Managing asthma & Inhaler devices for respiratory
disease
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Managing asthma
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Unfortunately asthma is a major cause of chronic morbidity and
mortality throughout the world ( estimated 300million ) and there
is evidence that its prevalence has increased considerably over the
past 20 years, especially in children. Fortunately asthma can be
effectively treated and most patients can achieve good control of
their disease. Global Initiative for Asthma (2012)
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When asthma is under control patients can; Avoid troublesome
symptoms night & day. Use little or no reliever medication.
Have productive, physically active lives. Have (near) normal lung
function. Avoid serious attacks. Global Initiative for Asthma
(2012)
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Four components of asthma care; Global Initiative for Asthma
(2012) 1. Develop patient/doctor partnerships 2. Identify and
reduce exposure to risk factors 3. Assess, treat and monitor
symptoms 4. Manage asthma exacerbations
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1. Develop patient/doctor partnerships; Effective management
requires partnership between the person with asthma and the health
care team. Education should be an integral part of all interactions
between patient & HCP. Together prepare a written, personal
asthma action plan.
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With your help, the help of others on the health care tem,
patients can learn to; Avoid risk factors Take medication correctly
Understand the difference between controller & reliever
medication. Monitor their status using symptoms and, if relevant
PEFR. Recognise signs that asthma is worsening and take action.
Seek medical advice as appropriate.
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2. Identify and reduce exposure to risk factors; Many patients
react to multiple risk factors that are ubiquitous to the
environment, avoiding these can be impossible, therefore medication
to maintain control have an important role. Physical activity is
common cause of asthma symptoms but patients should not avoid
exercise. Moderate/severe asthma should receive flu vaccination
every year
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Avoidance of common allergens/pollutants Tobacco smoke Drugs,
food & additives Occupational sensitizers House dust mite
Animal fur Outdoor pollen & mold Indoor mold
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3. Assess, treat and monitor symptoms a. Assessing asthma
control b. Treating to achieve control c. Monitoring to maintain
control
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a. Assessing asthma control Current treatment regime Adherence
to current regime Level of asthma control Daytime symptoms
Limitation of activity Nocturnal symptoms/waking Need for
reliever/rescue inhaler Lung function rapid decline Risk of
exacerbation instability
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b. Treating to achieve control - prescribing devices Inhaled
medications are preferred because they deliver drugs directly to
the airways, this results in potent therapeutic effects with fewer
systemic side effects. Only prescribe inhalers after patient has
received training in the use of the device and have demonstrated
satisfactory technique. The choice of device may be determined by
the choice of drug. (GINA 2012)
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b. Treating to achieve control - prescribing devices Patients
should have an assessment of their ability to use an inhaler device
by a competent health care professional. Reassess inhaler technique
as part of structured clinical review. Exacerbations of
mild/moderate asthma should be treated by pMDI + spacer with dose
titrated according to clinical response. (BTS/SIGN Quick Reference
Guide 2011)
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b. Treating to achieve control Use a step-wise approach. At
each step, reliever medication should be provided for quick relief,
as needed. If asthma is not controlled on current treatment regime
then treatment should be stepped up until control is achieved.
Patients who do not reach acceptable level of control at step 4
should be referred to an asthma specialist (unless already known to
specialist as difficult to treat)
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c. Monitoring to maintain control (GINA 2012) Ongoing
monitoring is essential to maintain control & establish the
lowest step & dose to minimize cost & maximize safety.
Review; 1-3 months after initial diagnosis 3 monthly 2-4 weeks
after exacerbation Monitoring is necessary after control is
achieved as asthma is variable Treated has to be adjusted
periodically in response to exacerbation
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4. Managing exacerbations Exacerbation = episodes of increase
in SOB; cough; wheeze or chest tightness, or combination of these
symptoms Do not underestimate the severity of an exacerbation
severe asthma can be life threatening. Patients should be taught to
recognise the symptoms of an acute exacerbation and when to seek
immediate medical attention. Can be part of a written management
plan.
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4. Managing exacerbations Mild exacerbation may be treated at
home, if the patient is prepared. Community increased rapid acting
B2-agonist oral glucocorticosteroids prednisolone Oxygen Monitor
response to treatment Follow up Severity of Asthma Exacerbation
GINA 2012 p.22 Special Consideration in Managing Asthma GINA 2012
p.23
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Pregnancy Obesity Rhinitis, sinusitis & nasal polyps
Occupational asthma Gastroesophageal reflux Aspirin & asthma
anaphylaxis Special considerations in managing asthma
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http://www.asthma.org.uk/about
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Inhaler medication RELIEVERS Short acting bronchodilators
PREVENTERS Corticosteroids CONTROLLERS Long acting bronchodilators
COMBINATION
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Inhaler technique
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What is an aerosol? An aerosol is a microscopic substance of
fine solid particles or liquid droplets dispersed in air or another
gas
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Therefore; all inhaler devices generate an aerosol Some are
PASSIVE the device creates the aerosol Some are ACTIVE the person
has to create the aerosol