Asthma

Asthma is a chronic (long-term) disease that makes your airways (breathing passages) very sensitive. Certain things can make your airways become swollen and the muscles around the airways tight, leaving you breathless.

Asthma can’t be cured, but with proper treatment people with asthma can lead normal active lives.

Have more questions or need more support? Download the Vik Asthma chat bot on the app store or visit e-asthma.ca to get your questions answered!

Symptoms

Most people with asthma will first show symptoms when they are young. However, asthma can develop at any age. Asthma symptoms are different from person to person, and they can change over time. People with asthma often have one or more of these symptoms:

• wheezing
• chest tightness
• coughing
• feeling short of breath

Speak with your healthcare provider if you have any of these symptoms.

Diagnosis

An accurate diagnosis is an important first step in managing asthma and only a healthcare provider can diagnose asthma. If you suspect you have symptoms of asthma, ask your healthcare provider about next steps.

An asthma diagnosis is generally made using a medical history, a physical examination, and breathing tests.

Medical History

A medical history will likely include questions about your past and current health related to asthma, such as common asthma symptoms and when you have them, your personal and family health history, and the environment you live in (including work and school).

Some example questions might include:

• Do you have a cough? Are you short of breath? Is your chest feeling tight? Do you wheeze?
• When do you have these symptoms? During the day? At nighttime? With exercise or activity?
• Do you or family members have allergies?

Physical Examination

Your healthcare provider may check for signs that you may have asthma. This might include:

• Listening to your chest for sounds that may be heard in those with asthma.
• Looking at your eyes and nose for signs of allergies, such as
  • Dennie-Morgan lines (extra folds under the eyes),
  • the appearance of ‘shiners’, or
  • the appearance of a nasal crease (line across the lower part of the bridge of the nose from repeated wiping or rubbing of the nose).
• Looking at your skin for signs of eczema, dermatitis or hives.

Breathing Tests

Breathing tests are the most reliable way to diagnose asthma. There are 3 common tests:

1. Spirometry is the most preferred breathing test. It is a simple breathing test that measures the speed and the amount of air you can blow out of your lungs.
2. A Peak Expiratory Flow (PEF) test involves taking in as deep a breath as possible and blowing out as hard and as fast as possible into the measuring device called a peak flow meter. While it is the simplest test to measure airflow limitation, PEF has many limitations, so it is not the preferred breathing test used to diagnose asthma. However, it is often used to help monitor asthma symptoms. To learn more about how to use a peak flow meter watch the following video – How to Use a Peak Flow Meter.
3. Challenge tests are used when spirometry results are normal and asthma is still suspected. They involve trying to induce bronchospasm (tightening of the muscles around the airways) by inhaling a chemical called methacholine or by exercising and measuring lung function (spirometry). These tests are performed in a specialized center where strict protocols are followed, and emergency care is available.

Other tests your healthcare provider might recommend:

• allergy testing
• chest x-rays
• blood test
• sputum (phlegm or mucus) test

Take the Canadian Asthma Control Questionnaire

Many people with asthma miss work, skip sports, or wake up during the night because of wheezing, coughing, chest tightness, or shortness of breath. But with proper care and monitoring, you can reach asthma control. Below you will find information on how to regularly check your asthma, and what to do if it does get out of control. To ensure that you are getting the proper treatment, you should continuously keep an eye on the disease and communicate with your doctor.

If you answer YES to any of these questions, speak to your healthcare professional about the right medications for you to take control of your asthma.

1. Do you have to use your reliever inhaler more than twice per week?
2. Do you have asthma symptoms more than twice per week (cough, wheeze, difficulty breathing)?
3. Do you ever have difficulty exercising or playing sports because of asthma?
4. Do you wake up even one night per week because of asthma (cough, wheeze, difficulty breathing) and if so, are the symptoms mild?
5. Have you missed school or work days in the last month because of asthma?
6. Do you ever have asthma flare-ups (worsening of cough, wheeze, difficulty breathing)?

This Canadian Asthma Control questionnaire is for information purposes only. It should not replace a complete medical examination by a doctor. If you are worried about your health, please see your doctor.

Asthma Severity

Asthma severity is determined based on how much medication is needed to gain asthma control. See ‘Medication’ for more information.

• Mild-to-Moderate Asthma: Asthma that is well-controlled by a reliever therapy (short-acting bronchodilator or budesonide/formoterol) when needed or by low to moderate doses of controller therapy (inhaled corticosteroids) is considered mild-to-moderate.
• Severe Asthma refers to asthma needing high doses of controller therapy (inhaled corticosteroids) or oral corticosteroids to remain well-controlled, or asthma that is uncontrolled despite these therapies. People with severe asthma may be on additional medications, often called ‘add-on’ therapies. These add-on therapies include additional controller medications such as
  • leukotriene receptor agonists – LTRAs,
  • biologics,
  • oral corticosteroids (prednisone), and
  • macrolides (antibiotic).

Asthma triggers are anything that make your asthma worse or causes asthma flare-ups.

Triggers

Triggers can be categorized into two different groups:

1. Inflammatory – cause mucous in the airways and muscle tightening around the airways (i.e. allergens)
2. Non-inflammatory – cause muscle tightening around the airways only (i.e. irritants)

Generally, triggers classified as inflammatory last longer, may not cause symptoms until hours after exposure, and are more difficult to treat. Triggers that do not cause inflammatory changes in the airways have a more immediate response, are shorter-lived, and are treated by removing the trigger and using reliever medication.

Triggers can be indoors or outdoors, at home, school or work. Triggers need to be re-evaluated over time as they can change.

Keep in mind that allergens and irritants can work in combination. For example, if your airways are already swollen because of your allergies, and then you are exposed to an irritant your asthma will not be well controlled. The more triggers you are exposed to, the harder it will be to control your asthma.

Recognize and Avoid Your Triggers

It helps to pay attention to when and where your asthma symptoms worsen. Is it when the air is cold? When you are near your neighbour’s cat? Paying attention to your symptoms will give you clues about your triggers. Try using an asthma diary to keep track of your symptoms and your surroundings. Show your asthma diary to your healthcare provider or Certified Respiratory Educator for more help.

Continued exposure to triggers can worsen swelling in the airway and contribute to poor asthma control.  Recognizing your asthma triggers and avoiding them as much as possible is key in best managing your asthma.

Medications

There are two types of asthma medications:

1. Controller medications are used daily to control and prevent asthma symptoms.
2. Reliever medications are taken as needed to quickly relieve asthma symptoms.

To get the full benefit from your medication, you must follow the healthcare provider’s instructions and take the medications exactly as prescribed.

Keep a list of all the medications you take and show it to your healthcare providers and pharmacist, so they can check for drug interactions.

Asthma Action Plan

It is helpful to have an action plan in case of emergency. Complete a personalized Asthma Action Plan with your healthcare provider and refer to it if your symptoms worsen.

Warning signs of an asthma emergency:

• struggling for breath
• very rapid breathing
• fast activating (rescue) inhaler doesn’t help or is required more than every 4 hours
• sucking in skin above breastbone and between ribs
• being really tired/lethargic (because of the work of breathing)
• finding it hard to speak (can’t finish a sentence)
• nostrils flaring out
• pale, grey, sweating
• blue lips or nail beds