Asthma Parent and Carer Information
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Asthma Parent and Carer Information
Contents
4 What is Asthma? 18 Types of Delivery
4 The Causes of Asthma Devices for Medication
4 What Happens During an and How to Use Them
Asthma Attack? 18 Metered Dose Inhalers (MDl) or
Puffer Turbuhalers
6 Common Symptoms
18 Spacers
of Asthma
19 How to Use a Spacer with a Mask
7 Different Types of Asthma
20 How to Use a Spacer
9 How to Assess Your Child for Asthma
22 How to Use a MDl or Puffer
10 Trigger Factors 24 Turbuhalers
10 Common Triggers 26 Autohalers
11 Asthma and Smoking 28 Accuhaler
13 How to Minimise Allergens in Your Home
30 Nebulisers
14 Medications 32 Visits to Your Doctor
14 Relievers
and the Role of the
15 Preventers
Asthma Action Plan
16 Symptom Controllers
32 Overview
16 Combination Medication
34 Action Plan
17 Is Asthma Medication Safe?
35 Asthma First Aid
17 Will the Amount of Medication Change?
17 Complementary Medications and Therapy
36 Patient Checklist
38 Notes
38 References Used in Preparing
This Information
38 Useful Websites
page 3
Asthma Parent Information What is Asthma? To define a complex disease in simple terms, asthma is a sensitivity of the airways. Sufferers experience a narrowing of the airways and difficult breathing due to a combination of changes, which include: >> Tightening of the muscles in the wall of the airway >> Swelling of the airway lining >> An increase in mucus production in the airway The Causes of Asthma Despite a great deal of research, the cause of asthma is still unknown. Evidence shows however, that asthmatics have sensitive or ‘twitchy’ airways, which are activated by triggers such as colds, exercise, allergies and cigarette smoke. It is also known that children with parents who suffer from asthma or allergies are at greater risk of developing asthma. Today, with improved treatment and management, the majority of asthmatics can lead a normal active life and be assured of relief from even the most severe attack. What Happens During an Asthma Attack? When an asthma attack starts >> The muscle in the walls of the airway tighten >> The sensitive, inner lining of the airway swells >> Thick mucus (phlegm) is produced in the airway Changes you may notice in your child >> A dry, irritating and persistent cough in conjunction with other changes >> Difficulty in breathing >> Faster breathing >> A wheeze (best heard when breathing out) Are these changes reversible? All of the above can be helped with treatment. The key is to recognise and treat the signs and symptoms of asthma early. page 4
What is Asthma?
Model of Airway in Asthma
Tightening of the
muscles in the
airway walls
Thickening of
the lining of the
bronchiole
Mucus blocking
the airway
page 5
Asthma Parent Information
Common Symptoms of Asthma
Wheeze
A wheeze is the most common sign of asthma
Cough
>> It may be dry and hacking or moist and chesty
>> It can be present day or night, but is often worse at night and present
on waking
>> It may be brought on or made worse by exercise, excitement, laughter
or distress
If not treated, an asthma cough can be present for many weeks. Coughs are
more common during the winter months, especially in young children and may
be triggered or made worse by colds, viral infections and temperature changes
(e.g. chilly air).
Note: Not all coughs are due to asthma. If asthma treatment is unsuccessful,
further investigation may be required.
Difficulty in Breathing, Shortness of Breath or Chest Tightness
Difficulty in breathing occurs due to the extra effort and energy required to move
air in and out of the lungs.
The symptoms of asthma can vary from mild to severe. Some attacks can appear
quickly, while others may take hours or days to develop.
page 6
Common Symptoms of Asthma
Different Types of Asthma
Asthma is a condition that affects individuals in different ways.
