WATCH: How The Rules of Two® Can Help Asthma Sufferers


This blog post is part of the Google+ Healthy Hangouts series on breaking and timely health news.

Asthma is often thought of as a childhood disease, and while it may occur more frequently in children, it can strike at any age. According to the Centers for Disease Control (CDC), more than 30 million Americans have asthma. Even more disturbing, its incidence seems to be on the rise and, on average, 10 people a day die from the disease.

Mark Millard, MD, a pulmonologist on the Baylor University Medical Center at Dallas medical staff, recently joined internal medicine physicians Roger Khetan, MD, Cherese Wiley, MD, and myself to discuss this trend and what we can do about it.

I encourage parents and people who have or may have asthma to watch the entire segment. Here are some of the things we discussed.

Definition and Symptoms

Asthma is a lung disease that is characterized by inflammation of the lungs and bronchial spasms (when muscles tighten the airways in the chest). Telltale signs include chest tightening, shortness of breath, chest spasms, coughing and wheezing.

Dr. Millard offered a great description saying that having an asthma attack is like, “breathing through a straw.”

Causes and Triggers

While viral infections and other factors can set off an asthma attack, the underlying basis for most cases of asthma is environmental allergens. It’s important for every asthmatic to identify what sets off their own attacks, as triggers differ. However, some of the most common triggers are:

  • Pollution
  • Dust
  • Pollen
  • Cigarettes
  • Chemicals
  • Certain perfumes/scents


Generally, physicians take a ‘layered approach’ to treating asthma. For mild asthmatics with infrequent symptoms, a rescue inhaler may be all that is needed.  For more severe cases, this means using a daily inhaled or oral controller medication to address the underlying lung inflammation that causes asthma, and then using a rescue inhaler on an as-needed basis during an asthma attack. 

According to Dr. Millard, current medications effectively control 60-80 percent of asthma cases.

However, for patients with severe asthma, a new procedure called bronchial thermoplasty may be the answer. This minimally invasive procedure, which is administered while a patient is sedated, uses heat to inhibit the function of the muscles that cause bronchial tubes to contract, inhibiting airflow.

Rules of Two®

While many asthmatics struggle daily with their condition, some people only occasionally suffer from asthma attacks/symptoms. So do these patients need to be on a daily medication, or do they only need a rescue inhaler?

The rule of thumb physicians often use to decide is the “rules of two.” Generally, a patient should be on a daily controller medication if he or she:

  • have asthma symptoms/attacks more than twice a week.
  • wakes up due to asthma symptoms more than twice a month.
  • needs to take prednisone by mouth more than twice a year.

In addition, people who may only have asthma attacks a few times a year, but have attacks that are severe, may need to be on controller medications. If you are unsure of your asthma triggers or simply looking for more information, join our free seminar on common asthma triggers at Baylor Regional Medical Center at Plano on Tuesday, November 19th from noon to 1 p.m.

Check out our quick Google+ Hangout below.

About the author

David Winter, MD
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David Winter, MD, is an internal medicine physician on the medical staff at Baylor Scott & White Signature Medicine – Tom Landry.

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WATCH: How The Rules of Two® Can Help Asthma Sufferers