Dr. Donald Levy, Allergy, Asthma, and Immunology, Orange County Ca


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Office Location:
705 W. La Veta Ave.
Suite 101
Orange, CA 92868
(714) 639-7847

 


New Approaches to Treating Asthma:
Tips for Correct Use of Medications

Take your inhaled, short-acting bronchodilator medication at the earliest sign that your asthma is getting worse. Watch for early warning signs — such as a drop in your peak flow number; symptoms such as a cough, chest tightness, wheezing or being short of breath; or worsening asthma symptoms at night when you sleep — and start taking your asthma medication right away to relieve the symptoms. An asthma episode is easier to stop if you take your medication as soon as symptoms start — and you won't have to take as much medication.

REMEMBER: Inhaled bronchodilators relieve symptoms, but they cannot reduce or prevent the airway swelling (inflammation) that causes the symptoms to return or persist. When you have to use a bronchodilator frequently, it may be a sign that the swelling in your airways is getting worse. If your bronchodilator medication does not seem to work as well or for as long as it used to, this may be a sign that your asthma is getting worse. If you use an inhaled short-acting beta2-agonist to relieve symptoms every day or if you use it more than three or four times in a single day, your asthma may be getting much worse and you probably need another kind of medication. Discuss this with your doctor right away.

Take your prescribed controller medication (such as inhaled or oral anti-inflammatory drugs) exactly the way your doctor recommends, even if you do not have any symptoms. This will reduce airway swelling and will help prevent asthma attacks. This medication must be taken regularly for it to be effective.

Correct Use of a Metered-Dose Inhaler

Using a metered-dose inhaler is a good way to take asthma medicines. There are fewer side effects because the medicine goes right to the lungs and not to other parts of the body. It takes only five to 15 minutes for short-acting bronchodilator medicines to have an effect compared with oral bronchodilator asthma medicines, which can take one to three hours to have an effect. Inhalers can be used by all asthma patients age 5 and older. A holding chamber (or spacer device) attached to the inhaler can help make taking the medication easier for even younger children. These devices also are helpful for people who have trouble using an inhaler. When learning to use an inhaler, ask your doctor to show you how to use it and then demonstrate your technique to your doctor so he or she can make sure you are doing it correctly. The following guidelines will help you use your inhaler correctly:

Using the Inhaler

  1. Remove the cap and hold the inhaler upright.
  2. Shake the inhaler three to five times.
  3. Tilt your head back slightly and breathe out all the way.
  4. Use the inhaler in any one of the following ways. (A and B are the best ways, but C is okay if you are having trouble with A or B.)
    1. With mouth open wide, holding inhaler one to two inches away
    2. Using a spacer device on the inhaler
    3. With inhaler in the mouth
  5. Press down on the inhaler to release the medication as you start to breathe in slowly.
  6. Breathe in slowly and completely for three to five seconds.
  7. Hold your breath for 10 seconds to allow the medication to reach deep into your lungs.
  8. Repeat puffs as prescribed. Never take more than one puff at a time (follow the "one shake, one puff" rule). Waiting one minute between puffs may help the second puff go deeper into the lungs.
Cleaning
The inhaler must be cleaned often to prevent buildup that can clog it and reduce its effectiveness.
  1. Clean the inhaler and cap once a day by rinsing them in warm running water. Let the inhaler dry before you use it again. Have another inhaler available to use while it is drying.
  2. Wash the plastic mouthpiece twice a week with mild dishwashing soap and warm water. Rinse and dry it well before reattaching it to the inhaler.
Checking How Much Medication Is Left in the Canister
  1. Some of the newer inhalers have built-in dose counters that keep track for you.
  2. If the inhaler is one that is used on a scheduled basis (a controller medicine), divide the total number of puffs in the inhaler by how many puffs you take each day to find out how many days the inhaler will last. Replace the inhaler after that many days, even if it feels like some medicine is still left in it.
  3. If the medicine is used only on an as-needed basis (a relief medication), you can estimate the number of doses left in the inhaler by keeping a record of the number of doses you have used (tape this record to the inhaler) or by shaking it.
Spacers

If you don't use your inhaler correctly, the medication can end up on your tongue, at the back of your throat, or in the air instead of in your lungs. Use of a holding chamber (or spacer device) can eliminate this problem.

A spacer is a device that attaches to a metered-dose inhaler and holds the medication long enough for you to inhale it in one or two slow deep breaths. The spacer makes it easy to use the medication the right way and is especially helpful for young children and people who have a hard time using an inhaler alone. Using a spacer reduces the coughing that some inhalers cause and lowers the risk of yeast infections in the mouth (thrush), which can develop from taking inhaled corticosteroid drugs.

There are many models of spacers that you can purchase through your pharmacist or a medical supply company. Ask your doctor which type of spacer is best for you.

How to use a spacer:

  1. Attach the inhaler to the spacer as explained by your doctor or by carefully following the directions that come with the spacer.
  2. Shake the inhaler well.
  3. Place the mouthpiece of the spacer in your mouth.
  4. Depress the canister on the inhaler. This will put one puff of the medication in the holding chamber of the spacer.
  5. Inhale slowly. (A facemask may be helpful for a young child; ask your child's doctor about this.)
  6. Hold your breath for five to 10 seconds and then exhale.
  7. Repeat steps 5 and 6 two more times. If your doctor has prescribed two puffs, wait between puffs for the amount of time he or she has recommended and repeat steps 2 through 6 as many times as recommended. Be sure to clean the spacer as directed.
Young children may need to use a different technique; have your doctor show you and your child the correct technique.