Different types of asthma include:
Infrequent Intermittent Asthma
>> This is the most common form of asthma and is often seen in younger children
>> Attacks occur every few months with no symptoms in-between
>> The most common trigger is a viral infection or cold
>> Usually needs treatment only during attacks
Frequent Intermittent Asthma
>> Asthma symptoms occur more often than every 6 - 8 weeks
>> Again, the most common trigger is a viral infection
>> Allergens such as dust or pollen can also be important triggers
>> Symptoms are often a cough and a wheeze (which may be worse at night), and are often not
present between attacks
>> Usually need a preventer medication only in the winter months, when viral infections are
most common
>> Child is well between episodes
Persistent or Chronic Asthma
>> This is the least common form
>> Symptoms occur on most days and may be most obvious overnight or early morning. While
symptoms may not be severe, there may be times when symptoms quickly become severe
>> Exercise will usually trigger symptoms. Good control of symptoms is often obtained with
preventative treatment, but minor breakthrough symptoms can be difficult to control in this
group of people
page 7
Asthma Parent Information Good asthma management aims to: 1. Help keep your child’s lungs healthy. 2. Minimise sickness and time away from school. 3. Enable full participation in daily activities. 4. Use the least amount of medication to control symptoms. 5. Allow normal growth and development. 6. Avoid or minimise the side-effects of medication. Good asthma management is achieved through the use of an Asthma Action Plan and a clear understanding of its goals. Good communication with your nurse and doctor are also essential. page 8
Common Symptoms of Asthma
How to Assess Your Child for Asthma
Firstly, know what is normal for your child. It is important to be aware of how your child looks
and behaves when well, so when symptoms do appear they will be easily recognisable, enabling
you to respond more readily.
You should ask these questions
>> Is my child wheezing?
>> Is my child complaining of chest tightness or saying that it is hard to breathe?
>> Is my child scared because he/she can’t breathe?
>> Is my child able to do the things he/she normally does?
>> Has my child’s behaviour changed i.e. unusually tired or quiet, loss of interest
in things?
>> Is my child short of breath?
>> Is my child able to speak normally?
>> Has my child a persistent cough?
>> Is my child’s breathing faster than normal?
>> Is the area between my child’s ribs being drawn in more than usual?
>> Is my child’s stomach being pulled in when he/she breathes?
>> Are my child’s nostrils moving in and out (nasal flaring)?
>> Is there drawing in at the base of the throat (tracheal tug)?
If the answer to any of the above questions is YES and your child’s medication is NOT helping:
a) Follow your Asthma Action Plan
b) Contact your child’s doctor or an Emergency Department for review.
page 9
Asthma Parent Information Trigger Factors There are a number of different factors that can trigger an attack or make asthma worse. These trigger factors may vary from child to child. Common Triggers Infections At least 85% of asthma attacks are triggered by chest infections, colds and sore throats (upper respiratory tract infections) or the flu. It is recommended that children with persistent asthma and their families have an annual flu vaccination. Temperature Cold temperatures and winds, high or low humidity, sudden changes in weather, air-conditioning and moving between hot and cold environments can all trigger an attack. Exercise People with asthma are encouraged to play sport. While exercising, symptoms of asthma may appear. However, warm-up and cool-down exercises along with medication can be used to prevent or reduce symptoms of exercise-induced asthma. It is recommended that you take your reliever medication up to 10 minutes before exercise. If you become wheezy, short of breath or start to cough during sport or exercise, treat with reliever medication. If there is no response, stop the activity. Allergens (allergies) These include: house-dust, house-dust-mite, pollens, moulds, animal hair, some foods as well as food additives and preservatives. Allergies vary from person to person and can change at different times in a person’s life. It is extremely rare for cow’s milk to cause asthma. It does not increase mucus in the lungs, although this is a common myth. Irritants Fumes from paint, fires and gas appliances along with smoke can trigger asthma in some people and should be avoided. Some cosmetics, hair sprays, soaps and perfumes etc can also trigger asthma. page 10
Trigger Factors
Asthma and Smoking
Smoking and asthma do not mix. Cigarette smoke, with its 4,000 harmful chemicals,
is a major trigger.
What happens if you have asthma and smoke?
>> Smoking makes your asthma worse
>> Smoking may increase your chance of attack
>> Smoking makes your day-to-day asthma control harder to achieve
>> Smoking increases your chances of permanently damaging your airways
Tobacco smoke damages the little hair-like structures (cilia) that help move dust, pollens and
other irritants from your lungs. With the normal cleaning action of your lungs damaged, you are
more prone to chest infections, which in turn may bring-on or worsen your asthma.
