Asthma Management UCSF Chest/Allergy Faculty Practice UCSF School of Nursing

Transcription

1 Your Asthma Treatment Plan Your daily treatment plan lists the medications you need to take EVERY DAY to keep your asthma under control. Note the name of the medication, type of medication, whether to inhale it or swallow it, how much to take, and how often to take it. If you are unsure about any of these directions, ask your doctor or nurse practitioner to clarify them. Daily Medication List Medication Type How Taken Dose How often Asthma Management UCSF Chest/Allergy Faculty Practice UCSF School of Nursing Contents Questions for Next Visit Your Asthma Action Plan Your Asthma Action Plan is a guide for treating yourself when your asthma gets worse or flares. When your symptoms or peak flow are in the yellow zone, you must take some rescue actions to bring your asthma back under control. Symptoms or peak flow in the red zone means your asthma is a lot worse and you need immediate medical treatment in addition to taking your rescue medication. Call your doctor and seek care at the nearest emergency department or urgent care clinic. It is important to remember, too, that anytime you are frightened or feel your breathing is in danger, you should go immediately to the nearest emergency room to be checked out. You have been given an Asthma Action Plan along with this booklet. Please review it with your doctor or nurse. For more information about asthma, see the American Lung Association s website at 12 SDPUL0031 Rev. 12/03 Living with Asthma... 2 Understanding Asthma... 2 Factors that Contribute to Asthma... 3 Treating Asthma... 4 Environmental Control of Allergens and Irritants... 4 Asthma Medications... 6 Long-term Control Medications... 6 Quick-relief Medications... 7 How to Use Your Inhaled Medications Correctly... 7 The Different Devices... 7 Steps for Using Your Metered Dose Inhaler... 8 Steps for Using Your Turbuhaler... 8 Steps for Using Your Dry Powder Diskus... 8 Know When to Replace Your Inhaler With a Refill... 9 Measuring Your Peak Flow... 9 What Does the Peak Flow Number Mean?... 9 How to Measure Your Peak Flow How to Get Your Personal Best Number When Should You Check Your Peak Flow? Peak Flow Daily Record Your Asthma Treatment Plan Your Asthma Action Plan Prepared by Susan Janson, DNSc, RN, ANP, and Sally McLaughlin, RN, MSN Ambulatory Care Center 400 Parnassus Avenue San Francisco, CA

2 Living with Asthma If you have just recently been told you have asthma, the idea of this disease may be overwhelming. If you have had asthma for a long time, then you are quite familiar with what the symptoms are and how it makes you feel. While, if untreated, this chronic disorder of the lungs can be serious, most people with asthma are able to control their disease and enjoy a happy and healthy life. To best control your asthma, you will need to learn about what causes asthma, what you can do to prevent or minimize problems and work closely with your health care team. This booklet is designed to teach you about asthma so that you too will be successful in controlling it. Understanding Asthma With each breath, air moves through your nose where it is filtered, warmed and humidified. The inhaled air then travels down the trachea, also called the windpipe, through the airways to the right and left lungs. These branching airways are called bronchi. These airways continue to branch over and over again until they become very small. The airways are lined with moist, smooth tissue and are wrapped with smooth muscle. The airways lead to very small grape-like sacs called alveoli where oxygen finally passes into the bloodstream. Please see the diagram below: Asthma is a common respiratory disorder affecting about 14 million Americans. Asthma occurs when there is inflammation, irritation, and swelling of the lining of the airways. This inflammation causes the muscles that wrap around each airway to tighten, making the airway smaller in size. Airway inflammation and tightening cause the symptoms of chest tightness wheezing, cough, and shortness of breath. Inflammation also causes mucus (phlegm) to build up in the airway. Treatment for asthma is directed at controlling inflammation and opening up the airways. The picture above shows the changes in the airway that occur with asthma. NAME UC NUMBER PEAK FLOW (L/MIN) DATE AM PM AM PM AM PM AM PM AM PM AM PM AM PM PRED- DOSE NIGHT UCSF CHEST FACULTY PRACTICE PEAK FLOW DAILY RECORD PRED- DOSE NIGHT 2 11

3 If your asthma is flaring, then your Peak Flow number will fall into the Yellow Zone (50-80% of your Personal Best number). Yellow means Caution and tells you that your asthma is getting worse and that you need to take action to get your asthma under better control now. If your asthma flare-up is severe, then your Peak Flow number will be in the Red Zone. A Red Zone Peak Flow indicates a medical alert, your asthma is out of control and you need to take quick action to help yourself now. How to Measure Your Peak Flow 1. Stand up. If you are unable to stand, sit up as straight and tall as you can. 2. Move the marker on the meter to the bottom of the scale (down to zero). 3. Hold the meter so that your fingers do not touch the marker or any openings. 4. Take as deep as a breath as you can and hold. 5. Put your lips around the mouthpiece tightly. Do not put your tongue into the mouthpiece. 6. Blow out the air in your lungs as hard and fast as you can. 7. Read the meter by looking at where the marker has landed. 8. Repeat this three times if you can. 9. Write down the highest number you got. This is your peak flow number. 10. Check to see which Peak Flow Zone you are in. How to Get Your Personal Best Number Check and write down your Peak Flow number each day for two to three weeks while you are feeling well and your asthma is under good control. The best times to check your Peak Flow during this time period is as follows: Between 12 noon and 2:00 PM Each time after you take your quick relief medicine Any other time your health care provider suggests Write down these numbers on the Peak Flow Daily Record (below). The highest number during this time period will be your Personal Best number. When Should You Check Your Peak Flow? Check your Peak Flow each morning before you take any medication. Check your Peak Flow when you are having asthma symptoms or an attack. This will tell you how bad the attack is. You can then use this information to see which Peak Flow Zone you are in and adjust your asthma medicines as needed. Any other time your health care provider suggests. Factors that contribute to asthma Allergens and irritants and other factors can make asthma worse: Allergens - Allergens are things you are allergic to. They can make asthma worse when you are exposed to them. Allergens can be found outdoors and indoors: Outdoor allergens can be seasonal, making asthma worse in the fall or the spring, for example. Some outdoor allergens can persist all year round. Common outdoor allergens include tree, grass and weed pollens. Indoor allergens are important because they present a constant source of exposure and can therefore be hard to control. Common indoor allergens are house dust mites, cockroach, dander from small animal (especially cats), molds, some food additives such as sulfites in dried fruits and wine. To know whether or not you are allergic, your doctor may order skin testing. Irritants - Irritants are things that irritate your airway and make asthma worse, but they are not allergens. Common irritants are: Cigarette smoke!! Work related dusts and vapors: Household products: Perfume Plastics Paint/fumes Wood smoke Grains Cleaners containing bleach Car Exhaust Metals Sprays Air pollution Wood Perfume Other Factors - In addition to the above, there are other factors that can make your asthma worse: Infections: Common cold The flu Sinus infections Stress Exercise Cold air or changes in the weather Heartburn (i.e., esophageal reflux, GERD) Certain medicines: Aspirin Some heart/blood pressure medications Some eye drops for glaucoma List Your Known Triggers Here: 10 3

4 Treating Asthma The two most important ways of treating asthma are controlling the environment and taking medications. Environmental Control of Allergens and Irritants Avoid what you are allergic to as much as possible this is absolutely necessary. Here are some ideas for controlling indoor and outdoor allergens and irritants: Control of the Outdoor Environment: 1. Keep your bedroom windows closed in the early morning and afternoon. Pollens are released from 7 am 3 pm. 2. Avoid being outside on windy days or during the times of days when pollen counts are highest (generally the early morning hours). 3. While in a car, keep doors and windows closed. 4. Wear a face mask when outdoors if needed, such as when cutting grass, raking leaves, or working near compost piles or grains. 5. Contact the American Lung Association at (800) LUNG-USA to obtain a brochure called Facts About Hay Fever. Control of the Indoor Environment: 1. Do not smoke and do not allow tobacco smoking in the house. 2. Do not use or allow others in the house to use or wear perfumes if you are sensitive to them. 3. Many household cleaning products contain bleach and are packaged in spray bottles. People with asthma who are sensitive to these agents should not use them. If necessary to use them, wear a high-efficiency mask, open the windows, and pour the product on a cloth or sponge rather than spray it. 4. Vacuuming should be done when the sensitive asthmatic person is absent from the house. Do not re-enter the room that has been vacuumed for at least 2 hours to allow the dust in the air to settle. Wear a high efficiency mask if you must do the vacuuming and you have asthma. 5. It is best not to keep pets if you are allergic to them. Try to find them another home. If this is not possible, keep pets out of the asthmatic person s bedroom at all times. Even brief entry into a room can leave behind significant dander. 6. Minimize dust in the bedroom. Keep the door shut at all times. Remove carpets from the bedroom whenever possible. Cover mattress, box springs, and pillows with dust mite barrier casings or plastic. Remove wall posters, drapes, stuffed toys, and upholstered furniture from the bedroom. 7. Minimize the time spent indoors watching TV, using computers or video games. Send children outside to play whenever possible to decrease exposure time indoors 8. Control dust mites in the bedroom. You spend many hours in your bedroom. Take these steps to control dust mites in your bed and bedroom: Know When to Replace Your Inhaler with a Refill For medicine you take each day use this example: Say your new canister has 200 puffs (number of puffs is printed on the label of the canister). You have been told to take 8 puffs per day. 200 puffs 8 puffs = 25 days So, your canister will last 25 days. If you started using this inhaler on May 1, replace it on or before May 25. Write the date on your canister and your calendar. For quick relief inhalers: Take as needed and estimate the average number of puffs you use per day, then divide by the total number of puffs in the canister (usually 200). For example, if on most days you take 2 puffs about two times per day, that is 4 puffs per day on the average that you are using. 200 puffs 4 puffs = 50 days. Do not float your canister in water to test if it is empty. This method is not accurate. Shaking the inhaler only tells you that there is some left, but not how much is left. The dry powder turbuhaler Pulmicort has a small window that turns red when there are only 2 puffs left. When you see the red numbers, it is time to replace. The diskus inhalers (Advair or Serevent) have a counter which tells you how many puffs are left in the inhaler. This may be easier for many people. Measuring Your Peak Flow The Peak Flow Meter is a device that can help you and your health care team check on how well your asthma is controlled. Measuring peak flow is most helpful for people who have moderate or severe persistent asthma, so not every asthmatic needs to use a Peak Flow Meter. This section will tell you what the peak flow number means, how to use your Peak Flow Meter, how to find your Personal Best peak flow number and how to use these numbers to check on how well you are doing. What Does the Peak Flow Number Mean? When your asthma is flaring, the swelling and mucus in the airways make it difficult to get air out of your lungs. The Peak Flow meter measures how well you are able to blow air out of your lungs. When your asthma is under control, the Peak Flow numbers will be higher. When your asthma is flaring the numbers will be below your normal and may fall below normal before your asthma flares, though some patients notice a worsening of symptoms before the peak flow falls. Peak Flow Zones are guidelines to help you see how well your asthma is controlled. These zones have colors that are the same as those on a traffic signal. If your asthma is under good control, you will be in the Green Zone (80-100% of your Personal Best number.) Since green means going well, if your peak flow is in this zone, you should continue your usual medication and activities. 4 9

5 Steps for Using Your Metered Dose Inhaler (MDI) 1. Getting ready Take off the cap and shake the inhaler. Breathe out normally Hold your inhaler the way your doctor showed you (pictures A, B, or C). 2. Breathe in slowly As you start breathing in slowly through your mouth, press down on the inhaler one time. Keep breathing in slowly, as deeply as you can. If you are using your inhaler with a spacer you may press it first and then inhale slowly. 3. Hold your breath Hold your breath as you count to 10 slowly, if you can. For inhaled quick-relief medicine (bronchodilators), wait about 1 minute between puffs. There is no need to wait between puffs for other medications like inhaled steroids. Clean Your Metered Dose Inhaler As Needed: Look at the hole where the medicine spray comes out of your inhaler. If you see powder in or around the hole, clean the inhaler. Remove the metal canister from the L-shaped plastic mouthpiece. Rinse only the mouthpiece and cap in warm water. Let them dry overnight. In the morning, put the canister back inside. Put the cap on. To Clean Your Spacer wash the mouthpiece and chamber once a week with warm water and mild soap. Rinse thoroughly. Allow to air-dry or use a soft, lint free cloth. Replace the spacer when the one-way valve near the mouthpiece becomes dry or cracked. Steps for Using Your Turbuhaler (Pulmicort) 1. Getting ready Take off the cap Twist the bottom of the turbuhaler to the right (clockwise), then Twist the bottom of the turbuhaler back to the left (counter clockwise) until you hear a click The device is now loaded with one dose Breathe out Put the device in your mouth and seal lips tightly (see picture D) 2. Breathe in quickly Breathe in fast and hard through your mouth and forcefully There is no need to hold your breath Keep the device clean Keep cap on when not in use. Wipe with a dry cloth as necessary Steps for Using Your Dry Powder Diskus (Advair or Serevent) 1. Getting ready Open the diskus with your thumb Slide the lever to load the medication Breathe out Hold the diskus parallel to the floor and seal lips tightly over mouth-piece (see picture E) Two inexpensive sources of allergy supplies are at , and at Breathe in quickly Breath in fast and hard through your mouth and forcefully There is no need to hold your breath Keep the device clean Keep diskus closed when not in use. Wipe with a dry cloth as necessary 8 5

6 Asthma Medications Asthma medications are used to control inflammation of the airways and to open up the airways. There are Long-term Control medications or Quick-relief medications. Long-term Control Medications q Corticosteroids q When used regularly and inhaled correctly, these anti-inflammatory medications are very effective in controlling asthma q Inhaled steroids to reduce inflammation include Azmacort (triamcinalone), Aerobid (flunisolide), Beclovent (beclomethasone), Flovent (fluticasone), Pulmicort (budesonide), and Qvar (beclomethasone) q Long-acting Bronchodilators q These medications open up the airway for up to 12 hours by relaxing the smooth muscle around the airway. They may be taken as a pill or by inhalation, but inhaled medications are preferred q Currently available inhaled medications include Serevent (salmeterol) and Foradil (fomoterol). Oral bronchodilators include Theodur or Uniphyl (theophylline oral tablets), or Volmax or Proventil (albuterol oral tablets) q Inhalers combining a steroid and a long-acting bronchodilator are preferable in the treatment of asthma. Only one is currently available (Advair). It comes in 3 strengths (100/50, 250/50 and 500/50) q Leukotriene modifiers q These oral medications may control inflammation of the airways q These medications seem to be most effective in people who have nasal allergies, nasal polyps, and who are sensitive to aspirin, but may be effective in others as well. q Three leukotriene modifiers are Accolate (zafirlukast), Singulair (montelukast), and Zyflo (zileuton) q Oral corticosteroids q These oral medications treat inflammation of the airways within hours and are usually used for short periods of time in high doses and then tapered off. q They are very effective for relief of acute asthma episodes. Even so, long term use of oral corticosteroids is generally avoided because of potentially serious side effects. If you need frequent or prolonged courses of oral steroids, be sure to discuss this with your doctor. q Prednisone and Medrol (methylprednisolone) are two oral corticosteroids q Anticholinergics q This mild bronchodilator is generally less effective than albuterol in opening up the airways, but does not cause heart palpitations. It also helps to decrease production of excess phlegm q It is often most helpful when combined with albuterol (as Combivent) q Atrovent (ipratropium) is an inhaled anticholinergic New asthma medications are being developed all the time. Ask your doctor or nurse about these. How to Use Your Inhaled Medications Correctly You must use your inhaler correctly to get the best results from your asthma medicine. There are several types of devices for inhaling: Metered Dose Inhaler often called an MDI, an inhaler or a puffer, which puffs medication when pressed. Spacer used with an MDI, especially with inhaled corticosteroids. It helps get your inhaled medications to the lungs better. Turbuhaler the name given to the device which delivers the corticosteroid Pulmicort, a dry powder. Diskus a dry powder inhaler, shaped like a disk. There are several other devices as well. Your MD or nurse will show you how to use them. q Non-steroid anti-inflammatory inhaled medications q These inhaled medications can help to control inflammation of the airways for some asthmatics, especially children. q Cromolyn (Intal) is the only medication currently available. A. MDI Open Mouth Technique Hold inhaler 1 to 2 inches in front of mouth (about 2 finger widths). B. MDI with Spacer A spacer or holding chamber makes it easier to inhale correctly. Use for steroids always. C. MDI Closed Mouth Technique Place inhaler in your mouth. Do not use this technique for steroids. D. Turbuhaler Dry Powder Inhaler Place the inhaler in your mouth and seal lips tight E. Diskus Dry Powder Inhaler Hold the diskus parallel to the floor and seal lips over the mouthpiece Quick-relief Medications q Short-acting bronchodilators (sometimes called rescue medications ) q Inhaled forms of these medications provide quick relief of asthma symptoms such as wheezing, coughing, chest tightness or shortness of breath by opening up the airways. q They start working within a few minutes, reach their peak effect in 20 minutes and last about 4 hours q Proventil (albuterol), Ventolin (albuterol), Alupent (metaproteronol), Maxair (Pirbuterol), Tornalate (bitolterol) are all short-acting bronchodilators A B C D E 6 7