USE OF INHALED ASTHMA MEDICATION
People with asthma have inflamed airways. When these individuals experience asthma symptoms, the inflamed airways become constricted so it becomes more difficult to breathe. Anti-inflammatory asthma medications lessen symptoms by treating the primary inflammation.
Inhalation is often the most effective route for delivery of medications to treat asthma. Many different devices have been introduced over the past several decades to allow people of all ages with asthma to use inhaled medications that help control respiratory symptoms. The major advantages of inhaled medications are their direct delivery to the area of difficulty the bronchi and bronchioles leading to the lungs and their lack of side effects in comparison to many medications taken by mouth or injection.
Classes of inhaled medication
Primary asthma medications available in inhaled form include:
Inhaled corticosteroids, also referred to as topical corticosteroidsor glucocorticosteroids,are potent anti-inflammatory medications that have been used successfully as a treatment for asthma since 1948. These types of steroids are very different from the anabolic steroids misused by some athletes to increase performance. Rather, inhaled steroid medications decrease airway inflammation, oversensitivity, swelling and constriction of the bronchial tubes, and mucus production. It is important to continue to take prescribed inhaled corticosteroids even if you feel well, because they are maintenance medications that help to generally lessen asthma symptoms. Some examples of inhaled corticosteroids are lomethasone, budesonide, flunisolide, fluticasoneand triamcinolone.Bronchodilators, also called beta2 agonists, are non-steroidal anti-inflammatory medications often used as short-term “rescue” medications to immediately relieve asthma symptoms. These include albuterol, bitolterol, pirbuterol and terbutaline. Sometimes these inhalers are over- ilized using more than one canister per month is cause for concern and indicates that you should see your physician for adjustment to your treatment plan. However, salmeterol is a long-acting beta2 agonist bronchodilator that is intended to be used on a long-term basis along with an anti-inflammatory medication for asthma maintenance. Those using salmeterol should take the medication on a daily basis, even if they are feeling fine, as it prevents symptoms.
Non-steroidal anti-inflammatory medications, such as cromolyn or nedocromil, reduce inflammation and can help prevent asthma symptoms. Although less potent than inhaled corticosteroids, these drugs rarely cause side effects.
Types of inhalation devices
There are three basic types of devices used to deliver inhaled medications. The most common of these is the metered dose inhaler (MDI), which uses a chemical propellant to push the medication out of the inhaler. Nebulizers deliver fine liquid mists of medication through a “mask” that fits over the nose and mouth, using air or oxygen under pressure. They are frequently used to treat those with asthma who cannot use an inhaler, including infants, young children and acutely ill patients of all ages. Rotary inhalers and dry powder inhalers have been introduced to deliver asthma medication without using the propellant chlorofluorocarbon (CFC), which damages the earth’s ozone layer. Soon, more inhaled asthma medications will become available in this form due to requirements that manufacturers address concerns about the environmental effects of CFC propellants used in most MDIs.
Most allergists highly recommend using a device called a spacer to improve delivery of inhaled medication. Spacers help individuals with asthma inhale a greater amount of medication directly into the lower airways, where it is intended to go, rather than into the throat. Many spacers fit on the end of an inhaler; for some, the canister of medication fits into the device. Spacers with holding chambers and one-way valves prevent medication from escaping into the air and allow those with asthma to breathe nearer to their own pace while still inhaling effective doses of medication. Many people with asthma, especially young children, may have difficulties coordinating their inhalation with the action necessary to trigger a puff from a metered dose inhaler. For these patients, use of a spacer is particularly recommended.
Proper MDI use
All metered dose inhalers come with instructions, which you must follow carefully. Individuals with asthma and/or their caretakers should request that their prescribing physician give a demonstration on the use of the specific MDI. This should be done again at the pharmacy if necessary, and the technique should be reviewed at follow-up doctor visits.
If you are using a spacer or holding chamber, make sure to follow the specific instructions that come with each. Also, MDIs used to deliver medications such as bitolterol, pirbuterol and triamcinolone are somewhat different from other MDIs. To ensure that you are using your inhaler(s) correctly, request specific training for each and every inhalation device you are instructed to use.
Although used to deliver different medications, many MDIs are similar. Following are directions that apply to many of these inhalers:
Shake the inhaler well immediately before each use, then remove the cap from the mouthpiece. If the cap is not on, check the mouthpiece opening for the presence of foreign objects before each use.
Keep track of inhalations as they are taken. Some manufacturers include a “check-off” in their patient directions. A device is also available that attaches to an inhaler and allows patients to keep track of the number of puffs taken. For daily maintenance medications, divide the number of inhalations per canister (printed on the canister and/or in the patient information dispensed with the medication) by the number of puffs to be taken each day to calculate how many days it will last and when the MDI should be replaced. The widely-used method of immersing the inhaler into water to see if it floats is inaccurate. Discard the canister after you have used the labeled number of inhalations. After that point, you cannot be sure your are receiving the correct amount of medication per inhalation.
Test spray the inhaler before using it initially if it has not been used for a month or more. Thereafter, this does not need to be done before each use.
Breathe out through the mouth to empty the lungs.
Position the inhaler one or two inches away from your open mouth (open mouth technique).
Press down firmly and fully on the top of the metal canister with your index finger while breathing in deeply and slowly through your mouth.
After breathing in the medication, continue to inhale as fully as you can and try to hold your breath for five to 10 seconds so the medicine has a chance to work.
Wait 30-60 seconds and shake the inhaler again. Repeat these steps for each inhalation as prescribed by your doctor.
Replace the mouthpiece cap after each use, and make sure to clean the inhaler thoroughly and frequently. Remove the metal canister and clean the plastic case and cap by rinsing thoroughly in warm, running water at least once a day. (Do not immerse metal canisters containing cromolyn or nedocromil.) After thoroughly drying the plastic case and cap, gently replace the canister into the case with a twisting motion and replace the cap.
If you are using a corticosteroid inhaler, rinse your mouth by gargling with water and spitting after completing the inhalations.
Nebulizers effectively deliver asthma medications in a fine mist through mouthpieces, through masks sized differently to fit infants through adults, or through T-tubes. Nebulized asthma medication is especially useful for infants, young children and some elderly patients who are unable to use an MDI. Nebulizers are also often used in older children and adults as intensive therapy to help reverse acute asthma attacks. There are many nebulizers on the market, offering such features as a small, portable size, battery packs or adapters for use in autos.
Again, it is necessary to receive proper instruction on the use of your nebulizer. Health care personnel working with the physician prescribing the nebulizer treatment can demonstrate their proper use. This training is often supplemented by staff of medical supply companies, who can demonstrate the nebulizer’s use when they deliver it to the patient’s home.
Appropriate medication use
Your physician will prescribe the inhaled medication that is most appropriate for you. If you have any questions about your prescribed inhaled medications or their proper use, make sure to contact your doctor. Many inhaled asthma medications are intended to be used on a daily basis to keep your airways open, even if you are not experiencing symptoms. Follow your physician’s instructions to ensure that you are optimally managing your asthma.