How To Use A Metered
- Prime your inhaler. Priming your inhaler is required to make sure that the dosing chamber of the inhaler has the right amount of medication available to dispense. It is necessary to prime an inhaler the very first time you use it and if it hasnt been used for several days or weeks.Remove the cap, shake the inhaler and spray it into the air. Check the instructions that come with your inhaler to see how many sprays are needed.
- For regular use, begin by removing the cap from the mouthpiece.
- Shake the inhaler to mix the medication and propellant.
- While standing or sitting upright, tilt your head back and gently breathe all the way out.
- Hold the inhaler upright and insert the mouthpiece into your mouth. Make sure your lips seal firmly around the mouthpiece.
- Begin taking a slow deep breath and at the same time release a dose of medication by pressing down once on the top of the canister.
- Continue breathing in until you have taken a full breath.
- Remove the MDI from your mouth and hold your breath for ten seconds.
- Breathe out gently through your nose.
- If a second dose is required then repeat the steps above.
- If using a corticosteroid preventer inhaler, rinse your mouth out or clean your teeth to help prevent thrush.
New Strategies In The Medical Management Of Asthma
KAREN M. GROSS, M.D., West Virginia University School of Medicine, Morgantown, West Virginia
CHARLES D. PONTE, PHARM.D., West Virginia University Schools of Pharmacy and Medicine, Morgantown, West Virginia
Am Fam Physician. 1998 Jul 1 58:89-100.
See related patient information handout on managing asthma flare-ups, written by the authors of this article.
Asthma is a chronic inflammatory disease of the airways that affects 14 million to 15 million persons in the United States. An estimated 4.8 million children have asthma, which makes it the most common chronic disease of childhood.1 With the increased understanding of the role inflammation plays in asthma and the addition of new pharmacologic agents, the management of this disease has improved.
What Are The Treatments For Asthma
If you have asthma, you will work with your health care provider to create a treatment plan. The plan will include ways to manage your asthma symptoms and prevent asthma attacks. It will include
- Strategies to avoid triggers. For example, if tobacco smoke is a trigger for you, you should not smoke or allow other people to smoke in your home or car.
- Short-term relief medicines, also called quick-relief medicines. They help prevent symptoms or relieve symptoms during an asthma attack. They include an inhaler to carry with you all the time. It may also include other types of medicines which work quickly to help open your airways.
- Control medicines. You take them every day to help prevent symptoms. They work by reducing airway inflammation and preventing narrowing of the airways.
If you have a severe attack and the short-term relief medicines do not work, you will need emergency care.
Your provider may adjust your treatment until asthma symptoms are controlled.
Sometimes asthma is severe and cannot be controlled with other treatments. If you are an adult with uncontrolled asthma, in some cases your provider might suggest bronchial thermoplasty. This is a procedure that uses heat to shrink the smooth muscle in the lungs. Shrinking the muscle reduces your airway’s ability to tighten and allows you to breathe more easily. The procedure has some risks, so it’s important to discuss them with your provider.
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What Are The Three Types Of Asthma
The three common types of asthma are as follows:
Other types of asthma include the following:
- Occupational asthma: This is common in carpenters, hairdressers, animal breeders, and farmers who are exposed to allergens at their workplace. Medication and counseling may be needed.
- Cough variant asthma: Severe coughing is the main feature of this asthma rather than wheezes. It may be triggered by infections or exercises.
Do Asthma Medicines Have Side Effects
Yes. All medicines have side effects. Tell your doctor how you are responding to the treatment and if you have any side effects. Follow up often with your doctor so you can control your asthma with the least amount of medicines and with the fewest side effects.
Medical Review: June 2021 by S. Allan Bock, MD Maureen George, PhD, RN, AEC, FAAN and Sumita Khatri, MD, MS
References1. Bonds, R., Asawa, A. and Ghazi, A. . Misuse of medical devices: a persistent problem in self-management of asthma and allergic disease. Annals of Allergy, Asthma & Immunology, 114, pp.74-76.e2.
Asthma Action Plan
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Which Is The Best Inhaler Device To Use
This depends on various factors such as:
- Convenience. Some inhalers are small, can go easily in a pocket, and are quick to use. For example, the standard MDI inhaler.
- Your age. Children under the age of 6 years generally cannot use dry powder inhalers. This is because such a strong breath is needed to inhale the medicine within the inhaler. Children aged under 12 years generally cannot use standard MDI inhalers without a spacer. Some elderly people find the MDI inhalers difficult to use.
- Your co-ordination. Some devices need more co-ordination than others.
- Side-effects. Some of the inhaler medicine hits the back of the throat. Sometimes this can cause problems such as thrush in the mouth. This tends to be more of a problem with higher doses of steroid inhalers. Less medicine hits the throat when using a spacer device. Therefore, a spacer device may be advised if you get throat problems, or need a high dose of inhaled steroid.
