You have asthma symptoms five or more times per week during the day, and more than five times per month during the night. 

What is happening in your lungs?

• You probably have chronic inflammation in the inner lining of the bronchioli, and this inflamed mucous membrane is swollen and red, decreasing the diameter of the lumen of the bronchioli. The inflammation is chronic. Using only a bonchodilator is not enough. The bronchodilator cannot reduce the inflammation. You need treatment to reduce the chronic inflammation, probably due to an allergen or allergens. The only way to reduce chronic inflammation is to treat it daily with an anti-inflammatory dru

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  g. In the case of inflammation of the bronchioli, the best and most effective treatment is corticosteroid (an anti-inflammary) administered directly to the lungs by inhaling it in aerosol form. In summary: you need to take your inhaled corticosteroid every day (probably twice a day, as prescribed by the doctor.) 
• The circular muscles around the bronchioli constrict quite often in your case,  probably triggered by some or other allergen or event. This constriction can narrow the inner, already swollen, lumen of the airways even more. This further narrowing will lead to asthma symptoms: your chest can feel tight, you will feel as if it is difficult to breathe, and you may have a dry, chesty cough. Whenever you feel these symptoms, you need to use your short-acting bronchodilator inhaler. This medication will relax the constricted circular muscle very soon and the whole muscle wall will relax, opening the lumen again.

Your treatment

You also need a long-acting bronchodilator to keep the muscles relaxed. This can be either a long-acting beta2-agonist (preferred) or theophylline, or even both, plus an increased dose of the inhaled corticosteroids. Nowadays the corticosteroid and long-acting beta2-blocker are combined in one inhaler. So you still need to carry two inhalers: one for daily use (the corticosteroid plus long-acting beta2-blocker, and one when needed (the short-acting bronchodilator), plus your theophylline.    

Helpful tips for an action plan

• Carry your bronchodilator inhaler with you, and use when you need to. If you get no relief from the prescribed dosage, or if you need it more frequently, consult your doctor. You may be advancing to the next category, but with correct and diligent treatment, you may soon be well controlled. The doctor may prescribe a pulse dosage of oral steroids for seven to 14 days to gain rapid control of your asthma.
• Use your daily inhaled corticosteroid or combination inhaler diligently as prescrided. You will experience the benefits within 10 to 14 days.
• Determine the cause of your asthma, and if it can be avoided (such as allergens, house dustmites), avoid it.
• Keep a diary to determine which factors play a role in causing your asthma. Whether weather, stress, tobacco smoke, cold air, certain perfumes, pollutants or other factors have an effect on your symptoms. Then avoid the causes, or try to avoid it. 

Read more:
See Asthma Xplane
National Asthma Education Programme (NAEP)
Allergy Society of South Africa (ALLSA)
 

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