How does passive smoking affect you if you have asthma?
Passive smoking occurs when non-smokers breathe in the harmful side-stream smoke of others.
If people around you smoke it can:
>> Trigger an asthma attack
>> Increase the number of asthma attacks you have
>> Increase your need for asthma medications
>> Increase your sensitivity to other environmental triggers (e.g. pet hair, pollens
and chemicals)
>> Reduce your lung function
How does smoking affect your family?
>> Women who smoke during pregnancy pass chemicals in the smoke on to their unborn
babies. These chemicals affect the cells of the developing lungs and increase an infant’s
chances of having lung disorders, such as asthma
>> If asthma is present in the family, smoking around non-smokers in the home can contribute
to the development of asthma and an earlier onset of the disease
>> Children who live in a home with smokers are more likely to have respiratory infections,
a known trigger for asthma
page 11Asthma Parent Information Quit Tips for Smokers Everyone can stop smoking. It’s never too late to quit. Contact Quitline at www.quitsa.org.au or 13 78 48 (24 hour statewide service) for free self- help resources, referral and counselling. It is important to recognise the triggers for your child’s asthma and to avoid them if possible (e.g. cigarette smoke or allergens). If ‘preventer’ medication has been prescribed, take it as prescribed. Remember that when asthma is well controlled, your child should be able to lead a full and active life. Take the time and make the effort to control asthma - don’t let asthma control your child’s life. page 12
Trigger Factors
How to Minimise Allergens in Your Home
This is dependent on your child’s asthma triggers.
Ways of reducing dust and dust-mite
>> Use a damp or oiled cloth when dusting
>> Keep soft toys to a minimum. Wash regularly (or place in freezer overnight) and keep toys off
the bed
>> If possible, do not have carpet in bedrooms. Damp-mop the floor to keep it free of dust
>> Remove sheepskins and woollen underlays
>> Wash sheets and pillowcases weekly. Wash blankets and quilt covers quarterly in hot, soapy
water (over 55°C) - Cold water does not kill house-dust-mite. Tumble-drying on hot for
10 minutes is also useful (over 55°C), if recommended by the manufacturer
>> If you are unable to wash in hot water, use a commercial product containing essential oils
such as tea-tree or eucalyptus oil, formulated to kill dust-mites in cold water. You can also
add a couple of drops of CP Eucalyptus oil to the wash when washing bedding
>> When changing bedding, vacuum the mattress and place in the sun
>> Encase bedding, mattress and pillows in dust-mite-resistant covers
>> Use low allergy bedding such as feather quilt’s and pillows
>> Ensure rooms are well ventilated with plenty of sunlight
>> Use a vacuum cleaner with a triple-filter system and strong suction. Vacuum house weekly
>> Check the dust bag in the vacuum cleaner does not leak
Ways of reducing mould growth
>> Air the house as much as possible
>> If you have a garden or yard, keep it free from fallen leaves
>> Dampen any visible mould with bleach (do not inhale the fumes)
>> Direct the airflow from laundry dryers outside
>> Remove spilt food or drink from surfaces (and animal or plant material that encourages
mould growth)
>> Keep evaporative coolers clean and serviced regularly
>> Keep air-conditioners in your home and car clean and serviced regularly
>> Remove indoor plants
page 13Asthma Parent Information Medications There are three different types of asthma medications used in the treatment of asthma. 1. Reliever medications relax the smooth airway muscles and help them re-open 2. Preventer medications reduce inflammation 3. Symptom controllers control day/night symptoms 4. Combination medications combine a symptom controller and a preventer Relievers Bronchodilators (blue/grey) Reliever medications make breathing easier but don’t have any long-term preventive action. They work by relaxing the small muscles surrounding the narrowed airways allowing them to re-open. The effect is usually quick and noticeable (5 -15 minutes) but short acting (3 - 6 hours). There are several types of reliever medications: Short-acting relievers Used in EMERGENCY situations and to treat asthma symptoms ‘as required’. They include Salbutamol (Ventolin, Epaq, Airomir, Asmol) and Terbutaline (Bricanyl). Ipratropium Bromide (Atrovent) Not commonly used in isolation, but may be used in combination with other medications to increase the effect of other relievers. It promotes bronchodilation and is used in severe asthma. If using both reliever and preventer medication USE THE RELIEVER MEDICATION FIRST. Ipratropium Bromide has a slower onset of action and would therefore not be of immediate benefit. If your child is having difficulty breathing, use short acting reliever medication for relief. Long-acting relievers Used on a REGULAR BASIS for the maintenance of asthma and should not be used alone in a severe attack. Continue taking the usual dose and frequency during an acute attack. Long-acting relievers act for more than 12 hours and include Salmeterol (Serevent) and Eformoterol (Foridile/Oxis). Side effects of relievers include tremors, increased heart rate, excitability, irritability and insomnia. page 14
Medications
Preventers
(orange/brown/yellow/red/white)
These medications work by reducing the sensitivity of the airways, preventing them from
becoming swollen, and decreasing the amount of mucus. They also reduce the sensitivity of the
airways to trigger factors. In this way, they prevent and decrease the severity of attacks.
