Asthma. Parent and Carer Information

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1 Asthma Parent and Carer Information

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3 Contents 4 What is Asthma? 4 The Causes of Asthma 4 What Happens During an Asthma Attack? 6 Common Symptoms of Asthma 7 Different Types of Asthma 9 How to Assess Your Child for Asthma 10 Trigger Factors 10 Common Triggers 11 Asthma and Smoking 13 How to Minimise Allergens in Your Home 14 Medications 14 Relievers 15 Preventers 16 Symptom Controllers 16 Combination Medication 17 Is Asthma Medication Safe? 17 Will the Amount of Medication Change? 17 Complementary Medications and Therapy 18 Types of Delivery Devices for Medication and How to Use Them 18 Metered Dose Inhalers (MDl) or Puffer Turbuhalers 18 Spacers 19 How to Use a Spacer with a Mask 20 How to Use a Spacer 22 How to Use a MDl or Puffer 24 Turbuhalers 26 Autohalers 28 Accuhaler 30 Nebulisers 32 Visits to Your Doctor and the Role of the Asthma Action Plan 32 Overview 34 Action Plan 35 Asthma First Aid 36 Patient Checklist 38 Notes 38 References Used in Preparing This Information 38 Useful Websites page 3

4 Asthma Parent Information What is Asthma? To define a complex disease in simple terms, asthma is a sensitivity of the airways. Sufferers experience a narrowing of the airways and difficult breathing due to a combination of changes, which include: >> Tightening of the muscles in the wall of the airway >> Swelling of the airway lining >> An increase in mucus production in the airway The Causes of Asthma Despite a great deal of research, the cause of asthma is still unknown. Evidence shows however, that asthmatics have sensitive or twitchy airways, which are activated by triggers such as colds, exercise, allergies and cigarette smoke. It is also known that children with parents who suffer from asthma or allergies are at greater risk of developing asthma. Today, with improved treatment and management, the majority of asthmatics can lead a normal active life and be assured of relief from even the most severe attack. What Happens During an Asthma Attack? When an asthma attack starts >> The muscle in the walls of the airway tighten >> The sensitive, inner lining of the airway swells >> Thick mucus (phlegm) is produced in the airway Changes you may notice in your child >> A dry, irritating and persistent cough in conjunction with other changes >> Difficulty in breathing >> Faster breathing >> A wheeze (best heard when breathing out) Are these changes reversible? All of the above can be helped with treatment. The key is to recognise and treat the signs and symptoms of asthma early. page 4

5 What is Asthma? Model of Airway in Asthma Tightening of the muscles in the airway walls Thickening of the lining of the bronchiole Mucus blocking the airway page 5

6 Asthma Parent Information Common Symptoms of Asthma Wheeze A wheeze is the most common sign of asthma Cough >>It may be dry and hacking or moist and chesty >>It can be present day or night, but is often worse at night and present on waking >>It may be brought on or made worse by exercise, excitement, laughter or distress If not treated, an asthma cough can be present for many weeks. Coughs are more common during the winter months, especially in young children and may be triggered or made worse by colds, viral infections and temperature changes (e.g. chilly air). Note: Not all coughs are due to asthma. If asthma treatment is unsuccessful, further investigation may be required. Difficulty in Breathing, Shortness of Breath or Chest Tightness Difficulty in breathing occurs due to the extra effort and energy required to move air in and out of the lungs. The symptoms of asthma can vary from mild to severe. Some attacks can appear quickly, while others may take hours or days to develop. page 6

7 Common Symptoms of Asthma Different Types of Asthma Asthma is a condition that affects individuals in different ways. Different types of asthma include: Infrequent Intermittent Asthma >> This is the most common form of asthma and is often seen in younger children >> Attacks occur every few months with no symptoms in-between >> The most common trigger is a viral infection or cold > > Usually needs treatment only during attacks Frequent Intermittent Asthma >> Asthma symptoms occur more often than every 6-8 weeks >> Again, the most common trigger is a viral infection >> Allergens such as dust or pollen can also be important triggers >> Symptoms are often a cough and a wheeze (which may be worse at night), and are often not present between attacks >> Usually need a preventer medication only in the winter months, when viral infections are most common >> Child is well between episodes Persistent or Chronic Asthma >> This is the least common form >> Symptoms occur on most days and may be most obvious overnight or early morning. While symptoms may not be severe, there may be times when symptoms quickly become severe >> Exercise will usually trigger symptoms. Good control of symptoms is often obtained with preventative treatment, but minor breakthrough symptoms can be difficult to control in this group of people page 7

