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Medical Treatment of Asthma and Related Equipment / Gadgets.

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Presentation on theme: "Medical Treatment of Asthma and Related Equipment / Gadgets."— Presentation transcript:

1 Medical Treatment of Asthma and Related Equipment / Gadgets

2 Overview Review of asthma medications Review of asthma medications Review and demonstration of common asthma equipment and gadgets Review and demonstration of common asthma equipment and gadgets Practical tips for integrating asthma medication and equipment/gadget knowledge into daily practice E8 Practical tips for integrating asthma medication and equipment/gadget knowledge into daily practice E8

3 Medication Treatment Goals Safe and effective medication delivery Safe and effective medication delivery Provide the least amount of medication needed to allow the student to be active and symptom- free Provide the least amount of medication needed to allow the student to be active and symptom- free Avoid adverse effects from medications Avoid adverse effects from medications Meet students and families expectations regarding medication Meet students and families expectations regarding medication

4 Key Aspects In The Medical Treatment Of Asthma Relationship with a primary Health Care Provider who is knowledgeable of current asthma treatment guidelines Relationship with a primary Health Care Provider who is knowledgeable of current asthma treatment guidelines Development, sharing, and use of a personalized Asthma Action Plan or Asthma Management Plan Development, sharing, and use of a personalized Asthma Action Plan or Asthma Management Plan Monitoring of symptoms with a peak flow meter and pulmonary function testing Monitoring of symptoms with a peak flow meter and pulmonary function testing

5 Key Aspects Continued… Catching early warning signs and referring for assessment or treatment Catching early warning signs and referring for assessment or treatment Well asthma check-ups Well asthma check-ups Every 6 months for asthma that is under control Every 6 months for asthma that is under control More frequently for asthma that is out of control More frequently for asthma that is out of control Stepping up and down therapy as needed Stepping up and down therapy as needed

6 Asthma Medication Overview

7 Controller vs. Reliever Meds Controller medication Controller medication Daily medications for all persistent asthma Daily medications for all persistent asthma Long term control Long term control Anti-inflammatory Anti-inflammatory Reliever or Quick-relief medication Reliever or Quick-relief medication Bronchodilators - As needed for all asthma severity levels Bronchodilators - As needed for all asthma severity levels Used PRN and preventative for EIA Used PRN and preventative for EIA Bronchodilators Bronchodilators Oral corticosteroid bursts Oral corticosteroid bursts

8 Methods Of Delivery Medications may be given by: Medications may be given by: Metered Dose Inhaler (MDI) Metered Dose Inhaler (MDI) Dry Powdered Inhaler (DPI) Dry Powdered Inhaler (DPI) Nebulizer Nebulizer Orally Orally Important to review technique for all delivery methods Important to review technique for all delivery methods

9 Inhalers Press and Breathe Breath Actuated Dry Powder Aerosol Aerosol

10 Aerosol Metered Dose Inhalers and Chambers / Spacers Use a spacer with an aerosol inhaler Use a spacer with an aerosol inhaler Gets more medication into the lungs (~5 x more than MDI alone) Gets more medication into the lungs (~5 x more than MDI alone) Fewer side effects such as smaller amount of absorbed medication systemically, less oral thrush and dyphonia F27 Fewer side effects such as smaller amount of absorbed medication systemically, less oral thrush and dyphonia F27

11 How MDI Technology Works

12 Holding Chamber / Spacer Use

13 Common Valved Holding Chambers and Spacers

14 Chamber / Spacer Demonstration MDI with common chambers / spacers MDI with common chambers / spacers Valved holding chamber (Aerochamber, Optichamber) Valved holding chamber (Aerochamber, Optichamber) Spacer (Ellipse, Optihaler) Spacer (Ellipse, Optihaler) MDI with Inspirease spacer MDI with Inspirease spacer Cleaning chambers/ spacers Cleaning chambers/ spacers F27

15 How To Use Your Inhaler

16 MDI Not Needing A Separate Chamber / Spacer MDI Not Needing A Separate Chamber / Spacer Maxair Autohaler - Reliever /Rescue med Maxair Autohaler - Reliever /Rescue med Breath actuated and should not be used with a chamber or spacer Breath actuated and should not be used with a chamber or spacer Azmacort - Controller (daily) med Azmacort - Controller (daily) med Has a built-in spacer Has a built-in spacer

