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Pulmonology 2 > Asthma Gadgets > Flashcards

Asthma Gadgets Flashcards

1
Q

What are the 4 key components of asthma management

A
  1. assessment and monitoring
  2. control of contributing factors (triggers)
  3. pharmacotherapy
  4. patient and family education
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2
Q

what are objective measurements of asthma

A
  1. radiology
  2. spirometry
  3. peak flow monitoring
  4. ABG/SpO2
  5. allergy testing
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3
Q

Periodic assessments of asthma control

A
  1. S&S
  2. pulmonary function testing
  3. Peak flow monitoring
  4. QOL survey
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4
Q

Peak flow

A

PEF

  • simple, quantitative and reproducible measure of existence and severity of airflow obstruction
  • measured via spirometer or hand-held portable peak flow meter
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5
Q

how often are peak flow meters used today

A
  • still a guideline but in reality usually only used in high risk patients, moderate to severe asthma, or those who are poor perceivers (aka S&S not always indicative of an exacerbation)
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6
Q

what is required for accurate measurement of peak flow

A

maximal inspiration followed by maximal forced exhalation

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7
Q

How to use Peak flow meter

A
  1. move indicator to bottom
  2. stand/sit straight
  3. deep breath
  4. close lips around mouthpiece
  5. blow hard and fast in single blow
  6. repeat two more times and record highest of the 3
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8
Q

advantages of peak flow

A
  • early warning sign
  • monitors asthma control
  • feedback to pt about airway
  • ID of exacerbating factors
  • evaluation of response to tx
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9
Q

How to determine peak flow meter personal best

A
  • 2 weeks of monitoring with 2-4 measurements a day.

- best usually in afternoon after max therapy has stabilized asthma

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10
Q

what PEF measurement suggests inadequate asthma control

A

peak expiratory flow

- 20% or more difference between am and pm measurements

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11
Q

what is best comparison value to use when using peak flow?

A

personal best is better than standardized “normal”

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12
Q

When should perform peak flow monitoring

A
  • upon waking in am before bronchodilator
  • if <80%, measure more than once a day, again before bronchodilator therapy
  • helps know if asthma is improving with treatment
  • if >80% of personal best, only do add’l testing if having sx
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13
Q

Green, yellow, red on peak flow meter

A

green >80%
yellow 50-80%
red <50%

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14
Q

patients monitoring PEF over time should do three things

A
  1. bring meter to appts to assess technique and measurement reliability
  2. use same brand meter
  3. have written asthma action plan that incorporates peak flow
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15
Q

reasons for nonadherenace with peak flow monitoring

A
  • inconvenience
  • lack of motivation
  • lack of treatment plan based on PEF
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16
Q

potential causes of incorrect peak flow reading

A
  • poor technique
  • misinterpretation
  • device failure
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17
Q

What is often used to determine how asthma is affecting life

A

QOL survey

quality of life

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18
Q

what is a major change that has occurred with inhalers

A

MDIs using CFCs were phased out, use HFA as propellent now

  • same medication
  • no HFA products are avail in generic form today
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19
Q

HFA difference

A
  • ozone friendly
  • slight diff taste and smell
  • finer mist
  • diff cleaning/care required
20
Q

Similarities between CFC and HFA inhalers

A
  • size
  • shape
  • FDA approved uses
  • 200 puffs/canister
21
Q

medication dosing schedule

A
  • review each visit
  • controller vs. rescue
  • BID dosing best
  • dosing schedule in writing (asthma action plan)
22
Q

dosing technique

A

review each visit

- encourage parents to directly observe children if compliance/technique is a concern

23
Q

who are valved holding spacers appropriate for?

