ASTHMA MEDICATIONS AND DELIVERY DEVICES

ASTHMA FOUNDATIONS

Asthma medications and delivery devices

To manage your asthma effectively, it is important that you know what asthma is and how the different medications and delivery devices work. This presentation describes asthma medications and delivery devices in detail.

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What is asthma?

People with asthma have sensitive airways in their lungs. When exposed to certain triggers their airways narrow, making it hard for them to breathe.

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Three main factors cause the airways to become narrow:

• The inside lining of the airways becomes red and swollen (inflammation)

• Extra mucus (sticky fluid) may be produced

• The muscle around the airways tightens (bronchoconstriction)

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There are three main groups of asthma medications:

1. Preventers 2. Relievers 3. Symptom controllers

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1. Preventers

Inhaled medications – Alvesco (rust), Flixotide (orange),

Intal Forte (white), Pulmicort, Qvar (brown), Tilade (yellow)

Oral medications – Singulair

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Preventers make the airways less sensitive, reduce the redness and swelling inside the airways and dry up the mucus. It may take a few weeks for preventers to reach their optimal effect.

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Preventers must be taken daily to keep you well, reduce the risk of asthma attacks and to prevent lung damage. A number of these medications are corticosteroids (more commonly known as ‘steroids’). They are similar to steroids that we produce naturally in our bodies. They are not the

same as the anabolic steroids misused by some athletes.

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Important points to remember

Some people may only need preventers for a set period while other people need to take preventers all year round.

Preventers need to be taken at the same time each day at the dosage prescribed by your doctor

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Preventers take time to work, so improvement in your symptoms may not be noticed for a couple of weeks. Do not stop taking your preventer medication after only a few days.

When you are well (no asthma symptoms and rarely using your blue reliever), talk to your doctor about a review of your medications.

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Make sure you ask your doctor if you have any questions or concerns about your asthma medication and/or asthma delivery devices

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2. Relievers Inhaled medications – Airomir, Asmol,

Bricanyl, Epaq, Ventolin (blue) Relievers provide relief from asthma

symptoms within minutes. They relax the muscles around the airways for up to four hours, allowing air to move easily through the airways.

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Treatment of acute asthma When there is little response to relievers, your doctor

may prescribe a short course of oral steroids in liquid or tablet form (Prednisolone/Prednisone). These are used to reduce the inflammation in the airways and quickly regain control of asthma in an acute attack or when symptoms persist.

They are usually given for short periods of 2 to 14 days and are generally free of significant side effects. People with severe persistent asthma may require oral steroids for longer periods, which may result in side effects. Ask your doctor for further information.

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3. Symptom controllers Inhaled medications – Foradile (pale blue),

Oxis, Serevent (green)

Symptom controllers (also called Long Acting Relievers) help to relax the muscles around the airways for up to 12 hours. They are taken daily and are only prescribed for people who are taking regular inhaled ‘steroid’ preventers.

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Combination medications Inhaled medications – Seretide (Flixotide and

Serevent - purple), Symbicort (Pulmicort and Oxis - red)

These medications combine a preventer with a symptom controller in the same delivery device.

Combination medications need to be taken at the same time each day at the dosage prescribed by your doctor.

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Important points

Always carry your blue reliever medication. It is the only medication to use in an asthma emergency

If you are using your reliever medication more than three times per week to ease asthma symptoms it may be a sign that your asthma is not well controlled. Check with your doctor

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Getting the most out of your asthma medications

The aim of delivery devices is to get the maximum amount of medication into your lungs with minimum side effects. It is important to:

Know how to care for and clean your medication devices

Ensure there is medication left in your device Ensure that your medication has not expired

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Use a spacer with a puffer to minimise side effects and deliver more medication to your lungs (a spacer is a device shaped like a clear plastic football or tube into which you fire medication from a puffer and inhale)

Use your inhaler correctly. Have your technique regularly checked by your doctor, pharmacist or asthma educator

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How are asthma medications taken? Asthma medications can be inhaled

(breathed in) or taken orally (swallowed). Most people use inhaled asthma

medication because: Medication goes directly to the lungs Smaller doses can be given so there are

fewer side effects

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Inhalers need to be used correctly to ensure maximum benefits are achieved. This means that:

Asthma improves more rapidly Better control is maintained Less medication is needed Fewer side effects are experienced

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There are two types of inhalers:

1. Aerosol inhaler (puffer) 2. Dry powder inhaler

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1. Aerosol inhalers These inhalers use an aerosol canister

to produce a fine mist of medication. There are two types:

1.1 Puffers - press and breathe 1.2 Autohalers - as you breathe in your

breath will activate the device

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1.1 Puffer Using your puffer 1. Remove the cover from the puffer mouthpiece 2. Hold the puffer upright and shake vigorously 3. Breathe out 4. Tilt the chin up 5. Put the puffer mouthpiece in your mouth and create a seal with your lips 6. Start to breathe in through your mouth, then fire

one puff of medication and continue to breathe in steadily and deeply

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7. Remove the puffer from your mouth, close your mouth and hold your breath for 10 seconds

8. Breathe out through your nose 9. Replace the cover 10. To take more medication repeat steps 2 – 8

Puffers require good coordination so it is important to press own on the canister and breathe in at the same time.