17 Minnesota Inhaler Law

18 MN Asthma Inhaler Law Summary (2001) Allows MN students to self-carry and administer inhalers Allows MN students to self-carry and administer inhalers In order for a child to carry his/her inhaler at school, authorization and signatures from the following individuals are required: In order for a child to carry his/her inhaler at school, authorization and signatures from the following individuals are required: Childs health care provider Childs health care provider Parent/guardian Parent/guardian Assessment and approval of the school nurse (if present in district) Assessment and approval of the school nurse (if present in district) R8, R9

19 The Statute: Key Points Public elementary and secondary school students can possess and use inhalers if Public elementary and secondary school students can possess and use inhalers if The parent has not requested that school personnel administer the medication and The parent has not requested that school personnel administer the medication and The school district receives annual written parental authorization and The school district receives annual written parental authorization and The inhaler is properly labeled and The inhaler is properly labeled and

20 Key Points Continued... Key Points Continued... The school nurse or other appropriate party assesses the students knowledge and skills to safely possess and use the inhaler and enters a plan into the students health record The school nurse or other appropriate party assesses the students knowledge and skills to safely possess and use the inhaler and enters a plan into the students health recordOR For schools without a school nurse, the students physician conducts the assessment and submits written verification For schools without a school nurse, the students physician conducts the assessment and submits written verification

21 Discussion What knowledge and skills do students need to obtain before being allowed to independently carry and administer their inhalers? What knowledge and skills do students need to obtain before being allowed to independently carry and administer their inhalers? F19, F20

22 Medication: Determined By Severity Level Classification 1. Mild Intermittent Reliever only prn Reliever only prn 2. Mild Persistent Controller and reliever Controller and reliever 3. Moderate Persistent Controller plus long-acting bronchodilator and reliever 4. Severe Persistent Controller plus long-acting bronchodilator and reliever

23 Order Of Medication Administration If a student is taking both an inhaled reliever and an inhaled controller at the same time: If a student is taking both an inhaled reliever and an inhaled controller at the same time: Give the reliever medication first, before taking the controller Give the reliever medication first, before taking the controller Wait a few minutes between medications Wait a few minutes between medications

24 Controllers Inhaled Corticosteroids Reduces airway swelling over time, decreases airway hyper-responsiveness Reduces airway swelling over time, decreases airway hyper-responsiveness Must be taken daily, even if no symptoms Must be taken daily, even if no symptoms Will not relieve acute asthma symptoms Will not relieve acute asthma symptoms

25 Controllers Inhaled Corticosteroids Cont... When used consistently over time will prevent/control inflammation acute episodes When used consistently over time will prevent/control inflammation acute episodes Dose/strength may need to be increased or decreased depending on season of the year (step up / step down) Dose/strength may need to be increased or decreased depending on season of the year (step up / step down) Inhaled steroids start to work in days to weeks, oral steroids within 6-24 hours Inhaled steroids start to work in days to weeks, oral steroids within 6-24 hours

26 Inhaled Corticosteroids Azmacort (Triamcinolone)Azmacort (Triamcinolone) Flovent (Fluticasone - Rotadisk or MDI )Flovent (Fluticasone - Rotadisk or MDI ) Pulmicort (Budesonide - DPI or nebs )Pulmicort (Budesonide - DPI or nebs ) Beclovent, Qvar, Vanceril (Beclomethasone)Beclovent, Qvar, Vanceril (Beclomethasone) Aerobid (Flunisolide)Aerobid (Flunisolide)

27 Inhaled Corticosteroids Potential adverse effectsPotential adverse effects Cough, dysphonia, thrush Cough, dysphonia, thrush Therapeutic issues Therapeutic issues Chambers/spacers necessary for MDIs Chambers/spacers necessary for MDIs Different inhaled corticosteroids are not interchangeable Different inhaled corticosteroids are not interchangeable Azmacort and Aerobid reportedly have particularly bad taste, Pulmicort Turbuhaler has no taste Azmacort and Aerobid reportedly have particularly bad taste, Pulmicort Turbuhaler has no taste

