TAKE CONTROL - Q&A for What to Look For?
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What is meant by good asthma control?
Good asthma control should mean that you can lead a normal life. You should be able to do what you wish and participate in any sports or activities unrestricted by your asthma. For most people, good control means not noticing you have it! This should be possible for all but a small percentage of people whose asthma is more severe.

How can I tell if my asthma is well controlled?
There are certain things which can indicate how well controlled you asthma is or whether it may be getting worse. The table below summarises some general signs which reflect how well you are. Remember that you do not have to have all the signs: only one can indicate good or bad control.

  Sign of Control Good Control Poor Control or Worsening Asthma
  Asthma Symptoms No symptoms or as few as possible. Your symptoms are getting worse. This could be:
(a) You have some asthma symptoms when previously you had none.
(b) Your asthma symptoms are occurring more frequently.
(c) Your asthma symptoms are lasting longer when they come on.
(d) Your asthma symptoms are disturbing your sleep or waking you at night
  Peak Flow Peak flow is stable.
This means:
(a) Readings remain in your green zone.
(b) No morning dip.
(c) Diurnal variation of less than 20%.
Peak flow is not stable. This can include one or more of the
(a) Readings not all in your green zone.
(b) Signs of a morning dip.
(c) Diurnal variation above 20%.
  Activities Your normal activities are not restricted by your asthma in any way. Your normal activities are restricted in some way by you asthma.
  School/work You do not miss school or work because of your asthma. You have to take time off
school or work because of your asthma.
  Reliever Use You hardly need your reliever inhaler at all. You need your reliever inhaler frequently.

Note:. Asthma is a very variable condition. Not everyone will have the same signs of good or poor control. The signs can also vary in one person from one time to another. You should work closely with your doctor or nurse in establishing what applies to your individual asthma.

What should I look for when monitoring my asthma?
When you are monitoring your asthma, you will generally be looking for signs of how well you are. Examples are the best way to answer this question, so we will refer to the situations outlined in the question When is monitoring particularly useful? in Why Bother? Remember, these are general guides on what to look for, and refer to the signs of how well you are as illustrated in the table in the previous question How can I tell if my asthma is well controlled?

  If Your Doctor is Not Sure it is Asthma.
Look for any signs which indicate asthma is present. These can be summarised as:

(a) An unstable peak flow which can include:
i Readings not in your green zone.
ii Signs of a morning dip.
iii Diurnal variation greater than 20%.

(b) Symptoms of asthma which:
i. Tend to come and go and are not present all the time.
ii. Are brought on by exercise.
iii. Are brought on by one or more common trigger factors.
iv. Are worse at night and in the early morning, then start to improve by the middle of the day.
  If You Have Just Been Diagnosed With Asthma
If you have just found out you have asthma then the chances are that you will have started on one or more treatments. You would therefore be looking for an improvement in your condition and a move from signs of poor control to signs of good control. How long this takes to happen will depend on the treatments you have been given.
  If Your Medication is Changed in Any Way
(a) Increasing Your Medication
Look for an improvement in your condition, and a move from signs of poor control to signs of good control. The time you take to improve and how much you improve will depend on a number of things:
i. If the change is an increase in your current preventer, it will depend on how much the dose goes up by.
ii. If your asthma has been very bad for a long time, you may take longer to see an improvement. If, however, you are normally well controlled and have had an asthma attack, you may recover more quickly.
iii. If a medication is being added to your current medication(s), the time you take to improve will depend to some extent on the type of medication. For example, if you already take a preventer and you doctor is adding in serevent (a long acting reliever), you should notice an improvement in a day or two. If you only had a relief medication in the past, and are being started on a preventer, the steroid based preventer inhalers take between 7 - 10 days to work so you will probably see a gradual improvement during this time.
iv. Your individual asthma! If you have severe asthma, which is more difficult to treat, you may only notice a slight benefit. This may be in how well you feel rather than a specific improvement in your peak flow and other asthma indicators. This 'feel good' factor is, however, very important to people with more severe asthma.

