Quick Reference

Asthma Quick Reference Respiratory Therapy Services RTS-002/pe/web • • • The Lungs Lung Before An Asthma Episode Lung During An Asthma Episode RTS-002 (rlv 1/8/07) 1 Asthma Quick Reference • • • Asthma Triggers Trigger Cockroach allergen Strategy • Store food in sealed containers. • Use baits, gels to kill cockroaches - do not use sprays. • Wash bed linens and blankets once a week in hot water and dry them in a dryer. • Encase pillows, mattresses and box springs in airtight covers. • Remove carpets, especially in sleeping rooms. • Use vinyl, leather or plain wooden furniture. Avoid fabric upholstered furniture. • No tobacco or other smoke in home, car or wherever patient is present. • If you smoke, get help from local smoking cessation programs. • Remove animals from home, or at least from sleeping area. • Animals in home need recurrent washings. • Close windows and doors, and remain indoors when pollen and mold counts are high. • Use air conditioners and clean filters regularly. • Dry clothes indoors. • Reduce dampness in the home with a dehumidifier. • Do not use humidifiers or vaporizers. • Clean any damp areas frequently (i.e., bathrooms, crawl spaces). • Regular physical activity should be encouraged. • Symptoms can be prevented by taking an appropriate inhaled medication before strenuous exercise. Domestic House Dust Mite allergens (so small they are not visible to the naked eye) Tobacco Smoke/Inhaled Illegal Substances (whether patient smokes or breathes in smoke from others) Allergens from animals with fur Outdoor pollens and mold Indoor mold Physical activity Wood smoke Strong odors and sprays • Avoid fireplaces, campfires, woodburning stoves. • Avoid using strong cleaning sprays, hair sprays, air fresheners, potpourri, and perfumes when patient is present. • Stay indoors. Listen to pollution advisories. • You may have to get an influenza vaccine annually. Wash hands often. • Diagnose and treat. 2 Asthma Quick Reference Weather and air pollution Colds and other infections Gastroesphageal reflux RTS-002 (rlv 1/8/07) • • • Peak Flow Meter A peak flow meter is a device that measures the maximum flow rate of air that you can forceably blow out in a single breath. This is called your peak expiratory flow rate. Your doctor will use these numbers to follow your breathing patterns. By following changes in your peak flow rate, your doctor will be able to choose the best treatment for you and regulate your medications accordingly. How To Use Your Peak Flow Meter 1. To do your best with the flow meter, stand up while you blow out. If you are unable to stand, you can sit. However, your peak flow will not be as good when sitting. Place the mouthpiece on the peak flow meter and/or open peak flow meter up. Be sure the marker on the scale is at the bottom. Hold the meter lightly, making sure that your fingers do not cover the scale or cover the end. Inhale as deeply as possible and then close your mouth tightly around the mouthpiece. Blow out as hard and as fast as your can. This will cause the marker to move up the scale. (Be sure to put forth your best effort each time.) Read the number next to the marker on the scale and write it down. Repeat the test two more times and write the highest number on your flow meter chart or on a small calendar. Normally, you should use your flow meter twice a day, in the morning and at bedtime. However, if you think your breathing is changing during the day, you should check your peak flow to find out for sure and then use your medication accordingly. 2. 3. 4. 5. 6. 7. 8. How To Clean Your Peak Flow Meter The mouthpiece should be rinsed with tap water after each use. Clean the peak flow meter with mild soap and water weekly; more often if the marker sticks. Rinse with tap water and shake to remove excess water. Air dry on a clean towel overnight. RTS-002 (rlv 1/8/07) 3 Asthma Quick Reference • • • General Asthma Medications Bronchodilators • Beta-agonist type (rescue medication) - Albuterol, Brethaire, Maxair, Proventil, Combivent These relax the muscle around the airways that are in spasm, allowing the airways to open. Bronchodilators relieve symptoms, but they do not reduce or prevent the swelling that causes the symptoms. If you have to use the bronchodilator a lot, it may be a sign that your asthma is not being controlled. When using a bronchodilator inhaler, wait one minute before taking the next puff. This is done to use the inhaler in the most efficient manner, as the first dose will tend to open the airways and allow for better penetration of the second dose. Other Bronchodilators • Anticholinergic type - Atrovent, Spiriva This is a unique bronchodilator that is chemically different from other inhalers. It is used for maintenance treatment of bronchospasm, NOT for acute episodes. This medication takes about 15-20 minutes to work. • Long acting beta-agonist type - Serevent Chemically similar to other beta-agonist inhalers, but used only for maintenance, NOT for emergency treatment of acute bronchospasm. This medication has a slow onset of effects (about 20-30 minutes), but lasts 10-12 hours. Do not use more than 2 puffs every 12 hours. • Theophylline type - Aminophylline, Constant-T, Slobid, Theo-24, Theochorn, Theodur, Theolair, Uniphyl, Unidur This medication is a pill taken orally. It too is a maintenance bronchodilator. Doses are adjusted according to the level of theophylline in your blood. Too much theophylline can be toxic. You should always tell your doctor that you are taking this medication when he prescribes new medication, especially antibiotics. Theophylline interacts with the following medications: allopurinol (Zyloprim), cimetidine (Tagamet), ciprofloxacin (Cipro), erythromycin, clarythromycin (Biaxin), Troleandomycin, oral contraceptives and propanolol. There may also be others. RTS-002 (rlv 1/8/07) 4 Asthma Quick Reference • • • General Asthma Medications Anti-inflammatory Medications • Corticosteroid type inhalers - Aerobid, Azmacort, Beclovent, Flovent, Pulmicort, Vanceril There medications reduce and control airway inflammation. This is the key to successful management of asthma and often important in other forms of obstructive airway diseases as well. If you are using a “steroid” inhaler, you need only wait about 10-15 seconds between puffs. If you have asthma during sleep hours, then the evening dose should be taken before sleep. You should use this inhaler with a spacer device and also rinse and spit after each use. This medication must be taken on a regular basis and may take days to even weeks before effects are noticeable. NOTE: Corticosteriods are not the same as anabolic steroids that body builders use. Cortisone is naturally produced in the body. Other Anti-inflammatory Medications • Non-steroidal type - Cromolyn sodium, Intal, Tilade These prevent symptoms of asthma that occur with exercise or contact with an asthma “trigger”. It should be taken 60 minutes before contact and lasts for 3 to 4 hours. This medication CANNOT be used to stop an asthma attack once it has begun. • Oral corticosteroids - Prednisone, Deltasone, Methylprednisolone, Medrol These medications are used in serious asthma episodes or for difficult to control asthma. It reduces the swelling and inflammation in the airways quickly. Because it is taken orally, it can have systemic side effects such as increased appetite, rounding of the face, elevation of blood pressure, thinning of the skin, osteoporosis, cataracts, muscle weakness and diabetes with long term use. This medication can be taken safely with little or no side effects for short periods of time. RTS-002 (rlv 1/8/07) 5 Asthma Quick Reference • • • Metered-Dose Inhaler (MDI) To receive the maximum benefit from your metered dose inhaler, it is very important to use the inhaler in an appropriate manner. The inhaler has three parts; a metal canister, a dust cap, and a plastic container. The metal canister contains your medication and fits inside the plastic container. Follow both, the instructions packaged with your medication and these guidelines. Prepare the inhaler for use: 1. Remove the dust cap from the mouthpiece. 2. Place the metal canister in the plastic container. 3. Shake the inhaler well for five seconds to mix the medication. Using the inhaler: 1. Hold the inhaler firmly between your forefingers and thumb. Your thumb should be on the bottom of the canister. (See figure #1) 2. Tilt your head back slightly to create a straighter airway. 3. Exhale completely. 4. Hold the inhaler between teeth with lips closed around the mouthpiece. 5. As you begin to inhale slowly and deeply, depress the canister. Take three to five seconds to inhale. Hold your breath for five to ten seconds or as long as comfortable. Figure 1 6. Exhale slowly through pursed lips. (Pursed lip breathing means to pucker your lips as if you are whistling.) If your physician has prescribed more than one puff of medication, wait one minute between each puff. Shake the inhaler again and repeat the procedure. RTS-002 (rlv 1/8/07) 6 Asthma Quick Reference • • • Metered-Dose Inhaler (MDI) Do’s and Don’ts of MDI Use • Don’t breath in too quickly. • Don’t breath in through your nose. • Don’t use the MDI before shaking it. • Don’t forget to hold your breath. • Do breath in slowly. • Do breath in through your mouth. • Do shake the canister for 5 seconds. • Do hold your breath as long as comfortable. Important Points 1. Be sure to rinse your mouth with water after taking inhaled steroids. 2. When taking both an inhaled bronchodilator and an inhaled steroid, take the bronchodilator first. 3. Don’t overuse your inhaler. Use only as prescribed by your physician. 4. Be sure to cap your inhaler when not in use and clean the plastic container once a week in warm running water. 5. Be careful when storing your inhaler. Avoid temperature extremes. Do not store in glove box or leave on dashboard of your car. 6. Always have your inhaler with you. 7. Keep the spray away from your eyes. 8. If after using this medication you still have trouble breathing or your condition gets worse, contact your physician or seek medical help immediately. 9. Know the side effects of your medications. RTS-002 (rlv 1/8/07) 7 Asthma Quick Reference • • • Metered-Dose Inhaler (MDI) Using a Spacer With Your Medication 1. Shake your inhaler well for five seconds. 2. Remove the cap on spacer and inhaler. 3. Attach spacer to inhaler. 4. Depress the medication canister to fill the spacer with your medication. As soon as you have depressed the canister, place your lips around the mouthpiece. Inhale slowly and deeply for 3 to 5 seconds. 5. Hold your breath for ten seconds or as long as is comfortable. 6. Exhale fully through pursed lips. 7. Clean the spacer according to manufacturer’s instructions. 8. Spacers are reusable. Do not discard after one use. A spacer holds the medication in a chamber until you inhale. A spacer is important if you have difficulty using your inhaler. When you use a spacer, your medication is not lost. Some spacers you may see look like the following: RTS-002 (rlv 1/8/07) 8 Asthma Quick Reference • • • More Information Websites with Asthma Information: www.aaaai.org www.aafa.org www.aafp.org www.aanma.org www.aap.org www.aarc. org American Academy of Allergy, Asthma and Immunology Asthma and Allergy Foundation of America American Academy of Family Physicians Allergy and Asthma Network *Mothers of Asthmatics Inc. American Academy of Pediatrics American Association for Respiratory Care www.allergy.mcg.edu/home.html American College of Allergy, Asthma & Immunology www.AsthmaAllStars.org www.chestnet.org www.lungusa.org www.nhlbi.hih.gov Asthma Education Program American College of Chest Physicians American Lung Association National Heart, Lung and Blood Institute References: • • National Heart, Lung and Blood Institute, “ACT” Program Community Health Care - Wausau Hospital, Regional Asthma Education Program RTS-002 (rlv 1/8/07) 9 Asthma Quick Reference