SPRINGFIELD CLINIC ASTHMA EDUCATION

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1 SPRINGFIELD CLINIC ASTHMA EDUCATION

2 Table of Contents 1. What is Asthma? 2. Asthma Triggers 3. Using Your Inhaler 4. Cleansing Practices for Inhaled Medication 5. Controlling Your Asthma 6. Fast Acting Bronchodilators 7. Inhaled Steroids 8. Combination: Inhaled Steroids and Long Acting Bronchodilators 9. Leukotriene Inhibitors and Other Medications 10. Your Peak Flow Meter 11. Peak Flow Zone System 12. Asthma Drug Therapy Springfield Clinic

3 What is Asthma? Asthma feels like a shortness of breath or tightness in the chest and often times may be associated with coughing or wheezing. There are three main symptoms associated with asthma: 1. Airway swelling with mucus production 2. Muscle constriction 3. Chronic inflammation of the airway Keep your asthma under control by taking your medication as directed and never miss a dose. Talk to your physician about your asthma triggers and how to avoid them. 3

4 Asthma Triggers Asthma cannot be cured, but it can be managed. If you have asthma, you may notice certain things seem to make your asthma worse. These are called triggers. Avoid these triggers if possible, or speak to your health care provider if you can t find ways to manage them. SMOKE: If you smoke, quit; don't allow smoking in the house or car. Make sure fireplaces are well ventilated, or avoid use, if possible. DUST MITES: Dust mites are tiny bugs found in most homes. Be sure to use mattress and pillow case covers, wash sheets and blankets in hot water and remove stuffed animals from bedrooms. POLLUTION: Pollution from factories or cars can trigger asthma. Pay attention to air quality forecasts and plan outdoor activities when levels are low. COCKROACHES: Don t keep food in bedrooms. Vacuum or sweep areas that may attract cockroaches. PETS: Furry pets can trigger asthma. Keep pets out of your bedroom or home, if possible. Bathe pets weekly or keep them outside. Vacuum or mop surfaces often. 4

5 Asthma Triggers continued... POLLEN: Stay inside and keep windows closed when pollen counts are high. MOLD: Get rid of mold in your home. Fix leaky faucets and pipes. Clean shower curtains and keep basement areas dry. Keep humidity levels in your home no higher than 50%. WEATHER: During cold weather, wear a scarf to avoid breathing in cold air. INFECTIONS: Avoid people with colds. Make sure to get plenty of rest and drink fluids. EXERCISE: Warm up prior to exercise, and check with your health care provider to see if you should take your asthma medicine prior to exercise. STRONG ODORS: Avoid perfume, aerosol sprays or any strong-smelling g cleaning products. 5

6 Using Your Inhaler Directions: 1. Shake your inhaler before use Exhale completely. 3. Hold the inhaler as instructed by your provider, either by: a. using your spacer or VHC attachment. 2. b. holding your inhaler approximately one to two inches in front of your mouth (the width of two fingers). a. b As you begin breathing in slowly through your mouth, press down on the inhaler one (1) time. If you are using a spacer or VHC, press down on the inhaler first. Within five seconds, begin to breathe in slowly. 5. Keep breathing in slowly, as deeply as you can. 6. Hold your breath and count to ten. Then exhale

7 Cleansing Practices for Inhaled Medication If you are using an inhaled corticosteroid, rinse your mouth out after taking the medication. Even with a perfect inhalation, some of the medication will land on your tongue and the insides of your cheeks. Spit out the rinse; do not swallow. Neglecting to rinse can lead to fungal infections. Cleaning your spacer or valved holding chamber Clean the inhaler according to your patient instructions. If using water, leave time for the inhaler to air dry. Holding chambers also need to be rinsed according to instructions. 7

8 Controlling Your Asthma The most effective way to control your asthma is to have an Asthma Action Plan in place. Make sure you consult with your health care provider to customize your plan. There are many medications used to treat asthma. Treatment is based on the individual and evidence-based practice guidelines. The following list provides some information on many of the medications used to treat asthma. Although it is a thorough list, it does not replace any treatment plan created by your medical provider. This list is to provide you with information so you may be active in working with your provider in establishing an asthma treatment plan that is best for you. FAST ACTING BRONCHODILATORS (Rescue Inhalers) Albuterol Levalbuterol Pirbuterol INHALED STEROIDS Beclomethasone Budesonide Ciclesonide Fluticasone Mometasone COMBINATION INHALED STEROID and LONG ACTING BRONCHODILATORS Fluticasone/Salmeterol Budesonide/Fometerol Mometasone/Fometerol LEUKOTRIENE INHIBITORS Montelukast Zafirlukast Zileuton OTHER MEDICATIONS: Allergy medications or allergy shots Theophylline Oral steroids like prednisone and injectable steroids Remember that treatment is based on the individual and his or her symptoms. Reference the subsequent pages for more information about specific medications. 8

9 Fast Acting Bronchodilators (Rescue Inhalers) Fast acting bronchodilators are used when acute symptoms, such as shortness of breath, chest tightness or cough, are present. They may also be used prior to sports/increased physical activity to reduce risk for asthma exacerbation. The most common side effect to this medication can be a jittery feeling, or feeling like your heart is racing or beating too fast. Common types of fast acting bronchodilators include: Albuterol: Levalbuterol: Brand names include Max-Air, Pro-Air, Proventil and Ventolin. Brand name is Xopenex. Pirbuterol: Brand name is Maxair. 9

10 Inhaled Steroids As fast acting bronchodilators do not reduce inflammation, your medical provider may recommend a control medication for your asthma treatment. Often the first step is an inhaled steroid. These medications work over time to reduce the inflammation of airways and risk of asthma exacerbation. Inhaled steroids are not rescue inhalers. Common types of inhaled steroids include: Beclomethasone: Budesonide: Ciclesonide: Fluticasone: Brand name is QVAR. It is available in metered dose inhaler (MDI). Brand name is Pulmicort. It is available for nebulizers and in a hand held administration device, the turbuhaler. Brand name is Alvesco. It is available in MDI. Brand name is Flovent. It is available in (MDI) and in a diskus. Mometasone: Brand name is Asmanex. It is available in a twisthaler. The most common side effect to these medications is thrush or white patches on your tongue. The best prevention is to make sure you rinse your mouth with water and spit it out after each use. 10

11 Combination: Inhaled Steroids and Long Acting Bronchodilators Many asthmatic patients with chronic persistent asthma or with exacerbations may need to step up to a combination controller medication. These medications provide the inhaled steroid medications to reduce inflammation and also provide long-acting bronchodilators to keep the airways open. These medications do not replace the rescue inhalers. The most common side effect to these medications is thrush or white patches on your tongue. The best prevention is to make sure you rinse your mouth with water and spit it out after each use. Common types of inhaled steroids include: Fluticasone/Salmeterol: Brand name is Advair. It is available in MDI and diskus. Budesonide/Fometerol: Brand name is Symbicort. It is available in MDI. Mometasone/Fometerol: Brand name is Dulera. It is available in MDI. 11

12 Leukotriene Inhibitors and Other Medications Leukotriene Inhibitors The immune system chemicals of leukotrienes can contribute to asthma symptoms. The following leukotriene inhibitors or modifiers help to block the leukotrienes and control asthma symptoms. They are taken daily. These medications are not inhaled; rather, they are in pill form to be swallowed. Montelukast: Zafirlukast: Brand name is Singulair. Brand name is Accolate. Other medications may be used to treat your asthma symptoms, including: Allergy medications or allergy shots Theophylline Oral steroids including prednisone and injectable steroids. Zileuton: Brand name is Zyflo. Treatment is based on the individual and their symptoms. 12

13 Your Peak Flow Meter What is a peak flow meter? A peak flow meter is a device that measures how quickly air can move out of the lungs. During an asthma episode, the lungs begin to narrow, making it hard to move air in and out of the lungs during breathing. How it can it help me and my doctor? Catch early airway narrowing hours or even days before symptoms occur (by using medicine early, you may be able to prevent a serious asthma episode). Learn what makes your asthma worse. Decide if your medicine plan is working well. Decide when to obtain emergency care. How do I use it? 1. Place indicator at zero. 2. Stand up and take deep breath. 3. Put the meter in your mouth closing your lips tightly around the mouthpiece. Do not put your tongue inside the hole. 4. Blow out as hard and as fast as you can. 5. Write down this number. 6. Repeat steps 1-5 two more times. 7. Write down the highest number in your peak flow numbers. 13

14 Peak Flow Zone System Each morning before taking your medication you should record your peak flow reading in a journal to gain better understanding and more control over your asthma. Green Zone: GOOD CONTROL No asthma symptoms are present. Take your medication as usual. Yellow Zone: CAUTION Your airways are becoming swollen and narrowed. Follow your asthma action plan to try to prevent a serious asthma episode. Also, your asthma may not be under good day-to-day control. If in the yellow zone, follow your yellow zone action plan and repeat peak flow reading two or three times throughout the day or as needed. Call your doctor s office if you are not in the green zone within 24 hours. Red Zone: MEDICAL ALERT You are having a significant asthma episode. Use your Albuterol as directed and follow your asthma action plan. If in the red zone, follow your red zone action plan and repeat peak flow reading within 30 minutes. If you do not return to your yellow or green zone, go to the emergency room or contact your physician immediately. Call 911 or go to the nearest emergency room if you are experiencing severe difficulty breathing. Finding your personal best peak flow Your personal best peak flow number is the highest peak flow number you can achieve when your asthma is under good control, meaning you feel well and are not experiencing asthma symptoms. To find your personal best, take and record peak flow readings when you wake up and between noon and 2:00pm everyday for 2 to 3 weeks. Also record before and after you take your medicine for quick relief. 14

15 Asthma Drug Therapy It is important to understand your inhalers and when you should use them. Anytime you are experiencing symptoms, refer to your asthma action plan provided by your health care team. This plan will help you know what steps to take to bring your asthma back under control. RESCUE INHALERS: Yellow Zone and Red Zone Short acting B-blockers: Proventil HFA (Albuterol) Ventolin HFA (Albuterol) Proair HFA (Albuterol) Maxair HFA (Pibuterol) Xopenex HFA (Levalbuterol) Albuterol (for nebulizer) Xopenex (for nebulizer) Anticholinergics: Atrovent HFA (Ipratropium) Foradil Aerolizer (Formoterol) Serevent Discus (Salmeterol) Spiriva (Tiotropium) Prevention: Asmanex Twisthaler (Mometasone) Flovent HFA or Flovent Discus (Fluticasone) Pulmicort Flexhaler (Budesonide) Qvar (Beclomethasone) Singulair (Montelukast) The asthma medications listed below are coded with the same colors as on your asthma action plan to help you identify the purpose of each one. If you do not have an asthma action plan, please discuss this with your health care team. MAINTENANCE INHALERS: Green Zone Foradil Aerolizer (Formoterol) Serevent Discus (Salmeterol) Spiriva (Tiotropium) Prevention: Asmanex Twisthaler (Mometasone) Flovent HFA or Flovent Discus (Fluticasone) Pulmicort Flexhaler (Budesonide) Qvar (Beclomethasone) Singulair (Montelukast) Combination: Dulera (Formoterol + Mometasone) Symbicort (Formoterol + Budesonide) Advair Discus or HFA (Salmeterol + Fluticasone) Combination: Dulera (Formoterol + Mometasone) Symbicort (Formoterol + Budesonide) Advair Discus or HFA (Salmeterol + Fluticasone) 15

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