How to take control of your asthma with the “Rules of Two” paradigm

Lung Health

by Dr. Mark Millard

Mar 4, 2019

More than 26 million Americans are all too familiar with the feeling of “breathing through a straw” — or in other words, an asthma attack. A patient of mine named Scott described it this way after being diagnosed with adult-onset asthma:

“Breathing is one of many things we take for granted. It’s something we don’t think about until it becomes difficult. But when you struggle to find that deep, cleansing breath, you realize just how important it is.”

Read Scott’s story: Adjusting to life with adult-onset asthma

Background on quick relief inhalers

With a condition this common, it is easy for some to underestimate the severity of asthma.

This was especially true in years past when quick relief inhalers were available over the counter (in addition to longer-acting relief inhalers for prescription use.) But rather than helping, it seemed there were more people with worse-controlled asthma and by the mid 1990s, more than 5,000 people in the U.S. died annually from asthma. However, with the introduction of “controller” inhalers for long-term therapy, the rise in asthma deaths was reversed. Now, through increased use of controller therapy, that number has been cut in half, yet it should even be lower.

Part of the problem is rooted in the fact that treatment for asthma is not one-size-fits-all. Some of my patients with asthma require daily prescription medication to manage their symptoms, while others may only require an inhaler for the occasional flare-up due to allergies or other triggers.

Related: Living your best life with asthma

How to safely manage your asthma therapy options

After being off the market for several years, these over-the-counter quick relief medications have again become available to provide fast relief from mild asthma symptoms. However, a word of caution: if you have asthma, it’s important to be able to recognize when an over-the-counter medication is not enough. At times, a second prescription for an asthma controller medication is still necessary. You can get yourself into a medical emergency if you count on these over-the-counter medications in every situation.

I encourage my patients to use the Rules of Two paradigm that I developed to determine whether there is a need for further treatment.

Using the Rules of Two, you ask yourself the following questions:

  • Do you have asthma symptoms or use your quick relief inhaler more than two times a week?
  • Do you awaken at night more than two times per month because of asthma-related symptoms?
  • Does your peak flow (a measurement of lung function taken with a peak flow meter widely available in pharmacies) drop more than 20 percent with symptoms?
  • Do you take corticosteroids (such as prednisone) more than two times per year to treat asthma flares?

If you answered “yes” to any of these questions, you should speak with your healthcare provider about adding a controller medication to improve your asthma control and reduce the risk of out-of-control asthma.

Never forget that this condition can be dangerous — and even fatal — if not cared for properly. But with the right treatment and attention, you can thrive in the face of asthma.

Get help for your asthma today.

About the Author

Mark Millard, MD, is a pulmonologist and medical director at the Martha Foster Lung Care Center. Dr. Millard developed the "Rules of Two®" to help determine if your asthma is under control. Get to know Dr. Millard.

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