DEAR DOCTOR K:
My son was recently diagnosed with asthma. His doctor wants to put together an asthma “action plan.” What is that?
Asthma is a complicated and serious disease. It can behave differently from hour to hour and from day to day. A person with asthma needs a plan for what to do at each stage of the disease. I’ll describe the elements of the plan in a minute, but first a little background on asthma itself.
Asthma assaults the lung’s airways. The airways are the tubes through which the air you breathe enters and leaves your lungs. During an asthma attack, the airways get narrower as the muscles surrounding them constrict. The airways also become inflamed, and mucus fills the narrowed passageways. As a result, the flow of air is partially or completely blocked.
A mild asthma attack may cause wheezing, difficulty breathing or a persistent cough. Symptoms of a more severe attack can include extreme shortness of breath, chest tightness, flared nostrils and pursed lips.
Two types of medications are used to treat asthma: controllers and relievers. Controllers — usually inhaled corticosteroids — are medicines taken regularly to reduce the likelihood of asthma attacks. They reduce inflammation, which decreases mucus production and reduces tightening of airway muscles.
Relievers, or “rescue” medications, are used just during asthma attacks. They stop or reduce the severity of the attack by relaxing the muscles around the airways to improve airflow. Bronchodilators are often used as rescue medications. (I’ve put an illustration showing how medications treat asthma at the end of this post.)
Everyone with asthma should have an asthma action plan. This is a written plan that details what you need to do to control your asthma. It also explains what to do when you experience asthma symptoms or in case of an emergency. You may feel that you already know this information, but when you or a loved one is struggling to breathe, it helps to have a set of written instructions to refer to.
Asthma action plans are often divided into “zones.” You should be able to tell what zone your son is in from his symptoms. The action plan will tell you what you need to do in each zone. For example:
- GREEN ZONE: Doing well. No coughing, wheezing, chest tightness or shortness of breath; can do all usual activities. Take prescribed long-term controller medicine.
- YELLOW ZONE: Getting worse. Coughing, wheezing, chest tightness or shortness of breath; waking at night; can do some, but not all, usual activities. Add quick-relief medicine.
- RED ZONE: Medical alert! Very short of breath; quick-relief medicines don’t help; cannot do usual activities; symptoms no better after 24 hours in yellow zone. Get medical help now.
People live with asthma for many years and come to know a lot about it. So a written asthma action plan may seem unnecessary. But in my experience, people who suddenly get sick sometimes forget to take the steps they know they should. A written asthma action plan can be a valuable reminder at a moment of trouble.
How medications treat asthma
When you inhale a bronchodilator or controller medication, the drug acts directly on your bronchial tubes (A).
(Medications taken as tablets reach your lungs indirectly, through the bloodstream.) Quick relievers act as bronchodilators, relaxing muscles in the bronchial tubes so that the restricted airway passage reopens, often within minutes (B).
Controllers, taken regularly, work to relax the bronchial muscles and reduce the swelling and inflammation of the airway lining (C).