Managing Asthma at Home:

Asthma Action Plans

Asthma action plans create a written document for patients to manage asthma during stable times and to more easily identify when asthma is worsening. Important components of a home program include:

• A clearly written plan for taking asthma medications when condition is stable
• A complete education regarding the difference between long-term control medications and quick-relief medications
• Monitoring of asthma on a daily basis. Symptom monitoring is adequate for patients with intermittent or mild persistent asthma. Peak flow monitoring should be performed in patients with moderate or severe persistent asthma or those with a history of more severe exacerbations (sudden worsening or increase in severity of symptoms).
• A list of environmental control measures that need to be taken
• When to seek medical care

Managing Asthma Exacerbations. Always refer to the written action plan from your doctors and nurses. Treatment approaches generally include:

• Recognizing symptoms and measuring peak flow
• Using for the first time or increasing usage of short-acting medications
• Eliminating or withdrawing from any triggers or irritants that may be responsible for increase in severity of symptoms
• Depending on written instructions from doctor, begin oral corticosteroids if available
• Monitoring response to treatments and communicating with doctor if symptoms worsen or if severe symptoms occur. [See: "Symptoms" section.]

Follow-up generally depends on the severity of asthma, how recently asthma was diagnosed, patient compliance, and whether recent changes in treatment were made.

Avoiding Environmental Triggers

Avoiding and controlling triggers that lead to asthma attacks are as much a priority as treatment of the disease.

Controlling Pets. Patients who already have pets and are not allergic to them probably have a low risk for developing allergies. If pets trigger asthma, take the following precautions:

• If possible, keep pets outside
• If this isn't possible, confine pets to carpet-free areas outside the bedroom. Cats harbor significant allergens, which can even be carried on clothing. Dogs usually cause fewer problems.
• Wash animals once a week to reduce allergens. Dry shampoos, available for both cats and dogs, can remove allergens from the skin and fur and are easier to administer than wet shampoos.

Controlling for Dust. Spray furniture polish is very effective for reducing both dust and allergens. Air cleaners, filters for air conditioners, and vacuum cleaners with High Efficiency Particle Arresting (HEPA) filters can help remove particles and small allergens found indoors. Neither vacuuming nor the use of anti-mite carpet shampoo, however, is effective in removing mites in house dust. In fact, vacuuming stirs up both mites and cat allergens. If possible, avoid carpets and rugs.

A High Efficiency Particle Arresting (HEPA) filter can remove the majority of harmful particles, including mold spores, dust, dust mites, pet dander and other irritating allergens from the air. Along with other methods to reduce allergens, such as frequent dusting, the use of a HEPA filtration system can help control the amount of allergens circulating in the air. HEPA filters can be found in most air purifiers, which are usually small and portable.

Bedding, Curtains, and Bedroom Environment.

• Replace curtains with shades or blinds, and wash bedding using the highest temperature setting.
• Encase mattress and pillow in special dust mite proof covers (synthetic pillows may pose a higher risk for asthma attacks than feather pillows, or no pillow at all).
• Wash pillow in water hotter than 150° F, or in cooler water with detergent and bleach.
• Wash sheets and blankets weekly in hot water.
• Avoid sleeping or lying on cushions or furniture that are cloth covered.

Reducing Humidity in the House. Living in a damp house is counterproductive. Dust mites thrive in humidity and damp houses increase the risk for mold. Humidity levels should not exceed 30-50%:

• Fix all leaky faucets and pipes, and eliminate collections of water around the outside of the house.
• Dehumidify basements, but empty humidifiers and clean them daily with a vinegar solution.
• Clean often any moldy surfaces in the basement or in other areas of the home.
• Avoid prolonged used of vaporizers to manage symptoms during asthma attacks.

Gas Stoves, Kerosene, and Cooking. People with asthma should choose electric ovens. Gas ovens release nitrogen dioxide, a substance that can aggravate asthma symptoms. Even smoky cooking can worsen asthma. Kerosene (used in space heaters and lamps) may also produce allergic reactions.

Exterminating Pests (Cockroaches and Mice).

• Use a professional exterminator to eliminate cockroaches. (One study reported that ridding a home of cockroaches and cleaning the house using standard housecleaning techniques failed to eliminate the cockroach allergens themselves.)
• Exterminate mice and attempt to remove all dust, which might contain mouse urine and dander.
• Keep food and garbage in closed containers.
• Keep food out of bedrooms.

Avoiding Cigarette Smoke. Cigarette smoke can accelerate the decline in lung function related to asthma. Even exposure to secondhand smoke can double the risk of asthma-related emergency room visits. Everyone should quit smoking and encourage others around them to quit. [For help quitting, see In-Depth Report #41: Smoking.]

Avoiding Outdoor Allergens.

• Avoid scheduling camping and hiking trips during times of high pollen count (generally, May and June for grass pollen and mid-August to October for ragweed).
• Avoid strenuous activity when ozone levels are highest, which usually occur in early afternoon, particularly on hot hazy summer days. Levels are lowest in early morning and at dusk.
• Asthma attacks are often higher during thunderstorms. It is not clear why. Some evidence points to a build-up of ozone that accompanies such storms.
• Patients who are allergic to mold should avoid barns, hay, raking leaves, and mowing grass. Exposure to automobile fumes may worsen asthma. Fungi in car air conditioners can also be a problem.
• Air pollution can worsen asthma.

Exercise

Asthma is no reason to avoid exercise. Historically, about 10% of Olympic athletes have asthma. Some studies indicate that long-term exercise even helps control asthma and reduce hospitalization. Exercise can help control weight, which can help with asthma symptoms. Patients should consult their doctors before starting any exercise program, however. Uncontrolled asthma can be dangerous and, rarely, fatal for athletes, even some with mild asthma. Using an inhaler is extremely important.

People who enjoy running should probably choose an indoor track to avoid pollutants. Swimming is excellent for people with asthma. Yoga, which uses stretching, breathing, and meditation techniques, may have particular benefits.

Hints for Reducing Exercise Induced Asthma (EIA). EIA occurs only after exercise and is more likely to happen during regular paced activities in cold, dry air. The following are some suggestions for reducing its impact:

• Comply with long-term control medications, particularly inhaled corticosteroids, when prescribed.
• Warm-up and cool-down before and after exercise.
• Participate in activities with short bursts of exercise (such as tennis and football) over exercises involving long-duration pacing (such as cycling, soccer, and distance running).
• Breathe through a scarf or through the nose. This helps warm up the airways when exercising in cold air.

Medications.

• Short-acting beta2-agonists taken before exercise are generally considered the first choice, and they last for 2 - 3 hours.
• Cromolyn is another option but it is not as effective.
• Leukotriene antagonists are another option, but they generally take hours to be effective.

Preventing and Treating Respiratory Infections

People with asthma should try to minimize their risk for respiratory tract infections. Washing hands is a very simple but effective preventive measure.