Asthma Education

Based on our broad experience in treating childhood asthma, the allergists at Riley Hospital for Children have developed a comprehensive educational approach to managing asthma. This approach helps patients and their families take control over their asthma and empowers them by establishing a relationship with an asthma/allergy oriented medical home.

In addition to knowing what asthma is, what triggers it and what medicines are used to treat it, the patient needs to know how to take the medicine, what symptoms to watch for and how to monitor his or her status.

MEDICATION ADMINISTRATION TECHNIQUE

Patients need clear instructions on how to take asthma medications. If not taken correctly, the medicines will not be effective. New medications and medication delivery devices are introduced frequently, so it’s important to be aware how to use them properly.

AEROSOLIZED MEDICATIONS

An aerosolized medication is a liquid medicine that has been changed into a fine mist. The child breathes this fine mist into his or her lungs for asthma relief.

A small air compressor, tubing, mask and medication-holding chamber (called a nebulizer) together are often referred to as a nebulizer machine. This machine is used to change a liquid medication into a mist that is delivered to the lungs with each breath. The homecare company of your choice provides this machine for you and teaches you how to use it and care for it.

General Steps for Aerosol Treatment

  1. Plug in machine.
  2. Connect tubing to machine nozzle.
  3. Place medication in nebulizer cup.
  4. Place mask or mouthpiece on nebulizer cup.
  5. Connect tubing to bottom of nebulizer cup.
  6. Turn compressor on.
  7. Breathe in mist until nebulizer cup is empty. This may take up to 15 minutes.
  8. Encourage slow deep breathing to allow the medication to go deeper into the lungs.

Helpful Hints

  • Babies and young children breathe through a mask that directs the medicine to the nose and mouth. Older children use a mouthpiece to inhale the medicine.
  • The masks and mouthpieces are available in many sizes. Be sure to obtain the correct size for your child.
  • Young children may not want to sit quietly during treatments. It may be helpful to have them watch television, read a book, sing a song or even offer some special indulgence that they love to look forward to after treatment.
  • It is best to finish an aerosol treatment even if your child is resisting the treatment. Your child needs to know that this medication is important and that you will give it regardless of his or her actions. Your child should eventually become comfortable with the aerosol treatments.

DRY POWDER INHALERS (DPIS)

Correct Use of the Diskus Inhaler

  1. Place thumb on thumb grip and push away to uncover mouthpiece. The thumb grip will snap into position.
  2. Inspect mouthpiece for foreign objects.
  3. Hold Diskus in a level position with mouthpiece toward you.
  4. Slide lever until it clicks. Your medication dose is now ready.
  5. Breathe out slowly.
  6. Place mouthpiece to your lips and breathe in quickly and deeply.
  7. Remove Diskus from your mouth.
  8. Hold your breath for 10 seconds to allow the medication to reach deeply into your lungs.
  9. Breathe out slowly.
  10. Repeat puffs as directed, starting with Step 3.

Correct Use of Flovent Rotadisk

  1. Remove the mouthpiece cover.
  2. Hold the corners of the mouthpiece tray and slide out and back in to rotate the disk. Your medication dosage is set.
  3. Place device in level position.
  4. Lift the lid fully to pierce the medication blister.
  5. Breathe out slowly.
  6. Place mouthpiece in mouth and breathe in steadily and deeply.
  7. Remove Rotadisk from your mouth.
  8. Hold your breath for 10 seconds to allow the medicine to reach deeply into your lungs.
  9. Repeat puffs as directed, starting with Step 2.

Helpful Hints

  • Each disk has four medication blisters. The blisters are numbered starting with 4. This will show you how many doses are left.
  • Breathe in through your mouth.
  • Use the provided brush to remove any powder left behind.

Correct Use of Floradil Aerolizer

  1. Remove Aerolizer inhaler cover.
  2. Hold Aerolizer base firmly and twist mouthpiece in direction of arrow to open.
  3. Remove capsule from foil and place in aerolizer base. NEVER PLACE CAPSULE IN MOUTHPIECE!
  4. Twist mouthpiece back to closed position. (You will hear it click.)
  5. Hold Aerolizer upright and press both blue buttons at the same time. Press only once and release.
  6. Exhale fully. Place mouthpiece in your mouth, closing lips around the mouthpiece. Keep blue buttons on the left and right of Aerolizer (not up and down).
  7. Breathe in rapidly and deeply. You will hear whirring noise as medicine empties. If you do not hear this, the capsule is stuck. Open Aerolizer and loosen the capsule. DO NOT press blue buttons again.
  8. Hold your breath for 10 seconds and then breathe out.
  9. Open Aerolizer to check for powder remains. If you see powder, repeat steps 6-8.
  10. Open Aerolizer and remove capsule. Do not leave empty capsule in the chamber.
  11. Close mouthpiece and replace the cover.

Correct Use of Pulmicort Flexhaler/Asmanex

  1. Remove cap.
  2. Inspect mouthpiece for foreign objects.
  3. While holding upright, twist the grip fully to the right or left, then back again. You will hear a click.
  4. Breathe out slowly.
  5. Close mouth tightly around mouthpiece.
  6. Breathe in rapidly and deeply.
  7. Remove mouthpiece from mouth.
  8. Hold your breath for 10 seconds to allow the medication to reach deeply into your lungs.
  9. Exhale.
  10. If repeat inhalation is needed, start with Step 3.

METERED-DOSE INHALERS

Correct Use of Metered-Dose Inhalers

  1. Remove the cap and hold inhaler upright.
  2. Shake the inhaler.
  3. Tilt your head back slightly and breathe out slowly.
  4. Position the inhaler 1 to 2 inches away from mouth, with mouth open.
  5. Press down on the inhaler to release puff of medication as you start to breathe in slowly.
  6. Breathe in slowly (3 to 5 seconds).
  7. Hold your breath for 10 seconds to allow the medicine to reach deeply into your lungs.
  8. Repeat puffs as directed. Waiting 1 minute between puffs helps the second puff to get farther into the lungs.

Helpful Hints

  • Breathe out before pressing your inhaler.
  • Inhale slowly.
  • Breathe in through your mouth, not your nose.
  • Press down on your inhaler at the start of inhalation (or within the first second of inhalation).
  • Keep inhaling as you press down on your inhaler.
  • Press your inhaler only once while you are inhaling (one breath for each puff).
  • Make sure you breathe in evenly and deeply.

Correct Use of Maxair Metered-Dose Inhaler

  1. Remove cap and hold inhaler upright.
  2. Inspect mouthpiece for foreign objects.
  3. Shake the inhaler.
  4. Push tab up to set dosage.
  5. Tilt your head back slightly and breathe out slowly.
  6. Place mouthpiece in mouth.
  7. Breathe in deeply and the medication will automatically be discharged.
  8. Hold your breath for 10 seconds to allow the medicine to reach deeply into your lungs.
  9. Remove mouthpiece and exhale.
  10. Repeat puffs as directed starting with Step 4. Wait 1 minute between puffs to help the medicine get farther into the lungs.

Correct Use of Metered-Dose Inhaler with Spacer and Mask

  1. Remove the cap and hold inhaler upright.
  2. Inspect mouthpiece for foreign objects.
  3. Shake the inhaler.
  4. Push inhaler into rubber end of spacer.
  5. Place soft mask on face, covering the mouth and nose.
  6. Keep mask firmly against face so that no air escapes around it. Your child is able to easily breathe through the mask.
  7. Press down on inhaler to release puff of medication.
  8. Continue to hold mask firmly against your child's face while he or she breathes at least six times.
  9. Wait 1 minute and repeat puff if directed. The waiting time helps the second puff get farther into the lungs.