A

all ages, not just kids

- improved delivery to lungs

24
Q

benefits to valved holding chambers with MDIs

A
  • faster than nebulizer
  • improved adherence
  • less manual dexterity
  • decreases oropharynx deposition
  • reduced side effects
25
Q

valved holding chamber with mask technique

A
  • shake inhaler
  • insert inhaler to spacer
  • apply mask
  • spray puff into chamber
  • 6 breaths, mask on whole time
  • wait 1 min between puffs for quick relievers
26
Q

valved holding chamber with mouthpiece use

A
  • shake inhaler
  • insert inhaler in tube
  • tilt head back, exhale, place spacer in mouth, close lips
  • spray one puff
  • breath in slowly and deeply over 3-5 seconds
  • hold breath 10 seconds
  • breathe out through NOSE
  • 15-30 seconds between puffs for quick relievers
27
Q

preferred method to use MDI without valved holding chamber

A

open mouth vs. closed mouth

28
Q

open mouth technique with MDI

A
  • shake inhaler
  • breathe out
  • hold inhaler 1-2 inches from mouth
  • start breathing in and press down inhaler once
  • breath in slowly and deeply
  • hold breath 10 seconds
  • 15-30 secs between puffs
29
Q

closed mouth MDI technique

A

same as open mouth but close mouth around mouthpiece of MDI

30
Q

how to clean MDI and valved holding chamber

A
  • close nozzle/mouthpiece, not canister
  • usually weekly with soapy water
  • follow manu instructions
31
Q

when discard chamber?

A

when actuations = 0 even if puffs still come out, that is HFA only OR when calculate have used all actuations if no counter

32
Q

dry powder actuatiors

A
  • breath-actuated
  • no indicated for <5
  • each has specific instructions
33
Q

do nebulizers work better than MDIs in children?

A

no, just slower :)

34
Q

use of nebulized medications

A
  • long term control and quick relief meds
  • no better than MDI if used with correct technique
  • review nebulizer treatment technique at every visit
35
Q

can nebulizer treatment be delivered via blow-by

A

NO, can be dangerous!!

36
Q

What is best strategy for managing asthma exacerbations?

A

early treatment at home! Use an asthma action plan

37
Q

Best way to control asthma at home

A
  • use written asthma action plan
  • recognize early sx of exacerbation
  • adjust medications as needed
  • remove/withdraw allergens/irritants
  • monitor response to treatment
  • communicate serious deterioration
38
Q

can mild asthma have sever, life threatening exacerbations?

A

Yes!

39
Q

What should every asthma pt have?

A

access to quick relief medications

  • inhaled beta2-agonist
  • oral steroid
40
Q

home management not recommended

A
  • large volumes of liquid
  • warm, moist air
  • OTC products like antihistamines, cold remedies
  • pursed lip breathing
41
Q

Asthma warning signs

A
  • trouble walking, talking secondary to SOB
  • cyanosis
  • lack of response to rescue meds
  • CALL 911/go to ER
42
Q

Asthma action plan

A
  • individualized, written plan of care
  • quick reference for family, school, etc.
  • emergency treatment plan helps ID exacerbations early
  • gives pt/family ownership over treatment plan, know what to do when sx change
43
Q

key components of asthma action plan

A
  • demographics
  • provider contact
  • daily med list
  • peak flow ranges
  • list of sx of progressing severity
  • list of rescue meds and detailed instructions
  • list of danger sings and detailed instructions for emergency care
44
Q

how to encourage adherence to asthma action plan

A
  • choose tx that achieves outcomes and is pt preference if possible
  • review success of treatment plan at each encounter
  • review pt concerns at each encounter
  • assess social support and encourage family involvement
  • tailor self-management approach to needs of patient/family
45
Q

clinical follow up timing

A
  • 2-6 wks while gaining control
  • 1-6 months for routine FU care
  • 3 months if step down in therapy is anticipated
46
Q

goal of asthma management

A
  • prevent chronic sx
  • minimize exacerbations
  • avoid activity limitations
  • maintain lung fn
  • optimize pharmacotherapy
  • min side effects
  • family satisfaction with care

*Want happy normal kids who run around and have a fun life :)

Pulmonology 2 (17 decks)

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