Asthma Gadgets Flashcards
What are the 4 key components of asthma management
- assessment and monitoring
- control of contributing factors (triggers)
- pharmacotherapy
- patient and family education
what are objective measurements of asthma
- radiology
- spirometry
- peak flow monitoring
- ABG/SpO2
- allergy testing
Periodic assessments of asthma control
- S&S
- pulmonary function testing
- Peak flow monitoring
- QOL survey
Peak flow
PEF
- simple, quantitative and reproducible measure of existence and severity of airflow obstruction
- measured via spirometer or hand-held portable peak flow meter
how often are peak flow meters used today
- 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)
what is required for accurate measurement of peak flow
maximal inspiration followed by maximal forced exhalation
How to use Peak flow meter
- move indicator to bottom
- stand/sit straight
- deep breath
- close lips around mouthpiece
- blow hard and fast in single blow
- repeat two more times and record highest of the 3
advantages of peak flow
- early warning sign
- monitors asthma control
- feedback to pt about airway
- ID of exacerbating factors
- evaluation of response to tx
How to determine peak flow meter personal best
- 2 weeks of monitoring with 2-4 measurements a day.
- best usually in afternoon after max therapy has stabilized asthma
what PEF measurement suggests inadequate asthma control
peak expiratory flow
- 20% or more difference between am and pm measurements
what is best comparison value to use when using peak flow?
personal best is better than standardized “normal”
When should perform peak flow monitoring
- 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
Green, yellow, red on peak flow meter
green >80%
yellow 50-80%
red <50%
patients monitoring PEF over time should do three things
- bring meter to appts to assess technique and measurement reliability
- use same brand meter
- have written asthma action plan that incorporates peak flow
reasons for nonadherenace with peak flow monitoring
- inconvenience
- lack of motivation
- lack of treatment plan based on PEF
potential causes of incorrect peak flow reading
- poor technique
- misinterpretation
- device failure
What is often used to determine how asthma is affecting life
QOL survey
quality of life
what is a major change that has occurred with inhalers
MDIs using CFCs were phased out, use HFA as propellent now
- same medication
- no HFA products are avail in generic form today
HFA difference
- ozone friendly
- slight diff taste and smell
- finer mist
- diff cleaning/care required
Similarities between CFC and HFA inhalers
- size
- shape
- FDA approved uses
- 200 puffs/canister
medication dosing schedule
- review each visit
- controller vs. rescue
- BID dosing best
- dosing schedule in writing (asthma action plan)
dosing technique
review each visit
- encourage parents to directly observe children if compliance/technique is a concern
who are valved holding spacers appropriate for?
all ages, not just kids
- improved delivery to lungs
benefits to valved holding chambers with MDIs
- faster than nebulizer
- improved adherence
- less manual dexterity
- decreases oropharynx deposition
- reduced side effects
valved holding chamber with mask technique
- 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
valved holding chamber with mouthpiece use
- 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
preferred method to use MDI without valved holding chamber
open mouth vs. closed mouth
open mouth technique with MDI
- 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
closed mouth MDI technique
same as open mouth but close mouth around mouthpiece of MDI
how to clean MDI and valved holding chamber
- close nozzle/mouthpiece, not canister
- usually weekly with soapy water
- follow manu instructions
when discard chamber?
when actuations = 0 even if puffs still come out, that is HFA only OR when calculate have used all actuations if no counter
dry powder actuatiors
- breath-actuated
- no indicated for <5
- each has specific instructions
do nebulizers work better than MDIs in children?
no, just slower :)
use of nebulized medications
- long term control and quick relief meds
- no better than MDI if used with correct technique
- review nebulizer treatment technique at every visit
can nebulizer treatment be delivered via blow-by
NO, can be dangerous!!
What is best strategy for managing asthma exacerbations?
early treatment at home! Use an asthma action plan
Best way to control asthma at home
- 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
can mild asthma have sever, life threatening exacerbations?
Yes!
What should every asthma pt have?
access to quick relief medications
- inhaled beta2-agonist
- oral steroid
home management not recommended
- large volumes of liquid
- warm, moist air
- OTC products like antihistamines, cold remedies
- pursed lip breathing
Asthma warning signs
- trouble walking, talking secondary to SOB
- cyanosis
- lack of response to rescue meds
- CALL 911/go to ER
Asthma action plan
- 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
key components of asthma action plan
- 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
how to encourage adherence to asthma action plan
- 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
clinical follow up timing
- 2-6 wks while gaining control
- 1-6 months for routine FU care
- 3 months if step down in therapy is anticipated
goal of asthma management
- 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 :)
