Asthma medicines come in several different forms. When you think of medicine, you probably think of liquids or pills, but only a few asthma medicines are taken by mouth. Asthma is best treated by inhaled medicine because it goes directly where it needs to work—the lungs—rather than into the intestinal tract, the bloodstream, and throughout the whole body. This chapter focuses on the correct ways to use inhaled medicines and the proper methods of taking care of them. One of the most important issues in controlling asthma is matching the treatment to the individual child. That means not only giving the most appropriate medicine, but also being sure its delivery device is used the right way for it to work effectively.
Treatment for asthma comes primarily in three types of inhaled midi-cines: metered dose inhalers (MDIs), dry powder inhalers (DPIs), and neutralizers.
MDIs have been used for Asthma medicines and other lung diseases for several decades. These small, plastic, handheld devices contain medicine in an aerosol canister. When sprayed, the inhaler expels an exact, measured dose of medicine either a controller or a quick relief type. The MDI container also contains a chemical propellant that delivers the medicine very fast. If you've ever put an MDI in your mouth and sprayed it, you have felt a wet, cold spray in your mouth and throat. But the problem with feeling that spray is that the medicine landed in your mouth and throat instead of going deep down your windpipe and into the lungs where it needs to work. In the past, many children used an MDI by itself, but today it is highly recommended that a spacer be added to the MDI for a more effective treatment. A spacer—also called a "holding chamber"—holds and slows down the spray so a child can inhale a slower, deeper breath. When a child uses a spacer with a one-way valve, he can't exhale air into the spacer, so he's able to inhale all the medicine deep into his lungs. (Other kinds, without a one-way valve are available, but the one-way valve type is preferable.) He will not feel a wet cold spray in his mouth. When using a spacer with an MDI, a child should be reminded to take a slow, deep breath and hold it for ten seconds.
A number of different brands of spacers are on the market. They require a prescription, and prices vary. Most brands have a mouthpiece that adults, teenagers, and children as young as five or six years old can use correctly and consistently. Spacers are also made with a face mask for babies and toddlers. Many children, particularly those with mild asthma, have been using MDIs without spacers for some time. They and their parents may assume that the MDI alone is enough, but it can present problems, as this fifteen-year-old discovered: David had been taking Flovent 44 as his controller medicine without a spacer for over two years. He used it when he was supposed to,
every morning and every night, but he still had symptoms during colds and exercise. When his nurse practitioner asked David how he knows when the inhaler is empty and how often he refills it, David said that he asks his mother for a refill whenever the inhaler feels empty and no spray comes out. The nurse explained that David's par-ticular MDI comes with 120 "actuations" (individual doses of med-icine). That means that if David takes four puffs a day (two puffs twice a day) for thirty days, one Flovent MDI should last a month. The nurse practitioner also urged David to get a new MDI every month even if he still feels liquid in the canister and sees spray come out. After.120 puffs of medicine have been taken, there may still be some liquid (preservative and propellant) in the canister. It may not "feel empty," but it contains no medicine.
Not all medicines that come as MDIs contain 120 doses per canister or are priescribed for four puffs a day. Be sure you understand how often your child is supposed to use the MDI/spacer and check the individual canister for its number of total doses. Sometimes parents worry that older children, who are allowed to monitor their own medicine, are taking it too often or too little. A rule of thumb to remember is that quick-relief medicine, such as albuterol dispensed as an MDI, should contain 200 doses. If a child's asthma is well controlled, a refill will be needed every six months. If your child is using more than this, or is taking albuterol twice a week or more, dis-cuss this with your child's health care professional. After David's nurse practitioner explained this, he and his mother decided to keep better track by writing down the date on the kitchen cal-endar each time he starts a new MDI—both controller and quick-relief medicines. This not only reminds them to call the pharmacy for a refill before the medicine runs out, but it also helps them both be aware of how much quick-relief medicine David is using so they can keep an eye on over-use or under-use.
Instead of increasing his dose of Flovent to 110, David's nurse prac-titioner considered two options. One was to continue the Flovent 44, but teach David how to use a spacer and explain that it will also help him get better relief by controlling airway inflammation and preventing symptoms. The second option was to switch him to a dry powder inhaler
DPIs are the newest device on the market. They deliver medicine to the airways as a dry powder. Taking medicine with a DPI is quick—it takes less than a minute to take a dose. DPIs require no special care except to keep them dry. Most children older than five years of age are able to learn the administration technique. But regardless of a child's age, par-ents still must pay attention to make sure their child performs the correct technique consistently. If your child has previously used an MDI/spacer and is just begin-ning to use a DPI, be sure she understands that the DPI is used differ-ently—she must be able to take in a fast, deep breath rather than the slow, deep breath required by an MDI/spacer. With both an MDI and DPI, a child should hold the breath for ten seconds after inhaling the puff of asthma medicine.
Since not all asthma medicines are available in the DPI form, your child needs to know the proper technique for more than one device—in other words, she'll have to become a switch-hitter and learn when and how to use at least two or maybe even three techniques for taking dif-ferent inhaled medicines. You may wonder what difference it makes whether she inhales a fast, deep breath or a slow, deep one. The answer lies simply in the fact that an MDI contains a chemical propellant that expels the spray very fast. As discussed earlier, the spacer holds the puff of medicine so, as a child slowly inhales it, the medicine is more effectively delivered deep down into her lungs. DPIs, however, do not contain a propellant. A DPI can only work and get deep down to her lower airways if she takes a fast, deep breath.
No comments:
Post a Comment