Question:

Are there periods when asthma is dorment so to speak?  I haven’t been using my inhalers recently and haven’t noticed any increase in asthma. Richard Harwood

Response:

For Step 1 asthma (Mild Intermittent), drugs are only needed when there are symptoms. I used to have seasonal asthma, just in the fall, in the ragweed pollination time. For Steps 2,3,4  asthma (Mild, Moderate, Severe Persistent) drugs are needed all the time. Current asthma guidelines are to use a self management Action Plan; increase drugs when symptoms worsen and peak flows drop; reduce when symptoms decrease and peak flow returns to normal. Ellis – Hide quoted text — Show quoted text – Are there periods when asthma is dorment so to speak?  I haven’t been using my inhalers recently and haven’t noticed any increase in asthma. Richard Harwood

Response:

For Step 1 asthma (Mild Intermittent), drugs are only needed when there are symptoms. I used to have seasonal asthma, just in the fall, in the ragweed pollination time. For Steps 2,3,4  asthma (Mild, Moderate, Severe Persistent) drugs are needed all the time.

Are there guidelines or a website that distinguishes between those categories in more detail? Current asthma guidelines are to use a self management Action Plan; increase drugs when symptoms worsen and peak flows drop; reduce when symptoms decrease and peak flow returns to normal.

When my symptoms go away, I don’t know whether to think that’s because the asthma is going away and that I don’t need the inhalers, or whether that means the inhalers are doing a good job at reducing the symptoms.  How are you supposed to tell the difference? Jill

Response:

Since getting treated for sleep apnea, and using a CPAP machine at night, I’ve only had ONE attack, and that was two days after starting use of the CPAP. (perfume at the office). Since then, I’ve weathered most of my usual triggers: cold dry air outdoors, exercise, humidity, colds and a very persistant cough for three weeks. WOW! OF course, I’ve remained on my usual maintenance meds; I just haven’t needed the higher levels stuff, or the nebulyzer, or albuterol. Just the Serevent, Flovent, and Accolade (and Zyrtec for the allergies). And I still use the air cleaner … But for me, this is unprecedented. I occasionally have weeks free of attacks. But months! (Since third week of November). Looks to me like the strain to breath each night was putting strain on the whole respiratory system and draining energy I needed to cope. Anyone else out there with experience with asthma plus apnea? Peggy – Hide quoted text — Show quoted text – For Step 1 asthma (Mild Intermittent), drugs are only needed when there are symptoms. I used to have seasonal asthma, just in the fall, in the ragweed pollination time. For Steps 2,3,4  asthma (Mild, Moderate, Severe Persistent) drugs are needed all the time. Current asthma guidelines are to use a self management Action Plan; increase drugs when symptoms worsen and peak flows drop; reduce when symptoms decrease and peak flow returns to normal. Ellis Are there periods when asthma is dorment so to speak?  I haven’t been using my inhalers recently and haven’t noticed any increase in asthma. Richard Harwood

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Response:

Sounds like you need an action plan. This is something that you must develop with your doctor or asthma educator and your doctor. In essence an asthma action plan uses a daily peak flow and symptom diary to keep track of your asthma. Your personal best peak flow is found. This is used to determine zones of asthma severity for you personally Then a horizontal line is drawn on a graph at the 80%, 60% and ( depending on the doctor ) 45-50% point of the graph. These represent 80, 60 and 45-50% of your personal best. Your peak flows are plotted twice daily on the vertical axis of the graph and if you are doing well will be in the upper 80 – 100% zone which represents your controlled asthma zone. Below is the 60-80% zone which reflects deterioration and as expected the 45 or 50 – 60% zone is your asthma at its worse. Some diaries use more or different zones, but the concepts are the same. By plotting your peak flows and symptoms, you can develop a plan of action with your doctor. If you are in the 80-100% zone, you are taking minimal meds which can be determined by using your asthma diary also. For some, this is a short-acting reliever as needed. For others, this may include AM/PM puffs of an inhaled steroid and the short acting reliever as needed. For other more severe patients, this may include the addition of a long-acting reliever or antileukotriene agent to the inhaled steroids and as needed short-acting reliever. If the patient starts to drop into the next zone, say from a viral infection, then you may have instructions to double your inhaled steroid dosage automatically until symptoms and peak flows improve etc etc. This follows through all the zones with the last zone often having the instruction to call 911 . The asthma diary monitor allows you to use the minimal medication to maintain asthma  control and to treat exacerbations of symptoms quickly. It is also useful for testing new medications and determining the minimal amount of medication to keep you in the top 80-100% zone. The type of asthma diary may vary from center and only the concepts of the above explanations should be used for understanding. You can also chart trigger exposure and learn how different triggers affect you and evaluate trigger reduction strategies. Not all centers use action plans and they should not be attempted without consulting your doctor. A comprehensive asthma education/assessment regime is often needed for teaching  concepts such as trigger avoidance, inhaler techniques and to objectively measure lung function with spirometry testing. Indeed, not all patients have the cognitive function to perform self-assessment with an action plan either. Talk to your doctor about it and perhaps they may agree or suggest an alternative means of treating/assessing you. http://www.cma.ca/cpgs/asthma.htm has some information on assessing asthma severity. This is the 1999 Canadian Consensus Guideline. In general asthma severity is assessed by 1. The frequency and chronicity of symptoms 2. The presence of persistent airflow limitation as determined by    objective lung function studies 3. The medication required to maintain control Hope this helps cheers Deol – Hide quoted text — Show quoted text – For Step 1 asthma (Mild Intermittent), drugs are only needed when there are symptoms. I used to have seasonal asthma, just in the fall, in the ragweed pollination time. For Steps 2,3,4  asthma (Mild, Moderate, Severe Persistent) drugs are needed all the time. Are there guidelines or a website that distinguishes between those categories in more detail? Current asthma guidelines are to use a self management Action Plan; increase drugs when symptoms worsen and peak flows drop; reduce when symptoms decrease and peak flow returns to normal. When my symptoms go away, I don’t know whether to think that’s because the asthma is going away and that I don’t need the inhalers, or whether that means the inhalers are doing a good job at reducing the symptoms.  How are you supposed to tell the difference? Jill

Response:

congrats richard.  I believe so.   My asthma is seasonal so iti s dorminat some. Ray Casper Flores

– Hide quoted text — Show quoted text – Are there periods when asthma is dorment so to speak?  I haven’t been using my inhalers recently and haven’t noticed any increase in asthma. Richard Harwood

Response:

For Step 1 asthma (Mild Intermittent), drugs are only needed when there are symptoms. I used to have seasonal asthma, just in the fall, in the ragweed pollination time. For Steps 2,3,4  asthma (Mild, Moderate, Severe Persistent) drugs are needed all the time. Are there guidelines or a website that distinguishes between those categories in more detail?

Go to: http://www.ama-assn.org/special/asthma/treatmnt/guide/guidelin/guidel… You can ‘drill down’ to get the information you need.  You can also download and print the entire document – an afternoon reading this is time well spent. No electrons were harmed in the posting of this message.

Response:

Sounds like you need an action plan. This is something that you must develop with your doctor or asthma educator and your doctor. In essence an asthma action plan uses a daily peak flow and symptom diary to keep track of your asthma.

I’ve been using a peak flow meter regularly and record the values but I haven’t exactly been keeping a symptom diary.   By plotting your peak flows and symptoms, you can develop a plan of action with your doctor.

How often are you supposed to go to your doctor? I’ve had my prescriptions refilled by the phone but have avoided going back to the doctor for a year basically because I am fearful of doctors, among other things, but that’s a problem for another newsgroup. I’m taking flovent and serevent and it seems like they are working pretty well, so I wasn’t sure when to go back to the doctor, although it does seem like I need an action plan, as you’ve suggested. Hope this helps

Yes. You, Ellis, and Colin were all helpful. Thanks! Jill

Response: