Do you have good asthma control? Guess again!
Do you know what it means to have good asthma control?
Do you think you have good asthma control? Think your doctor does?
Approximately 6 out of 10 asthmatics who’s doctor “thinks their asthma is controlled” are NOT really controlled! Surprised?
Let me ask you one final question: Have you heard of the asthma control test PDF?
Because if not, I can easily fix your asthma and have you feeling better!
Why write about asthma control?
First, let me tell you that I have written this post for you, the reader with asthma.
- If you have a friend with asthma, then forward this to them.
- If you have a child with asthma, then consider reading my post about Asthma in Children (coming soon)
I want you to focus on you. Because it’s time that YOU had your asthma controlled the best it can be!
I wrote this post because with every asthmatic patient I see, every patient just like you, I assess their asthma control according to the NIH guidelines. It’s something that I do multiple times a day and, for me, it’s routine.
Appropriately assessing whether your asthma is controlled is what you should EXPECT from ANY medical provider treating your asthma.
But most providers FAIL at assessing asthma control.
In fact, 55% of providers who medically think you have good asthma control are wrong!
So I have decided on a different approach: it is time to show YOU what defines good asthma control and, by the end of this article, I will empower you to check your own asthma control!
What should you expect from good asthma control?
I had a patient come to see me today that helped me realize the need for this post. Her name was Rebecca and her story is probably very similar to yours:
Rebecca is a mother who initially came to see me for her child’s allergies and asthma. Her daughter had been struggling with a cold recently that caused asthma problems.
During the course of the visit, I wrote down a quick set of “normal expectations” of good asthma control:
- Daytime symptoms less than 2 days per week
- Nighttime symptoms less than 2 nights per month
- Less than 2 albuterol canisters in a year
- Less than 2 steroid bursts per year
- NO activity limitation
She looked at me very confused and asked where I got these “normal expectations” of asthma control. I told her this was a very simple version created from 1991 (over 20 years ago!) and that it is the very minimum expectation for good asthma control.
Even better criteria comes from the Asthma Control Test PDF.
It was at this point that she started to get a little upset. I thought I did something wrong.
However, after a moment she told me that her primary care provider had been treating her, Rebecca, with albuterol only and had been telling her that it was “normal to get shortness of breath with activities and to have to stop” for years.
She told me that she has not had a good night sleep for as long as she could remember because of nighttime symptoms and had just assumed that this was her life!
In fact, the reason she was getting care for her daughter was to prevent the same type of life for her child!
Rebecca had done an amazing job taking care of her daughter, but had never really been taken care of herself! And THAT is what I want to fix for you today!
Let me start by asking: what does controlled asthma mean to you?
I asked this question of my patients who had asthma this week and some of the responses:
- I want to breathe better
- I want to have my symptoms go away
- I want to use my inhaler less
- I want to exercise without wheezing
These are all great responses, but they fall into one consistent problem: they are subjective!
What do I mean?
- If I were to ask you what is 1 + 1, you’d say 2. No question, there is a measurable answer.
- If I were to ask you if you thought the weather was nice, some people would say yes, some no, some so-so.
The second question varies by each person. So if I ask if “you are breathing better” the answer would mean different things to different people. THAT is the problem with subjective questions.
So… what are objective (measurable) tests for determining asthma control?
Before I get even before I get any further, I think it’s important to discuss the objective measures used to assess your asthma. You can answer these questions OR you can take my test (or click link below) and I’ll give you an answer customized right away.
Test #1: Baylor Rule of Two Asthma Control Test
This is the most basic test, created in 1991 at Baylor and, since that time, the Baylor Rule of Two Asthma Control Test began to create objective measures of asthma. The questions are:
- Have asthma symptoms or take your quick-relief inhaler more than two times a week?
- Awaken at night with asthma symptoms more than two times a month?
- Refill your quick-relief inhaler more than two times a year?
And I added, based on current guidelines:
- Do you need steroid bursts more than two times a year?
- Do you have activity limitation due to asthma?
Interpretation: if you answered “yes” to ANY of these questions, then according to the Baylor Rule of Two Asthma Control Test, your asthma is NOT WELL CONTROLLED.
Test #2: Asthma Control Test PDF
The asthma control test PDF is a newer and scientifically validated version of the asthma control test which asks a series of 5 questions and gives you a score on whether or not your asthma control is adequate. You can take these questions below, , or take my automated quiz for immediate results!
