Asthma management

Do you know what to do in an asthma emergency?

The truth is that asthma attacks can strike at any time but the risk of having an asthma attack is increased with poorly controlled asthma. Signs of poorly controlled asthma include:

• Experiencing asthma symptoms every day or every other day
• Using more than 2 puffs of your reliever inhaler per week
• If you have had more than two reliever inhalers dispensed in the last 12 months
• Asthma symptoms that come in the night while you are sleeping or early in the morning
• If you are missing days of work or school
• If your asthma is worsening despite using your preventer as prescribed every day
• If you are unable to take part in things you enjoy doing such as playing sports
• If you have used more than one course of oral steroids (I.e. prednisone, prednisolone, redi-pred) in the last 12 months
• Have presented to an urgent care clinic or hospital (ED) or been admitted to hospital in the last 12 months

Whether your asthma is mild or severe, it is vital to know how to manage an asthma emergency.

Reliever inhalers

There are a few types of medications that can be used to treat the symptoms of asthma.

• Salbutamol – a group of reliever medications including Ventolin and Salair | 
  Contains salbutamol
• Anti-inflammatory Reliever (AIR) Inhalers – includes Symbicort and Duoresp Spiromax | Contains budesonide/formoterol
• Bricanyl Turbuhaler | Contains Terbutaline Sulfate

How to manage asthma when you are unwell

Respiratory illness (cold, flu etc) is one of the biggest asthma triggers in New Zealand. Here are some tips for staying on top of your asthma while you are sick so you can recover quicker and stay safe:

• Follow your asthma action plan – know what steps to take if your symptoms get worse
• Keep taking your preventer inhaler every day – it works on the inside of your airways, keeping inflammation at bay, protects your airways and reduces the chance of an asthma attack
• Use your reliever inhaler as directed if you notice more wheeze, cough, or shortness of breath
• Check your peak flow (if you use one) – it can help you spot early changes in your asthma condition
• Rest and keep hydrated – fluids help thin mucus and make it easier to clear your airways
• Watch for warning signs – if your reliever isn’t working as well, you’re needing it more often, or you’re struggling to speak or breathe, seek medical help straight away
• Keep up with vaccinations – flu and COVID-19 vaccines help reduce the risk of serious illness
• See your doctor or nurse early if your asthma symptoms are worsening – don’t wait until you are very unwell

Exercise-induced asthma (EIA) – also known as exercise-induced bronchoconstriction) is a very common asthma trigger and estimated to affect about 40-90% of people with asthma.

NB: The wide ranges reflect differences in definitions, populations, intensity of exercise, and measurement methods.

Many people with asthma experience symptoms such as coughing, wheezing, or shortness of breath during or shortly after exercise. For some, exercise is the only time they notice asthma symptoms. Even in people who are not officially diagnosed with asthma, about 5-20 % may develop airway narrowing in response to exercise.

The excellent news is that most people with asthma can continue to enjoy sport and physical activity without limitation and if symptoms are present, they can be easily managed.

Tips for managing EIA

• Stay active – Physical activity is important for everyone, especially for people with asthma. It strengthens your lungs, improves blood flow, and releases endorphins that help you feel good. With the right management, asthma shouldn’t stop you from enjoying sport or exercise
• Use your reliever inhaler if needed
  • Salbutamol – Take 1–2 puffs 15 minutes before exercise
  • Symbicort/Duoresp – take 1 puff/actutatin 15 minutes before exercise
• Keep taking your preventer inhaler (ICS) every day – This protects your airways and reduces the chance of symptoms during exercise
• Warm up before you start – Gentle warm-ups prepare your lungs and reduce sudden airway narrowing. In cold or damp weather, covering your mouth and nose with a scarf can help
• Choose activities that suit you – Running and cycling are often the hardest with EIA. Many people find sports like walking, tramping, tennis, yoga, tai chi, aerobics, martial arts, or team sports easier to manage
• Try nose breathing – Breathing through your nose warms, moistens, and filters the air before it reaches your lungs. It also helps regulate your breathing.
• Check for nasal problems – If you find nose breathing difficult, it may be due to hay fever, dust mites, or sinus issues. Talk to your doctor or nurse, as treatments like nasal sprays (e.g. flixonase) or antihistamines may help.
• Watch for symptoms – Wheezing, coughing, or shortness of breath during or after exercise are signs of EIA. If these happen often, check in with your doctor or asthma nurse to review your asthma management plan – it may need to be tweaked
• Don’t avoid exercise – Sometimes children or teens try to skip PE or sports because of asthma worries. This usually means their asthma isn’t well controlled, not that they shouldn’t exercise. With the right plan, exercise is safe and healthy

