A better way to determine asthma severity

I think it was last week I wrote a post (click here) about how according to the Asthma Guidelines my asthma is severe. I personally don't think my asthma is severe at all, but the guidelines say so, so severe my asthma is.

Today, however, as I was perusing this book called "Allergy & Asthma: Practical Diagnosis and Management," I came across criteria for determining if a person has severe asthma I think is fair. It goes like this (I'll quote this right out of the book):

The following defines severe asthma

1. Treatment with continuous or near continuous oral corticosteroids (more than 50% of the year).
2. Requirement of high-dose inhaled corticosteroids to achieve control of mild to moderate persistent asthma.

That to me looks much better. Going by this determination, my asthma isn't even close to severe, because I haven't been on oral corticosteroids in over ten years, and the inhaled corticosteroid I use is the medium and most commonly used dose of Advair (250/50).

Likewise, while I do have mild asthma symptoms occasionally throughout any given day, my peak flows are above normal for me. So I think the Advair does a pretty good job of keeping down the chronic inflammation in my lungs.

Granted, however, the asthma guidelines do say that the best way of determining severity of asthma is "before" starting a patient on inhaled corticosteroids. And, absent the Advair, I'm pretty certain my asthma would be severe.

So, we'll have to conclude this post by saying the asthma guidelines for determining severity are fair pre-corticosteroids, and the chart listed above is best for once a patient is on inhaled corticosteroids.

By my own determination, I now consider that my asthma is mild persistent. Yet not to be treated any less serious than if it were considered severe, because all asthmatics (no matter how severe) can have a severe, life threatening attack.

It's true with all asthmatics (mild, moderate or severe) that asthma should be re-evaluated regularly. The new recommendation is that all asthmatics see their doctor twice yearly.

Any questions or comments please inquire within.

How severe is your asthma?

My asthma story has been so good the past couple years sometimes I don't even feel like I have it except for when I'm dosing myself with asthma controller meds every morning and evening.

Sometimes I wonder if all those bad asthma attacks were all in my head, or not real, or perhaps maybe I was a Goofus Asthmatic with a Goofus Doctor. But we all know that was not true: I was a real Hardluck Asthmatic. I was a Poor Generation Asthmatic.

In fact, I've even been known to leave home now without even taking my inhaler with me, which is a major accomplishment. I jog without taking it. I go out of town without it even in my pocket. I work 12 hour shifts without it in my pocket. This is great. It makes me feel normal.

Still, while I haven't had a bad attack in about two years, I still do use my rescue inhaler a few times a day. I still take it before I go to sleep and a few times during the night when I get up. And while I do feel relief, if I can't find it I don't panic like I used to when I was a Hardluck Asthmatic.

Again, my asthma is better than it ever has been. My inhalers are lasting longer than they ever have. And, despite this, I can't help feeling awkward as I look at the asthma guidelines' asthma severity chart that I found over at Respiratory Care K.I.S.S.

Now I've seen this chart before, although I never really examined it. I never put two and two together.

According to this chart I am a severe persistent asthmatic.

I mean, I don't sit around puffing on my inhaler (puff-puff), but I do use it more often than one night a week.

In a way, this doesn't seem right to use a chart to determine how bad someones asthma is, and to base severity not on severity of the attacks but on how often a person uses his rescue inhaler.

Then again, am I just an asthmatic in denial? No, I know I have asthma. I know I need to play it safe. I know I need to continue to strive to be a the best asthmatic I can be.

My asthma attacks are not severe at all. In fact, I wouldn't even say they are moderate. They are about as mild as they come. They are almost non-existent (at least on my current controller regime).

This is one of the reasons my doctors and I have always thought of my asthma as "unique." This is also one of the reasons I'm not completely in agreement with people who think every asthmatic should be treated exactly according to the asthma guidelines.

A year ago I wrote on this blog that my asthma is under control, but I still use my rescue inhaler more than once a day. One of my readers commented: "According to the asthma guidelines, if you use your inhaler that often your asthma is not under control."

What you have to realize about guidelines is this: they are guidelines. And this is one of the key things I've learned as an RT: you cannot treat every person the same, guidelines or no guidelines.

Sure you can follow the guidelines as best you can (you should), but you most certainly cannot treat all asthma patients the same, as we all know every person in unique in their own way. The asthma guidelines might work for most asthmatics, but one must have the common sense to know when to step out of bounds.

And, when it comes to asthma severity, I certainly don't think my asthma is severe. However, even my wife tells me it is, so I'll trust her. And I'll trust the guidelines. But I'm certainly not going to call my doctor every time I use my rescue inhaler. If I did I'd be on the phone daily, and my doctor would have fired me years ago (he might even accuse me of being an Actor Asthmatic).

"You need to call your doctor right away," one commenter wrote me, "If you use your inhaler more than twice a week that's a sign your asthma is out of control."

Well, out of control and level of severity are two different things. Yes, most asthmatics who normally don't need to use their rescue inhaler, and all of a sudden they need it more often, should definitely call their doctors.

My asthma, on the other hand, is to the point that I have to use other indicators as to when I call my doctor. My indicators are that I develop a certain level of dyspnea not resolved by using my rescue medicine.

Yet, even then, when I do have bad asthma attacks (not anymore remember), I have had so many of them that I have become almost tolerant to a high level of dyspnea. In a sense, when I get bad enough, I usually have to have someone tell me to go to the ER -- Gallant Asthmatic or not.

Either way, it's been at least two years since I had a significant asthma attack while moving around dusty boxes in my basement, or sweeping the garage, or mowing the lawn, or going to my dad's musty cabin, or simply by breathing in air during pollen season. Those days, I pray, are gone forever.

However, I am now able to move boxes in my basement (I finally got those boxes unpacked), and I do sweep the garage, and mow the lawn, hang out at my dad's cabin, and breath in pollinated air. Allergies still tackle me (and that's a story for another day), but not the asthma.

And it's been since February of 1998 that I've had to go to the ER or had to be admitted for my asthma. Yeah, there may have been a few times I should have gone since then, but I never did.

Plus you have to add I haven't needed oral corticosteroids in over 10 years, and my peak flows are perfectly normal for my age and height and, as I've written, my asthma has no effect on my day to day normal daily activities.

Like I said, I have unique asthma. I'm, as my doctor says, a cunundrum. That's even true if you go by the asthma severity charts on this link.

Yet, I will say this: any person with as many allergies as I have, and airways as sensitive as mine, no matter how mild your asthma is or how good you feel or how good your peak flows are, you are still at risk for having that fatal asthma attack. You should always keep that in mind.

If you have asthma, think to yourself how severe you think your asthma is right now. Then check out the chart above and see if your asthma might be more or less severe than you think. When you're done, jot down a comment below and let me know your results and what you think of them.

Likewise, if I'm missing something here feel free to chime in.