Asthma: Stop making breathing harder for yourself!
BY Rafael Mendonca, RRT & CMS Team
Apr 5, 2022
Stop making breathing harder for yourself, get an AeroChamber!
Asthma is a condition where the small airways in the lungs swell, narrow and increase mucus production leading to difficulty in breathing, exponentially increased exhalation time. It is often in conjunction with monophonic or polyphonic wheezing heard either by auscultation or by proximity.
Are there different severities of Asthma?
Yes. While for some Asthma can be a bit of a nuisance, for others it can mean the difference between life and death. Asthmatic bronchospasm frequency can progress and it can settle and be very well controlled with medication and environment exposure control. There are methods to reduce asthma attack onset and improve lung function by going back to basics.
How do I Prevent an onset of an asthma attack?
We need to look at this scenario via a global approach. There is NEVER only ONE factor that induces an asthma attack. Take a look at the picture below for a general reference.
There can be many triggers for any individual and at times triggers that we may not even be aware. These triggers are especially dangerous if there is no routine use of Inhalers - One of the leading causes of uncontrolled asthma; patient non-compliance.
What medications are there and why & how should I take them?
There are several different categories of Medications and many different medications with 3 names each (Generic, Molecular & Brand names) within every category… some include:
Rescue Inhalers (Short Acting)
SABA (Short-Acting-Beta Agonists): Ventolin (Salbutamol)
SAMA (Short-Acting Muscarinic antagonists) Anticholinergics: Ipratropium (Atrovent)
Long acting inhalers
LABA (Long-Acting-Beta Agonists): Salmeterol (Serevent), Formoterol (Foradil)
LAMA (Long-Acting Muscarinic antagonists) Anticholinergics: Tiotropium (Spiriva)
Corticosteroids (Mainstay): Flovent (Fluticasone), Budenoside (Pulmicort), Beclomethasone (Qvar), Ciclesonide (Alvesco)
Systemic steroid: Prednisone (oral)
Combination Inhalers (Mainstay)
Combination (LABA & Steroid): Symbicort (Fluticasone & Vilanterol), Zenhale (Mometasone & Formoterol), BREO (Fluticasone & Vilanterol)
Generally, we find patients non-compliant with the most important inhalers: the LONG ACTING & Steroidal medications and end up using the “Rescue inhalers” much more frequently than they would have to.
As an RRT, I’ve had the pleasure of educating many patients on proper use of MDI, DPI inhalers and nebulizer systems. The main reason we see lack of compliance with respiratory medication is because patients don’t notice a difference when they are using the inhaler and possibly because of incorrect ways to take the medication. It is CRUCIAL to understand the general pathology, why we are using each puffer and how to use each inhaler.
How to use inhalers?
To find out how to use your inhaler, first we need to find out how your medication comes. Is it a Dry Powder Inhaler (DPI) a Metered Dose Inhaler (MDI), or Soft Mist (Nebulizer).
MDI (Metered Dose Inhalers)
Must use a SPACER/ AeroChamber! Without the use of an aerochamber, over 90% of the medication gets deposited in the back of the throat. It may seem quite silly that a chamber would benefit that much but in reality it comes down to physics. The chamber allows the particles to slow down to then be breathed in slowly and controlled for maximal deposition to the distal ends of the lungs where the inflammation is taking its course.
Whenever using an MDI for a Corticosteroid, ensure to gargle and rinse your mouth/throat thoroughly to prevent oral thrush (fungal growth).
DPI (Dry Powder Inhalers)
Ensure to follow the instructions printed on the inhaler or how your pharmacist or therapist has advised you to do.
Dry powder can be a bit irritating to the throat as well so it is recommended to rinse your mouth afterwards.
A Spacer is not able to be used with this medication. This can come in several types of inhalers:
Accuhaler, Ellipta, Aerolizer, Respimat, Breezhaler, Turbuhaler
Soft Mist (Nebulizer)
Easiest way to deliver medication but the least effective due to the heterogeneous mist formation with particles varying in sizes which alters how medication is delivered to the lungs.
Lots of unused medication is wasted.
Saline Solution mixture can cause some bronchospasms.
Chamber | Spacers: Why should I use them?
There are many reasons as to why someone should be using the spacers with MDI administration. The main reasons are:
It is scientifically proven to drastically improve deposition of medication to the affected areas of the lungs (Distal ends of then lungs)
Provides a more controlled method of administrating MDI medications leading to less waste and improved outcome
Less wasted medication in the back of throat due to lower velocity of particles and controlled breath in.
Using you puffers without much results? Are you using a Spacer? If the answer is No, then Get one TODAY and stop making breathing harder for yourself. That $50.00 will be much better off having you breathing right.
Overall, It is very important to know what the TRIGGERS are for proper asthma control as well as understand and follow the physician’s prescription even if we think we are okay! Seriously, this is the #1 reason people will stop their everyday puffers- because they feel well. I’ve got news for you, You’re feeling well because you re taking the medications! Once you do not, the lungs become hypersensitive again and likeness is you will have another asthma attack.
Are you finding your asthma uncontrolled even with proper use of inhalers?
It is unfortunate that sometimes it can take us a little longer to figure out what works best for us, and even when we do, the body changes over time which can lead to needing medication change once more!
If you are following the Asthma treatment guidelines to the T, and keeping away from any known triggers, maybe it would be wise to talk to your physician. Ensure to keep a log on how you were feeling on a day by day basis and what you did to exacerbate/treat the onset of asthma and how the weather was. Just keeping a log can clear up what the triggers are. However, you can always converse with your physician about:
Medication switch (Specifically the corticosteroids and long acting medications)