GINA Assessment of Asthma Control allows you to self assess your level of control based of these 4 SIMPLE QUESTIONS

In the past 4 weeks, have you had

  • Daytime asthma symptoms more than twice a week?
  • Any night waking due to asthma?
  • Reliever needed for symptoms more than twice a week?
  • Any activity limitation due to asthma?

If you say YES to 0 of these questions, your level of asthma control is WELL-CONTROLLED

If you say YES to 1-2 questions, your level of asthma control is PARTLY-CONTROLLED

If you say YES to 3-4 questions, your level of asthma control is UNCONTROLLED

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An Asthma Action Plan is a plan created by your doctor to help asthmatic patients like you to control your asthma effectively. Each plan may differ from patient to patient depending on severity and condition of the disease. The plan may get reviewed and modified from time to time depending on how well you manage to control your asthma. It is extremely useful because patients who use a plan is up to 4 times less likely to be admitted to hospital.

Click below to watch a video on “How does Asthma work”

What is in the plan?

Each Asthma Action Plan should give you the following information:

  • The name of the medicines and how & when to take them
  • How much of medication to take in different circumstances
  • When to take rescue medication
  • How to use and chart your peak flow reading
  • How to recognize signs if your asthma is getting worse
  • What to do during an asthma attack

Asthma medication is divided into either:

  • PREVENTER inhaler (to reduce airway inflammation)
  • RELIEVER inhaler (to open up the airways in the lung)

This guide shows how asthma medication may be used in different situations and in different individuals. Do consult your doctor to about your own situation.

Situation 1: When your child is well

  • Has good breathing
  • Has no cough
  • Has no wheezing
  • Can play and do daily activities without any restriction
  • Peak flow reading is more than 80% of personal best

ACTION PLAN: Give preventer medicine as prescribed by doctor

Situation 2: When your child is not well (with the following symptoms)

  • Cough
  • Wheeze
  • Chest tightness
  • Waking up at night due to coughing
  • Peak flow reading is reduced to 50-80% of personal best

ACTION PLAN: Continue giving preventer medicine as prescribed by doctor. Take reliever medication once and then as when required. Your child may need up to 4 hourly medication depending on whether there is improvement. If symptoms improve, return to Situation 1.

Situation 3: When your child gets worse

  • The symptoms are not relieved DESPITE getting the treatment in Situation 2
  • The cough and wheeze get worse
  • Difficulty in breathing with flaring around the nostrils
  • The reliever medications are needed more frequently than every 4 hours
  • Peak flow reading is less than 50% of personal best

ACTION PLAN: Continue giving preventer medicine as prescribed by doctor. Take reliever medication every 4 hours and an oral dose of Prednisolone as prescribed by doctor. See your doctor as soon as possible.

Situation 4: What to do during an emergency

Give 4-6 puffs of reliever medication immediately and every 20 minutes up to a maximum dose of 12 puffs. Go IMMEDIATELY to the emergency department of the nearest hospital (Also read more on “What to do during an asthma attack” here).


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One in 11 children in UK has asthma while around 8% of adults in USA have asthma (Also refer to our other health articles on What is Asthma? and Treatment of Asthma). Nearly half of all asthmatics have experienced an asthma attack. An asthma attack can be triggered by allergens such as smoke, air pollution, dust, irritant chemicals, exercise, change in weather and stress. As such it is important for parents with asthmatic children and people with asthma to recognise signs of poor asthma control AND of asthma attack.

During an asthma attack, there is a sudden worsening of asthma symptoms due to the tightening of muscles around the airways (known as bronchospasm). The lining of the airways becomes swollen with production of thick mucus resulting in the following symptoms:

  • Severe wheezing
  • Coughing
  • Shortness of breath or rapid breathing
  • Chest tightness or feeling of pressure
  • Tightening of the neck and chest muscles
  • Feelings of anxiety or panic
  • Pale and sweaty face
  • Blue lips or fingernails (known as cyanosis)

Click below to watch a video on “What to Do during an Asthma Attack”

Do monitor your asthma control by checking your peak flow regularly as this gives you a direct measurement of your lung function. An asthma attack can escalate rapidly and as such it is important to recognise the early signs of poor asthma control and they include:

  • Reduced peak flow readings
  • Frequent coughing especially at night or after exercise
  • Increasing shortness of breath
  • Wheezing or feeling tired during or after exercise
  • Difficulty sleeping


If you’re experiencing an asthma attack, go (ideally with someone) to the Emergency Department of the nearest HOSPITAL as soon as possible.

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Watch ‘How to use Meter Dose Inhaler’ below

Treatment of asthma

Although there is no cure for asthma most people who have asthma are able to manage the disease and live normal active lives as long as they take good care of themselves and is compliant with their medication. Famous sportsman such as footballer David Beckham, basketball player Dennis Rodman and marathon runner Paula Radcliffe did not let asthma affect their life.

The goal of good asthma treatment is to control the disease and will achieve the following:

  • Prevent troublesome symptoms such as shortness of breath or coughing

Image Source: Wareable 

  • Allows you to maintain normal activity and sleep undisturbed through the night
  • Reduce your need for quick-relief medicines
  • Reduce asthma flareups (exacerbations) and most importantly, prevent asthma attacks that could result in hospital admission

Medication for Asthma

Asthma is treated with two types of medication namely long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms while quick-relief (or ‘rescue’ medicine) is required to relieve asthma symptoms that may flare up.

