What are asthma inhalers and how should they be used?

A Look at Asthma Inhalers

Asthma inhalers have made life significantly easier for both doctors and patients. Inhalers are portable devices that deliver asthma medication directly to the lungs and can be easily used in any setting. This means that an asthma attack – which can happen at any time – can be treated with medication right away, without waiting for medical help to arrive.

It is not too far fetched to say that asthma inhalers are the main reason why patients with acute asthma symptoms can function with a high degree of independence.

Asthma inhalers form the key element in emergency rescue medication for use during asthma attacks. Carrying inhalers makes it possible for patients to travel or engage in sports without fear of the consequences of a sudden attack. Some kinds of inhalers are however not for use in emergencies and are rather for treating chronic bronchial problems.

Types of inhalers

There are two kinds of inhalers – metered dose inhalers and dry powder inhalers.

Metered dose inhalers use a chemical propellant (usually a fluorocarbon) to deliver the medication as a fine mist into the air. The patient presses a plunger to release a preset dose of medication.

The other kind of asthma inhaler is the dry powder inhaler. Manufacturers developed this partly in response to concerns about fluorocarbons having an adverse affect on the atmosphere. The difference here is that the medication is delivered in the form of a powder rather than as a mist.

Types of medications used

Emergency rescue inhalers use a class of medication called short acting bronchodilators. These medications do their work by inducing the muscles surrounding the bronchi to relax, which helps the patient breathe more easily. Common drugs used include pirbuterol and albuterol and they are effective for around four to eight hours only.

Another kind of asthma inhaler makes use of long acting bronchodilators. They are not meant to be used for short term relief in an asthma attack. They include medications like formoterol and salmeterol which relax the bronchial muscles over a period of time. These drugs are used to treat chronic problems.

Some asthma inhalers contain corticosteroids, which is used as preventive medication. Corticosteroids have long lasting effects and help to reduce inflammation in the bronchi. Typically, corticosteroids are used once or twice a day as part of an ongoing treatment plan.

There are also inhalers making use of non-steroidal medications like nedocromil and cromolyn which control inflammation. Finally, some brands of asthma inhalers contain a combination of a long-acting bronchodilator and a corticosteroid.

Using asthma inhalers

It is best to follow the doctor’s instructions on how to use asthma inhalers. Here are some general guidelines.

Metered dose inhalers are pressurized canisters, somewhat like small spray cans. Place the canister mouthpiece against the patient’s mouth. To release a dose of medication, press down on the canister’s top and the medication comes out as a fine mist. The patient should inhale the medication through the mouth at the same time that the canister top is pressed.

This coordination can be quite difficult for small children or for the elderly. To get around this problem, a hollow tube called a spacer is placed between the inhaler outlet and the patient’s mouth. This allows the patient to inhale the medicine over several breaths instead of a single breath.

Dry powder inhalers do away with the need for any such coordination. These inhalers are activated by the patient’s breath. The patient has to put his lips onto the mouthpiece of the inhaler and take in a quick, sharp breath. This will pull in a dose of medication in powdered form.

Asthma inhalers have given patients the enormous benefit of being able to lead normal lives. They should be used according to an asthma action plan drawn up by a doctor for each patient.

Asthma relief with nebulizers

The portable inhaler is the most commonly used device for delivering asthma relief medication. However, some asthma patients have trouble using inhalers because of the coordination required between pressing down on the inhaler and breathing in the medication. For instance, young children as well as old people who are very ill may not be able to use inhalers. In such cases, nebulizers are used to provide asthma relief.

What is a nebulizer? It is basically a device that delivers medication in the form of a fine mist that can be breathed in through a face mask / mouthpiece. The medication in the nebulizer is in liquid form which is then converted into a mist.

The main components of an asthma relief nebulizer are the air compressor, nebilizer cup and a mouthpiece / mask connected using flexible tubing. There are also nebilizers that don’t use an air compressor. Instead, they use sonic waves to achieve the same effect.

Dispense medication

Nebulizers may be used to dispense medication like Proventil or Atrovent, which are bronchodilators. The nebulizer delivers medication directly into the lungs and is a highly effective delivery method. It is also much easier to use than inhalers.

