2. ASTHMA FOUNDATIONS
Asthma medications and delivery devices
To manage your asthma effectively, it is
important that you know what asthma is and
how the different medications and delivery
devices work. This presentation describes
asthma medications and delivery devices in
detail.
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What is asthma?
People with asthma have sensitive airways
in their lungs. When exposed to certain
triggers their airways narrow, making it hard
for them to breathe.
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Three main factors cause the airways to
become narrow:
⢠The inside lining of the airways becomes red
and swollen (inflammation)
⢠Extra mucus (sticky fluid) may be produced
⢠The muscle around the airways tightens
(bronchoconstriction)
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ď Preventers make the airways less sensitive,
reduce the redness and swelling inside the
airways and dry up the mucus. It may take a
few weeks for preventers to reach their
optimal effect.
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ď Preventers must be taken daily to keep you
well, reduce the risk of asthma attacks and to
prevent lung damage. A number of these
medications are corticosteroids (more
commonly known as âsteroidsâ). They are
similar to steroids that we produce naturally in
our bodies. They are not the
same as the anabolic steroids misused by
some athletes.
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Important points to remember
Some people may only need preventers for
a set period while other people need to take
preventers all year round.
Preventers need to be taken at the same
time each day at the dosage prescribed by
your doctor
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Preventers take time to work, so
improvement in your symptoms may not be
noticed for a couple of weeks. Do not stop
taking your preventer medication after only a
few days.
When you are well (no asthma symptoms
and rarely using your blue reliever), talk to
your doctor about a review of your
medications.
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Make sure you ask your doctor if you have
any questions or concerns about your
asthma medication and/or asthma delivery
devices
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2. Relievers
ď Inhaled medications â Airomir, Asmol,
Bricanyl, Epaq, Ventolin (blue)
Relievers provide relief from asthma
symptoms within minutes. They relax the
muscles around the airways for up to four
hours, allowing air to move easily through the
airways.
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Treatment of acute asthma
ď When there is little response to relievers, your doctor
may prescribe a short course of oral steroids in liquid
or tablet form (Prednisolone/Prednisone). These are
used to reduce the inflammation in the airways and
quickly regain control of asthma in an acute attack or
when symptoms persist.
ď They are usually given for short periods of 2 to 14
days and are generally free of significant side effects.
People with severe persistent asthma may require
oral steroids for longer periods, which may result in
side effects. Ask your doctor for further information.
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3. Symptom controllers
ď Inhaled medications â Foradile (pale blue),
Oxis, Serevent (green)
Symptom controllers (also called Long Acting
Relievers) help to relax the muscles around the
airways for up to 12 hours. They are taken daily
and are only prescribed for people who are
taking regular inhaled âsteroidâ preventers.
17. ASTHMA
Combination medications
ď Inhaled medications â Seretide (Flixotide and
Serevent - purple), Symbicort (Pulmicort and
Oxis - red)
These medications combine a preventer with a
symptom controller in the same delivery device.
Combination medications need to be taken at
the same time each day at the dosage
prescribed by your doctor.
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Important points
ď Always carry your blue reliever medication. It is
the only medication to use in an asthma
emergency
ď If you are using your reliever medication more
than three times per week to ease asthma
symptoms it may be a sign that your asthma is
not well controlled. Check with your doctor
19. ASTHMA
Getting the most out of your asthma
medications
The aim of delivery devices is to get the
maximum amount of medication into your
lungs with minimum side effects. It is
important to:
ď Know how to care for and clean your medication
devices
ď Ensure there is medication left in your device
ď Ensure that your medication has not expired
20. ASTHMA
ď Use a spacer with a puffer to minimise side
effects and deliver more medication to your
lungs (a spacer is a device shaped like a
clear plastic football or tube into which you
fire medication from a puffer and inhale)
ď Use your inhaler correctly. Have your
technique regularly checked by your doctor,
pharmacist or asthma educator
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How are asthma medications taken?
ď Asthma medications can be inhaled
(breathed in) or taken orally (swallowed).
Most people use inhaled asthma medication
because:
ď Medication goes directly to the lungs
ď Smaller doses can be given so there are
fewer side effects
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ď Inhalers need to be used correctly to ensure
maximum benefits are achieved. This means
that:
ď Asthma improves more rapidly
ď Better control is maintained
ď Less medication is needed
ď Fewer side effects are experienced
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There are two types of inhalers:
ď 1. Aerosol inhaler (puffer)
ď 2. Dry powder inhaler
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1. Aerosol inhalers
ď These inhalers use an aerosol canister to
produce a fine mist of medication. There are
two types:
1.1 Puffers - press and breathe
1.2 Autohalers - as you breathe in your
breath will activate the device
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1.1 Puffer
Using your puffer
ď 1. Remove the cover from the puffer mouthpiece
ď 2. Hold the puffer upright and shake vigorously
ď 3. Breathe out
ď 4. Tilt the chin up
ď 5. Put the puffer mouthpiece in your mouth and
ď create a seal with your lips
ď 6. Start to breathe in through your mouth, then fire
one puff of medication and continue to breathe in
steadily and deeply
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7. Remove the puffer from your mouth, close your
mouth and hold your breath for 10 seconds
8. Breathe out through your nose
9. Replace the cover
10. To take more medication repeat steps 2 â 8
Puffers require good coordination so it is important
to press own on the canister and breathe in at the
same time.
