The choice matters Aim is for asthma control: no daytime symptoms - - PowerPoint PPT Presentation

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

• f 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

• ropharynx 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

• nale

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.