Preventer medications take time to reach their full effect. They should be taken every day,
whether there are symptoms or not. They must not be stopped and started as symptoms
appear/disappear, unless advised by your doctor. They DO NOT relieve an acute asthma attack.
Preventer Medications include:
Corticosteroids (Pulmicort, Flixotide, Respocort, QVAR, Alvesco)
Inhaled steroids are often used as maintenance treatment for moderate or severe cases of
asthma. They work to reduce the underlying inflammation. In normally prescribed doses,
side effects are minimal but can include hoarseness of the voice, sore throat and oral thrush.
Side effects can be avoided by using a spacer device when inhaling oral medication and
gargling with water afterwards. In larger doses, side effects can be more significant, however,
under-treated asthma can be fatal.
Sodium Cromotoglycate (Intal Forte)
Often used to help prevent mild or moderate exercise-induced asthma. Side effects include
unusual taste and coughing.
Nedocromil Sodium (Tilade)
Often used in mild to moderate asthma. Side effects include unusual taste, coughing and headache.
Montelukast (Singulair)
This preventative medication is taken orally once a day in tablet form. Montelukast has been
used in exercise-induced asthma and night asthma. It also may be used to reduce the dose
of preventer medication. Side effects are uncommon and mild, such as headache and
abdominal pain.
Please discuss these options further with your child’s doctor.
To prevent skin and eye irritation when giving Budesonide (Pulmicort) via a
nebuliser, it is important that your child wears goggles and that his/her face is
washed following administration.
It is best to use a spacer with a corticosteroid puffer to minimise side effects and
maximise lung deposition.
page 15Asthma Parent Information Symptom Controllers (Foradile (pale blue), Oxis, Serevent (green) This type of medication is known as long acting relievers and help to relax the muscles around the airways for up to 12 hours. They are prescribed for children who are already on a preventer medication but are still having asthma symptoms especially at night or with exercise. Symptom controllers should not be used as a short acting reliever. Combination Medication Symbicort (red)/Seretide (purple) This type of medication contains both a preventer medication and a symptom controller (i.e. a corticosteroid and a long-acting bronchodilator). It works by reducing airway sensitivity, preventing airways from becoming swollen and producing mucus. It also helps relax the tiny muscles around the air-way, reducing daily symptoms. These medications should be taken everyday at the same time whether symptoms are present or not. Side effects are minimal but can include increased heart rate and excitability, hoarseness of voice and oral thrush. Some of these side effects can be avoided by using a spacer with the Seretide and by rinsing the mouth with water and spitting out after taking the medication. Oral Steroids (Prednisolone) Usually required to regain control of asthma when there is an acute attack or symptoms persist. When asthma is very severe, they can be used for weeks or months but this is not commonly required. Steroids act by reducing airway swelling. These steroids (corticosteroids) are different from steroids abused by athletes, which are called Anabolic Steroids. When used in short courses of 3 - 5 days, and fewer than 5 - 6 times per year, they are generally considered free of significant side effects. However, oral steroids have the potential for side effects when used in high doses for weeks to months at a time. This treatment and its side effects should be discussed with your child’s doctor. New asthma medications are being developed and trialled all the time. Contact your treating doctor for more information or the Asthma Foundation of SA. page 16
Medications
Is Asthma Medication Safe?