8 Asthma Parent Information Good asthma management aims to: Help keep your child s lungs healthy. Minimise sickness and time away from school. Enable full participation in daily activities. Use the least amount of medication to control symptoms. Allow normal growth and development. Avoid or minimise the side-effects of medication. Good asthma management is achieved through the use of an Asthma Action Plan and a clear understanding of its goals. Good communication with your nurse and doctor are also essential. page 8

9 Common Symptoms of Asthma How to Assess Your Child for Asthma Firstly, know what is normal for your child. It is important to be aware of how your child looks and behaves when well, so when symptoms do appear they will be easily recognisable, enabling you to respond more readily. You should ask these questions >> Is my child wheezing? >> Is my child complaining of chest tightness or saying that it is hard to breathe? >> Is my child scared because he/she can t breathe? >> Is my child able to do the things he/she normally does? >> Has my child s behaviour changed i.e. unusually tired or quiet, loss of interest in things? >> Is my child short of breath? >> Is my child able to speak normally? >> Has my child a persistent cough? >> Is my child s breathing faster than normal? >> Is the area between my child s ribs being drawn in more than usual? >> Is my child s stomach being pulled in when he/she breathes? >> Are my child s nostrils moving in and out (nasal flaring)? >> Is there drawing in at the base of the throat (tracheal tug)? If the answer to any of the above questions is YES and your child s medication is NOT helping: a) Follow your Asthma Action Plan b) Contact your child s doctor or an Emergency Department for review. page 9

10 Asthma Parent Information Trigger Factors There are a number of different factors that can trigger an attack or make asthma worse. These trigger factors may vary from child to child. Common Triggers Infections At least 85% of asthma attacks are triggered by chest infections, colds and sore throats (upper respiratory tract infections) or the flu. It is recommended that children with persistent asthma and their families have an annual flu vaccination. Temperature Cold temperatures and winds, high or low humidity, sudden changes in weather, air-conditioning and moving between hot and cold environments can all trigger an attack. Exercise People with asthma are encouraged to play sport. While exercising, symptoms of asthma may appear. However, warm-up and cool-down exercises along with medication can be used to prevent or reduce symptoms of exercise-induced asthma. It is recommended that you take your reliever medication up to 10 minutes before exercise. If you become wheezy, short of breath or start to cough during sport or exercise, treat with reliever medication. If there is no response, stop the activity. Allergens (allergies) These include: house-dust, house-dust-mite, pollens, moulds, animal hair, some foods as well as food additives and preservatives. Allergies vary from person to person and can change at different times in a person s life. It is extremely rare for cow s milk to cause asthma. It does not increase mucus in the lungs, although this is a common myth. Irritants Fumes from paint, fires and gas appliances along with smoke can trigger asthma in some people and should be avoided. Some cosmetics, hair sprays, soaps and perfumes etc can also trigger asthma. page 10

11 Trigger Factors Asthma and Smoking Smoking and asthma do not mix. Cigarette smoke, with its 4,000 harmful chemicals, is a major trigger. What happens if you have asthma and smoke? >> Smoking makes your asthma worse >> Smoking may increase your chance of attack >> Smoking makes your day-to-day asthma control harder to achieve >> Smoking increases your chances of permanently damaging your airways Tobacco smoke damages the little hair-like structures (cilia) that help move dust, pollens and other irritants from your lungs. With the normal cleaning action of your lungs damaged, you are more prone to chest infections, which in turn may bring-on or worsen your asthma. How does passive smoking affect you if you have asthma? Passive smoking occurs when non-smokers breathe in the harmful side-stream smoke of others. If people around you smoke it can: >> Trigger an asthma attack >> Increase the number of asthma attacks you have >> Increase your need for asthma medications >> Increase your sensitivity to other environmental triggers (e.g. pet hair, pollens and chemicals) >> Reduce your lung function How does smoking affect your family? >> Women who smoke during pregnancy pass chemicals in the smoke on to their unborn babies. These chemicals affect the cells of the developing lungs and increase an infant s chances of having lung disorders, such as asthma >> If asthma is present in the family, smoking around non-smokers in the home can contribute to the development of asthma and an earlier onset of the disease >> Children who live in a home with smokers are more likely to have respiratory infections, a known trigger for asthma page 11