Often the choice of inhaler is just personal preference. Most GPs and practice nurses have a range of devices to demonstrate, and let you get a feel for them. If you are unhappy with the one you are using then ask your GP or practice nurse if you can try a different type.
How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at www.mhra.gov.uk/yellowcard.
Whats An Asthma Attack
When you breathe normally, muscles around your airways are relaxed, letting air move easily. During an asthma attack, three things can happen:
- Bronchospasm: The muscles around the airways constrict . When they tighten, it makes the airways narrow. Air cannot flow freely through constricted airways.
- Inflammation: The airway linings become swollen. Swollen airways dont let as much air in or out of the lungs.
- Mucus production: During the attack, your body creates more mucus. This thick mucus clogs airways.
Can Asthma Be Prevented
Asthma cant be prevented entirely, but there are some practical ways to reduce the risk of an asthma attack and live well with asthma.
- Get vaccinated for influenza: flu and other respiratory viruses are common triggers for asthma.
- Manage any allergies: asthma and allergies are closely linked, so treating allergic rhinitis and avoiding or managing any allergy triggers will help with your asthma.
- Live smoke-free: quit smoking if you smoke, and avoid any second-hand smoke .
- Eat well: a balanced diet helps you to maintain a healthy weight. Being overweight or obese makes asthma harder to manage.
- Care for yourself: mental health and asthma are linked, so let a trusted friend or your doctor know if you have been feeling sad or anxious, or dont enjoy things as much as before.
- See your doctor regularly: asthma needs to be regularly assessed and managed, and your medication needs may change over time. Ensure your asthma action plan is up to date by checking in with your doctor regularly.
Asthma And Associated Eosinophilic Conditions
Asthma may lead to chronic cough under different clinical settings. Asthma may present predominantly with cough, often nocturnal, and the diagnosis is supported by the presence of reversible airflow limitation and bronchial hyperresponsiveness.93 This condition of cough-variant asthma is a common type of asthma in children. Elderly asthmatics may also give a history of chronic cough before a diagnosis of asthma. Cough as the only presenting symptom of asthma has been reported in up to 57% of patients and is often its most prominent symptom.94 Cough may also arise as a first sign of worsening of asthma the cough usually presents first at night, associated with other symptoms such as wheeze and shortness of breath with drops in early morning peak flows. Some patients with asthma may also develop a persistent dry cough despite good control of their asthma.
Atopic cough is recognized in Japan as an isolated chronic cough characterized by an atopic background, sputum eosinophilia, cough hypersensitivity, normal pulmonary function, and airway hyperresponsiveness.95 On the other hand, eosinophilic bronchitis is characterized by cough without asthma symptoms or bronchial hyperresponsiveness but with eosinophilia in sputum.96
Rakesh K. Kumar, Peter K. Jeffery, in, 2014
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Research For Your Health
The NHLBI is part of the U.S. Department of Health and Human Services National Institutes of Health the Nations biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including asthma. Learn about the current and future NHLBI efforts to improve health through research and scientific discovery.
With Nocturnal Asthma Symptoms Are Worse At Night
You may notice that your asthma symptoms worsen at night.
Classified as nocturnal asthma, this type involves the same symptoms as other types of asthma, but they are exacerbated during the evening hours:
- Shortness of breath or difficulty breathing
- Inflammation of airway
In a series of surveys of asthmatic patients from different countries, nocturnal asthmatic symptoms were reported in 47 to 75 percent of cases. No matter which type of asthma you have, you may experience difficulties breathing at night.
It’s unclear whether or not there is a circadian rhythm factor or an additional aspect of sleep that makes asthmatic symptoms worse. Some triggers that may make asthmatic symptoms worse in the evening include:
- Having a cold, flu, or virus
- Dust or other allergens
- Acid reflux
- Anti-inflammatory drugs or pain relievers or beta-blockers
Nocturnal asthma has been shown to negatively affect mental performance in children. A study published in the Archives of Diseases in Children found that children whose sleep was disturbed by nocturnal asthma also exhibited signs of psychological problems and impaired functioning in school.
Fortunately, researchers found that mental function improved when asthma symptoms were treated.
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What Types Of Asthma Are There
Healthcare providers identify asthma as intermittent or persistent . Persistent asthma can be mild, moderate or severe. Healthcare providers base asthma severity on how often you have attacks. They also consider how well you can do things during an attack.
Asthma can be:
- Allergic: Some peoples allergies can cause an asthma attack. Molds, pollens and other allergens can cause an attack.
- Non-allergic: Outside factors can cause asthma to flare up. Exercise, stress, illness and weather may cause a flare.
Having An Asthma Action Plan
You and your doctor will also put together an asthma action plan. This is a personalised set of instructions that includes a list of your usual asthma medications and doses, guidance on what to do in different situations , and your doctors contact details.
