detergent.

• Get rid of indoor plants.

• Make sure your clothes dryer vents to the outside.

• Clean the inside and outside of your air conditioner.

FOODS

Although food allergies are rare, children can suﬀer from them. Some allergens in

food can be found in cow’s milk, eggs, peanuts, soybean products, shellﬁsh, corn

and wheat. These food allergies can trigger asthma attacks.

So…

• Avoid foods you know you’re allergic to.

• Read the labels and check carefully for allergens.

• Avoid processed foods and stick with natural, organic options.

MEDICATIONS

While most commonly prescribed medicine treats problems eﬀectively,

some can worsen your asthma symptoms. Read the labels of over-the-

counter meds and don’t take those with known allergens. Make sure your

doctor and pharmacist know of your allergies. It’s a smart idea to carry a list

of your medication allergies with you.

Dust Mites: Everything You Might Not Want

to Know!

ehso.com/ehshome/dustmites.php

FARE: Food Allergy Research & Education

foodallergy.org

15

IRRITANTS







THAT IS SO IRRITATING

Remember earlier we stated that irritants are not

allergens, but rather substances that can bother

your breathing tubes and trigger asthma symptoms?

Here are some of the sources that make up irritants

for asthma suﬀerers.

AIR POLLUTION

People with asthma are more sensitive to both

indoor and outdoor sources of the unclean air called

pollution. Pollution comes from traﬃc, high ozone

levels, smoke, gases and fumes.

•

KEYS OF

WISDOM

16

HOW TO BEAT THE THREAT OF AIR POLLUTION

Stay indoors when it’s smoggy outside or when

nearby traﬃc is heavy.

Stay away from areas with heavy industry or

power plants.

Avoid pumping gas, and roll up your windows at

gas stations to avoid breathing the fumes.

Don’t use kerosene heaters, and keep away

from wood-burning stoves and ﬁreplaces.

Always use exhaust fans in the kitchen while

cooking.

Make your house a strict NO SMOKING zone.

Stay away from places where smoking is

permitted.

STRONG ODORS

Strong smells are often oﬀensive even to people without asthma. Imagine what asthma suﬀerers have to face when

challenged with a strong whiﬀ of perfume, aftershave, cologne or cleaning products. Avoid aerosol sprays and use solid

deodorants and liquid or gel hygiene products. Make it a point not to use cleaning products like ammonia, chlorine

bleach, mothballs and other products with strong odors.

CHANGES IN THE WEATHER

Wear a scarf or mask over your mouth and nose during cold weather, and don’t exercise or work outdoors during

times of extreme heat. Changes in weather conditions, temperature and humidity can trigger a reaction in people with

asthma.

INFLUENZA (FLU)

Watch out for the symptoms of this easily-spread illness:

• Fever

• Achy muscles

• Weakness and tiredness

• Sore throat and cough

If you’re an asthma suﬀerer and you catch the ﬂu, you’re more likely to

experience asthma symptoms and lung infections. Get a ﬂu shot each year

in the early fall. Contact your health care professional at the ﬁrst sign of

the ﬂu.

ACUTE BRONCHITIS

There’s nothing

cute about acute bronchitis. Catch it and your lower breathing tubes will swell and cause a painful

cough, wheezing and shortness of breath. Antibiotics aren’t eﬀective against the sickness. You have to ride it out and

let the infection run its course.

PNEUMONIA

The bad news: You’re more likely to develop pneumonia if you have asthma,

especially in the winter. Pneumonia makes your breathing tubes swell, ﬁll with

mucus and restrict airﬂow. Fever, shortness of breath and a lot of mucus are

symptoms of pneumonia.

The good news: A pneumonia shot from your doctor can protect you from

many of the causes of this disease for several years.

Asthma and Allergy Foundation of America: What Causes or Triggers Asthma?

aafa.org/asthma-triggers-causes/

National Center for Biotechnology Information: Inﬂuenza burden for children

with asthma

ncbi.nlm.nih.gov/pubmed/18166550

17

SMOKING AND ASTHMA

A DEADLY COMBINATION

SMOKING = BIG PROBLEMS

Smoking cigarettes is never a good idea. It can lead to several serious diseases and death, it makes everything

look and smell bad and it’s an expensive habit. Smoking is hazardous even for people without asthma, so imagine

what it can do to someone with a breathing problem.