12 Asthma Parent Information Quit Tips for Smokers Everyone can stop smoking. It s never too late to quit. Contact Quitline at or (24 hour statewide service) for free selfhelp resources, referral and counselling. It is important to recognise the triggers for your child s asthma and to avoid them if possible (e.g. cigarette smoke or allergens). If preventer medication has been prescribed, take it as prescribed. Remember that when asthma is well controlled, your child should be able to lead a full and active life. Take the time and make the effort to control asthma - don t let asthma control your child s life. page 12

13 Trigger Factors How to Minimise Allergens in Your Home This is dependent on your child s asthma triggers. Ways of reducing dust and dust-mite >> Use a damp or oiled cloth when dusting >> Keep soft toys to a minimum. Wash regularly (or place in freezer overnight) and keep toys off the bed >> If possible, do not have carpet in bedrooms. Damp-mop the floor to keep it free of dust >> Remove sheepskins and woollen underlays >> Wash sheets and pillowcases weekly. Wash blankets and quilt covers quarterly in hot, soapy water (over 55 C) - Cold water does not kill house-dust-mite. Tumble-drying on hot for 10 minutes is also useful (over 55 C), if recommended by the manufacturer >> If you are unable to wash in hot water, use a commercial product containing essential oils such as tea-tree or eucalyptus oil, formulated to kill dust-mites in cold water. You can also add a couple of drops of CP Eucalyptus oil to the wash when washing bedding >> When changing bedding, vacuum the mattress and place in the sun >> Encase bedding, mattress and pillows in dust-mite-resistant covers >> Use low allergy bedding such as feather quilt s and pillows >> Ensure rooms are well ventilated with plenty of sunlight >> Use a vacuum cleaner with a triple-filter system and strong suction. Vacuum house weekly >> Check the dust bag in the vacuum cleaner does not leak Ways of reducing mould growth >> Air the house as much as possible >> If you have a garden or yard, keep it free from fallen leaves >> Dampen any visible mould with bleach (do not inhale the fumes) >> Direct the airflow from laundry dryers outside >> Remove spilt food or drink from surfaces (and animal or plant material that encourages mould growth) >> Keep evaporative coolers clean and serviced regularly >> Keep air-conditioners in your home and car clean and serviced regularly >> Remove indoor plants page 13

14 Asthma Parent Information Medications There are three different types of asthma medications used in the treatment of asthma. 1. Reliever medications relax the smooth airway muscles and help them re-open 2. Preventer medications reduce inflammation 3. Symptom controllers control day/night symptoms 4. Combination medications combine a symptom controller and a preventer Relievers Bronchodilators (blue/grey) Reliever medications make breathing easier but don t have any long-term preventive action. They work by relaxing the small muscles surrounding the narrowed airways allowing them to re-open. The effect is usually quick and noticeable (5-15 minutes) but short acting (3-6 hours). There are several types of reliever medications: Short-acting relievers Used in EMERGENCY situations and to treat asthma symptoms as required. They include Salbutamol (Ventolin, Epaq, Airomir, Asmol) and Terbutaline (Bricanyl). Ipratropium Bromide (Atrovent) Not commonly used in isolation, but may be used in combination with other medications to increase the effect of other relievers. It promotes bronchodilation and is used in severe asthma. If using both reliever and preventer medication USE THE RELIEVER MEDICATION FIRST. Ipratropium Bromide has a slower onset of action and would therefore not be of immediate benefit. If your child is having difficulty breathing, use short acting reliever medication for relief. Long-acting relievers Used on a REGULAR BASIS for the maintenance of asthma and should not be used alone in a severe attack. Continue taking the usual dose and frequency during an acute attack. Long-acting relievers act for more than 12 hours and include Salmeterol (Serevent) and Eformoterol (Foridile/Oxis). Side effects of relievers include tremors, increased heart rate, excitability, irritability and insomnia. page 14