More medication gets into the lungs when a puffer is used with a spacer device.

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Cleaning your puffer

1. Remove metal canister. Do not wash canister

2. Wash the plastic casing only. Rinse the mouthpiece through the top and bottom under warm running water for at least 30 seconds. Wash mouthpiece cover

3. Allow to air dry 4. Reassemble

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Spacer It is recommended that all puffers are

used with a spacer. A spacer is a special device shaped like a clear plastic football or tube. Puffer medications are fired into this device and then the medication is inhaled through a facemask or mouthpiece.

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Using your spacer 1. Assemble the spacer (if not already

assembled) 2. Remove the cap from the puffer and shake

the puffer well 3. Attach the puffer to the end of the spacer 4. Place the mouthpiece of the spacer in your

mouth and close your lips around it. If using a spacer with a facemask, place the facemask over the mouth and nose to ensure a good seal

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5. Press down on the puffer canister once to fire the medication into the spacer

6. Breathe in and out normally for 4 breaths, or breathe in for 5 seconds, hold for 10 seconds and breathe out

7. To take more medication, shake the puffer and repeat steps 3-6

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Cleaning your spacer About every month the spacer should be

washed in clean hot soapy water and allowed to drip dry. Do not rinse or wipe dry.

Using a spacer helps control asthma because: There are fewer side effects from the medication It is easier to use as it requires less coordination

than a puffer alone More medication is inhaled into the lungs

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2. Dry powder inhalers Dry powder inhalers require a deep

inhalation to get the medication into your lungs. They include:

2.1 Turbuhaler 2.2 Accuhaler 2.3 Aerolizer

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Important points • Always hold the devices upright when loading the

medication. This stops the powder from falling out • Always check the amount of medication left in

your device. Doses may be indicated on the device • Keep dry powder devices away from moisture

and do not blow into them • Correct inhaler use is very important. Have your

technique checked regularly by your doctor pharmacist or asthma educator

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2.1 Turbuhaler When using a Turbuhaler a deep inhaled

breath is required to get the medication into the lungs. This may be difficult for young children and adults who are short of breath. It is wise to have a puffer and spacer available for emergencies.

The indicator on the side of the device will either highlight the doses left in the device (Symbicort) or it will appear red to indicate that it is nearly empty (Bricanyl, Pulmicort and Oxis).

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2.2 Accuhaler The indicator on the device shows how

many doses are left 1. Hold the Accuhaler by its base in one

hand 2. Place the thumb of the other hand in the

thumb grip 3. Open the Accuhaler by pushing the thumb

grip around until it clicks 4. Slide the lever until it clicks

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5. Breathe out away from the accuhaler 6. Put the mouthpiece in the mouth ensuring a

good seal is formed with the lips 7. Breathe in steadily through your mouth for

approximately 5 seconds 8. Remove the Accuhaler from your mouth and

hold your breath for approximately 10 seconds 9. Breathe out slowly 10. Close Accuhaler 11. To take more medication repeat steps 2 - 9

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2.3 Aerolizer The Aerolizer (used only for Foradile)

contains powdered medication in a capsule. The medication is released when the blue buttons on the base are pressed, piercing the

capsule.

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Using an Aerolizer correctly 1. Lift off the blue cap 2. Hold the blue base with one hand and

with the other grasp the white mouthpiece and turn in the direction of the arrow

3. Remove a capsule from the blister pack and place in the slot inside the blue base

4. Twist the mouthpiece back into place

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5. Hold the Aerolizer upright and firmly squeeze the two blue buttons on the side until the capsule is pierced

6. Breathe out away from the mouthpiece

7. Place the mouthpiece in your mouth sealing the lips around it

8. Inhale deeply for approximately 5 seconds

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9. Remove the mouthpiece from your mouth and hold your breath for approximately 10 seconds

10. Breathe out slowly 11. Remove the used capsule and replace blue

cap 12. To take more medication repeat steps 2 -

11 When inhaling medication, you should be able

to hear the capsule rattling inside the Aerolizer.