THE ASTHMA FACTOR

Smoking is extra risky if you have asthma because of the further damage it can do to your lungs. Smoke irritates

the airways, making them swollen, narrow and mucus-ﬁlled, just like during an asthma attack. Smoking increases

the chance for coughing, wheezing and shortness of breath, which can be more intense than normal and even

harder to control.







• Cancel out the eﬀectiveness of controller

medicine

• Cause him/her to use rescue medicine

more often

• Increase coughing at night and aﬀect sleep

• Aﬀect the ability to play sports or be active

• Send him/her to the emergency room with

a severe asthma attack

18

E-CIGS AND ASTHMA

Electronic cigarettes, vapes, e-hookahs, e-cigs—whatever you call

them—are electronic “cigarettes” that allow you to “smoke” without

actually smoking, at least not in the traditional sense.

E-cigs are made up of a liquid-ﬁlled cartridge, a heating element, and

a battery to make the whole thing work. There is no tobacco in an

e-cig. Instead, nicotine is included in the cartridge, along with other

chemicals like propylene glycol, which is a solvent found in antifreeze!

E-cigs seem like a safe alternative to smoking cigarettes or quitting

them, right? Wrong. Unlike cigarettes, nobody is regulating e-cigs. This

is important because nicotine can really hurt you—even kill you—if

you take in too much. Without standards, it’s easy to overdose. And,

while the FDA (the Food and Drug Administration) says small amounts

of propylene glycol are safe, nobody knows the eﬀects of its long-term

use.

E-cigs aren’t a substitute for smoking tobacco products, and they

aren’t a good option if you’re trying to quit.

JUST QUIT IT

There really are no good reasons for smoking, especially if you have

asthma. If you’re a smoker and are committed to quitting, you don’t

have to do it by yourself. Find people who will help you kick the habit.

Ask your doctor about medication or strategies that can take away

the craving to smoke. You’re stronger than any bad habit. Don’t let a

bad habit control who you are as a person.

19

THE FATAL FACTS ABOUT SMOKING

• Cigarette smoke contains at least 4,000 chemicals. Many of them are harmful and cancer-

causing.

• Smokers are twice as likely to have a heart attack as nonsmokers.

• Smokers are 10 times more likely to develop cancer than nonsmokers.

• Cigarette smoke is harmful to everybody who inhales it, including friends and family members

who don’t smoke.

QUITTING IS FOR WINNERS

Check out the chart to see how quitting the habit can help you survive.

AFTER 24 HOURS OF

QUITTING

Your chances of having a heart attack decrease.

2 WEEKS TO 3 MONTHS

AFTER

Your blood circulation improves and your lung function increases by

up to 30 percent.

1 TO 9 MONTHS AFTER

Your lungs get stronger and can ﬁght infection better. Coughing, sinus

infection, tiredness and shortness of breath decrease.

5 YEARS AFTER

Your risk of a stroke is reduced to that of a nonsmoker.

10 YEARS AFTER

Your risk of death from lung cancer is half that of a smoker.

15 YEARS AFTER

Your risk of heart disease is that of a nonsmoker.

20

$

KEYS OF

WISDOM

MONEY FOR NOTHING: THE COST OF SMOKING

Want to blow about $1,000 on nothing? Pay for cigarettes for a year!

That’s about the average cost to support a cigarette habit for a year.

Wouldn’t you rather have that kind of cash for:

Date money

Video games

New clothes

Handbags and accessories

New shoes and sports equipment

Movies, malls, amusement parks

Gas to get places

Teen’s Health: Smoking and Asthma

kidshealth.org/teen/drug_alcohol/tobacco/

smoking_asthma.html

smokefree.gov

21

MEDICAT NS

THE ART OF GAINING CONTROL

CONTROLLER MEDICINES

Your doctor can prescribe medicine to help you breathe easier and control your asthma. These meds can help prevent

the symptoms of an asthma ﬂare-up. And that’s the plan: Self-manage your asthma by keeping your symptoms from

even happening.

