Your Asthma Control Checklist for the Fall and Winter
For many of us, it's hard to believe the summer is over. Actually, those of us in the Midwest and Northeast regions of the United States aren't certain when summer 2009 began. October is typically my busiest month for managing patients with asthma. The return of children to school, the arrival of cold and flu season, the use of forced air heating systems, the increased indoor activities, the return of quilts and comforters to the bedroom, and increased exposure to pets (assuming the pets spend more time indoors) seems to create the "Perfect Storm" for asthma attacks.
Are You Prepared?
I have provided a checklist of preparatory measures for you to consider and discuss with your asthma care provider:
1) Check your "reliever" medication for the expiration date and also determine whether it is close to being empty (reliever medication is typically your bronchodilator, sometimes called a "rescue inhaler"). Unfortunately, Ventolin HFA is the only reliever inhaler presently that comes with a dose counter. You have to use your best guess (based on how many times you have used it) with other aerosol relievers. Most of them start out with 200 doses. If you were given a free sample by the doctor or nurse the total number of starting doses may be considerably less.
2) Check the status of your "controller" inhaler. Your controller inhaler is your steroid medication or a combination inhaler. Determine when you will need to refill it in order to avoid any missed doses that may result from delays associated with required doctor visits or call-ins for prescription refills.
3) Review your Asthma Maintenance/Action Plan (MAP). See your doctor about formulating or updating your MAP if necessary. Your Map is very important. It gives you a set of steps to take if asthma becomes more active. It should go further than simply taking more reliever inhaler for chest symptoms.
4) Locate your Peak Flow Meter (they often get lost around the house). For those over 6 years old, the Peak Flow Meter can be helpful in determining how severe the asthma attack is. It can also tell you whether your action plan is working. Ask about a Peak Flow Meter if you don't have one.
5) Change the filters on your heating system (if you have forced air heating). Have your heating and humidifier units checked for proper functioning. Disposable filters should usually be changed monthly. It is important to reduce dust mite, mold and dander levels in your home.
6) Minimize indoor pollution by maintaining a completely tobacco smoke-free home. Stoves and fireplaces and gas dryers should be properly ventilated to the outside. Fragrance-free cleaners for clothing and household cleaning are preferred.
7) If it is too cold to keep pets outdoors the next best thing is to restrict them from the bedroom at all times.
8) Indoor allergens can be further reduced by having certified dust-mite proof encasements on the pillows mattress and box spring.
9) Seasonal flu shots are available and should be given to asthma patients and household members unless there is a history of allergic reactions to egg, the flu vaccine or other factors (detailed at the time of the shot). H1N1 vaccine will soon be available and should also be considered based on your age and other factors (which should be discussed with your doctor).
10) Follow up with your asthma care provider to review many of the above suggestions as well as concerns that may be unique to your medical history. Many people have other medical problems which when active, may contribute to poor asthma control (for example gastro-esophageal reflux or obstructive sleep apnea). Have the nurse or doctor observe your inhaler technique in order to point out any flaws.
Many of my patients have weathered the storm, so to speak, this time of the year when asthma attacks are more common, by following the above guidelines.
What other steps do you take for improving your asthma control?