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Red & Yellow Flags-Controlling Your Asthma

Asthma affects different people in different ways - from the type of asthma they have, to their level of severity, their triggers, and their level of asthma control. Most people with asthma should be able to control their disease primarily by relying on their controller medication, and infrequent use of their reliever medication. Despite this fact, many people with asthma continue to experience asthma symptoms and frequent flare-ups. Their asthma is not well controlled.

There are many possible reasons for uncontrolled asthma, including:

• Not taking medication as prescribed
• Not using inhalers properly
• Frequent exposure to asthma triggers,
• Smoking
• Having another medical condition that makes asthma symptoms worse.

Many people have trouble recognising when their asthma is not properly controlled. They tolerate symptoms which are indicative of poor control thinking that it is a part of living with asthma. People tend to normalize frequent wheezing, coughing, night-time symptoms and many other issues as a normal part of living with asthma, not realising that they could live symptom-free.

Below, we have listed a number of red flags and yellow flags to help you recognise the signs of uncontrolled or Severe Asthma so you know when to ask for specialist help. Red flags are clear symptoms or signs that your asthma is not controlled. If you have one or more red flag, you definitely need some help to make sure you are managing your asthma properly and would most likely benefit from seeing a specialist.

Yellow flags are also indicators of uncontrolled asthma, but taken individually, they may not be as serious as a red flag. They still warrant a conversation with your healthcare provider. Also, if you have three or more yellow flags, then you would also likely benefit from seeing a specialist.

If you fall into either of these categories, please visit your doctor. Tell them about your symptoms and ask them to:

• make sure your breathing has been measured (through spirometry)
• watch you use your inhaler to check your technique
• discuss whether you are taking your medication as prescribed
• discuss if you should be referred to a specialist

Some people with asthma have Severe Asthma, and they require more than just controller and reliever medications to manage their asthma. They need some add-on therapies to control their asthma. Once they have those additional medications, they too can live symptom-free. But they need to see a specialist first!

When to see a specialist

People with asthma should see a healthcare provider about asthma at least once a year if their symptoms are well controlled, and more frequently if they are experiencing symptoms.

General practitioners (GP), primary care physicians or family doctors are able to treat people with asthma and help them control their disease in most cases.

However, some people, such as those with one or more red flags and/or three or more yellow flags, can probably benefit from seeing an asthma specialist. Asthma specialists are doctors who have been specially trained to deal with asthma and are particularly recommended for those with uncontrolled asthma, and/or Severe Asthma. They can help with your daily management of asthma, decrease your work/school/activity absences, reduce your exacerbations and lessen the number of emergency room visits.

Asthma specialists can be: respirologists, pulmonologists, allergists or immunologists. In order to visit any of these specialists, you will need a referral from your family doctor/primary care provider.

If you think you can benefit from seeing a specialist but unsure of how to speak to your doctor, we have some great resources on self-advocacy here.

Asthma Red Flags

• Frequent visits to the ER,  or a stay in the hospital
• Using 3 or more puffs of your rescue inhaler per week (excluding use before exercise)
• More than 2 courses of steroids in a year
• A feeling that asthma is controlling your life & nothing seems to work
• Frequent flare-ups, asthma attacks and severe symptoms
• A feeling that your condition is life-threatening
• Regular absences from work, school or other activities
• A feeling of wanting to withdraw

Asthma Yellow Flags

• Feeling frightened, frustrated or angry due to asthma
• A need to make too many lifestyle compromises
• Over-reliance on a caregiver
• Negative impacts on your family or relationships
• Unable to be as active as desired or unable to keep up with peers
• Prioritizing reliever medication over controllers
• Fear of medications or side-effects, or not taking medication properly
• Symptoms indicative of more serious disease including: chest pain, nighttime symptoms, increased breathlessness, inability to walk up stairs, feeling of an elephant on your chest, coughing that prevents you from continuing your activities, constant wheezing, or fatigue
• Diagnosed with other conditions that make asthma worse or difficult to control, such as: nasal polyps, chronic sinusitis or rhinitis, anaphylactic food allergy, obesity, obstructive sleep apnea or sleep disordered breathing, gastroesophageal reflux, upper airway dysfunction, other respiratory conditions, and psycho-social factors such as stress, anxiety, or depression
• Too many negative side effects from medication such as weight-gain, irritability, mood changes, facial swelling, or insomnia.