A SIDE NOTE ON SIDE EFFECTS

Because over-the-counter medicines (those bought oﬀ the shelf at the

drugstore, not as a prescription from a doctor) can have serious side eﬀects,

it’s always important to check with your doctor ﬁrst before taking them. These

meds may include vitamins, herbs, cough syrups and other medications.

MEDICATIONS: WHAT THEY ARE AND WHAT THEY DO

Bronchodilators (bron•co•di•lay•ters)

These relax and open the muscles surrounding the airways. Some are short acting

(rescue or quick relievers lasting 4-6 hours), some are long acting (6-12 hours, not to be

used for quick relief of symptoms).

Corticosteroids (cor•tih•co•stair•oyd)

These meds reduce, reverse and sometimes prevent irritation, swelling and mucus

buildup in the breathing tubes. The three forms of corticosteroids are Oral, Inhaled and

Nasal.

Non-Corticosteroids (non•cor•tih•co•stair•oyd)

These prevent swelling and mucus buildup when you come into contact with a substance

that irritates you. The two types of non-corticosteroid meds are Anti-Inﬂammatories

and Anti-Leukotrienes.

22

•

Anti-Histamines (an•ti•hiss•tuh•meens)

These prevent the symptoms of allergies, like itching, sneezing, runny nose and watery eyes.

Expectorants (Ex•pec•tor•ents) and Mucolytics (Myoo•co•lit•ix)

These loosen the mucus so that it’s easier to cough up.

Cough Suppressants (Sup•press•ents)

These stop the constant dry cough that doesn’t bring up any mucus.

KEYS OF

WISDOM

FOLLOW THESE TIPS FOR USING MEDICATIONS CORRECTLY

Learn your early warning signs for an asthma attack and take

your quick-relief meds as soon as you feel the symptoms.

Take your doctor-prescribed anti-inﬂammatory or

corticosteroids every day, even when you feel ﬁne.

These will decrease the swelling in your breathing tubes.

Bronchodilators don’t.

Monitor your med use. If you have to use your quick-relief

meds each day or several times in a single day, it’s a sign that

your asthma may be getting worse. Tell your doctor.

WebMD: Asthma Medications:

webmd.com/asthma/guide/asthma-medications

23

PARTNERS IN CARE

YOUR TEAM NEEDS YOU

ASTHMA ACTION TEAM

Partnering up with your doctor and health care professionals is

important for getting the care you need and maintaining your health.

Take an active role in your treatment plan and you can keep your

asthma in check.

•

KEYS OF

WISDOM

24

HELPFUL HINTS FOR MANAGING YOUR ASTHMA

Keep all of your appointments. Write yourself reminder notes and place them

where you will easily see them. If you can’t keep an appointment, always call to

reschedule.

Make sure you clearly understand your medical condition. Your doctor is there

to answer your questions. Don’t be afraid to ask them. Speak up!

Write down questions ahead of time.

Be honest and tell your doctor about your symptoms.

MANAGING YOUR MEDICINE

Always follow your doctor’s instructions when taking meds. If taken incorrectly,

medicine can be harmful. Here are tips for managing your medicine:

Read labels carefully before taking medicine. Always take the right dosage.

Check the expiration date on the label and throw away any expired

prescriptions.

Report any side eﬀects to your doctor.

Never share medicine with another person.

Some meds shouldn’t be taken together. Be sure your doctor and pharmacist

know which medicines you take to avoid dangerous side eﬀects.

BE PREPARED

Before you see your doctor at your next appointment, write down a list

of questions about your medications. Make yourself a list like this one

with important questions to ask and write down the answers:

QUESTION ANSWER

What am I taking?

Why am I taking this?

How should I take it?

How long will I have to take it?

What are the possible side eﬀects?

What other drugs or foods may interact with this?

