Don't Let Asthma Control You

Don’t let asthma control you

Susana came to us as a new patient last year for another opinion on her asthma. She was still experiencing asthma attacks in spite of using her maintenance inhalers daily. Overall, though, she thought her asthma was “pretty well controlled.”

Asthma is a chronic condition manifested by wheezing, shortness of breath, cough and/or chest tightness. Some patients have all these symptoms; some just have one or two. Asthma can be mild, moderate or severe. But mild, moderate and severe asthma can all be controlled.

Asthma control is defined by how often and how severe the symptoms are.  To assess control, we ask five questions:

1) Have asthma symptoms kept you from getting as much done at home, school or work?

2) How often are you experiencing shortness of breath, wheeze, cough or chest tightness?

3) Are you waking up at night because of any asthma symptoms?

4) How often do you have to use your rescue inhaler (e.g., albuterol)?

5) How well do you think your asthma is controlled?

Each question can be answered from 1 to 5, with 1 indicating poor control and 5 indicating complete control. When we add up the five answers, we get a total score ranging from 5 to 25. A score between 20 and 25 indicates good control. If your score is below 20, your asthma could be better managed.

Many patients with asthma use Advair to prevent asthma symptoms. Advair was state of the art 15 years ago, but much better alternatives are now out. As Advair’s ingredients became generic, the name-brand drug’s price skyrocketed. It now retails for over $400. But a therapeutic alternative, AirDuo, has the exact same ingredients and can be purchased for $51 at Walgreens using GoodRx. Big difference. For those whose symptoms aren’t adequately controlled on Advair, we have about 8 to 10 newer inhalers that work better. 

Sometimes, no combination of inhalers provides adequate relief. Fortunately, we also have four biologic injectables to help control asthma. These classes of medication neutralize either the allergic antibody or the allergic white blood cell, and have been shown to be very effective in patients with the most severe types of asthma. Although expensive, each company has very generous co-pay assistance to keep the out-of-pocket costs affordable.

Susana’s initial asthma control score was 14, but is now consistently between 19 and 25. She now takes the stairs instead of the elevator, and no longer dreads having to walk across a parking lot to her car. If you feel your asthma is not controlled, we can help.

No one nose allergies like we do.™ 

Note: Information contained in this article should not be considered a substitute for consultation with a board-certified allergist to address individual medical needs.


David B. Engler, MD, FACAAI, FAAAAI Dr. Engler is a board-certified allergist and immunologist who hails from Houston, Texas. He was recently voted Best Allergist/Immunologist in Houston by H Texas Magazine, an honor based on peer and reader voting, as well as a Super Doctor by Texas Monthly Magazine.

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