Demonstrate for your doctor how you (or your child) use the spacer to make sure you are using it correctly.

Use of a Dry Powder Inhaler

Dry powder inhalers have advantages over the typical metered-dose inhaler: more of the medication gets to the airways where it is needed, and they can be more convenient and easier to use.

The technique for using dry powder inhalers is different from that for a typical metered-dose inhaler. Your doctor or the doctor's staff will review the instructions for using the type of dry powder inhaler that may be prescribed for you. Each dry powder inhaler is different, and the technique for using each may be different depending on the medication used. Ask for a demonstration of how to use the inhaler if your doctor prescribes a dry powder inhaler for you. As with other types of inhalers, it's a good idea to periodically review your inhaler technique with your doctor or nurse.

Use and Care of a Nebulizer

A nebulizer is a device driven by a compressed air or ultrasonic machine that allows you to take some asthma medications in the form of a mist (wet aerosol). A nebulizer consists of a cup, a mouthpiece attached to a T-shaped part (called a T-connector) or a mask, and thin, plastic tubing that connects to the compressed-air machine. Nebulizers are used mostly by young children under age 5, people who have problems using metered-dose inhalers, and people who have severe asthma.

Like a properly used metered-dose inhaler, a nebulizer helps ensure that the correct dose of medication is delivered to the airways. When using a nebulizer, you need to have a routine for cleaning it because an unclean nebulizer can cause infections. Keeping the nebulizer clean also prevents it from clogging up and helps it last longer.

Directions for using nebulizers may vary (check the machine's instructions), but generally the tubing has to be attached to the machine before it is turned on.

How to use a nebulizer:

  1. Some nebulizer medications come premixed and ready to use; others need to be correctly measured and mixed together. Make sure you know which medications and exactly how much to add to the cup.
  2. Fasten the mouthpiece to the T-connector and then fasten this unit to the cup OR fasten the mask to the cup. For a child over the age of 2, use a mouthpiece unit because it will deliver more medication than a mask.
  3. Put the mouthpiece in your mouth. Seal your lips tightly around it OR place the mask on your face.
  4. Turn on the nebulizer.
  5. Take slow, deep breaths in through the mouth.
  6. Hold each breath for one to two seconds before breathing out.
  7. Continue until the medication is almost gone from the cup (about 10 minutes).
  8. Store the medication as directed after each use. Note: Some newer nebulizers (ultrasonic) may have slightly different instructions. Check with your doctor.
Cleaning the nebulizer:
Don't forget: Routinely cleaning and drying the nebulizer helps eliminate germs, prevents infection, keeps the nebulizer from clogging and helps it last longer.

After each use:

  1. Remove the mask or the mouthpiece and T-connector from the cup. Remove the tubing and set it aside. The tubing should not be washed or rinsed. Rinse the mask or mouthpiece and T-connector in warm running water for 30 seconds. Use distilled (or sterile) water for rinsing, if possible.
  2. Shake off excess water. Air dry on a clean cloth or paper towel.
  3. Put the mask or the mouthpiece and T-connector, cup and tubing back together and connect the device to the compressed-air machine. Run the machine for 10 to 20 seconds to dry the inside of the nebulizer and tubing.
  4. Disconnect the tubing from the compressed-air machine. Store the supplies in a closable plastic bag.
  5. Place a cover over the compressed-air machine.
Once every day:
  1. Remove the mask or the mouthpiece and T-connector from the cup. Remove the tubing and set it aside. The tubing should not be washed or rinsed.
  2. Wash the mask or the mouthpiece and T-connector with a mild dishwashing soap and warm water.
  3. Rinse under a strong stream of water for 30 seconds. Use distilled (or sterile) water if possible.
  4. Shake off excess water. Air dry on a clean cloth or paper towel.
  5. Put the mask or the mouthpiece and T-connector, cup and tubing back together and connect the device to the compressed-air machine. Run the machine for 10 to 20 seconds to dry the inside of the nebulizer and tubing.
  6. Disconnect the tubing from the compressed-air machine. Store the supplies in a closable plastic bag.
  7. Place a cover over the compressed-air machine.
Once or twice a week:
  1. Remove the mask or the mouthpiece and T-connector from the cup. Remove the tubing and set it aside. The tubing should not be washed or rinsed. Wash the mask or the mouthpiece and T-connector with a mild dishwashing soap and warm water.
  2. Rinse under a strong stream of water for 30 seconds.
  3. Soak for 30 minutes in a solution that is one part distilled white vinegar and two parts distilled water. Throw out the vinegar-water solution after use; do not reuse it.
  4. Rinse the nebulizer. Use distilled water, if possible.
  5. Shake off excess water. Air dry on a clean cloth or paper towel.
  6. Put the mask or the mouthpiece and T-connector, cup and tubing back together and connect the device to the compressed-air machine. Run the machine for 10 to 20 seconds to dry the inside of the nebulizer and tubing thoroughly.
  7. Disconnect the tubing from the compressed-air machine. Store the supplies in a closable plastic bag.
  8. Clean the surface of the compressed-air machine with a well-wrung, soapy cloth or sponge. You also could use an alcohol or disinfectant wipe. NEVER PUT THE COMPRESSED-AIR MACHINE IN WATER.
  9. Place a cover over the compressed-air machine.
Excerpted from Understanding Asthma Health Management Bulletin: Information for asthma patients and their friends

Medical Writer: Claudia Morain, Davis, Calif.

Last Updated: February 2005 by Steven R. White, M.D., Associate Professor of Medicine, University of Chicago, Pulmonary and Critical Care Medicine

© Original Copyright 1997 American Medical Association. Updated February 2005.
 


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