What symptoms should make me call you right away?

Should I take it with food or on an empty stomach?

What should my diet be around this medication?

Where should I store the medication?

Should I continue to take all of my current

prescriptions?

How Stuﬀ Works: Managing Asthma Medications:

health.howstuffworks.com/diseases-conditions/asthma/managing-asthma-

medications.htm

25

DAILY MEDICATION CHART

MEDICINE DOSE BREAKFAST LUNCH DINNER BEDTIME

AS

NEEDED

COMMENTS

26

THE INS AND OUTS

OF YOUR INHALER

MISSION: DEFINITION

Rescue inhaler: A device that gets medicine

directly into the lungs in the form of a mist or spray

that is inhaled. The medicine works quickly to relieve

asthma symptoms by opening the narrow airway.

?

HOW TO USE YOUR INHALER

1. Shake the inhaler before using. Then remove the cap from the mouthpiece.

2. Open your mouth wide and place the mouthpiece an inch or two from your mouth.

3. Tilt your head back slightly, keeping your mouth wide-open.

4. While taking a slow, deep breath through your mouth, press down one time on the canister.

5. Close your mouth.

6. Hold your breath for 10 seconds if you can.

7. Open your mouth slightly and breathe out slowly.

8. Wait two to three minutes before repeating the dose.

9. Replace the cap on the mouthpiece after your ﬁnal puﬀ of medicine.

10. Rinse your mouth with water to avoid irritation to your throat and mouth.

Some inhalers used for asthma are breath-activated. For this type, you need to place your lips tightly

around the mouthpiece for the inhaler to work properly.

27

HOW TO TAKE CARE OF YOUR INHALER

First, never store your inhaler in places of extreme temperature, like your car’s glove box or in your refrigerator.

Make sure you clean it every few days or sooner if it gets clogged.

•

TO CLEAN YOUR INHALER:

• Remove the metal canister from the plastic dispenser

.

• Run warm water through the dispenser.

• Shake the water from the dispenser and let it air dry.

• Place the cap back on the mouthpiece.

Once the dispenser is dry, replace the metal canister and spray a little into the

air to make sure the inhaler is working properly, then take your regular dose,

if needed.

28

PLAN AHEAD.

It’s really important to know how much medicine you have left and how long it lasts. Many inhalers have a meter to

tell you how many doses are left. Others don’t, though, so make sure to keep track so you don’t run out. Plan ahead

for holidays, traveling, weather situations and your busy lifestyle. Make sure you always have a good supply.



Going without your meds, even for a day or two, can cause

breathing trouble. Always have enough.

The number of puﬀs in a canister varies with the medicine.

So ask your pharmacist how many puﬀs are in your canister

and keep track as you use them.

KEYS OF

WISDOM

DO THE MATH

You can estimate how much medicine is left in your inhaler this way:

Estimate how many puﬀs of inhaler you need in a month. For example,

if you take two puﬀs four times a day for 30 days, you’ll use 240 puﬀs

each month.







If you know how many puﬀs are in your inhaler, you can ﬁgure out how

many puﬀs are left at any time during the month. Keep a small piece

of paper with your inhaler and subtract as you use it to keep track.

Health Tip: Using an Asthma Inhaler:

health.tips.net/Pages/T003673_Using_an_Asthma_Inhaler.html

29

OPERATION SPACER

USING A SPACER WITH YOUR INHALER

SPACER INHALER

MISSION: DEFINITION

Spacer: An add-on tube creating a chamber from an

inhaler to the mouth of an asthma suﬀerer. Spacers make it

easier to administer medication by creating space in which

a patient can inhale the spray.

30

SPACERS

Using a spacer with a metered dose inhaler (MDI – an inhaler that tells you how many doses

are left) can help the medicine go deeper into the lungs, cause less mouth irritation and make

the inhaler easier and more eﬀective to use. Use a spacer whenever possible but never with dry

powder or breath-activated inhalers.





















31











32



















KEEP IT CLEAN

Here’s your spacer cleaning checklist:

CHECK IT…

☐ Clean at least once a week, more if you’re having breathing problems.

