A couple of years ago, my asthma specialist described my moderate-to-severe asthma as “well-controlled.”

After years of feeling like my asthma wasn’t under control, I had finally gotten it to a good place.

But it wasn’t easy. It took a lot of persistence and teamwork to feel as if I was, indeed, living with controlled asthma. Plus, my definition of control had to change from what I’d thought it was.

What is asthma “control”?

There is a common set of criteria that doctors use to determine if a person’s asthma is under control. The problem is that this may look different for severe asthma than it does for mild-to-moderate asthma.

The Global Initiative for Asthma guidelines consider asthma to be well-controlled if over the past 4 weeks a person:

  • experiences symptoms less than twice a week
  • doesn’t wake at night or earlier in the morning due to asthma symptoms
  • doesn’t need to use their rescue/reliever inhaler more than twice a week
  • doesn’t experience limitations in activities due to asthma, whether at work, school, home, etc.

Asthma isn’t one size fits all. Severe asthma calls for different control parameters. For instance, just because I need my rescue inhaler more than three times a week on average and have some degree of symptoms most days, doesn’t mean that my asthma isn’t controlled.

You and your asthma specialist will define what control specifically means for you. A big part of finally feeling in control of my severe asthma was learning that control will look different for me than it might for those with milder forms of the disease.

But there was also work to put in, too.

Here are four changes I had to make to manage my symptoms and get my asthma to where it is now.

1. Many medication switches

For me, the biggest part of controlling my asthma was figuring out the best combination of medications.

Everyone’s asthma is different, and everyone reacts to medications differently. But there are many medications available, so talk with your doctor to figure out which ones work for you.

You may have to give the medications a month or two to work, so the key is to be persistent. Keep in mind, your goal is to find the combination of medications that works best.

I now take three to four medications a day for my asthma, but they’re in lower doses than if I were taking one or two medications.

2. Environmental changes

Making modifications to your environment can be a helpful step to take to manage your asthma.

I’m fortunate to not have many allergies. I do have a dust mite allergy, though, so I have allergy- and asthma-friendly bedding in my room, including a dust-proof mattress cover. Recently, I got hardwood flooring in my room to replace the carpet that had been there for ages.

I don’t have pets, but for those with pet allergies, keeping a pet out of your bedroom can help with your breathing. Showering and changing clothes when coming in from outdoors can also help if you’re allergic to pollen.

I mainly have non-allergic asthma, so many of the ways I deal with my asthma are through luck.

For example, I don’t feel as if my level of asthma control has changed greatly since going from carpeting to wood flooring in my bedroom. My primary non-allergic triggers are fragrances, exercise, weather (extreme cold and humidity), colds and viruses, and hormone fluctuations. Unfortunately, there aren’t many things I can do to avoid most of these things, with the exception of not using fragrant products myself.

3. Happy accidents toward greater control

As mentioned, hormone fluctuations surrounding menstruation are one of my triggers that took a long time for me to figure out. In 2013, I was diagnosed with uterine fibroids, for which I’ll likely have to take oral contraceptives for the foreseeable future.

But this turned into an uncommon happy accident that comes with having multiple chronic health conditions. Being on oral contraceptives has been ultimately positive for my asthma control. It’s not often little bonuses like that happen.

4. Evaluation, re-evaluation, and education

Unfortunately, severe asthma can be a tricky beast. There are so many factors you may need to consider to control your severe asthma symptoms. Here are a few topics to discuss when you talk to your doctor:

  • Treatment changes. Have new treatments come out that may help you? Are there things you haven’t discussed in a long time that could be a good fit now? These could include new inhaled medications, allergy shots, and trying out new biologic medications.
  • Confirm your diagnosis. A 2017 study indicated that up to a third of people diagnosed with asthma by a physician may not actually have asthma. In some cases, masquerading conditions may be present, such as vocal cord dysfunction or heart problems. Other times, symptoms may be in remission. Having your doctor schedule pulmonary function tests or challenge testing to confirm you are indeed treating asthma can be important.
  • Consider other conditions. Co-existing conditions can make asthma more difficult to control. Some conditions can also “mimic” asthma, including anxiety, vocal cord dysfunction, acid reflux, and hypersensitivity pneumonitis. These are known as asthma masqueraders. In addition to confirming your asthma diagnosis, talk to your doctor about other conditions you may have.
  • Asthma education. Sometimes, a fresh set of eyes can make a big difference. In addition to seeing your regular doctor, you may benefit from seeing a certified asthma educator. Certified asthma educators can teach you about asthma and help you understand your asthma’s uniqueness.

Takeaway

Asthma is different for everyone, but severe asthma can be especially difficult to control. The best way you can manage your asthma is to put in the work and don’t stop pushing for better.

Even though your symptoms might be frustrating right now, it’s important to make changes that can improve your quality of life with asthma. You never know when a new treatment will come along and be life-altering for you.


Kerri MacKay is a Canadian writer and ePatient owning asthma and ADHD. A former hater of gym class, she now has a Bachelor of Physical & Health Education from the University of Winnipeg. Kerri loves airplanes, t-shirts, cupcakes, and archery. Connect with her on Twitter @KerriYWG or KerriOnThePrairies.com.