(a) Long-term medication includes:

Image Source: Freepik

  • Inhaled corticosteroids are the preferred medicine for long-term control of asthma because they reduce inflammation and swelling that makes airways sensitive to allergens
  • Inhaled long-acting beta2-agonists to relax the smooth muscles in the lungs open the airways may be added to inhaled corticosteroids to improve asthma control. Inhaled long-acting beta2-agonists should never be used on their own for long-term asthma control.

Image Source:

  • Nebulisers using anti-histamines such as Cromolyn as prophylaxis to prevent airway inflammation
  • Oral steroids may be required in severe asthma to get the asthma under control
  • Singular (Montelukast) is a leukotriene inhibitor and is taken orally to relieve symptoms of allergies. It is useful in asthmatics with seasonal rhinitis, eczema and nocturnal symptoms
  • Immunomodulators, such as omalizumab (anti-IgE) is given as injection to reduce to body reaction to allergens

Long-term control medicine must be taken as instructed to control your asthma otherwise asthma symptoms will return or get worse if you stop taking your medicine.

(b) Quick-Relief Medicines

Image Source: Medical News Today

All asthma patients need quick-relief medicines when asthma symptoms flare up and inhaled short-acting beta2-agonists are the first choice for quick relief. This must be with you at all times to prevent a possible asthma attack which can occur anytime.

Take the quick-relief medicine the moment you first notice asthma symptoms.

Treatment Plan

The initial treatment plan depends on the severity of your asthma and during the followup period, your doctor will make adjustments to your medications depending on how well the medication is controlling your symptoms and preventing asthma attacks. Do not worry too much if your asthma control varies over time because the medication will be adjusted to help you maintain the best control possible with the least amount of medicine necessary.

Image Source: Judy Banfield

Asthma treatment for certain groups of people such as children and pregnant women need more supervision as their control many be more challenging.

What is the definition of good asthma control?

Asthma is well controlled if you have:

  • symptoms no more than 2 days a week and don’t wake you up more than 2 nights a month
  • can do all your normal activities
  • take quick-relief medicines no more than 2 days a week
  • have no more than one asthma attack a year that requires you to take corticosteroids by mouth
  • peak flow which doesn’t drop below 80 percent of your personal best number

See your doctor is your asthma is NOT well controlled or if your peak flow score is less than 50% of your personal best score.

Asthma Action Plan

Image Source: Reader’s Digest

This plan should describe your how and when to take your daily medications and also what to do during an asthmatic attack. If your child has asthma, all his caregivers such as teachers or sport coach should be informed of the diagnosis.

You also need taking an active role to control your asthma. This involves:

  • Avoiding things that worsen your asthma (asthma triggers)

Image Source: Freepik

  • Be aware of your environment such as air pollution (wear mask or avoid going out) or weather changes (wear appropriate clothing)
  • Understand your medication and never skip medication. Always have access to quick-relief medication (especially when travelling)
  • Learn to recognise the early symptoms of asthma attack and take appropriate action

Image Source: Asthma and Allergy Foundation of America

  • Self monitor to track your asthma using a peak flow meter on a regular basis and share the records with your doctor during the clinic followup. You should also record your symptoms to discuss with your doctor at the next visit

References: American Lung Association, National Heart, Lung, and Blood Institute, Asthma Malaysia

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Click below to watch ‘What is Asthma’ video
(American Lung Association)

Asthma affects people of all ages, but usually starts during childhood. It affects around a quarter of all children and up to 15% of adults in Malaysia but only 40% of them feel that their asthma is well-controlled.

What is asthma?

Asthma is a lung disease affecting the airways making them narrow and difficulty to breath. The narrowing is caused by the following factors:

  • Inflammation of the airway walls causing it to be red and swollen
  • Tightening of the small muscles around the airways which go into spasm
  • Mucous (phlegm) which is sticky lung secretions, blocks the already narrowed airways

Image Source:

What are the causes of asthma?

Although the exact cause is not known, genetic and environmental factors are responsible.

  • Most asthma patients have allergies
  • There a family history of asthma, eczema or atopy (allergic tendency)
  • There is a history of lung infections during childhood

There many trigger factors which make asthma worse and these include:

  • Allergens from dust, animal fur, mould and pollens from grasses and flowers

Image Source: Freepik

  • Irritants such as cigarette smoke, air pollution (haze), chemicals (such as hairspray or paint)
  • Dust or dust mites
  • Certain preservatives in foods or drinks
  • Change in temperature (especially cold)
  • Physical activity such as sports
  • Stress or anxiety
  • Any upper respiratory infections such as cold or flu
  • Lack of sleep

What are the symptoms of asthma?

Airway narrowing results in a reduction of the amount of air that can be breathed in thus causing breathlessness and wheezing (whistling sound when they breathe) in the patient. In addition, there is tightness in the chest and coughing which is usually occurs at night or early in the morning. When the coughing is bad, the sleep is interrupted.

Image Source: Medical News Today

Usually asthma symptoms are mild and resolve after minimal treatment with medication. However, symptoms can continue to get worse in some patients or result in a flareup (or exacerbation) known as an asthma attack. It is very important to know what to do during an asthma attack because it can be fatal if left untreated (see below).

How is asthma diagnosed?
a) Chest X-ray to make sure there is no other issues with the lung such as infection

Image Source: University Hospital of South Manchester NHS Foundation Trust

b) Lung functions tests to check how your lung efficiency. These include:

  • Spirometry which measures how much air you can breathe in and out
  • Peak Flow Meter measures your ability to push air out the lungs in a single puff

c) Allergen skin patch test is optional but it helps to identify what can exacerbate your asthma
d) Sometimes, the doctor may use a short trial of medication to confirm the diagnosis

References: American Lung Association, National Heart, Lung, and Blood Institute, Asthma Malaysia

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