15 Medications Preventers (orange/brown/yellow/red/white) These medications work by reducing the sensitivity of the airways, preventing them from becoming swollen, and decreasing the amount of mucus. They also reduce the sensitivity of the airways to trigger factors. In this way, they prevent and decrease the severity of attacks. Preventer medications take time to reach their full effect. They should be taken every day, whether there are symptoms or not. They must not be stopped and started as symptoms appear/disappear, unless advised by your doctor. They DO NOT relieve an acute asthma attack. Preventer Medications include: Corticosteroids (Pulmicort, Flixotide, Respocort, QVAR, Alvesco) Inhaled steroids are often used as maintenance treatment for moderate or severe cases of asthma. They work to reduce the underlying inflammation. In normally prescribed doses, side effects are minimal but can include hoarseness of the voice, sore throat and oral thrush. Side effects can be avoided by using a spacer device when inhaling oral medication and gargling with water afterwards. In larger doses, side effects can be more significant, however, under-treated asthma can be fatal. Sodium Cromotoglycate (Intal Forte) Often used to help prevent mild or moderate exercise-induced asthma. Side effects include unusual taste and coughing. Nedocromil Sodium (Tilade) Often used in mild to moderate asthma. Side effects include unusual taste, coughing and headache. Montelukast (Singulair) This preventative medication is taken orally once a day in tablet form. Montelukast has been used in exercise-induced asthma and night asthma. It also may be used to reduce the dose of preventer medication. Side effects are uncommon and mild, such as headache and abdominal pain. Please discuss these options further with your child s doctor. To prevent skin and eye irritation when giving Budesonide (Pulmicort) via a nebuliser, it is important that your child wears goggles and that his/her face is washed following administration. It is best to use a spacer with a corticosteroid puffer to minimise side effects and maximise lung deposition. page 15

16 Asthma Parent Information Symptom Controllers (Foradile (pale blue), Oxis, Serevent (green) This type of medication is known as long acting relievers and help to relax the muscles around the airways for up to 12 hours. They are prescribed for children who are already on a preventer medication but are still having asthma symptoms especially at night or with exercise. Symptom controllers should not be used as a short acting reliever. Combination Medication Symbicort (red)/seretide (purple) This type of medication contains both a preventer medication and a symptom controller (i.e. a corticosteroid and a long-acting bronchodilator). It works by reducing airway sensitivity, preventing airways from becoming swollen and producing mucus. It also helps relax the tiny muscles around the air-way, reducing daily symptoms. These medications should be taken everyday at the same time whether symptoms are present or not. Side effects are minimal but can include increased heart rate and excitability, hoarseness of voice and oral thrush. Some of these side effects can be avoided by using a spacer with the Seretide and by rinsing the mouth with water and spitting out after taking the medication. Oral Steroids (Prednisolone) Usually required to regain control of asthma when there is an acute attack or symptoms persist. When asthma is very severe, they can be used for weeks or months but this is not commonly required. Steroids act by reducing airway swelling. These steroids (corticosteroids) are different from steroids abused by athletes, which are called Anabolic Steroids. When used in short courses of 3-5 days, and fewer than 5-6 times per year, they are generally considered free of significant side effects. However, oral steroids have the potential for side effects when used in high doses for weeks to months at a time. This treatment and its side effects should be discussed with your child s doctor. New asthma medications are being developed and trialled all the time. Contact your treating doctor for more information or the Asthma Foundation of SA. page 16

17 Medications Is Asthma Medication Safe? Although side effects occur in some people, asthma medicines are much safer than untreated or under-treated asthma. They are not addictive. Will the Amount of Medication Change? Asthma is a changing condition and as the asthma changes and your child grows; your doctor may need to increase or decrease the medication. Your child needs to be reviewed regularly, at least every three months, in order to monitor and control symptoms and manage side effects. Complementary Medications and Therapy >> No alternative medications available for treating asthma have been shown to be effective in clinical tests >> These medications may be useful for some people but should not be used in place of prescribed medications >> Some people find relaxation exercises beneficial e.g. yoga, hypnotherapy and various breathing techniques >> Talk to your doctor before commencing complementary medication or therapy page 17