The nebulizer and medication must be used only with your doctor’s prescription. You will need to be shown how to use a nebulizer – a respiratory therapist or a nurse can help you with this. Once you are familiar with its operation, you can use it yourself to take medication.

How to use a nebulizer for asthma relief

Follow the doctor’s instructions precisely when using a nebulizer. The following guidelines are fairly general and the instructions you receive may vary.

In most cases, medication for use in nebulizers is in the form of a liquid. A specified quantity of medication must be poured into the bottom of the nebulizer cup.

Once the medication is in place, the nebulizer cup must be closed. The face mask or mouthpiece must now be attached to the top portion. There is flexible tubing going from the air compressor to the nebulizer cup – this must be be fixed in place.

If everything is set up correctly, when you turn on the compressor, you should see a fine mist coming out of the mouthpiece or face mask.

Now place the mouthpiece between your teeth. The lips should be closed around the mouthpiece to retain the medication inside. In nebulizers that come with a face mask, fix the mask in a comfortable position over your nose and mouth.

Breathe in and out in a relaxed manner. Try to hold the breath in for a second or two so that the medication can seep into the lung tissues. Continue breathing the medication in until the nebulizer cup is emptied of the drug.

Each session with an asthma relief nebulizer generally takes seven or ten minutes. Most people who use a nebulizer find it an enjoyable experience – they can relax for a few minutes in a restful position while the medication does its work. A few patients find it frustrating to sit still for even this short period of time. In such cases, the doctor may be able to prescribe other alternatives.

Like all other medical equipment, nebulizers must be maintained well. The cup, which holds the medication, should be thoroughly washed after each use. At the end of each day, use a mild detergent to wash the mask / mouthpiece and the cup. They should be allowed to air dry after that. In addition, every two or three days, use a mixture of vinegar and water to disinfect the equipment. You can also use a commercial disinfectant.

Maintaining the nebulizer is important to eliminate the possibility of an infection. Used properly, nebulizers are very effective in providing asthma relief.

Can breathing exercises really help improve asthma symptoms?

Some asthma patients claim that breathing exercises have helped them reduce their asthma symptoms; in some cases quite dramatically. Is there any evidence to back up their claims?

Breathing exercises are considered part of complementary and alternative medical treatments. There are many different kinds of breathing exercises – ranging from ancient techniques based on yoga to modern biofeedback training systems. On the face of it, claims of improvement may seem to have a basis, because asthma is a disease of the lungs and so might respond to training in breathing.

A study on this issue was published by Current Opinion in Pulmonary Medicine. This study concluded that some types of alternative treatments may have a positive effect on asthma symptoms. The researchers say that both quality of life and lung function might be improved with breathing exercises. The authors mention that such exercises may form a useful complement to conventional medicine and that retaining exercises certainly warrant further research.

Pranayama Breathing Techniques

It appears that pranayama, which is a set of breathing techniques originating from yoga practices, is the most effective among the different types of training studied. Groups of adult asthmatics were trained in pranayama techniques and monitored for asthma. These persons showed considerable improvements in asthma symptoms.

Lung function is measured objectively using peak flow meters. The asthma patients above showed no improvements in lung function although their asthma symptoms certainly improved. Apart from pranayama, muscular relaxation techniques and Buteyko breathing techniques also resulted in improved asthma symptoms.

Some experts estimate that almost a third of all asthma patients have some degree of impairment in their breathing function. That is why a combination of biofeedback training and breathing exercises may help asthmatics.

Even in cases where such training does not directly improve asthma symptoms or lung function, learning to breathe properly is likely to have a positive impact on the patients’ overall health and quality of life.

The researchers also observed that muscle relaxation training helps asthma patients breathe more easily than before. They studied a group of thirty three patients and found that their asthma symptoms as well as overall life quality improved significantly with the use of muscle relaxation techniques. Moreover, those improvements continued to be evident six months after the training was given.

A couple of other studies concluded that patients’ dependence on bronchodilators came down with relaxation training. Not only did the quality of life improve, the patients’ maximum inspiratory pressure also showed improvement.

Finally, the researchers suggested that further studies were needed to uncover the exact strategies that lead to the best improvements in asthma symptoms. Breathing right does have major health benefits.