Tips for Staying Well with Asthma

• Take your preventer inhaler every day as prescribed – this helps control inflammation in the airways and reduces the chance of asthma attacks
• Have an up-to-date asthma action plan – know what to do when your child’s asthma is getting worse, and share the plan with teachers, caregivers, and family
• Get regular asthma check-ups – at least once a year, or sooner if symptoms or asthma control changes
• Avoid smoking and vaping
  • Smoke and vape aerosol irritate the airways, making asthma worse
  • Smoking reduces the effectiveness of preventer inhalers
  • Children exposed to smoke or vape are more likely to have severe and frequent asthma attacks

For smoking or vaping quitting advice, click here

• Keep your home warm and dry – dampness and mould can trigger asthma. Aim for a healthy indoor temperature (around 18–20°C) and use ventilation to reduce condensation
• Reduce dust, mould, and allergens – vacuum regularly, wash bedding weekly in hot water, and fix leaks or damp spots
• Keep up with vaccinations – including annual flu and COVID-19 vaccines, which help prevent serious respiratory illness
• Recognise triggers – such as colds, pollen, pets, dust mites, smoke, or exercise, and learn how to manage them
• Stay active – physical activity is good for lung health and overall wellbeing. With good asthma management, children should be able to join in sports and play
• Eat well and sleep well – a balanced diet and good rest support strong immunity and recovery
• Seek help early – if symptoms are getting worse, don’t wait. Contact your doctor, nurse, or asthma educator

Asthma Control Test

A Simple Test to Help Manage Your Asthma

Click Here for the Asthma Control Test

The Asthma control test is a commonly used tool by healthcare providers globally, and has been scientifically tested with hundreds of people with asthma.

The asthma control test (ACT) is a commonly used, subjective tool, filled out by patients and whanau to help determine the level of someones current asthma control. The test asks questions relating to the last four weeks.

There is both an adult and a child’s test and they come in a variety of lanugages. The adults test is comprised of 5 questions with a total score available of 25.

The childrens test allows for both the child and parent/caregiver to fill in their respective sections and a total score of 27 is available.

For both adults and childrens asthma control tests, a score of 19/20 or less suggest partly or poorly controlled asthma.

Based on the score, you can help take appropriate action to better manage your asthma.

If you are struggling with asthma or would like to understand more about it, get in touch with us today.

What is a peak flow meter?

A peak flow meter, also known as a peak expiratory flow rate meter, is a small handheld device that helps you measure how well air moves out of your lungs. This is measured in litres per minute (L/min). By blowing into the mouthpiece as hard as you can after a deep breath, you get a reading of the maximum (or peak) rate at which you can blow air out of your lungs. It can help monitor changes in your airways.

During an asthma flare-up, the airways in the lungs slowly start to narrow and this slows the speed of air moving in and out of the lungs which is detected by the peak flow meter. A peak flow meter can help show the narrowing of the airways well before an asthma attack happens and help you figure out what may be triggering your asthma.

A peak flow is not used as a diagnostic tool on its own and sometimes it is not used at all to diagnose asthma. If it used to determine if you have asthma or to see if a low peak flow reading can be reversed (which can indicate asthma), your doctor or nurse may perform something called ‘reversibility’.

Reversibility is a test done by your health professional using your peak flow and a reliever medication. You will be given a specific number of puffs of a reliever and asked to measure your peak flow again. They will calculate the percentage that your peak flow has improved (if at all) and this can help form a picture of what is going on inside your airways at that time.

Measuring peak flow can be useful at certain times in a person’s asthma management, such as tracking changes over several weeks, especially if your asthma is not as controlled as it could be. Some people use them all the time while others don’t find it adds value to their asthma care.

What is my expected peak flow?

Everyone has a peak flow ‘normal range’ and this is important to know before you measure your peak flow to determine what you should be aiming to blow. Click here to find out your expected peak flow. You can keep track of your peak flow by using it with a peak flow/symptom diary.

It is important to always use the same peak flow meter. Your results may differ on your peak flow meter verses your doctor’s peak flow meter. This is one of the reasons why knowing your personal best is important.

How to measure peak flow

• Move the marker of the peak flow to the bottom of the numbered scale
• Stand up straight
• Take a deep breath in and make sure you have filled up your lungs as much as possible
• Hold your breath as you place the peak flow mouthpiece between your teeth and lips – make sure you have a tight seal and your tongue is out of the way
• Blow out as hard and fast as you possibly can in a single blow. Your first blast of air out is the most important – continuing to blow after this will not change the result
• Take note of your first result
• Repeat this process two more times
• Write down the best blow of the three – this is your ‘actual’ peak flow recording which you can compare to your ‘expected’ peak flow
• From here, you can update your doctor, nurse or educator with the result or keep a copy of the result in your symptom diary

Top tip: When measuring peak flow, imagine a birthday cake with candles at the other end of the house/building and imagine you have to blow hard enough to blow the candles out from where you are standing – this is the amount of force you should be blowing into the peak flow.

Where to get a peak flow

You can ask your doctor or nurse for a free peak flow and to help you determine what your expected peak flow is. Alternatively, contact your local asthma society.