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Nebulisers Nebulisers convert liquid medication into a

fine mist that is inhaled through a mask or mouthpiece. The airflow and pressure of a nebuliser should be checked regularly (at least once a year). Depending on use, disposable nebuliser bowls may need replacing every three months. It is advisable to always have a spare bowl. Nebuliser filters should be changed and the machine serviced according to the manufacturer’s instructions.

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Ask your doctor, nurse, pharmacist or asthma educator for advice on how to use a nebuliser if it is prescribed for you.

Most people DO NOT need to have a nebuliser at home.

Appropriate doses of medication given via a puffer and spacer are just as effective as using a nebuliser. For more information talk to your doctor or local Asthma Foundation

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Managing your asthma effectively • Find a doctor who has a keen interest in

asthma and have regular reviews of your asthma

• Ask your doctor for a written Asthma Action Plan

• Avoid things that make your asthma worse (triggers - other than exercise)

• Know your asthma symptoms and how to treat them

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• Make sure you use asthma medications correctly

• Recognise signs of worsening asthma and follow your written Asthma Action Plan

• Know your Asthma First Aid Plan and how to use it

• Inform your family members about your asthma and how they can provide Asthma First Aid

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What is an Asthma Action Plan? An Asthma Action Plan is a written set of

instructions prepared in partnership with your doctor that assists you to manage your asthma at different times. Your plan should

help you to: • Recognise worsening asthma symptoms • Start treatment quickly • Seek the right medical assistance

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ASTHMA FIRST AID PLAN

Step 1. Sit the person upright and give reassurance. Do not leave them alone.

Step 2. Without delay give 4 separate puffs of a blue reliever (Airomir, Asmol, Epaq or Ventolin)*.

The medication is best given one puff at a time via a spacer device**. Ask the person to take 4 breaths from the spacer after each puff of medication.

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Step 3. Wait 4 minutes. If there is little or no

improvement repeat steps 2 and 3.

Step 4. If there is still no improvement call an ambulance immediately (DIAL 000). Continuously repeat steps 2 and 3 while waiting for the ambulance.

* A Bricanyl Turbuhaler may be used in first aid treatment if a puffer and spacer is unavailable. ** If a spacer is not available, simply use the puffer on its own.

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Peak flow meter How to use a peak flow meter Your doctor, or other health professional such as a

nurse, pharmacist or asthma educator, will show you how to use your peak flow meter correctly.

These are the key steps to using the meter: 1 Stand up. 2 Hold the peak flow meter level, so that the indicator

faces upwards. Make sure the indicator is on zero or ‘start’.

3 Take in as deep a breath as possible.

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4 Place your lips tightly around the mouthpiece and blow as hard and fast as you can.

5 Check your score on the meter. 6 Repeat steps 1-5 two more times. 7 Record the highest score out of the

three scores.

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If your airways are narrower than usual, the peak flow meter will have a lower score than your ‘best’. When your airways are wide open, the score will be at or close to your ‘best’. What each person should score depends on their height, age and sex and so will vary from person to person.

Always use the same peak flow meter for each measurement as readings may vary between different peak flow meters. It is a good idea to take your own peak flow meter with you when you visit your doctor.

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Other times you may need to use a peak flow meter a peak flow meter may be useful in monitoring any change in your asthma when:

1 You leave hospital. 2 You need to take your blue reliever puffer more often. 3 You are getting a cold or you don't feel as well as usual. 4 You have been near a known trigger. 5 Your medication is changed or new medication is started. 6 You are waking at night with your asthma (a sign of

poorly controlled asthma).

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Further information

Asthma Foundations of Australia   Contact your local Asthma Foundation on 1800 645 130 or visit their websites:

   Asthma Australia www.asthmaaustralia.org.au    Asthma Foundation of the ACT www.asthmaact.org.au     Asthma Foundation of New South Wales

www.asthmansw.org.au     Asthma Foundation of Northern Territory

www.asthmant.org.au    Asthma Foundation of Queensland www.asthmaqld.org.au   

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Asthma Foundation of South Australia

www.asthmasa.org.au    Asthma Foundation of Tasmania www.asthmatas.org.au    Asthma Foundation of Victoria www.asthma.org.au    Asthma Foundation of Western Australia

www.asthmawa.org.au National Asthma Council www.NationalAsthma.org.au Asthma http://www.health.gov.au HealthInsite www.healthinsite.gov.au Australasian Society of Clinical Immunology and

Allergy www.allergy.org.au

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© Copyright Asthma Foundations of Australia June 2008

Reproduction for educational purposes is permitted.

This resource satisfies the guidelines and standards approved by the National Asthma Council and Asthma Foundations of Australia.

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Power point presentation by Leanne Edwards