Asthma management

Explanation of typical asthma management

Understanding the triggers for and the body’s response during an asthma episode provide the basics to understanding the treatment of asthma. Avoidance or management of triggers can significantly decrease the possibility of having or decreasing the severity of an asthma episode. Proper medication management is also critical.

The two primary medication types used for asthma management are bronchodilators and corticosteroids. Albuterol inhalers are an example of a short term bronchodilator. It is easily administered with a multidose inhaler or a nebulizer and provides quick relief of symptoms for about 4 hours. If we revisit the causes of the symptoms though bronchodilation (squeezing of the airway tubes) is just one of the 3 events occurring.

The swelling or inflammation in the airways must also be addressed and the corticosteroids are able to effectively reduce that swelling. The corticosteroid can also be given with an inhaler or a nebulizer or given orally (in more severe situations it may be given by an IV). The difference a child and family will observe is that while taking the corticosteroid there is not an immediate relief from symptoms, often times they might question if it is necessary to continue this medication if symptoms have resolved.

Due to the nature of the asthmatic response it is important to follow your healthcare providers instructions, be confident in the difference between the bronchodilator and the corticosteroid and respect each one’s unique use and contribution to asthma management. Having several different inhalers can be tricky but also dangerous. Be sure to understand which medication is given when and why.

Goal of asthma management

The goal with asthma management is to have no symptoms, no disruption in normal activities and to be able to access all activities. With good asthma management all that is possibly. There are ever growing options with asthma management - please continue to work with your health care provider until you have the best asthma action plan.

Using an inhaler with a spacer or aerochamber

Inhalers are quick and easy to use. The metal canister of medication also contains propellant chemicals which allow the medication to turn into a spray and when depressed in the inhaler dispenser the medication comes shooting out with tremendous gusto. Unfortunately our breathing anatomy is not a perfect receiver of this phenomenal technology. Once medicated air enters the mouth (oral cavity) it has to make a right turn to go down to the lungs. Unless the puff of medication is not perfectly timed with a strong inhaled breath some of that medicated spray hits the back of the throat (instead of turning right) and turns back into liquid - dripping down into the stomach. That medicine is ineffective now. The bronchodilators (albuterol) and inhaled corticosteroids are designed to work directly on the lungs - but they have to get there first.

The use of an aerochamber or spacer maximizes the use of the inhaled medication. The inhaler is attached to the spacing device. When puffed the medication enters a holding chamber where it dispersing into a volume of air contained in the chamber. When the child takes a breath, via a mask or mouthpiece the medicated air is easily breathed directly into the lungs, delivering the maximum amount of therapeutic medication. Child as young as 2 years of age can learn this technique. I have attached directions below for using an inhaler with a spacer. I strongly encourage you to have a discussion with your Healthcare Provider about using a spacer with your child's inhalers.

Always shake your inhaler before using it

Above I mentions that inhaled medication contain liquid medication and propellant chemicals. These separate easily and quickly when not mixed together (think about oil and vinegar salad dressing). It is so important that you vigorously shake your inhaler before each use to be sure that the components are mixed together. This ensures you get the right amount or medicine with the right amount of burst.

Timing is everything, with inhaler use

When using an inhaled medication it's important to follow the directions of the Healthcare provider. Bronchodilators are usually given with a number of puffs (ie 2 puffs). Those puffs should be spaced at least one minute apart. The reason has to due with the action of the bronchodilator. The bronchodilator is going to relax those muscles which are squeezing the airways, making breathing more difficult. They work directly on those muscles. The first puff will begin to work on the muscles they come in contact with first. As airways relax the medication can continue down the airways opening up breathing further down, and outward into smaller airways. The second puff, one minute later, with be able to pick up where the first puff left off, relaxing muscles and opening airways beyond what the first puff was able to do. This provides for more complete effects from the medication, relieving symptoms more thoroughly.

Inhaled Corticosteroids do not act in the same way so the minute spacing is not as important to follow. Always remember to rinse your mouth with water or brush your teeth after using inhaled corticosteroids.

Care of your inhaler and spacer

Spacers will come with manufacturers directions for care and storage. There are many different designs and materials for spacers or aerochambers so the specific manufacturer knows best about it's product care and storage. Please follow those directions.

I have attached a chart which describes the care, cleaning and storage of popular inhalers. If you have any questions about your specific inhaler do not hesitate to call the manufacturer or speak with your Pharmacist or Healthcare Provider.

Will your child need asthma medication at school?

If you and your Healthcare provider think your child will need asthma medication at school please complete and sign the top of the Medication Authorization form, have your Healthcare provider complete and sign the lower portion of the form. Remember one form is needed for each order. If your child will need albuterol as needed (if they begin to cough, wheeze or have difficulty breathing at school - this is one order, if they will also need the albuterol before they go to PE this is a separate order and will need a seperate form). Please contact me at sue.righter@pgcps.org if you have any questions.