More medication gets into the lungs when a puffer is
used with a spacer device.
28. ASTHMA
Cleaning your puffer
1. Remove metal canister. Do not wash
canister
2. Wash the plastic casing only. Rinse the
mouthpiece through the top and bottom under
warm running water for at least 30 seconds.
Wash mouthpiece cover
3. Allow to air dry
4. Reassemble
30. ASTHMA
Spacer
It is recommended that all puffers are used
with a spacer. A spacer is a special device
shaped like a clear plastic football or tube.
Puffer medications are fired into this device
and then the medication is inhaled through a
facemask or mouthpiece.
32. ASTHMA
Using your spacer
1. Assemble the spacer (if not already
assembled)
2. Remove the cap from the puffer and shake
the puffer well
3. Attach the puffer to the end of the spacer
4. Place the mouthpiece of the spacer in your
mouth and close your lips around it. If using a
spacer with a facemask, place the facemask
over the mouth and nose to ensure a good seal
33. ASTHMA
5. Press down on the puffer canister once to
fire the medication into the spacer
6. Breathe in and out normally for 4 breaths,
or breathe in for 5 seconds, hold for 10
seconds and breathe out
7. To take more medication, shake the puffer
and repeat steps 3-6
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Cleaning your spacer
About every month the spacer should be
washed in clean hot soapy water and allowed to
drip dry. Do not rinse or wipe dry.
Using a spacer helps control asthma because:
ď There are fewer side effects from the
medication
ď It is easier to use as it requires less coordination
than a puffer alone
ď More medication is inhaled into the lungs
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2. Dry powder inhalers
Dry powder inhalers require a deep
inhalation to get the medication into your
lungs. They include:
2.1 Turbuhaler
2.2 Accuhaler
2.3 Aerolizer
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Important points
⢠Always hold the devices upright when loading
the medication. This stops the powder from
falling out
⢠Always check the amount of medication left in
your device. Doses may be indicated on the
device
⢠Keep dry powder devices away from moisture
and do not blow into them
⢠Correct inhaler use is very important. Have
your technique checked regularly by your doctor
pharmacist or asthma educator
38. ASTHMA
2.1 Turbuhaler
When using a Turbuhaler a deep inhaled
breath is required to get the medication into the
lungs. This may be difficult for young children
and adults who are short of breath. It is wise to
have a puffer and spacer available for
emergencies.
The indicator on the side of the device will
either highlight the doses left in the device
(Symbicort) or it will appear red to indicate that it
is nearly empty (Bricanyl, Pulmicort and Oxis).
40. ASTHMA
2.2 Accuhaler
The indicator on the device shows how
many doses are left
1. Hold the Accuhaler by its base in one
hand
2. Place the thumb of the other hand in the
thumb grip
3. Open the Accuhaler by pushing the thumb
grip around until it clicks
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5. Breathe out away from the accuhaler
6. Put the mouthpiece in the mouth ensuring a
good seal is formed with the lips
7. Breathe in steadily through your mouth for
approximately 5 seconds
8. Remove the Accuhaler from your mouth and
hold your breath for approximately 10 seconds
9. Breathe out slowly
10. Close Accuhaler
11. To take more medication repeat steps 2 - 9
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ď 2.3 Aerolizer
The Aerolizer (used only for Foradile)
contains powdered medication in a capsule.
The medication is released when the blue
buttons on the base are pressed, piercing the
capsule.
45. ASTHMA
Using an Aerolizer correctly
1. Lift off the blue cap
2. Hold the blue base with one hand and
with the other grasp the white mouthpiece
and turn in the direction of the arrow
3. Remove a capsule from the blister pack
and place in the slot inside the blue base
4. Twist the mouthpiece back into place
46. ASTHMA
5. Hold the Aerolizer upright and firmly
squeeze the two blue buttons on the side
until the capsule is pierced
6. Breathe out away from the mouthpiece
7. Place the mouthpiece in your mouth
sealing the lips around it
8. Inhale deeply for approximately 5 seconds
47. ASTHMA
9. Remove the mouthpiece from your mouth
and hold your breath for approximately 10
seconds
10. Breathe out slowly
11. Remove the used capsule and replace blue
cap
12. To take more medication repeat steps 2 - 11
When inhaling medication, you should be able
to hear the capsule rattling inside the Aerolizer.