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How To Treat Severe Asthma
Once your asthma specialist has determined the type of severe asthma you are suffering from, they can tailor treatment based on your specific type. Basic treatment for severe persistent asthma consists of inhaled corticosteroids. Additional long-term controller medicines, such as long-acting beta 2 agonists , montelukast or theophylline, are added if asthma is still uncontrolled. Oral corticosteroids can be added on to treatment if patients are still experiencing symptoms and flare-ups.
A personalized treatment plan may include:
Macrolide AntibioticsMacrolide antibiotics are used to help the body fight infection. These medicines control the number of white blood cells found in your airways. One study showed positive results using macrolide antibiotics in people with high counts of neutrophils in blood or sputum samples. Doctors dont suggest these medications be used long term though because side effects, such as antibiotic resistance, can be very serious.
What Are The Symptoms Of Asthma
The symptoms of asthma include
- Chest tightness
- Shortness of breath
- Wheezing, which causes a whistling sound when you breathe out
These symptoms can range from mild to severe. You may have them every day or only once in a while.
When you are having an asthma attack, your symptoms get much worse. The attacks may come on gradually or suddenly. Sometimes they can be life-threatening. They are more common in people who have severe asthma. If you are having asthma attacks, you may need a change in your treatment.
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How To Use A Dry Powder Inhaler
- Prime your inhaler. Read the instructions for use that come with your inhaler to find out how to load a dose of medication. Some DPIs require a powder-filled capsule to be loaded for each use, while others have pre-loaded doses of powder. DPIs with pre-loaded powder will have an indicator to show how many doses are left.Do not load a dose until you are ready to use it or shake your inhaler. Do not try to inhale the contents of a capsule without the appropriate device.
- For regular use, stand or sit up straight and empty all the air out of your lungs by breathing out completely.
- Put the mouthpiece up to your mouth and form a tight seal around it with your lips. The mouthpiece should be pointed up or held horizontally. Do not use a spacer with a DPI.
- Breathe in quickly and forcefully through the mouthpiece, then remove the inhaler from your mouth and hold your breath for 10 seconds before slowly exhaling.
- If using a capsule device check that there is no powder left in the capsule. If powder is still visible then close the device and repeat the steps above to inhale the remainder of the powder.
- If a second dose is required, load a new dose and repeat the steps above.
- Close the device and store in a dry place.
- Rinse your mouth out if instructed to do so.
How Do Healthcare Providers Diagnose Asthma
Your healthcare provider will review your medical history, including information about your parents and siblings. Your provider will also ask you about your symptoms. Your provider will need to know any history of allergies, eczema and other lung diseases.
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What Are Common Asthma Attack Triggers
An asthma attack happens when someone comes in contact with substances that irritate them. Healthcare providers call these substances triggers. Knowing what triggers your asthma makes it easier to avoid asthma attacks.
For some people, a trigger can bring on an attack right away. Sometimes, an attack may start hours or days later.
Triggers can be different for each person. But some common triggers include:
- Air pollution: Many things outside can cause an asthma attack. Air pollution includes factory emissions, car exhaust, wildfire smoke and more.
- Dust mites: You cant see these bugs, but they are in many homes. If you have a dust mite allergy, they can cause an asthma attack.
- Exercise: For some people, exercising can cause an attack.
- Mold: Damp places can spawn mold. It can cause problems for people with asthma. You dont even have to be allergic to mold to have an attack.
- Pests: Cockroaches, mice and other household pests can cause asthma attacks.
- Pets: Your pets can cause asthma attacks. If youre allergic to pet dander , breathing in the dander can irritate your airways.
- Tobacco smoke: If you or someone in your home smokes, you have a higher risk of developing asthma. The best solution is to quit smoking.
- Strong chemicals or smells.
With asthma, you may not have all of these symptoms. You may have different signs at different times. And symptoms can change between asthma attacks.
What Are The Different Types Of Delivery Devices For Asthma Medicines
You take most asthma medicines by breathing them in using an inhaler or nebulizer. An inhaler or nebulizer allows the medicine to go directly to your lungs. But some asthma medicines are in pill form, infusion form, or injectable form.
There are four types of asthma inhaler devices that deliver medicine: metered dose inhalers , dry powder inhalers , breath actuated inhalers, and soft mist inhalers.
- Metered dose inhalers have medicine plus a propellant. The propellant sprays the medicine out of the inhaler in a short burst.
- Dry powder inhalers do not have a propellant and do not spray the medicine out of the inhaler. The medicine is released from the inhaler when you breathe it in.
- Breath actuated inhalers have a dry powder or aerosol medicine. The medicine does not spray out of the inhaler. The medicine is released from the inhaler when you breathe it in.
- Soft mist inhalers do not have propellant, but they do spray the medicine out of the inhaler. They create a cloud of medicine that sprays out softly.
Different types of asthma devices
For inhalers to work well, you must use them correctly. But 70 to 90% of people who use inhalers make at least one mistake when using their inhaler.1 Inhaler mistakes can lead to uncontrolled asthma. Ask your doctor or nurse to watch you use your inhaler to make sure you are using it correctly.
Spacers and valved holding chambers
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