28 Steroid Phobia: Unfounded! Inhaled steroids in doses most often prescribed are very safe Inhaled steroids in doses most often prescribed are very safe Inhaled meds delivered directly to lungs where they are needed Inhaled meds delivered directly to lungs where they are needed Little systemic absorption if proper technique used Little systemic absorption if proper technique used CAMP study results CAMP study results

29 Turbuhaler Use Demo Need deep, forceful inhalationNeed deep, forceful inhalation May use Turbutester to help determine if an individual is able to useMay use Turbutester to help determine if an individual is able to use Counter (dots in window) turns red when doses running outCounter (dots in window) turns red when doses running out

30 Non-Steroidal Anti-inflammatories Intal (Cromolyn) (also available as Intal HFA) Intal (Cromolyn) (also available as Intal HFA) Tilade (Nedocromil) Tilade (Nedocromil) For symptom prevention or as preventive treatment prior to allergen exposure or exercise For symptom prevention or as preventive treatment prior to allergen exposure or exercise Potential adverse effects None (Tilade tastes bad ) None (Tilade tastes bad ) Therapeutic issues Must be taken up to 4 times a day, maximum benefit after 4-6 weeks Must be taken up to 4 times a day, maximum benefit after 4-6 weeks

31 IgE Blocker Therapy Xolair (Omalizumab) Dosing based on IgE levels and weight Dosing based on IgE levels and weight Only for ages over 12 years old Only for ages over 12 years old Use in conjunction with other meds Use in conjunction with other meds Must have evidence of specific allergy sensitivity Must have evidence of specific allergy sensitivity Used for those with poorly controlled asthma and non-compliant with standard recommended therapy Used for those with poorly controlled asthma and non-compliant with standard recommended therapy Delivered by SQ injection Delivered by SQ injection

32 Long-acting Beta-agonists Serevent (Salmeterol) (Diskus ) Serevent (Salmeterol) (Diskus ) Foradil (Fomoterol) (DPI) Foradil (Fomoterol) (DPI) Potential adverse effects Tachycardia, tremors, hypokalemia Tachycardia, tremors, hypokalemia Therapeutic issues Should not be used in place of anti-inflammatory therapy Should not be used in place of anti-inflammatory therapy

33 Serevent Diskus (Salmeterol) Foradil (Formoterol)

34 Methylzanthines Theophyline Theophyline For prevention of symptoms (bronchodilation, and possible epithelial effects ) For prevention of symptoms (bronchodilation, and possible epithelial effects ) Potential adverse effects Insomnia, upset stomach, hyperactivity, bed wetting Insomnia, upset stomach, hyperactivity, bed wetting Therapeutic issues Must monitor serum concentrations, not helpful in acute exacerbations, absorption and metabolism affected by many factors Must monitor serum concentrations, not helpful in acute exacerbations, absorption and metabolism affected by many factors

35 Combination Medication Advair (Flovent + Serevent) Combo corticosteroid and long acting beta-agonist Combo corticosteroid and long acting beta-agonist 3 strengths: 100/50, 250/50, 500/50 3 strengths: 100/50, 250/50, 500/50 Strengths based on Flovent doses, Serevent dose remains the same in all three strengths. Strengths based on Flovent doses, Serevent dose remains the same in all three strengths. Diskus Dry Powdered Inhaler Diskus Dry Powdered Inhaler Usual dosing, 1 inhalation every 12 hours Usual dosing, 1 inhalation every 12 hours Has remaining-dose counter Has remaining-dose counterF28

36 Diskus Demonstration Diskus (Advair and Serevent) Breath in deep and steady Breath in deep and steady 1 breath per dose 1 breath per dose Counter tracks remaining doses Counter tracks remaining doses 3 strengths Advair 100 (green label), 3 strengths Advair 100 (green label), 250 (yellow label), 500 (red label) 250 (yellow label), 500 (red label) 60 doses per diskus 60 doses per diskus

37 Leukotriene Modifiers Singulair (Montelukast) Singulair (Montelukast) Accolate (Zafirlukast) Accolate (Zafirlukast) Zyflo Zyflo Oral: Prevention of symptoms in mild persistent asthma, and/or to enable a reduction in dosage of inhaled steroids in moderate to severe persistent asthma Oral: Prevention of symptoms in mild persistent asthma, and/or to enable a reduction in dosage of inhaled steroids in moderate to severe persistent asthma Potential adverse effects None significant elevation of liver enzymes None significant elevation of liver enzymes Therapeutic issues Drug interactions, monitor hepatic enzymes (esp. Zyflo) Drug interactions, monitor hepatic enzymes (esp. Zyflo)