☐ Remove inhaler from spacer.

☐ Gently separate the parts, including the mask, if you use one.

☐ Soak the spacer parts in warm water with a mild detergent for 20 minutes.

☐ Rinse with clean warm water.

☐ Shake spacer parts and place them on a clean surface to air dry.

☐ Allow the spacer parts to completely air dry before putting them together.

☐ When completely dry, store spacer in a clean plastic bag.

NOTE: Do not boil or put the spacer in the dishwasher.

Mayo Clinic: Using a Metered Dose Asthma Inhaler and Spacer:

mayoclinic.com/health/asthma/MM00608

33

800

700

600

500

400

300

200

100

L/min

750

650

550

450

350

250

150

50

REACHING YOUR PEAK

PEAK FLOW MONITORING

GETTING TO KNOW YOUR PEAK FLOW METER

A peak ﬂow meter is a device that measures how fast and hard you can

blow air out of your lungs. It gauges your lung strength. The narrower your

airways are due to swelling, mucus buildup and tightening, the slower the air

exits your lungs. Just like a thermometer measures your body temperature

and detects fever, a peak ﬂow meter detects breathing problems.



• It’s portable and convenient.

• It can help you track what triggers are making your asthma worse.

• It can help ﬁgure out if you need emergency care.

• It can help ﬁgure out if your lungs are tight before symptoms occur.

• It can help you ﬁgure out if your treatment plan is working.

34

•

HOW TO USE YOUR PEAK FLOW METER

• Always stand up (when possible) to make sure you can

breathe as deeply as possible.

• Move the indicator to the base of the peak ﬂow meter.

• Hold the peak ﬂow meter at the opposite end of the

mouthpiece.

• Take a deep breath to fully ﬁll up your lungs.

• Put the mouthpiece in your mouth between your teeth

and over your tongue. Close your lips tightly around it.

• With as much force as possible, blow out as fast as you can,

as if you were blowing out all your birthday candles.

• Remove the peak ﬂow meter from your mouth and read the

number at the level of the indicator.

• Repeat these steps two more times.

• Record your highest number of the three readings on the chart.

?

35

PEAK FLOW METER CLEANING

Wash your peak ﬂow meter at least once a week or more if you’re

having asthma symptoms.

Here’s how:

Wash the peak ﬂow meter in warm, mild soapy water.

Rinse really well.

Allow it to air dry.

Never try to clean the inside of the meter with a brush.

Never boil or place the meter in a dishwasher (unless

the accompanying instructions indicate you can do so).

PEAK FLOW ZONES

After you’ve ﬁgured out your best peak ﬂow number, your health care team (nurse, respiratory therapist, asthma

educator, etc.) can calculate your Peak Flow Zones. These zones will help you see any changes in your peak ﬂow

readings. To make it easy, experts have set up a symbol that looks like the colors of a traﬃc light.

 This signal means your asthma is in good control.

• You’re at 80–100 percent of your personal best.

• Your breathing is good.

• You have no asthma symptoms or warning signs.

• Remember to take all your doctor-prescribed medicines.

• Take your inhaler before you exercise.

  This signal means your asthma is not under

control and you should proceed with caution. Your doctor may instruct you

to take quick-relief meds or even call in for further advice.

• You’re at 50–79 percent of your personal best.

• You may experience a runny or stuﬀy nose, sneezing, coughing,

itchy throat.

• You may experience restlessness, red or pale face, dark circles

under the eyes.

• You may feel more tired.

• Use your rescue medicine.

• Recheck your peak ﬂow meter after at least 15 minutes.

• Call your doctor or health care professional if the next reading

is not green.

36

 This signal is an alert. You may have to call your doctor for

immediate medical care.

• You’re below 50 percent of your personal best.

• You may cough and wheeze, more at night.

• Your chest may feel tight and hurt.

• Your breathing may be faster.

• You may become short of breath easily.

• Use your quick-relief medicine with an inhaler or nebulizer immediately.

• Call your doctor or 911 now.