Although side effects occur in some people, asthma medicines are much safer than untreated
or under-treated asthma. They are not addictive.
Will the Amount of Medication Change?
Asthma is a changing condition and as the asthma changes and your child grows;
your doctor may need to increase or decrease the medication. Your child needs to
be reviewed regularly, at least every three months, in order to monitor and control
symptoms and manage side effects.
Complementary Medications and Therapy
>> No alternative medications available for treating asthma have been shown to be effective
in clinical tests
>> These medications may be useful for some people but should not be used in place of
prescribed medications
>> Some people find relaxation exercises beneficial e.g. yoga, hypnotherapy and various
breathing techniques
>> Talk to your doctor before commencing complementary medication or therapy
page 17Asthma Parent Information Types of Delivery Devices for Medication and How to Use Them Medications are mostly given via inhalers or puffers that deliver small amounts of medication straight into the airways. This allows the medication to act more quickly and reduces the risk of side effects. Spacers and other devices are available to help your child use his/her puffer. Metered Dose Inhalers (MDl) or Puffer Turbuhalers Most children need a spacer device to use their puffer effectively. >> Always keep a spare puffer on hand in case your puffer runs out unexpectedly or expires just when your child needs it >> Whether a puffer is used for preventive therapy or in an emergency situation (an acute asthma attack), it is more effective if used with a spacer device Spacers A spacer is a device that helps to deliver medication more effectively. It is a holding chamber. The type of spacer and technique used is dependent on your child’s age, development and understanding. Using a spacer is equally as effective as a nebuliser in most patients and is the preferred way to give asthma medication to both children and adults. The benefits of using a spacer >> Assists in coordination while pressing the puffer and breathing in >> Traps large particles inside the spacer before they reach your child’s mouth (preventing oral thrush and foul taste) >> Allows for evaporation of the medication, reducing particle size and enabling more medication to reach the lungs >> Decreases unwanted side effects by reducing the amount of medication swallowed page 18
The types of Delivery Devices for Medication and How to Use Them
How to Use a Spacer with a Mask
(appropriate age: 4 years and under)
1. Remove caps from inhaler and spacer (if applicable).
2. Shake the puffer well - approximately 3 seconds.
3. Insert puffer into the end of the spacer.
4. Attach the mask over the mouthpiece of the spacer and put the mask to your child’s face.
Make sure the mask is sealed tightly over the mouth and nose.
5. Press one dose from the puffer into the spacer.
6. Keep the mask in place until at least four breaths have been taken.
7. Repeat procedure if another dose is required.
Note:
>> Only one puff at a time is to be placed into the spacer
>> When using a spacer, always give reliever medication first,
followed by preventer medication
page 19Asthma Parent Information
How to Use a Spacer
(appropriate age: 4 years and over)
1. Remove caps from inhaler and spacer (if applicable).
2. Shake puffer well - approximately 3 seconds.
3. Insert puffer into the end of the spacer.
4. Place lips tightly around the mouthpiece of the spacer. Tell your child to bite on the
mouthpiece and close his/her lips around it. Breathe out into the spacer.
5. Press one dose from the puffer into the spacer.
6. Ask your child to take a slow, deep breath in through the mouthpiece. When your child’s
lungs are full, instruct him/her to hold their breath for ten seconds if able.
7. If unable to complete step 6 your child should take 4 normal breaths in and out.
8. Repeat the procedure if another dose is required.
page 20The types of Delivery Devices for Medication and How to Use Them
When to Clean Your Spacer
>> Spacers require cleaning weekly, or as recommended by the manufacturer
How to Clean Your Spacer
Wash in warm soapy water. Do not rinse.
>> Leave to dry overnight or dry with a hairdryer. Do not dry with a tea-towel
>> Some spacers have a detachable valve. This valve is easily damaged and/or lost. Without a
valve, the spacer is unable to function. To clean the valve, wash in tepid water and leave on a
flat surface to dry. Replace the valve immediately when dry
>> Spacers should be replaced annually
page 21Asthma Parent Information
How to Use a MDl or Puffer
(closed mouth puffer
technique)
Children under the age of 8 MUST USE the
Spacer Device with a Metered Dose Inhaler.
