Asthma Health Article

Patient education

Nurses, respiratory therapists, and health educators teach patients and families how to prevent, recognize, and manage asthma attacks, including the distinction between mild episodes and those requiring immediate medical attention. They can also train them in stress management techniques that reduce anxiety to help them gain control of this chronic condition.

USING AN INHALER. Perhaps most importantly, these professionals show patients the proper technique for using inhalers and other medications, and stress the importance of compliance. Using a respiratory inhaler properly is a critical skill in asthma management and it's vitally important that patients be instructed in its proper use:

• Remove the inhaler's cap.
• Holding the inhaler upright, shake it thoroughly for several seconds.
• Exhale as much air as possible, while tilting the head back slightly.
• Hold the inhaler in the position required by the manufacturer. Some should be held an inch or two away from the mouth, others should be placed directly in the mouth.
• Press the inhaler to dispense the medication.
• Inhale slowly and deeply through the mouth only for several seconds.
• Hold the breath for at least 10 seconds; this allows the medication to penetrate into the lungs. Take only one breath for each puff.
• Exhale.
• Wait a minute or so between puffs. This delay allows the second dose to get even farther into the airways.

Successful use of metered-dose inhalers requires a close degree of coordination between dispensing the drug and inhaling it. Because this is usually difficult for young children, they are often told to attach "spacers" to their inhalers. These are chambers into which the drug is sprayed before it is inhaled, allowing the medication to be ingested in one or more breaths. For the tiniest patients, masks are attached to the spacers. Many doctors recommend spacers for adult patients as well, since they decrease the chances of using the inhaler improperly, and increase the amount of medication that reaches the lungs. During a severe asthma attack, when patients may not have the ability to inhale a full dose, spacers can literally save lives by allowing patients in distress to take their medication in shorter breaths. Spacers are also usually attached to corticosteroid inhalers.

When using powder inhalers (Rotacaps), patients should close their lips around the inhaler's mouthpiece and inhale quickly. After using a corticosteroid inhaler patients should gargle or rinse their mouths with water to avoid thrush, an overgrowth of yeast in the mouth.

Pharmacists and pharmacy assistants may offer additional instruction about medication use and reiterate the importance of adhering to prescribed treatment.

Minimizing exposure to allergens

There are a number of ways patients can reduce exposure to allergens and irritants that provoke asthmatic attacks, or to avoid them altogether:

• If the patient is sensitive to the family pet, remove the animal or at least keep it out of the bedroom. Keep the pet away from carpets and upholstered furniture. Remove all feathers.
• To reduce exposure to dust mites, remove wall-to-wall carpeting, keep the humidity down, and use special pillow and mattress covers. Wash bedding in hot water once a week.
• Reduce the number of stuffed toys, and wash them each week in hot water as well.
• Eliminate cockroaches using poison, traps, or boric acid rather than chemical pesticides.
• Keep indoor air clean by vacuuming carpets once or twice a week (with the patient absent), avoid using humidifiers, and use air conditioning during warm weather so windows can remain closed.
• Avoid exposure to tobacco smoke.
• Do not exercise outside when air pollution levels are high.
• To reduce occupational exposure, wear a mask when working with or around irritants. Some patients may find it necessary to find work in a safer environment.

KEY TERMS

Allergen—A foreign substance, such as mites in dust or animal dander which, when inhaled, causes the airways to narrow and produces asthma symptoms.

Allergen challenge—"Provocation" testing in which a patient is exposed to a suspected allergen under controlled conditions.

Atopy—An allergy (probably hereditary) that makes people react immediately to allergens they encounter. Atopic individuals are more likely to develop allergic reactions of any type, including the inflammation and airway narrowing typical of asthma.

Hypersensitivity—The state where even a tiny amount of allergen can cause the airways to constrict and bring on an asthmatic attack.

Spirometry—A test using an instrument called a spirometer that shows how well an asthmatic is breathing, the severity of the asthma, and how well it is responding to treatment.

BOOKS

American Medical Association. The Washington Manual of Medical Therapeutics, 30th ed. Philadelphia: Lippincott Williams & Wilkins, 2001, pp. 245-251.