Staying Out of Asthma’s Danger Zone

Asthma specialists issued new guidelines to help asthma patients know signs of trouble

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Asthma has warning signs that can be fairly obvious, giving people with asthma time to take positive action. Not every asthma patient, however, knows how to ward off a crisis.

An organization of allergists and asthma researchers has issued updated guidelines designed to help asthma patients know when they’re in good health, when an asthma crisis may be close at hand and when they’re in trouble.

"Ask your allergist about how to keep asthma from flaring up."

A task force of doctors and members of the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology has issued guidelines to help cut the number of asthma attacks.

The guidelines come at a time when the number of people with asthma — and the cost of treating them — has been steadily growing. They were designed to help people with asthma when they are away from their doctors’ offices, hospitals or other clinical settings.

“The ideal intervention should provide quick relief of symptoms, prevent progression to the red zone, be safe enough to initiate at home, be convenient and practical for self-administration, be portable, so that it is always available, and be cost effective,” the researchers wrote.

The authors wrote that, as a first step, doctors should provide all asthma patients with a written plan for curbing asthma symptoms when they first start to appear. That plan should be divided into green, yellow and red zones, similar to the lights of traffic signals, they said.

In the green zone, a patient has two or fewer days each week of wheezing or coughing and, after using his or her inhaler or nebulizer as needed, gets the desired relief. The patient neither coughs nor wheezes during sleep.

“This is a 'feeling good' zone, where you should be every day,’” the researchers wrote.

If the patient moves from feeling good to feeling bad by, for example, starting to cough or wheeze during normal activity or during sleep, he or she should increase use of the inhaler or nebulizer. The patient also should begin gauging breathing with a portable peak flow monitor and figuring whether he or she has been exposed to allergens or other asthma symptom triggers.

At that point, the patient should begin to determine whether he or she has moved into the yellow zone. That's done by taking a prescribed number of medicinal puffs from an inhaler or prescribed amount of medicine from a nebulizer, a device that delivers a spray of medicine. That amount of medicine would be repeated over a set time period, the guidelines authors noted.

If that repeated use eases the asthma symptoms, the patient remains in the yellow zone. If not, the patient has moved into the red zone, which involves coughing and wheezing steadily; being short of breath while walking or talking; and possibly showing signs of being “sunken in” around the neck, chest and ribs.

At that point, the patient should continue use of an inhaler or nebulizer but also immediately seek treatment from a doctor who is likely to prescribe oral steroids to ease the swelling and inflammation that keeps a person from breathing properly, the authors wrote.

“If you have trouble speaking and/or your lips and fingernails are blue, call 911,” they said.

Such an overall, individualized plan for cutting asthma attacks may be determined strictly by an asthma patient's symptoms or on symptoms and measurements of air flowing through his or her respiratory system. The choice depends on the doctor and the patient.

“Establishment of a patient-provider partnership was a key component of the guidelines and the asthma action plan helped create this relationship by empowering patients to monitor their asthma status and take action when control deteriorated,” the authors of the guidelines wrote.

The study was published online Aug. 1 in the Annals of Allergy, Asthma and Immunology.

These researchers had open access to the results of clinical trials and other previous studies, upon which they based their recommendations.

Several of the authors received research grants and consulting fees from pharmaceutical companies.

Review Date: 
July 31, 2014
Last Updated:
August 1, 2014