There's a lot of asthma out there and much of it is very poorly controlled.  And it doesn't have to be that way.  At this time of year it's especially important to understand how to keep your asthma under control and avoid serious illness. A large proportion of deaths from H1N1 have occurred in people who are asthmatic.  Any respiratory illness can cause an asthma flare. First some stats--asthma affects:

• Over 22 million people
• Over 6 million children
• In 2006  3,613 people died from asthma

Chicago and New York City share the dubious distinction of having the highest asthma death rates in the country. While much extraordinary work has been done by the Chicago Asthma Consortium (funded by the Otho S.A. Sprague Foundation), closing the gap has proven challenging.  Many asthma attacks can be avoided.

Asthma is a chronic condition and like all chronic conditions, your healthcare team doesn't manage the disease, YOU DO!  Don't get me wrong, it's important to check in with your healthcare team on a very regular basis to discuss treatment and your level of symptom control, but we see you for 15 minutes every few months or so, if we're lucky!  All the rest of the days, hours and minutes in between, it's up to you!  So how can you take control of asthma instead of letting it control you? It CAN be done. 

First: Understand Your Condition and the Proper Treatment of Asthma

There are two things going on in the asthma process:

• Bronchospasm
• Inflammation

Bronchospasm is a condition in which the airways do just that--they go into spasm.  This is the part of asthma that people can often feel. Bronchospasm creates wheezing, a tight or burning sensation in the chest and shortness of breath.  But the real trick to prevent the spasm in the first place is to treat the inflammation part of the equation.  Inflammation is the part you don't feel.  Many asthmatics have underlying inflammation that creates swelling in the airways and mucus.

Asthma can show up in a variety of patterns. These include:

• Intermittent
• Mild persistent
  
• Moderate persistent
• Severe persistent

If you truly have mild asthma you only have a problem with your breathing once in a while.  When this happens you respond quickly to your "rescue" inhaler which is usually something like albuterol.  But be cautious about putting yourself in this category.  If you have significant problems with your asthma several times a year or even regular mild symptoms, you likely have one of the persistent forms. 

How can you and your healthcare team work best to get your asthma under control.  Well, first and foremost, you must have a regular healthcare team to work with on it.  Far too many people use the emergency room or walk-in clinics as their main source of asthma care. You need to work with the doctors and nurses at your primary care physician's office.  Think of that office as your "medical home"--a term you're likely to hear more in the coming months and years.  The concept of the medical home will be particularly important to an improved healthcare system.

There are two types of medicines used to treat asthma:

• Rescue medicines--used when you feel symptoms
  
• Controller medicines--used daily to prevent symptoms
  

Two: Get Proper Monitoring and Treatment

If you have several flare-ups per year, you should really be on one of the controller medicines.  Talk to your doctor about it.  I also highly recommend a peak flow meter.  Some people with asthma have become so accustomed to not breathing well that they become "numb" to their asthma symptoms.  A peak flow meter can help you see where things are with your asthma control at any given time and can be purchased at most drug stores. While everyone has their own "personal best", the reference chart that comes with the meter can give you some idea about where you should be on the meter. 

Many people with asthma think of going to the doctor when their illness is acting up.  Did you know that you should also go to the doctor for a "well asthma visit"?  Well you should.  Your doctor needs to perform an assessment of your true level of asthma control when you feel pretty well. At that time he can also discuss preventive tactics with you. 

Three: Have an Asthma Action Plan (AAP)

If your doctor hasn't talked with you about an AAP, I encourage you to bring it up to her.  Bring this form in and review it.  It's important for you to understand how your different medicines fit in with the overall control of your condition and what to do when your symptoms kick in.  By recognizing your symptoms, checking your peak flow, and taking action according to your AAP, you can avoid those long, boring and inconvenient waits in the emergency room and get on with the things you'd rather be doing.  

Four: Exercise Prevention

• Wash your hands
• Keep a distance from others who are ill
• Get a seasonal flu shot and an H1N1 flu shot
• Consider environmental control measures and allergy testing -or at least ask your doctor about whether you might need to look into these