18 Asthma Parent Information Types of Delivery Devices for Medication and How to Use Them Medications are mostly given via inhalers or puffers that deliver small amounts of medication straight into the airways. This allows the medication to act more quickly and reduces the risk of side effects. Spacers and other devices are available to help your child use his/her puffer. Metered Dose Inhalers (MDl) or Puffer Turbuhalers Most children need a spacer device to use their puffer effectively. >> Always keep a spare puffer on hand in case your puffer runs out unexpectedly or expires just when your child needs it >> Whether a puffer is used for preventive therapy or in an emergency situation (an acute asthma attack), it is more effective if used with a spacer device Spacers A spacer is a device that helps to deliver medication more effectively. It is a holding chamber. The type of spacer and technique used is dependent on your child s age, development and understanding. Using a spacer is equally as effective as a nebuliser in most patients and is the preferred way to give asthma medication to both children and adults. The benefits of using a spacer >> Assists in coordination while pressing the puffer and breathing in >> Traps large particles inside the spacer before they reach your child s mouth (preventing oral thrush and foul taste) >> Allows for evaporation of the medication, reducing particle size and enabling more medication to reach the lungs >> Decreases unwanted side effects by reducing the amount of medication swallowed page 18

19 The types of Delivery Devices for Medication and How to Use Them How to Use a Spacer with a Mask (appropriate age: 4 years and under) Note: Remove caps from inhaler and spacer (if applicable). Shake the puffer well - approximately 3 seconds. Insert puffer into the end of the spacer. Attach the mask over the mouthpiece of the spacer and put the mask to your child s face. Make sure the mask is sealed tightly over the mouth and nose. Press one dose from the puffer into the spacer. Keep the mask in place until at least four breaths have been taken. Repeat procedure if another dose is required. >>Only one puff at a time is to be placed into the spacer >>When using a spacer, always give reliever medication first, followed by preventer medication page 19

20 Asthma Parent Information How to Use a Spacer (appropriate age: 4 years and over) Remove caps from inhaler and spacer (if applicable). Shake puffer well - approximately 3 seconds. Insert puffer into the end of the spacer. Place lips tightly around the mouthpiece of the spacer. Tell your child to bite on the mouthpiece and close his/her lips around it. Breathe out into the spacer. Press one dose from the puffer into the spacer. Ask your child to take a slow, deep breath in through the mouthpiece. When your child s lungs are full, instruct him/her to hold their breath for ten seconds if able. If unable to complete step 6 your child should take 4 normal breaths in and out. Repeat the procedure if another dose is required. page 20

21 The types of Delivery Devices for Medication and How to Use Them When to Clean Your Spacer >> Spacers require cleaning weekly, or as recommended by the manufacturer How to Clean Your Spacer Wash in warm soapy water. Do not rinse. >> Leave to dry overnight or dry with a hairdryer. Do not dry with a tea-towel >> Some spacers have a detachable valve. This valve is easily damaged and/or lost. Without a valve, the spacer is unable to function. To clean the valve, wash in tepid water and leave on a flat surface to dry. Replace the valve immediately when dry >> Spacers should be replaced annually page 21

22 Asthma Parent Information How to Use a MDl or Puffer (closed mouth puffer technique) Children under the age of 8 MUST USE the Spacer Device with a Metered Dose Inhaler. See Page 20. It is recommended that ALL asthmatic s use a spacer as it helps medication delivery to the lungs Remove cap. Shake puffer well - approximately 3 seconds. Hold inhaler upright (with mouthpiece down). Place lips tightly around mouthpiece. Ask your child to bite on the canister and close his/her lips around it. Breathe out gently into the puffer. Press the puffer once, at the start of a slow, deep breath in. Hold breath for ten seconds. Breathe out gently. Wait one minute before taking the next puff, following the above steps. Replace cap. The correct puffer technique is essential for medication to reach the airways and work effectively. NOTE: It is recommended that all asthmatics should use a spacer for medication delivery. page 22

23 The types of Delivery Devices for Medication and How to Use Them When to Clean Your Puffer >> Requires cleaning at least weekly How to Clean Your Puffer >> Remove the medication cylinder from the mouthpiece - do not wash medication cylinder >> Wash the mouthpiece in warm soapy water. Rinse thoroughly >> Dry in the sun or with a hair dryer. Ensure that it is completely dry, with no residual fluff or dust >> Check the expiry date ( valid to end of month is written on the cylinder) >> Replace all ports and put the cap on There is no effective way to test how much is left in a puffer, however some puffers (eg. Seretide) have counters. Shaking it will give you an indication, as will keeping track of how many times you use it. If you are unsure, use a new puffer. Always keep a new puffer on hand. page 23

