What Do They Mean When They Say My Asthma Is (Or Is Not) In Control?

by Carolyn Bell, BSRT, RRT, AE-C

Mary is the mother of two very active children; she also has asthma. She feels her asthma is much better than it was in the past. She is not having attacks as often. Mary does still get a little short of breath when having to run after her daughters, and she doesn't play on the softball team now since it caused her to have trouble breathing while practicing. But she only uses her inhaler a few times a day and feels she is doing well. In reality, though, Mary has uncontrolled asthma.

Asthma is a common disease that affects people of all age groups. Symptoms can vary between one person and another. They can also change over time, getting better or worse during a person's lifetime. The goal in managing asthma is to keep it in control.

Three groups

So what does "control" mean? The Guidelines for the Diagnosis and Management of Asthma, from the National Heart, Lung and Blood Institute's National Asthma Education and Prevention Program, divide "asthma control" into three groups: well controlled, not well controlled, and very poorly controlled. When we state someone's asthma is well controlled, we mean the person has no symptoms without changing normal activities. Frequent episodes requiring urgent care, emergency room visits, or hospitalizations due to symptoms or episodes, would be classified as very poorly controlled asthma. This is the tricky one. If you have asthma, ask yourself these questions:

• Do you use your rescue medication more than twice a week?
• Do you wake up with coughing or short of breath?
• Do you avoid activities such as sports or walking due to shortness of breath or coughing?

If you do, then your asthma may not be in control.

Symptoms = lack of control

Many people fall into the second group with their asthma not well controlled. These people function daily and life goes on. Many times they think their asthma is controlled but they wake up at night, or are using their rescue medication more than twice a week because they have trouble breathing or coughing. They might also avoid doing activities that may cause them to have symptoms, such as playing sports or walking long distances. But they do not think their asthma is "bad" enough to seek help or even call the doctor.

Mary falls into this group; she does not have attacks, but her symptoms impact her daily life and activities. The national asthma guidelines state that using rescue medicine more than twice a week signifies uncontrolled asthma. Another example is waking at night with symptoms of coughing, shortness of breath, or wheezing. This is NOT controlled asthma!

Working with your health care team is an important part of preventing your symptoms and "controlling" your asthma. People with well-controlled asthma should be able to take their daily medications as prescribed without the use of—or with the very infrequent use of—rescue medications. Asthma should not alter your daily activities, nor should it prevent you from doing activities that you enjoy.

If you think your asthma is not well controlled, or have any questions, please contact your health care provider.