Monitoring Asthma Control

At the time of diagnosis the doctor will choose treatment based on the severity of symptoms. Over time a treatment plan may be developed based on how well symptoms are controlled. The following chart reveals the guidelines set for various components used to assess asthma control.

Components assessed	Well controlled	Not well controlled	Very poorly controlled
Symptoms	=< 2 days/week	> 2 days /week	Throughout the day
Interferes with daily activities	None	Some	Extreme
Nighttime awakenings	Age 0-4 =< 1 x month Age 5-11 =<1 x month Age => 12 =<1 x month	Age 0-4 > 1 x month Age 5-11 => 2 x month Age => 12 1-3 per week	Age 0-4 > 1 x week Age 5-11 => 2 x week Age => 12 > 4 per week
SABA use for symptom control	=< 2 days/wk	> 2 days/wk	several times per day
Lung Function FEV1 or peak flow (this component is not used in children 0-4) FEV6 or FVC (this component is not used in children 0-4)	> 80% of predicted or personal best >80%	60-80% of predicted or personal best 75-80% of predicted value	<60% of predicted or personal best <75% of predicted value
Exacerbations Age ?5 consider the severity of exacerbations and the length of time between them
Age 0-4 (0-1x year) Age 5-11 (0-1x year) Age => 12 (0-1 x year)	Age 0-4 (2-3x year) Age 5-11 (=>2 year) Age => 12 (=>2 year)	Age 0-4 (> 3x per year) Age 5-11 (=>2 per year) Age => 12 (=>2 per year)

Medical devices used for diagnosing, monitoring and treating asthma

Peak flow meters

A peak flow meter is a simple device that patients can use at home to measure the force with which they are able to exhale (breathe out). This can help patients detect any decline in lung function early so they can step up treatment before symptoms become serious. The meters are inexpensive and readily available in most drug stores and do not require a prescription.

To use peak flow measurements to monitor asthma control, you need to know your 'personal best' measurement. This is the highest measurement you are able to achieve in a two to three week period, when you have no asthma symptoms. Based on your 'personal best' measurement and the percentages given below, your physician can help you calculate ranges that show you how well controlled your asthma is. Color coding these ranges can be helpful.

Green-stable

- well controlled
- measurement should fall between 80 to 100% of your personal best

Yellow-caution

- not well controlled
- measurements are 60 to 80% of your personal best

Red-danger

- very poorly controlled
- measurements are less than 60% of your personal best

How to use your peak flow meter

1. Connect the mouthpiece to the peak flow meter (if it comes as a separate piece).
2. Move the marker to the bottom of the scale.
3. Stand up.
4. Take a deep breath. Fill your lungs completely.
5. Place your lips tightly around the mouthpiece. Blow as hard and as fast as you can with a single breath.
6. Now, look at where the marker is. This is your peak flow rate.
7. Blow into the peak flow meter two more times. Record the highest reading of the three in your asthma diary.

Tips for using your peak flow meter

• Keep it clean for more accurate reading
• Keep a daily record of your readings. Record any special circumstances that may account for changes in the readings (i.e. had a cold, around pets, encountered-heavy scents, smoke, dust etc)
• Use it the same time every day
• In addition to regular monitoring you may want to check it when you need rescue medication and then 20 to 30 minutes after using your medication
• You may want to use it more frequently when you have a flu, cold, etc.
• Take your asthma diary with you when you see your health care provider to discuss your asthma.

Spirometers

A spirometer is a simple device used to look at how well your lungs work by measuring how much air you can inhale and exhale. This simple test involves holding the end of a tube in your mouth (which is attached to the spirometer), while you inhale as much air as possible and then exhale forcefully for six seconds or more. Spirometers are generally used in the physician's office or hospital. However, a number of hand-held spirometers are now available at reasonable prices, making it easier for patients who need to be more carefully monitered to do this at home on a regular basis. Spirometer measurements that are commonly used to monitor asthma control include:

• Forced vital capacity (FVC), which is the maximum amount of air you can inhale and exhale.
• Forced expiratory volume ₁ (FEV₁), which is the maximum amount of air you can exhale in one second.
• Forced expiratory volume ₆ (FEV₆), which is the maximum amount of air you can exhale in six seconds. FEV₆ is known to give an excellent picture of FVC and is sometimes used in its place since people find it more comfortable.

Spacers

Asthma medication is often delivered using an inhaler. A spacer is a device that can be attached to an inhaler that

• makes an inhaler easier to use, by allowing you to breathe normally
• helps distribute the medication more deeply and evenly into the lungs
• helps reduce thrush from corticosteroid inhalers by reducing the amount of spray that settles on the back of the throat and tongue
• helps reduce the bad taste of inhalers by reducing the amount of spray that settles on the back of the throat and tongue
• makes it easier to inhale medication during an asthmatic attack

Spacers come in various shapes and are made of different materials. The inhaler is inserted into one end of the spacer, while the patient breathes into the mouthpiece or mask at the opposite end, while spraying a dose of medication into the device. It is important to avoid any delay in breathing in and out of the spacer after the medication is sprayed, since delays will result in the medication particles settling onto the bottom and sides of the reservoir and patients will receive a smaller dose.

Spacers are available with a mouth piece or different sized face masks. Face masks are easier for infants, small children (0-4), people with disabilities and some seniors.

Spacers can be purchased in pharmacies and do not require a prescription. Some people find the bulky size of a spacer makes it inconvenient to carry. Using a spacer at home for morning and evening doses of inhaled steroids and long acting beta2 agonists can decrease thrush and increase the effectiveness of asthma prevention medications.

Tips for using spacers

• Remove the cap from the spacer mouthpiece before using.
• Remove the plastic cap from the inhaler mouthpiece and insert the mouthpiece into the opening in the spacer.
• Breathe normally in and out of the spacer.
• Release only one spray of medication into the spacer at a time.
• Continue to breathe normally for 4 to 5 more breaths.
• If a second spray of medication is required. Wait one minute before releasing the second dose into the spacer.
• Some spacers have a whistle to help you detect if you are breathing properly. If your spacer makes a whistling noise you are breathing too hard and/or fast. Try to take long, slow, deep breaths.
• Follow washing instructions for the specific device you purchased. Most spacers are not dishwasher safe and should be washed in mild soapy water using a gentle swishing motion and allowed to air dry. Do not use brushes or cloths to clean inside spacers that have airflow valves.