24 Asthma Parent Information Turbuhalers (appropriate age: 6 years and over) Turbuhalers provide a single dose and need to be reloaded for each dose given. How to Use a Turbuhaler Remove cap. While holding the Turbuhaler upright, twist the grip to the right, then to the left. Listen for the click. Before placing the Turbuhaler into your child s mouth, ask him/her to breathe out gently. The child MUST NOT blow into the Turbuhaler before inhaling the medicine. Place the mouthpiece into your child s mouth and ask him/her to breathe in forcefully and deeply - remove Turbuhaler from mouth before breathing out gently. If a second dose is required, wait one minute and repeat steps 2, 3 & 4. Wipe mouthpiece, replace the cap and screw it shut. NOTE: The delivery of the medication depends on a deep breath in. Most children under the age of 6 are unable to take a deep enough breath, and therefore are unlikely to be able to use a Turbuhaler effectively. page 24

25 The types of Delivery Devices for Medication and How to Use Them When to Clean Your Turbuhaler >> Requires cleaning at least weekly How to Clean Your Turbuhaler >> Wipe the mouthpiece with a dry cloth or tissue AFTER EACH USE >> Ensure it is always kept dry as the powder becomes inactive when wet >> Always keep the lid on when not in use >> A reliever Turbuhaler cannot be used for asthma first aid. Always keep a puffer and spacer on hand for first aid use How to Identify if Your Turbuhaler is Empty >> On the side of the Turbuhaler is a dose indicator. When the red indicator appears, it is close to empty. Buy a new Turbuhaler immediately >> Some Turbuhalers have a numerical dose counter page 25

26 Asthma Parent Information Autohalers (appropriate age: 6 years and over) How to Use an Autohaler Unclip and remove the mouthpiece cover. Shake the Autohaler well - approximately 3 seconds. While keeping the Autohaler upright, push the lever up. It should stay in this position. Place lips tightly around the mouthpiece. Tell your child to bite on the canister and close his/her lips around it. Ensure your child s tongue is under the canister and his/ her teeth don t get in the way. Breathe out gently into the Autohaler. Note: When your child is holding the Autohaler, ensure that the air entry holes at the bottom are not blocked off. Ask your child to breathe in with a slow, deep steady breath. You will hear a click & whoosh sound as the medication is released. Ask your child to continue breathing in until he/she has taken a full breath. Take the Autohaler out of your child s mouth and ask him/her to hold their breath for 10 seconds before breathing out gently. Gently lower the lever. Wait one minute and repeat the procedure if another dose is required. page 26

27 The types of Delivery Devices for Medication and How to Use Them Note: The delivery of the medication depends on a deep breath in to open the valve and to release the medication. If you do not hear a click & whoosh as your child breathes in, the medication has not been released. When to Clean Your Autohaler >> Requires cleaning at least weekly How to Clean Your Autohaler >> Unclip and remove the mouthpiece cover, then rinse the mouthpiece in luke warm water >> Leave to dry then replace the mouthpiece cover >> Do NOT push a dry cloth or any other object into the mouthpiece How to Assess if Your Autohaler is Empty >>Remove mouthpiece cover. In the upright position, click grey lever upwards >>Holding the Autohaler upside-down, tap the mouthpiece on the palm of your hand >> If the Autohaler is NOT empty, you will hear a clear click & whoosh. You may also feel a slightly cold sensation on your hand and see a puff of medication. If there is no click & whoosh or cold sensation, then the Autohaler is empty As you cannot determine when your Autohaler is nearly empty, it is important to always keep a spare Autohaler on hand. page 27

28 Asthma Parent Information Accuhaler (appropriate age: 6 years and over) How to Use an Accuhaler Open the Accuhaler by placing thumb in thumb grip and pushing right around until a click is heard. Slide lever on the right side of Accuhaler until a click is heard. Medication is now ready for inhaling. Before placing the Accuhaler into your child s mouth, ask him/her to breathe out gently. The child must not blow out into the Accuhaler. Place your child s lips around the mouthpiece. Ask your child to take a breath in, forcefully and deeply. Remove Accuhaler from mouth and hold breath for 10 seconds. Breathe out slowly. Place thumb in thumb grip and slide the cover around until a click is heard. If a second dose is required repeat the above steps. Note: The delivery of the medication depends on a deep breath in. Most children under the age of 6 are unable to take a deep enough breath, and therefore are unlikely to be able to use an Accuhaler effectively. page 28

29 The types of Delivery Devices for Medication and How to Use Them When to Clean Your Accuhaler >> Requires cleaning at least once a week How to Clean Your Accuhaler >> Wipe mouthpiece with a dry cloth >> Ensure Accuhaler is always kept dry as moist powder will block the Accuhaler >> Always keep lid shut when device is not in use How to Determine if Your Accuhaler is Empty On the top of your Accuhaler is a number, which corresponds to doses left. When the number falls to 5, another Accuhaler should be obtained. page 29

30 Asthma Parent Information Nebulisers A nebuliser is a pump used to give liquid medication as a fine mist. Air is pumped through the liquid under pressure to produce a fine mist, which is then breathed in through a mask or mouthpiece. Ask a nurse to show you how to prepare the medication for your child s nebuliser. Note: Nebulisers need only be used in special circumstances and for very young children. page 30

31 The types of Delivery Devices for Medication and How to Use Them 8 Points to Remember When Using a Nebuliser 1. Breathe through the mouth when taking medication. A mouthpiece is encouraged for anyone over 5 years, and a mask for anyone under 5 years. 2. The pump will take approximately 10 minutes to deliver the medication. When the mist stops, the mask/mouthpiece can be removed and the pump switched off. 3. After each use, rinse the mask/mouthpiece and bowl in hot soapy water and leave to dry. Do not rinse tubing. 4. Store equipment in an airtight container. 5. Nebuliser bowls need to be replaced quarterly. 6. A pump should have a flow rate of at least 6-8 litres/min. 7. Service pump and check flow rate annually (contact Asthma Foundation of SA for your nearest location). 8. Do not place nebuliser pump on the floor. This will increase the amount of dust drawn through the machine. page 31

32 Asthma Parent Information Visits to Your Doctor and the Role of the Asthma Action Plan Overview Asthma control is a patient-parent-doctor partnership. It can take a few months to get your child s treatment right. There is a great deal to discuss so be prepared for several visits. It is best to try to see the same doctor each time. Information is the key to management Good asthma management partly depends upon the information you can give your doctor. Giving a full picture of your child s condition means your doctor is better able to plan management. This information can take many forms such as: >> The events leading up to an attack or worsening of your child s condition >> Triggers that bring on your child s symptoms >> Night symptoms >> Your child s response to medication taken page 32

33 Visits to Your Doctor and the Role of the Asthma Action Plan Ongoing review Visit the same doctor on a regular basis to review your child s condition and fine-tune the management plan. At each appointment: >> Prepare a list of questions. If you are uncertain about what you have been told, ask for clarification or further explanation until you completely understand (See Asthma Patient Checklist page 36) >> Tell your doctor about any changes in your child s condition and what you feel may have caused them >> If you have a long list of questions for your next visit, arrange for a longer appointment so there is no need to rush page 33

34 Asthma Parent Information Action Plan An Asthma Action Plan is a response to worsening asthma in your child and explains stepby-step what to do when it occurs. It is important that the plan is individualised to suit the pattern and severity of your child s asthma. The essential elements of an Action Plan are that you must: >> Be able to recognise worsening asthma >> Have an individualised plan >> Know how to obtain medical assistance quickly >> Have the Action Plan reviewed and, if necessary, modified following an acute asthma attack >> Bring your Action Plan with you to all review appointments Asthma Action Plans are based on symptoms alone in younger children. Sometimes, peak flow measurements are used for adolescents. This should be discussed with your young person s doctor. It is important to understand that acute asthma attacks are frequently triggered by events beyond one s control (e.g. colds or chest infections). It is important that your child s teacher and carers are aware of his/her condition. They should be provided with clearly labelled reliever medication (blue/grey puffer), and a current Asthma Action Plan signed by your child s doctor. It is wise to be a member of an ambulance fund in case your child is ever in need of urgent medical treatment and requires transportation to hospital. It is also worthwhile completing a recognised first aid course. page 34