38 Common Relievers (Bronchodilators) Relaxes muscles in the airways to help relieve asthma symptoms Relaxes muscles in the airways to help relieve asthma symptoms Should be taken as needed for symptoms Should be taken as needed for symptoms Need to wait 1-2 minutes between puffs for best deposition of medication in the lungs Need to wait 1-2 minutes between puffs for best deposition of medication in the lungs Overuse is a big warning sign indicating the childs asthma may not be well controlled Overuse is a big warning sign indicating the childs asthma may not be well controlled

39 Short-acting Inhaled Bronchodilators Proventil, Ventolin (Albuterol) Proventil, Ventolin (Albuterol) Xopenex (Levalbuterol) – (nebs only) Xopenex (Levalbuterol) – (nebs only) Maxair Autohaler (Pirbuterol) Maxair Autohaler (Pirbuterol) Alupent (Metaproterenol) Alupent (Metaproterenol) For relief of acute symptoms or as preventive treatment prior to exercise For relief of acute symptoms or as preventive treatment prior to exercise Potential adverse effects Tremors, tachycardia, headache Tremors, tachycardia, headache Therapeutic issues D rugs of choice for acute bronchospasm F29 D rugs of choice for acute bronchospasm F29

40 Anticholinergics Atrovent (Ipatromium Bromide) Combivent (Albuterol + Atrovent) For relief of acute bronchospasm, especially if albuterol alone isnt effective For relief of acute bronchospasm, especially if albuterol alone isnt effective Potential adverse effects Dry mouth, flushed skin, tachycardia Dry mouth, flushed skin, tachycardia Therapeutic issues Does not reverse allergy-induced bronchospasm or block exercise-induced asthma Does not reverse allergy-induced bronchospasm or block exercise-induced asthma May have additive effect to beta-agonist, slower onset May have additive effect to beta-agonist, slower onset

41 Systemic Corticosteroids PediapredPrelonePrednisoneOrapred Prevents progression of moderate to severe exacerbations, reduces inflammation Prevents progression of moderate to severe exacerbations, reduces inflammation Potential adverse effects Short-term- increased appetite, fluid retention, mood changes, facial flushing, stomachache. Long term- growth suppression, hypertension, glucose intolerance, muscle weakness, cataracts Short-term- increased appetite, fluid retention, mood changes, facial flushing, stomachache. Long term- growth suppression, hypertension, glucose intolerance, muscle weakness, cataracts

42 Systemic Steriods c ontinued… 2 or more bursts a year signifies poor control and need for daily controller 2 or more bursts a year signifies poor control and need for daily controller 5 bursts/year in asthma is considered steroid dependent and caution should be used 5 bursts/year in asthma is considered steroid dependent and caution should be used Tapering of oral steroids Tapering of oral steroids Not needed if less than days of burst Not needed if less than days of burst

43 Herbal Therapy Ephedra (Ma Huang) Dangerous and should be avoided Dangerous and should be avoided Potent CNS and CV stimulant Potent CNS and CV stimulant Can be a precursor for methamphetamine Can be a precursor for methamphetamine FDA recently banned its use FDA recently banned its use Many other herbal folk remedies used by different culturesMany other herbal folk remedies used by different cultures

44 Remember To... Remember To... Ask about daytime and nighttime symptoms and the frequency of albuterol use Ask about daytime and nighttime symptoms and the frequency of albuterol use Assess current severity/control Assess current severity/control If poor control, refer to Health Care Provider to assess for need for controller/s or dosage change (step up or step down) If poor control, refer to Health Care Provider to assess for need for controller/s or dosage change (step up or step down)

45 Remember To (Continued)… Remember To (Continued)… Be aware of meds that are not being used appropriately and educate student and family accordingly Be aware of meds that are not being used appropriately and educate student and family accordingly Give guidance and suggestions how to better obtain meds and gadgets for home AND school Give guidance and suggestions how to better obtain meds and gadgets for home AND school Consider family dynamics when communicating Consider family dynamics when communicating Check inhaler technique at every opportunity Check inhaler technique at every opportunity Reinforce successful behavior Reinforce successful behavior


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