An asthma action plan helps you chart and keep track of your peak ﬂow readings

and zones. Anyone with asthma should have an asthma action plan, no matter

how old. See pages 40-43 for a sample or download your own at lung.org.

WebMD: Asthma and the Peak Flow Meter:

webmd.com/asthma/guide/peak-ﬂow-meter

Video: How to Use a Peak Flow Meter:

youtube.com/watch?v=LHvBH0O6u8c&feature=related

37



KNOWING YOUR EARLY WARNING SIGNS AND SYMPTOMS

SIGNS OF DANGER

Asthma ﬂare-ups don’t usually occur without some warning signs. Most people can tell when an asthma issue is

coming. Remember your last episode? What were your early warning signs or symptoms? Those early warning

signs are the small changes that can tell you if your asthma condition is getting worse. Symptoms are signs

that tell you you’re having an asthma issue. Notice both of these danger signals to be in better control of your

condition.

When you’re experiencing these signs and symptoms, you can follow your doctor’s instructions for controlling

your asthma. Doing so may keep more serious problems from starting. Read this list and check the signs and

symptoms that you experience. Share them with your family and friends and your doctor. Be sure to update

your list as you identify other signs and symptoms.

☐ Decreasing peak ﬂow

☐ Tightness in chest

☐ Out of breath easily

☐ Tired

☐ Scratchy or sore throat

☐ Stuﬀy or runny nose

☐ Restless

☐ Coughing

☐ Faster breathing

☐ Shortness of breath

☐ Itchy, watery eyes

38

☐ Sneezing

☐ Headache

☐ Itchy back of neck

☐ Diﬃculty speaking

☐ Color change in face

☐ Other (signs that you notice)

_________________________________________________________________________________



• Increased mucus or sinusitis

• Internal triggers

• Lying in a ﬂat position

• Air conditioning

• GERD (acid reﬂux)

• Late Phase Response (symptoms occurring after the trigger)

• Hormones

WebMD: The Warning Signs of Asthma:

webmd.com/asthma/asthma-warning-signs

39

YOUR ASTHMA ACTION PLAN

An asthma action plan is created with your doctor and written to help control your asthma. It shows your daily

treatment, such as what kind of meds to take and when to take them. It shows how to control asthma long term

and how to handle it during episodes and ﬂare-ups. Like the Peak Flow Chart, it shows the Peak Flow Zones and

explains when to call the doctor or go to the emergency room.

Make sure that anyone who needs to know about your asthma—such as teachers or coaches—has

a copy of your asthma action plan.

______________________________

________________________________ _______________

_________________________ _______________

__________________________________ __________________



General information:

Name:

Emergency contact: Phone #:

Doctor/health care provider: Phone #:

Doctor signature: Date:

☐

Severity:

☐ Intermittent

☐ Mild persistent

☐ Moderate persistent

☐ Severe persistent

☐

Triggers:

Colds

Exercise

Animals

Smoke

Weather

Dust

☐ Air pollution

☐ Food

☐ Other _______________

40

______________

________________ __________________ __________________

•

Green Zone: Doing Well Peak Flow Meter Personal Best =

41

Symptoms

Breathing is good

No cough or wheeze

Can work and play

Sleeps well at night

Peak Flow Meter

More than 80 percent of personal best or

Control medications:

Medicine How much to take When to take

________ _________

________________ __________________ __________________

☐

____________________________________

☐

___________________________________

☐ _____

•

Yellow Zone: Getting Worse Contact doctor if using quick relief

more than twice per week.

42

Symptoms

Some problems breathing

Cough, wheeze or tight chest

Problems working or playing

Wake at night

Peak Flow Meter

Between 50 percent and 80 percent of personal best or to

Continue control medicines and add:

Medicine How much to tak

e When to take

If symptoms (and peak ﬂow, if used) return to Green Zone after one hour of the quick-

relief treatment, then:

Take quick-relief medication every four hours for one to two days

Change your long-term control medicine by

Contact your doctor for follow-up care.