- In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home?
All of the time  Most of the time Some of the time A little of the time None of the time
- During the past 4 weeks, how often have you had shortness of breath?
More than once a day Once a day 3-6 times per week Once or twice a week Not at all
- During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?
4 or more nights a week 2-3 nights a week Once a week Once or twice Not at all
- During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)?
3 or more times per day 1-2 times per day 2-3 times per week Once a week or less Not at all
- How would you rate your asthma control during the past 4 weeks?
Not controlled at all Poorly controlled Somewhat controlled Well controlled Completely controlled
Add your score here:_____
If you score is 19 or less, your asthma control is not as well controlled as it could be and you should see your primary care, allergist (or ask me) on how to get better control.
It’s really that simple!
While asthma itself is pretty complicated (see the post on what causes asthma), finding out whether or not you have good asthma control is simple.
It is because of this simplicity… because these have been questions that are been out for over 20 years, that I get so frustrated when doctors are so bad at properly controlling your asthma!
Summary so far…
I thought about stopping the post here because it was getting long, but wanted to address one more part: spirometry (breathing tests).
If you are tired of reading, I certainly understand. You can download the article here and finish it later.
The value of the Baylor Rule of Two Asthma Control Test questions and the is that these are specifically designed to be answered BY YOU and are VALID AT ASSESSING ASTHMA.
There is no special equipment needed to assess asthma. By answering these questions (another quick link to download the or take my online quiz), you can assess your asthma control.
What about spirometry (asthma control breathing tests)?
The reason that allergists do spirometry breathing tests are to see how your lungs are performing:
- When compared to yourself / your best potential
- When compared to other people
- When compared to fixed guideline standards
There are some people who are called “poor perceivers” who, quite honestly, just don’t know what good asthma control really means.
They think their asthma is under good control (or that they do not have asthma symptoms) but really they are breathing with hurt or reduced lungs.
I have a whole article here (coming soon) on the concept of poor perceivers. But for this article, know that a spirometry is the second part of a good asthma control test.
Any provider who treats asthma NEEDS to do spirometry at least once a year, when any medication is changed, with any symptom changes, or with any other contributing symptom changes). If they are not, then I would HIGHLY suggest asking them to start or finding a provider who does!
How do I, as an allergist, assess if your asthma is controlled?
When I make sure you have good asthma control, I want to see two areas that are BOTH in control:
1. Symptomatic control
- Assessed by Baylor Rule of Two Asthma Control Test
- Assessed by Asthma Control Test PDF
If your asthma symptoms are well controlled but your spirometry breathing test is low, the you do not have good asthma control. On the other hand, if you’re breathing test is normal but your symptoms are bad, then you do not have good asthma control. You need both in order to consider your asthma well controlled.
If there is one area that is not well controlled, then your asthma control is not at it’s best!
Putting it all together: What does this mean for you?
DO NOT just rely on your medical provider to assess your asthma control.
Take matters into your own hands:
- Ask yourself the Baylor Rule of Two Asthma Control Test
- If ANY are a yes –> your asthma needs to be better controlled.
- If they are all normal, then take the Asthma Control Test PDF
- Assessed by Asthma Control Test PDF
- If your score is equal to or less than 19 –> you asthma can be better controlled.
- If your score is over 19, then your symptoms would be well controlled
- If you have not done so, get a spirometry test to determine your lung function.
- If your lung function is abnormal –> you need better asthma control.
- If your lung function is normal then you have good asthma control
- If you have both normal symptoms and normal breathing test, then you should consider talking to your doctor about REDUCING your medications. But, again, that’s another post.
Stop accepting “good enough” for asthma control. Stop accepting a 55% “good enough” asthma control plan.
With the medications currently available, there is no excuse for poor asthma control!
If you know anyone who is struggling with asthma, please share this page with them or download the Asthma Control Test PDF and send it to them directly. They will thank you when they can breathe better.
If you don’t know anyone with asthma (1 in 12 people have asthma or an asthma variant, so you most likely do) then consider sharing this on Facebook or Pinterest.
- If you had 200 friends on Facebook, then 17 will have asthma / asthma-variant.
- Of those 17 friends, about 10 currently have asthma that isn’t well controlled.
- That means that 5% of your friends are struggling with bad asthma!
And you can help them feel better!