The choice matters
Aim is for asthma control: no daytime symptoms no night time awakening due to asthma no need for rescue medication no exacerbations no limitations on activity including exercise normal lung function Before moving up to the next step: Check compliance Check inhaler technique Eliminate trigger factors At any stage, ge, step p down n therapy apy once ce asthma hma is co contro troll lled ed
We have effective medication We have trained staff BU BUT 3 patients still die each day in the UK
To be effective the medication has to reach the airways Patients have to understand the importance of the medication and how it is administered Correct treatment and correct inhaler technique saves money, time and hospital admissions or time off school or work
Most of the medication reaches the airways by impaction-90% 9% of the medication reaches the airways through gravity 1% reaches the airways by diffusion
Metered dose inhalers Dry powder inhalers
Can mean only 5% of the medication reaches the airways More side effects as more medication is absorbed in the oropharynx Increased doses required
The drug is mixed with the propellant by GENTLE shaking The aerosol mixture comes out at high speed Smaller particles will be able to reach smaller airways NEEDS TO BE INHALED GENTLY TO BE EFFECTIVE
Co-ordination difficulties are prevented as the aerosol is captured within the spacer Reduce the amount of particles hitting the oropharynx area Aerochambers have no valves Volumatics have valves Even Spacer can be used wrongly!
Medication attached to particle -- -often lactose Inhalation has to ‘pull’ the medication off the carrier Requires forceful and fast inspiratory flow
Important to breathe out gently before using inhaler Inhale appropriately for the device Spacers need to be used correctly Hold breath for 5-10 seconds after inhaling
An empty inhaler will continue to spray!! Not possible to determine when the inhaler is empty by shaking it Even when the medication is gone, propellant can remain in the canister Check on the prescribing screen when the inhaler was prescribed Ask questions in a non threatening way
Need to be meaningful and individual Management plans --- with patient’s symptoms/peak-flow information Don’t step up before looking at Triggers Technique Treatment Compliance
Quality ality statement tement People with asthma are given specific training and assessment in inhaler technique before starting any new inhaler treatment Rati tional onale e People with asthma need to be able to use their inhaler correctly to ensure they receive the correct dose of treatment. There are several types of inhaler and it is important that training and assessment are specific to each inhaler Training and assessment need to take place before any new inhaler treatment is started, to ensure that changes to treatment do not fail because of poor technique
Patients without a personal asthma action plan are four times more likely to be admitted Inequalities exist nationally – The Asthma Divide Report / Asthma UK 2007 Source: Adams, R. J., et al. "Factors associated with hospital admissions and repeat emergency department visits for adults with asthma." Thorax . 55.7 (2000): 566-73.
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