Dry Powder Inhalers

General points include:

    * The medicine is only inhaled when a breath is taken.
    * The devices do not contain propellants to help the medication go into the lungs.
    * The devices are portable and come in convenient sizes.
    * To load the Diskhaler®, remove the cover and cartridge unit
    * Place a disk on the wheel with the numbers facing up and slide the unit back into the Diskhaler®
    * Smoothly push the cartridge in and out until the number 8 appears in the window, the Diskhaler® is now ready for use
    * Lift the lid up as far as it will go - this will pierce the blister
    * Shut the lid
    * Take breaths in and out
    * Place the mouthpiece between your teeth & lips - make sure you don't cover the air holes at the sides of the mouthpiece and tilt your head back slightly
    * Breathe in deeply & vigorously
    * Hold your breath for 10 seconds or as long as you can, sometimes 2 or 3 forceful breaths in are needed to make sure all the medication is taken
    * If a second blister is prescribed, advance the cartridge to the next number & repeat the steps

Care of Diskhaler

Any remaining powder must be cleared to ensure proper dosage.

Proper Use of a Turbuhaler®

    * Unscrew the cover and remove it
    * Holding the device upright, turn the coloured wheel one way & back the other until it clicks - it is now loaded
    * Breathe out
    * Place the mouthpiece between your lips and tilt your head back slightly
          o breathe in deeply and forcefully
          o hold your breath for 10 seconds or as long as you can
          o if a second click is prescribed, repeat the steps
          o Keep the Turbuhaler clean.

Nebulizers (Compressors)

A nebulizer or compressor is used chiefly for small children and elderly people. Each treatment requires sitting quietly for 20-30 minutes whilst the drug is nebulized from a liquid to a mist.

Care of Nebulizer and Equipment

Wash the mask with hot, soapy water. Rinse well and allow it to air dry before re-use.

Management of Asthma

Asthma is very common and causes substantial morbidity. The aims of treatment are:

    * to abolish the symptoms
    * to re-establish normal or best possible long-term airway function
    * to decrease the risk of severe attacks
    * to facilitate normal growth  occurring in children
    * to reduce absence from school or employment.

This involves:

    * patient and family instruction about asthma
    * patient and family input in treatment
    * prevention of identified causes where possible
    * use of the lowest efficient doses of convenient medications to minimize short-term and long-term side-effects.

Control of extrinsic factors

Measures should be taken to avoid contributing allergens such as the house-dust mite, pets, moulds and certain foodstuffs, particularly in childhood.

Evasion of house-dust mites is now achievable with efficient and secure covers for bedding and changes to people's living accommodation. Smoking should be avoided at all cost.

Other agents (e.g. preservatives and colouring materials such as tartrazine) should be avoided if shown to be a causative factor. Fifty per cent of those sensitized to work-related agents could be cured if they are kept permanently away from contact.

This emphasises:

    * The significance of rapid identification of extrinsic causes of asthma and their removal wherever possible (e.g. occupational agents, family pets)
    * Once extrinsic asthma is started, it can become self-perpetuating.

How to manage catastrophic sudden severe (brittle) asthma

This is an unusual variation of asthma in which patients are in danger of sudden death despite their asthma being well controlled between attacks. Severe life-threatening attacks can occur within hours or even minutes.

Brittle Asthmatics should ensure they have

          o emergency supplies of medications at home, in the car and at work
          o oxygen and resuscitation kit at home and at work
          o nebulized β2 agonists at home and at work
          o self-injectable epinephrine (adrenaline): two Epipens of 0.3 mg epinephrine at home, at work and to be carried by the asthmatic at all times
          o prednisolone 60 mg
          o Medic Alert bracelet.

Asthma Prevention:

Asthma symptoms can be significantly reduced by avoiding known allergens and respiratory irritants. If somebody with asthma is responsive to dust mites, contact can be reduced by encasing mattresses and pillows in allergen-impermeable covers, removing carpets from bedrooms, and by vacuuming regularly. Exposure to dust mites and mould can be reduced by lowering indoor humidity.

If a individual is allergic to an animal that cannot be removed from the home, the animal should be kept out of that person's bedroom at least.

If a individual is allergic to an animal that cannot be removed from the home, the animal should be kept out of that person's bedroom at least.

Filtering material can be placed over the heating outlets to trap animal dander. Exposure to cigarette smoke, air pollution, industrial dusts, and irritating fumes should also be avoided as much as possible.

Allergy desensitization can be helpful in reducing asthma symptoms and medication use, but the size of the advantage compared to other treatments is not known.
 

Asthmatics can also prevent and control attacks by limiting their exposure to environmental triggers.

    * Carpets, beddings etc should be regularly cleaned.
    * A mask should be worn
    * Bathe pets regularly
    * steer clear of pollutants and irritants
    * Cyclic allergies to pollen and mold spores can be reduced by avoiding the outside during peak periods of activity

Asthma Complications

Respiratory fatigue
Pneumothorax
Side effects of any medication used
Death

Asthma Prognosis (Prospect)

There is no cure for asthma, though symptoms sometimes decrease over a period of time. With appropriate self management and therapeutic treatment, most people with asthma can lead normal lives.

Although asthma often improves in children as they reach their teens, it is now realized the illness frequently returns in the second, third and fourth decades of life.

Previously data indicating a natural reduction in asthma through adolescent years has led to childhood asthma being treated as an intermittent disorder. However, it is now considered that airway inflammation is present continuously from an early age and frequently persists even if the symptoms resolve.

Furthermore, airways remodelling accelerates the process of decline in lung function over a period of time. This has led to a review of the management strategy for asthma, encouraging the early use of efficient and effective controller drugs and environmental measures from the time asthma is first diagnosed.