Asthma
Patient Education Handout associated with
UMHS Clinical Care Guideline

This information is not a tool for self-diagnosis or a substitute for medical treatment. You should speak to your health-care provider or make an appointment to be seen if you have questions or concerns about this information or your medical condition.

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What is asthma?

Asthma is a disease of the lungs characterized by swelling of the airways (inflammation) and narrowing of the airways (bronchoconstriction).

What are the symptoms?

What can cause an asthma attack?

Triggers are things that make you have an asthma attack. Ask your health-care provider for help in deciding what triggers you need to avoid. These triggers are different for everyone.

Triggers that can cause asthma attacks include:

If you have asthma it is extremely important to avoid, reduce or get rid of your asthma triggers.

Asthma Medications
There are two main kinds of asthma medications: rescue (fast-acting) medications and control medications.

Rescue medications help stop symptoms of asthma attacks by opening up airways. These medicines can relieve symptoms within minutes but they do not reduce or prevent the inflammation (swelling) that causes the symptoms. Some commonly used rescue medications are:

Control medications help prevent and reverse asthma attacks by decreasing the inflammation (swelling) in the airways. They actually treat the disease, not just the symptoms, but must be used on a daily basis for them to work effectively.

Asthma control medications include inhaled corticosteroids such as:
and inhaled mast cell stabilizers like:

as well as oral (tablet) "leukotriene modifiers" like:

Other medications used for asthma include oral corticosteroids, used for severe attacks, and long-acting bronchodilators, which relieve symptoms like rescue medications, but which start to work more slowly and are not used for acute attacks.

Oral corticosteroids include:

Long-acting bronchodilators, which should not be used without an inhaled corticosteroid, include:

Inhaler techniques:
The above medications are frequently prescribed in an inhaler form so that the medication will work directly in the lungs. Correct use of the inhaler is very important. Instructions for the use of one basic type of metered-dose inhaler are given below and you may also receive video instructions at the following web site: http://www.umich.edu/~pharmacy/inhaler/index.html. If your inhaler is a different type or if you are having problems using your inhaler, ask your pharmacist to assist you.

Inhalers are often used with a spacer, which is a tool that is used to help get the asthma medication to the lungs. Spacers attach to the mouthpiece of the inhaler or have a place to connect the canister of the inhaler to the spacer itself and should be used every time you use your MDI. (Note: the Maxair Autohaler (pirbuterol) does not require a spacer).

Steps for Correct Use of Your Metered-dose Inhaler (MDI)
1. Remove the dust cover

2. Clear the mouthpiece each time before use by tilting it forward and then blowing out any dust or other loose material. If this is not done, dust or other material in the mouthpiece may be inhaled into the throat to trigger a cough. Coughing during use of your MDI will cause loss of the medication.

3. Shake the MDI vigorously 10-15 times.

4. If the MDI is new or has not been used in seven or more days, activate one spray into the open air to prime the spray system.

5. Push the inhaler mouthpiece into the end of the spacer

6. Correctly position the inhaler and spacer comfortably in the hand. The metal canister should be upright with your first or second finger securely placed in the concave top and thumb securely on the bottom. Hand and fingers should be dry.

7. Inhale a comfortable breath

8. Exhale comfortably to remove most of the air from the lungs.

9. Open your mouth and seal your lips around the mouthpiece of the spacer while keeping your jaw relaxed and teeth apart. It is important not to bite the mouthpiece or close your teeth in front of the mouthpiece. If you are using a mask with the spacer make sure that the mask fits tightly around your child’s nose and chin. There should not be any gaps.

10. Tilt your head back slightly to look at the ceiling, which will straighten the airway to allow easy inhalation of the medication into the lungs.

11. Activate the MDI by pressing down the canister to release the medication spray and begin a slow deep breath in through the mouthpiece of the spacer. You must continue to breathe in to completely fill your lungs with air. It is very important to breathe in slowly- many spacers have whistles that sound if you are breathing in too fast.

12. Following a slow full breath, hold your breath about 10 seconds, or as long as your feel comfortable, to allow the medication to remain in your lungs. If you do not hold your breath for at least a short time, some of the medication will be lost when you breathe out.

13. Breath out slowly through pursed lips (pucker you lips as if to whistle).

14. If a second puff of your MDI is to be used, wait at least 1-5 minutes between doses and shake the MDI vigorously in the same manner as the first puff. Do not activate 2 doses into the spacer at the same time. Time and shaking are required between MDI uses to regenerate the MDI spray pressure and to adequately mix the propellant and drug to ensure full medication delivery.

15. When you have finished using your MDI and spacer, swish and rinse your mouth and gargle with water. Spit out the rinse water.

16. To clean your MDI, remove the metal canister from the plastic sleeve. Wash the sleeve with warm water and dry thoroughly before reuse. It is very important to clean/clear the small medication spray hole in the mouthpiece to prevent clogging. Do not submerge or wash the metal medication canister since water may damage the spray system. Also, remember to clean your spacer if you use one.

17. The number of doses that will be accurately delivered from the canister is listed on the medication label on the metal canister. This number should be divided by the average number of puffs used per day to determine when the MDI is empty and should be discarded. One week prior to this date a note should be made on the calendar to refill the medication. Unless a dose counting mechanism is connected to the delivery system such as Serevent Diskus, it is not possible to determine by shaking alone when the MDI is empty since the canister is filled with extra propellant which will continue to spray even though the medication is gone. Discarding and replacing the MDI at the correct time is very important to prevent an asthma attack due to prolonged use of a controller anti-inflammatory MDI which contains no medication or severe respiratory distress due to lack of needed bronchodilator rescue medication when a wheezing episode occurs.

18. Keep your MDI in a cool dry place. Do not crush or burn the MDI even when it is empty as it could explode.


                         
Aerochamber with Mask                                           Aerochamber without Mask

Peak flow meter:

A peak flow meter is a device to help you and your care-provider to monitor your asthma and determine if your asthma is doing well or getting worse. The measurements will often show changes in your asthma before you develop a severe attack. Using this information to adjust your medications according to a prearranged action plan will help to prevent many asthma attacks from starting or progressing to a more severe degree. Instructions for use of a peak flow are given below. If you are having problems using your peak flow meter, ask your health-care provider to assist you.

Call the office immediately if:

or

Seek emergency medical care if:

For further information, see the Asthma Initiative of Michigan (AIM) web site www.GetAsthmaHelp.org

Reviewed by Cary Johnson, PharmD & Karla Grossman, BSN, RN, AE-C, September 2006

Information maintained by the UMHS Clinical Care Guidelines Committee

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