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Asthma Control

Long-term Goal: Total Asthma Control

According to the Global Initiative for Asthma, there are different types of asthma control: controlled, partly controlled and uncontrolled.

Basically, asthma control is a measure of how normal your life is compared to other people your age. It is measured once you are on asthma controller medicine and measures of how well your asthma therapy reduces asthma symptoms and impairments.

In other words, Asthma Control measures:

  • The degree your symptoms are minimized (short of breath, wheezing, etc.)
  • The degree your impairments are minimized (ability to exercise, walk, live a normal, active life)
  • The degree to which your goals of therapy are met (I'm able to exercise without limitations.  No school or work days missed.)


(over the past 4 weeks)


Partly controlled


All of the following

1 or 2 of the following

3 or more of the following

Daytime symptoms

None/twice or less a week

Thrice or more a week

Limitation of activities



Nocturnal symptoms



Need for bronchodilator

None/twice or less a week

Thrice or more a week

Lung function



< 80%

Source: GINA Pocket Guide for Asthma Management and Prevention 2010, p.8

Control is generally measured to adjust your asthma regime. By measuring this at your doctor visits your doctor may tweak your medication regime and /or your asthma action plan, or keep things as they are.

Asthma patients can have mild or severe diseases or mild and severe attacks. It is important to note that asthma control is necessary for all levels of severity. Even patients with more severe disease can have their drugs adjusted to achieve a better control of asthma. On the other hand, patients with milder diseases may not be able to lead a normal life if their controller medications are not adjusted well enough and suffer unnecessarily.

With proper care, asthma patients can lead a healthy and active life. You and your doctor need to set a goal and move towards “total asthma control”.

Management Approach Based on Control (for adults and children older than 5 years)
            Reduce                                                                                                                       Increase
Step 1
Step 2
Step 3
Step 4
Step 5
Asthma education and environmental control
As needed short-acting bronchodilator
As needed short-acting bronchodilator; plus controller
Controller not needed
Select one controller
Select one controller
Step 3 treatment +
Select one controller
Step 4 treatment +
Select one controller
Low-dose inhaled steroid
Low-dose inhaled steroid
long-acting bronchodilator
Medium-or high-dose inhaled steroid
long-acting bronchodilator
Oral steroid (lowest dose)
Leukotriene modifier
Medium-or high-dose inhaled steroid
Leukotriene modifier
Anti-IgE treatment
Low-dose inhaled steroid
Leukotriene modifier
Sustained release theophylline
Low-dose inhaled steroid
Sustained release theophylline

Source: GINA Pocket Guide for Asthma Management and Prevention 2010, p.14

Severe Astham

Asthma severity involves both the severity of the underlying disease and its responsiveness to treatment.

It is important to note that severity is not a fixed feature of asthma, but may change over months or years, whereas the classification by severity alone suggests a static feature.

So, in the current management of asthma, the treatment emphasis and paradigm has shifted from taking into account of asthma severity alone, to the level of control.

No matter how severe your asthma is, by being asthma smart most asthmatics can obtain good asthma control.

How to Tell Asthma is not Controlled?

  • Poor sleep, persistent cough or breathing difficulty because of asthma
  • Asthma attacks caused by sports or daily physical activities (e.g. climbing up stairs)
  • Increased use of bronchodilator
  • No relief of symptoms after the use of bronchodilator
  • Dropped peak flow readings
  • Enormous difference between morning and night peak flow readings


Patients may use the peak flow meter and the Asthma Control Test (ACTTM) to assess whether their asthma is under control, to monitor the treatment results and to promptly detect any worsening of their condition.

The Key to Total Asthma Control

  • Proper use of medication.
  • Monitor your disease with the peak flow meter every morning and evening.
  • Conduct the ACTTM once a month and inform your doctor of the result directly.
  • Learn and accept that asthma is a chronic disease; discuss your maintenance plan with the doctor and make a contingency plan.
  • Avoid any known allergens that are asthma triggers.
  • Engage in an appropriate amount of physical activities, especially aerobic exercise, for better heart and lung functions.
  • Quit smoking.