Patient information from BMJ

How can I tell when my asthma is getting out of control?

Last published:Sep 14, 2022

You should see your doctor if any of the following are happening to you:

• You're waking up at night more than usual with asthma symptoms. These symptoms might include coughing

• The inhaler you use to treat your symptoms quickly (your reliever) doesn't help your breathing for very long or doesn't help at all, or you are using it more often

• You can't breathe out as much air as you normally would, as indicated by a PEFR meter (PEFR is short for peak expiratory flow rate). Doctors sometimes recommend people use these meters at home to regularly check their breathing.

You should seek emergency treatment if:

• It's hard to talk because of your asthma

• Your nose opens wide when you breathe

• Your skin is pulled in around your ribs and neck when you breathe

• Your heartbeat or pulse is very fast

• You're finding it hard to walk

• Your lips or fingernails turn gray or blue.

At least once a year, your doctor, or a nurse with special training in asthma, should check that your asthma is well controlled. They might ask you questions about your symptoms, such as:

• Have you had difficulty sleeping because of your asthma symptoms (including cough)?

• Have you had your usual symptoms during the day (cough, wheeze, chest tightness, or breathlessness)?

• Has your asthma stopped you from doing anything (such as your job or housework)?

Depending on your answers, they might suggest that you change your treatment. They might also do tests to measure your lung function.

If your lung function is poor, or if your symptoms are getting worse, you might need to increase your dose of medication, or to add more medications to your treatment. This is called stepping up.

But if your asthma is under control, you might be able to reduce your medications. This is called stepping down.