This does not mean that you can toss out bronchodilators and be fine just by leaning yoga and relaxation. Both ongoing preventive medication as well as emergency relief medication is critically important. If you choose to take up breathing exercises or other types of complementary therapy, it is necessary to keep your doctor informed. He will be able to monitor your progress and make adjustments to your asthma management plan as needed.

How to find an asthma-friendly school for your child

Your child will spend about thirty five hours per week at school. That’s approximately one third of her waking hours. If she is prone to asthma attacks, those hours may be filled with anxiety for you as a parent. What will happen if she were to get a sudden asthma attack at school? Will the people in charge be able to handle the situation well?

Is the school doing everything it can to provide a safe environment for asthmatic children?

Today, many schools have zero tolerance for any kind of drugs on the campus. This is understandable in most cases. However, for an asthmatic child, this policy could potentially prove fatal.

Access to Medication at School

You need to know if your child will have access to life saving medication at school, at the precise time she needs it. You need to know if she will be able to take preventive medication according to a schedule drawn up by the doctor. Are there people available who know exactly what must be done when a child has an asthma attack? These considerations are doubly important if the school follows a blanket no-drugs policy.

To assess how asthma friendly a school is, here are several questions you should ask.

  • Does the school monitor and control the quality of air indoors? This is important because asthma attacks are often triggered by airborne substances including pollen, animal dander, pet hair, dust mites and so on. Check if the classrooms have upholstered furniture or carpets, which can be a source of dust mites.

    Does the school use strong chemicals for cleaning? Are there paint fumes from a recent or ongoing paint job? Are there adequate pest control measures to check cockroaches and other pests (cockroach allergens are a very common trigger for asthma attacks)?

  • Does the school have a plan in place for dealing with asthma attack cases? Are the teachers and all other adults aware of how to help a person having an attack? Since this disease can strike unpredictably at any time, it is critical that the adults present be able to take care of the child.

  • Are the school premises totally tobacco-free? This is important for asthmatics. No smoking should be allowed by anyone anywhere in the school – either indoors or out.

  • Is the child allowed to carry an emergency inhaler with her at all times? If the child is prone to asthma attacks, having an inhaler close at hand could save her life. Unfortunately, there are many schools that do not allow children to have any kind of medication with them – even essential, life-saving drugs. You may want to keep your child far away from such schools. Remember, it is not enough if your child is allowed to keep her inhaler at school locked away in a cabinet. That can cause delays in receiving medication which can put her life at risk. Such arrangements are completely unacceptable for asthmatics.

    At the end of the day, your child’s life is far more valuable than any rules and regulations imposed by school managements. Keep that in mind if the school administration attempts to bully you into submission.

  • Does the school have a nurse available throughout the day, every day? Some schools do, but this is not always feasible. At the minimum, a nurse’s services should be available at regular times to students to take care of asthma and other medical emergencies.

  • Does the school promote physical activities in a safe manner for asthma patients? As an example, children with asthma may need to take preventive medication half an hour before beginning physical activity.

  • Asthma is a very common health condition these days. Some estimates say as much as seven percent of the population is affected by the disease and certain schools are said to have a full quarter of their students affected by asthma. Does the school educate both adults and students about the disease? Everyone needs to know the essential facts about the disease.

Ensure that the school is a safe place for children with asthma before you enroll your child. If necessary, talk to the principal, the teachers and the parent-teacher organization to create a safe environment for your asthmatic child.

If you have breathing problems, could it be asthma?

Many people around the world are asthma patients without knowing it. They may have one or more symptoms of the disease including breathing problems, but may not realize the seriousness of the issue. There is no reliable estimate of the number of people with ‘hidden asthma’.

It is true that asthma is on the rise in America and in the rest of the world. Some statistics indicate that asthma related breathing problems account for a loss of about fourteen million school days per year and another fourteen and a half million work days in the country. The real cost is probably several billion dollars.

Breathing Problems?

There are several possible signs and symptoms that point to asthma. Breathing problems are an obvious one. Some people get out of breath when they walk even a short distance. This can be due to other factors including lack of fitness, but in many cases asthma is the underlying reason for breathing problems.