48. ASTHMA
Nebulisers
Nebulisers convert liquid medication into a fine
mist that is inhaled through a mask or
mouthpiece. The airflow and pressure of a
nebuliser should be checked regularly (at least
once a year). Depending on use, disposable
nebuliser bowls may need replacing every three
months. It is advisable to always have a spare
bowl. Nebuliser filters should be changed and
the machine serviced according to the
manufacturerâs instructions.
49. ASTHMA
Ask your doctor, nurse, pharmacist or
asthma educator for advice on how to use a
nebuliser if it is prescribed for you.
Most people DO NOT need to have a
nebuliser at home.
Appropriate doses of medication given via a
puffer and spacer are just as effective as
using a nebuliser. For more information talk
to your doctor or local Asthma Foundation
51. ASTHMA
Managing your asthma effectively
⢠Find a doctor who has a keen interest in
asthma and have regular reviews of your
asthma
⢠Ask your doctor for a written Asthma
Action Plan
⢠Avoid things that make your asthma worse
(triggers - other than exercise)
⢠Know your asthma symptoms and how to
treat them
52. ASTHMA
⢠Make sure you use asthma medications
correctly
⢠Recognise signs of worsening asthma and
follow your written Asthma Action Plan
⢠Know your Asthma First Aid Plan and how
to use it
⢠Inform your family members about your
asthma and how they can provide Asthma
First Aid
54. ASTHMA
What is an Asthma Action Plan?
An Asthma Action Plan is a written set of
instructions prepared in partnership with your
doctor that assists you to manage your
asthma at different times. Your plan should
help you to:
⢠Recognise worsening asthma symptoms
⢠Start treatment quickly
⢠Seek the right medical assistance
55. ASTHMA
ASTHMA FIRST AID PLAN
Step 1. Sit the person upright and give reassurance.
Do not leave them alone.
Step 2. Without delay give 4 separate puffs of a blue
reliever (Airomir, Asmol, Epaq or Ventolin)*.
The medication is best given one puff at a time via a
spacer device**. Ask the person to take 4 breaths from
the spacer after each puff of medication.
57. ASTHMA
Step 3. Wait 4 minutes. If there is little or no
improvement repeat steps 2 and 3.
Step 4. If there is still no improvement call an ambulance
immediately (DIAL 000). Continuously repeat steps 2 and
3 while waiting for the ambulance.
* A Bricanyl Turbuhaler may be used in first aid
treatment if a puffer and spacer is unavailable. ** If a
spacer is not available, simply use the puffer on its own.
58. ASTHMA
Peak flow meter
How to use a peak flow meter
Your doctor, or other health professional such as a nurse,
pharmacist or asthma educator, will show you how to use
your peak flow meter correctly.
These are the key steps to using the meter:
1 Stand up.
2 Hold the peak flow meter level, so that the indicator
faces upwards. Make sure the indicator is on zero or
âstartâ.
3 Take in as deep a breath as possible.
60. ASTHMA
4 Place your lips tightly around the
mouthpiece and blow as hard and fast as
you can.
5 Check your score on the meter.
6 Repeat steps 1-5 two more times.
7 Record the highest score out of the three
scores.
62. ASTHMA
If your airways are narrower than usual, the peak
flow meter will have a lower score than your âbestâ.
When your airways are wide open, the score will be
at or close to your âbestâ. What each person should
score depends on their height, age and sex and so
will vary from person to person.
Always use the same peak flow meter for each
measurement as readings may vary between
different peak flow meters. It is a good idea to take
your own peak flow meter with you when you visit
your doctor.
63. ASTHMA
Other times you may need to use a peak flow meter a peak flow
meter may be useful in monitoring any change in your asthma
when:
1 You leave hospital.
2 You need to take your blue reliever puffer more often.
3 You are getting a cold or you don't feel as well as usual.
4 You have been near a known trigger.
5 Your medication is changed or new medication is started.
6 You are waking at night with your asthma (a sign of poorly
controlled asthma).
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Further information
Asthma Foundations of Australia Contact your local Asthma
Foundation on 1800 645 130 or visit their websites:
Asthma Australia www.asthmaaustralia.org.au
Asthma Foundation of the ACT www.asthmaact.org.au
Asthma Foundation of New South Wales www.asthmansw.org.au
Asthma Foundation of Northern Territory www.asthmant.org.au
Asthma Foundation of Queensland www.asthmaqld.org.au
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Asthma Foundation of South Australia
www.asthmasa.org.au
Asthma Foundation of Tasmania www.asthmatas.org.au
Asthma Foundation of Victoria www.asthma.org.au
Asthma Foundation of Western Australia
www.asthmawa.org.au
National Asthma Council www.NationalAsthma.org.au
Asthma http://www.health.gov.au
HealthInsite www.healthinsite.gov.au
Australasian Society of Clinical Immunology and
Allergy www.allergy.org.au
66. ASTHMA
Š Copyright Asthma Foundations of Australia
June 2008
Reproduction for educational purposes is
permitted.
This resource satisfies the guidelines and
standards approved by the National Asthma
Council and Asthma Foundations of
Australia.