Helpful Hints

  • If your child is scared of the mask, let your child hold it or rub it on his or her cheek.
  • If your child cries during the treatment, he or she will still receive the medicine as long as the mask is firmly against his or her face with no air escaping.
  • It may be necessary to hold your child's arms down to keep him or her from pulling the mask away from the face.
  • Many inhalers have a counter that indicates the number of doses left. Look at the counter frequently to be sure that doses are available for use. The counter will help you know when to refill the prescription.

PEAK FLOW ZONE SYSTEM

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 increasingly hard to move air out of the lungs during breathing.

The peak flow meter has a role in asthma care, but it may not be an important part of every asthma education program. The decision to do peak flow monitoring should be made between you, your child and your allergist.

How It May Help You And Your Doctor

  • Catch early airway narrowing hours or even days before symptoms occur. (By giving your child medicine early, you may be able to prevent a serious asthma episode.)
  • Learn what makes your child’s asthma worse.
  • Decide if your child’s medicine plan is working well.
  • Decide when to obtain emergency care.

How To Use

  1. Place indicator at zero.
  2. Stand up and take a deep breath.
  3. Put 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 the number shown on the indicator.
  6. Repeat Steps 1-5 two more times. Write down the highest number in your peak flow diary.

Finding Your Child’s Personal Best

The personal best peak flow number is the highest peak flow number your child can achieve when his or her asthma is under good control or is his or her usual best. Good control is when your child feels good and does not have any asthma symptoms.

To find your child’s personal best, take peak flow readings as directed below:

  • Perform three measures at least twice a day for 2 to 3 weeks.
  • Measure when the child wakes in the morning and between noon and 2:00 pm.
  • Check the numbers before and 15 minutes after your child takes quick relief medicine for symptom control.
  • Record these numbers.
  • Find the usual best number and that will be your child’s personal best.

Zones Defined

  • Green Zone: Good control (usually a value of 80 percent or more of the personal best). No asthma symptoms are present. Take medicines as usual.
  • Yellow Zone: Caution (usually a value between 50-80 percent of the personal best). Airways are becoming swollen and narrowed. Follow asthma action plan to try to prevent a serious asthma episode. Also, your child’s asthma may not be under good day-to-day control. Call our office if your child is not back in the green zone within 24 hours.
  • Red Zone: Medical alert (a value less than 50% percent of the personal best). Your child is having an asthma episode. Follow asthma action plan. If your child does not return to the yellow or green zone within 30 minutes, go to the closest emergency room. If your child has severe difficulty breathing, go to the nearest emergency room immediately or call 911 or an ambulance.

RELAXATION METHODS

It can be very frightening to your child when he or she has difficulty breathing. It is important to relax and remain calm because anxiety can make the symptoms worse. If your child becomes anxious during an asthma episode, you can try one of the following methods to help your child relax.

First Method

  • Relax the shoulders and neck.
  • Breathe in through the nose.
  • Breathe out through puckered lips.

Second Method

  • Place hands on stomach.
  • Breathe in deeply through the nose so stomach and hands rise.
  • Breathe air slowly out of the mouth while watching stomach and hands fall.
  • Try not to move the chest while breathing.

WARNING SIGNS OF DIFFICULT BREATHING

If your child has any of the symptoms below, follow your emergency medicine plan. If these symptoms are not relieved within 30 minutes or your child's symptoms worsen, take your child to the hospital.

  • Skin in chest is pulling in with each breath. (You may see this between and below the ribs, at the throat or at the shoulder blades.)
  • Nose flares with each breath.
  • Child cannot finish sentence without extra breath.
  • Child is hunching shoulders upward with each breath.
  • Infant is unable to nurse or take a bottle.
  • Breathing is fast or shallow.
  • Your child appears unusually scared because of difficulty breathing.

If your child has any of the symptoms below, call 911:

  • Lips or nail beds are gray or blue.
  • Difficult to walk or talk.
  • Cannot stop coughing.
  • Extreme difficulty breathing.
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