35 Visits to Your Doctor and the Role of the Asthma Action Plan Asthma First Aid If you do not have an individualised asthma action plan and your child is having difficulty breathing or his/her asthma is become worse, follow the Asthma First Aid Plan as shown below. If a child is having difficulty breathing and it is unknown whether that child has asthma, no harm is likely to result from giving reliever medication as a first aid measure. In this situation call an ambulance immediately by dialing 000 (triple zero). Asthma First Aid Plan Sit the person upright and give reassurance. Do NOT leave the person alone. Without delay give 4 separate puffs of a blue reliever. 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. If no spacer is available, use the puffer alone. Wait 4 minutes. If there is little or no improvement repeat steps 3 and If there is still no improvement call an ambulance immediately by dialing 000 (triple zero). 6. Continuously repeat steps 2 and 3 while waiting for the ambulance. Asthma First Aid Plan adapted from the Asthma Pocket Guide produced by the Asthma Foundation of SA. page 35

36 Asthma Parent Information Patient Checklist Do you understand what asthma is? Ask your doctor/nurse to explain what happens in your child s airways, and what is happening during an asthma attack. Do you know what triggers your child s asthma? Asthma affects people in different ways, but it is helpful to think back over what occurred just prior to your child s attacks (e.g. when visiting a friend with a live-in pet). If this factor affects your child the same way again, it can be classified as a trigger and should be avoided. Do you know the names of your child s asthma medications? Ask your doctor/nurse to write down the names of your child s medications and the part they play in controlling asthma. Do you know how much medication your child should take? Knowing when to increase or change your child s medication can be a vital factor in controlling asthma and leading an active lifestyle. Discuss each medication your child has been prescribed. Ask the doctor to explain any side effects that may occur. Do you know the name of your child s RELIEVER medication and how it helps? Short acting reliever medication is used for immediate relief in the event of an attack (it generally comes in a blue/grey coloured container). Do you know the names of your child s PREVENTER medications? These medications need to be taken daily and it may be some weeks before improvement is noticeable. They are of NO BENEFIT in an acute attack (they are generally in an Autumn-coloured container). Some preventers come as tablets. page 36

37 Patient Checklist Do you know how your child s preventer medication works? Ask the doctor/nurse to tell you what each medication does in controlling asthma. If your child uses a puffer, Turbuhaler or spacer, has the doctor/nurse checked your child s technique recently? Using these devices incorrectly can make you believe your child is receiving medication when he/she is not, and could lead to ineffective treat-ment. Have the doctor/nurse observe your child use the device to see if it is being used correctly. Do you know the signs and symptoms that indicate your child s asthma is becoming worse? These include: >> A dry cough that keeps coming back >> Any shortness-of-breath after minor physical activity Discuss the above with your doctor/nurse and any other signs and symptoms that could indicate a worsening of your child s condition. Do you know what to do when an asthma attack occurs? Ask your child s doctor/nurse to go through all the steps in detail. Do you have an Action Plan? Ask your doctor to write one for your child. Do you have an Asthma Plan for school or childcare? Ask your doctor to write one for your child. Do you know which doctor is going to manage your child s asthma after discharge from hospital? Do you have a contact number for the doctor and hospital? Does the hospital have your contact details? page 37

38 Asthma Parent Information Notes References used in preparing this information National Asthma Council, Asthma Management Handbook 2006 Asthma Australia, Asthma in the Under 5s 2005 National Asthma Council, Asthma and Infant Bedding 2005 National Asthma Council, Asthma And Allergy 2005 Useful websites Asthma Foundation of SA and the Women s and Children s Hospital provide information and support for people with asthma If you are having difficulties with your child s asthma or you are unsure about your child s Management Plan, consult: Your Child s Doctor Phone: Breathe Better Healthline Phone: For all Emergencies, Ambulance Phone: 000 (triple zero) For First Aid Courses St John Ambulance Phone: (08) Australian Red Cross Phone: page 38

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40 For more information The Women s and Children s Hospital 72 King William Road North Adelaide SA 5006 Office Hours: Respiratory Clinical Practice Consultant Phone: (08) After Hours: Paediatric Emergency Department Phone: (08) Asthma Foundation of SA 300 South Road Hilton SA 5033 Telephone: (08) Breathe Better Healthline Telephone: Non-English speaking: for information in languages other than English, call the interpreting and Translating Centre and ask them to call The Department of Health. This service is available at no cost to you, contact (08) Department of Health, Government of South Australia. All rights reserved. ISBN: Printed December 2008.