(b) Decreasing Medication
If you are decreasing your medication, monitoring will ensure you do not miss any signs that your asthma is becoming uncontrolled. You would therefore be looking for signs of poor asthma control creeping in. Remember, only decrease your medication on the advice of your doctor or nurse!
  To Check That You Really Are as Well as You Can be!
Make sure you really are as well as you can be by looking for any signs of poor asthma control. Most people with asthma, with the correct treatment and education, should not suffer regular symptoms and their peak flow should be stable.
  If You are Trying to Establish Your Personal Best Peak Flow
Look for your very highest peak flow reading over a 2 - 3 week period. Make sure this is when your asthma is stable and you are as well as you can be.
  If You Suspect Something is Making Your Asthma Worse But are not Sure What it is
If you are trying to identify what is triggering your asthma, look for any signs of poor control after contact with anything you suspect as a trigger. This can be quite difficult and is explained more fully in Getting to Know Your Triggers!
  If You Have Recently Had an Asthma Attack
The time you take to fully recover from an asthma attack will vary depending on your individual asthma, the treatments you are given and how severe your attack was, amongst other things. What you should see is a move from indicators of poor control to good control. Even when monitoring shows you are back to normal, look out for any signs that your condition is worsening if you are advised to reduce your medication or you have just finished a course of oral steroid tablets.
Note:. All these guidelines on interpreting the results of asthma home monitoring are general. You are strongly advised to discuss your individual asthma with your doctor or asthma nurse.

Are there any common patterns to look out for?
There are a number of common patterns which can occur in asthma. Establishing common patterns between symptoms, peak flow, triggers and medication can help you keep yourself well. Monitoring your asthma can help you identify these patterns. Some possible patterns are summarised below.

  A Change in Peak Flow Before any Change in Symptoms
It is not uncommon for peak flow to become unstable before asthma symptoms come on or get worse. This is why peak flow monitoring is so useful: you may be able to detect changes early enough to prevent a bad asthma episode. The change in peak flow may present as a falling average peak flow, an increase in diurnal variation and/or the presence of a morning dip. The time over which the change occurs will vary. It may be over a number of days or it may be just the day before the symptoms come on that you notice changes.
  An Increase in Symptoms Before Change in Peak Flow
Although less common, sometimes your asthma symptoms may come on or become worse before your peak flow shows signs of becoming unstable.
  A Change in Symptoms and/or Peak Flow after Contact with a Trigger
A huge benefit of home monitoring is as an aid to identifying your triggers. This can sometimes prove a difficult task! The reasons for this are explained in Getting to Know Your Triggers. You may be able to establish patterns over time between changes in peak flow and/or symptoms that can help in identifying your triggers. Go to Case Study V: Identifying Your Triggers for an example.

Why might my asthma get worse?
There are a number of reasons why your asthma may be uncontrolled or getting worse. It is important to discuss your particular problems with your health professional. However, there are several common reasons why you may not be as well as you should be. The main reasons are summarised below. Fortunately, most of them are surprisingly easy to remedy!

  Not Taking Medication Regularly
Forgetting to take your medications each day can cause your asthma to worsen. If you are fortunate enough to have very mild asthma, your only medication may be the occasional puff of immediate reliever as needed. However, many people with asthma require daily preventer medication(s) as well. It is very easy to fall into bad habits and forget the odd dose or day here and there. It does not take long for the symptoms to creep back in!
  Poor Inhaler Technique
You may be shown how to use your inhaler when you are first prescribed it by the doctor. It is very easy to fall into bad habits when using inhalers. The slightest change in your technique can mean the difference between getting all the medication or none at all! Make sure you have your technique regularly reviewed.
  Your Inhaler is Past its Expiry Date
If you are using an old inhaler you must check the expiry date. The medication will not have the same effect once this date has past.
  Old or Dirty Spacer Device
If you use a spacer, it is essential to follow the cleaning instructions supplied with the device. If you do not keep it clean, the medication will stick to the inside surfaces instead of passing into your lungs when you breathe in. Your spacers should also be changed regularly. Check the manufacturers recommendations on the leaflets that accompany your spacer. Speak to your doctor or nurse if you are unsure as to when to change your spacer or how to clean it correctly.
  Contact with Trigger(s)
You may previously have come into contact with a trigger that has made you asthma worse. Sometimes, contact with one trigger makes your airways even more twitchy and sensitive to other things. Alternatively, there maybe something in your everyday environment which is responsible for your symptoms on a daily basis. This is why it is important to get to know your triggers.
  Not on Best Treatment to Keep you Well
Owing to the variable nature of asthma, it may just be that you are going through a 'bad patch' with no specific identifiable reason. This usually requires a change in your medication. This might mean increasing the dose of what you already take, changing to a different medication or adding in something else. There are many options available and changes can usually be made to improve your asthma. You should discuss this with your doctor or nurse.
Topic "Take Control" Updated 14th August 2003  
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