Asthma Awareness: Taking Control of a Chronic Condition

Come with me on a journey into the life of a young child with asthma: Feel what they feel when their asthma strikes.

It is nighttime and you are comfortably sleeping. Suddenly you begin to cough, and you awaken feeling as if you can’t breathe. As if your lungs are being painfully squeezed or something heavy is sitting on your chest. You try to take a deep breath but cannot. You are frightened and struggling for air. Still in the fog between sleep and being fully awake, coughing and wheezing, panic grips you, making breathing even more difficult. At a deep level you feel as if you might die. You slide out of bed and hurry to your parents’ room, seeking help and comfort. Gasping for air, and it… is… hard… to… speak. You want these terrible feelings to stop, to be able to breathe easily again. Mom and dad wake up and move into action. They prepare your asthma nebulizer, meaning help is on the way. Slowly, ever so slowly, you feel the tightness begin to subside as you breathe in the soothing medication mist. You relax, and the weight is lifted from your chest. The attack has subsided, but the fear that it could happen again at any time stays in your memory.

A frightening experience, this not-uncommon scenario is one of the faces of uncontrolled asthma. In addition to sleep disturbance, asthma results in thousands of unexpected doctor visits and ER visits; missed days of school and work; hospitalizations; an inability to engage in daily activities; and, at its worst, death for 4,000 Americans each year.

But people with asthma shouldn’t feel resigned to living with uncontrolled asthma. Asthma can, and should be, controlled.

Well-controlled asthma allows full participation in life. It rarely if ever disturbs your sleep, sends you to the ER, hospitalizes you, disrupts your daily routine, or frightens you. When asthma does begin to tilt out of control, there are often warning signs that develop early on that, when recognized and acted upon, greatly reduce the chance that an asthma attack will surprise you.

Dr. Mark Millard, a pulmonary specialist at Baylor Health System in Dallas Texas, developed a set of questions known as the “Rules of Two,” an easy-to-use tool to help you recognize when asthma is not well-controlled and action is necessary. Each question involves the number two, hence the “Rules of Two.” I use these every day in my asthma practice.

When asthma is controlled,

  • You use your rescue medication (bronchodilator inhaler) fewer than twicea week
  • Nighttime asthma symptoms occur fewer than twotimes a month
  • You refill your rescue inhaler prescription fewer than two times a year


If one or more of these guidelines are not being met, that should serve as an alert that asthma is no longer well-controlled, and it’s time to take action to head off future problems. You may want to visit your physician for further evaluation, treatment, and a possible an adjustment to your medication regimen.

Please keep the Rules of Two in mind for your child with asthma. They are a first, critical step in shifting away from the frightening surprises of uncontrolled asthma and moving toward the relative calm and peace of mind that comes with controlled asthma.

I would love to hear your thoughts on how the “Rules of Two” work for you!

Published on: May 14, 2012
About the Author
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Dr. Stephen Apaliski is a practicing asthma and allergy specialist in Texas and author of the book Beating Asthma: Seven Simple Principles, which can be found in paperback on CreateSpace, through his website,

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