Others have persistent coughs that don’t go away even after months of medication use. Most of the time, the cough is not very bad, although it gets worse and the person may end up coughing very hard for a short while.

Other people may have sounds inside their chest while breathing, particularly at night, which make them think they have a cold. Or they may have a slight wheezing that they don’t consider very seriously.

Asthma can exhibit other symptoms as well, like tightness in the chest or shortness of breath for no apparent reason.

Neither breathing problems nor any of the other symptoms mentioned above is a conclusive indicator of asthma. However, they warrant medical attention to discover the underlying cause even if it is not asthma.

Factors / symptoms like the ones below might point to the presence of asthma.

  • Allergies – do substances like pollen, pet dander, dust, etc trigger allergic reactions?

  • Family history of either asthma or allergies (or both)

  • Wheezing during or after exercise

  • Coughs that do not go away or get worse at night. Sleep that is interrupted by night-time coughing

  • Wheezing triggered by cold. Having a cold at all times.

  • Having to stay away from work because of symptoms like those above.

If one or more of these symptoms are present, the affected person must go for a medical checkup. If these symptoms occur in a child, the parents must be doubly careful. Asthma in children is particularly problematic and can have many consequences like poor performance at school, depression, etc.

Overall, breathing problems and other such signs does not necessarily confirm the presence of asthma. However, medical attention should be sought if such symptoms are present.

What you should know about asthma in children

Asthma in children can be a truly frightening experience. An asthma attack is bad enough in adults. It can cause acute distress to a child who is yet to reach a basic level of understanding.

An estimated five million children in America suffer from asthma. Asthma in children usually manifests by age five or earlier. Boys tend to have a higher incidence of the disease than girls.

The vast majority of pediatric asthma cases – around 80% of them – are caused by allergies. The child usually inhales the allergen, which triggers a series of biochemical reactions that results in an asthma attack. For this reason, the single most important factor in managing asthma in children is to identify the specific allergen/s that triggers the disease and to avoid exposure to those substances.

Child asthma attacks

If the child has other health conditions like sinusitis or rhinitis, it can increase the frequency and severity of asthma attacks. Conditions like gastroesophageal reflux disease (GERD) can cause asthma to worsen. Certain medications like aspirin as well as beta blockers (used to control hypertension) are known to worsen asthma.

In general, triggers for asthma in children are similar to those for adults and may include the following.

  • Dust and dust mites

  • Mould and fungi

  • Animal dander

  • Cockroach parts

  • Pollen from trees, weeds, grass, etc

  • Wood smoke

  • Second hand tobacco smoke

  • Strong fumes or odors including paint fumes, industrial pollutants and perfumes

Apart from the above, asthma attacks in children can also be triggered by high levels of stress or anxiety, exercise (this is called exercise-induced asthma) and cold air.

There are several risk factors that predispose children to developing asthma. Low birth weight is one. So is the presence of asthma in close relatives or having a family history of allergies. If the mother is exposed to tobacco smoke during pregnancy or if the child is exposed to it after birth, it can lead to a higher risk of developing asthma. If the child is allergic to one or more substances, that can heighten chances of becoming asthmatic. Infections affecting the respiratory tract can also increase the risk, particularly if such infections occur repeatedly.

Controlling asthma in children involves two kinds of treatments – quick-acting medication to relieve symptoms when attacks occur and ongoing treatment aimed at preventing asthma attacks. Both are equally important. Quick-relief medications should be available at all times to deal with attacks.

If the child has persistent symptoms, the doctor may prescribe anti-inflammatory drugs as well.

When a child has a severe asthma attack, treatment should be given as quickly as possible with minimum loss of time. If the attack is severe enough, it may be necessary to give oxygen as well. A beta-receptor agonist prescribed by the doctor should be inhaled continuously, where required.

The doctor will prescribe a specific asthma treatment plan for the child. He will then monitor the child regularly to observe if the plan is effective, measuring lung function using spirometry. If the disease has been brought under control for a period of time, the doctor may adjust the medication accordingly. If there is no improvement, he may prescribe another course of treatment.

With the right care, asthma in children can be brought under control in a majority of cases. Asthma attacks usually respond well to medication and the child can breathe easy again.

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