If symptoms (and peak ﬂow, if used) DO NOT return to Green Zone after one hour of

the quick-relief treatment, then:

Take quick relief treatment again.

Change your long-term control medicine by

Call your doctor/health care provider within hour(s) of changing your medication

routine.

________ _________

________________ __________________ __________________

☐

•

Red Zone: Medical Alert Ambulance/Emergency Phone Number:

____________________________________

43

Symptoms

Many breathing problems

Can’t work or play

Getting worse and not better

Medicine doesn’t help

Peak Flow Meter

Less than 50 percent of personal best or to

Continue control medicines and add:

Medicine How much to take When t

o take

Go to the hospital or call 911 if:

Still in the red zone after 15 minutes.

You have not been able to reach your doctor/health care provider for help.

Call an ambulance or 911 right away if these danger signs are present:

Trouble walking/talking due to shortness of breath.

Lips or ﬁngernails are blue.

Q&A

Questions and answers for Your doctor

Write down the questions

you have for your doctor.

Write down your

doctor’s answers:

44



DATE AND

TIME

WHEEZING

COUGHING

CHEST TIGHTNESS

LIMITED ACTIVITY

NIGHT

AWAKENINGS

EARLY MORNING

COUGH

45

Triggers/

Quick–relief

medications

Record your best peak ﬂow

each morning and early

afternoon before and a few

minutes after using your

inhaler or nebulized medicine.

PM AM



DATE AND

TIME

Triggers/

Quick–relief

medications

Record your best peak ﬂow

each morning and early

afternoon before and a few

minutes after using your

inhaler or nebulized medicine.

PM AM

WHEEZING

COUGHING

CHEST TIGHTNESS

LIMITED ACTIVITY

NIGHT

AWAKENINGS

EARLY MORNING

COUGH

46



DATE AND

TIME

Triggers/

Quick–relief

medications

Record your best peak ﬂow

each morning and early

afternoon before and a few

minutes after using your

inhaler or nebulized medicine.

PM AM

WHEEZING

COUGHING

CHEST TIGHTNESS

LIMITED ACTIVITY

NIGHT

AWAKENINGS

EARLY MORNING

COUGH

47



DATE AND

TIME

Triggers/

Quick–relief

medications

Record your best peak ﬂow

each morning and early

afternoon before and a few

minutes after using your

inhaler or nebulized medicine.

PM AM

WHEEZING

COUGHING

CHEST TIGHTNESS

LIMITED ACTIVITY

NIGHT

AWAKENINGS

EARLY MORNING

COUGH

48



DATE AND

TIME

Triggers/

Quick–relief

medications

Record your best peak ﬂow

each morning and early

afternoon before and a few

minutes after using your

inhaler or nebulized medicine.

PM AM

WHEEZING

COUGHING

CHEST TIGHTNESS

LIMITED ACTIVITY

NIGHT

AWAKENINGS

EARLY MORNING

COUGH

49

MY NOTES

_________________________________________________________________________________

50

MY NOTES

_________________________________________________________________________________

51

MY NOTES

_________________________________________________________________________________

52



American Academy of Allergy, Asthma &

Immunology

414-272-6071

aaaai.org

American Academy of Pediatrics

800-433-9016

aap.org

American College of Allergy, Asthma &

Immunology

Find an Allergist in Your City

acaai.org

American Lung Association

800-LUNGUSA (800-586-4872)

lung.or

g

Asthma and Allergy Foundation of America

1-800-7-ASTHMA (1-800-727-8462)

aafa.or

g

Centers for Disease Control and Prevention

800-CDC-INF

O (800-232

-4636)

cdc.gov

National Asthma Education and Prevention

Program

nhlbi.nih.go

v/about/org/naepp

National Heart, Lung, and Blood Institute

nhlbi.nih.gov

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teens on course

it's all about asthma





You’ve got real questions about

your asthma, and Teens on Course™

has answers.

ISBN: 978-0-9862116-3-8

MADE IN THE USA

This book was printed

on recycl

ed paper.

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Fillable Teens On Course - It's All About Asthma (Superior HealthPlan)

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