See Page 20. It is recommended that
ALL asthmatic’s use a spacer as it helps
medication delivery to the lungs.
1. Remove cap.
2. Shake puffer well - approximately
3 seconds.
3. Hold inhaler upright (with
mouthpiece down).
4. Place lips tightly around mouthpiece.
Ask your child to bite on the canister
and close his/her lips around it.
5. Breathe out gently into the puffer.
6. Press the puffer once, at the start of a
slow, deep breath in.
7. Hold breath for ten seconds.
8. Breathe out gently.
9. Wait one minute before taking the next
puff, following the above steps.
10. Replace cap.
The correct puffer technique is essential for
medication to reach the airways and work
effectively.
NOTE: It is recommended that all
asthmatics should use a spacer for
medication delivery.
page 22The types of Delivery Devices for Medication and How to Use Them
When to Clean Your Puffer
>> Requires cleaning at least weekly
How to Clean Your Puffer
>> Remove the medication cylinder from the mouthpiece - do not wash medication cylinder
>> Wash the mouthpiece in warm soapy water. Rinse thoroughly
>> Dry in the sun or with a hair dryer. Ensure that it is completely dry, with no residual
fluff or dust
>> Check the expiry date (‘valid to end of month’ is written on the cylinder)
>> Replace all ports and put the cap on
There is no effective way to test how much is left in a puffer, however some puffers
(eg. Seretide) have counters. Shaking it will give you an indication, as will keeping track
of how many times you use it. If you are unsure, use a new puffer. Always keep a new
puffer on hand.
page 23Asthma Parent Information
Turbuhalers
(appropriate age: 6 years and over)
Turbuhalers provide a single dose and need
to be reloaded for each dose given.
How to Use a Turbuhaler
1. Remove cap.
2. While holding the Turbuhaler upright,
twist the grip to the right, then to the
left. Listen for the click.
3. Before placing the Turbuhaler into your
child’s mouth, ask him/her to breathe
out gently. The child MUST NOT blow
into the Turbuhaler before inhaling
the medicine.
4. Place the mouthpiece into your child’s
mouth and ask him/her to breathe
in forcefully and deeply - remove
Turbuhaler from mouth before
breathing out gently.
5. If a second dose is required, wait one
minute and repeat steps 2, 3 & 4.
6. Wipe mouthpiece, replace the cap and
screw it shut.
NOTE: The delivery of the medication
depends on a deep breath in. Most
children under the age of 6 are unable to
take a deep enough breath, and therefore
are unlikely to be able to use a Turbuhaler
effectively.
page 24The types of Delivery Devices for Medication and How to Use Them
When to Clean Your Turbuhaler
>> Requires cleaning at least weekly
How to Clean Your Turbuhaler
>> Wipe the mouthpiece with a dry cloth or tissue AFTER EACH USE
>> Ensure it is always kept dry as the powder becomes inactive when wet
>> Always keep the lid on when not in use
>> A reliever Turbuhaler cannot be used for asthma first aid. Always keep a puffer and spacer on
hand for first aid use
How to Identify if Your Turbuhaler is Empty
>> On the side of the Turbuhaler is a dose indicator. When the red indicator appears, it is close
to empty. Buy a new Turbuhaler immediately
>> Some Turbuhalers have a numerical dose counter
page 25Asthma Parent Information
Autohalers (appropriate age:
6 years and over)
How to Use an Autohaler
1. Unclip and remove the mouthpiece cover.
2. Shake the Autohaler well -
approximately 3 seconds.
3. While keeping the Autohaler upright,
push the lever up. It should stay in
this position.
4. Place lips tightly around the
mouthpiece. Tell your child to bite
on the canister and close his/her lips
around it. Ensure your child’s tongue
is under the canister and his/ her teeth
don’t get in the way.
5. Breathe out gently into the Autohaler.
Note: When your child is holding the
Autohaler, ensure that the air entry
holes at the bottom are not blocked off.
6. Ask your child to breathe in with a
slow, deep steady breath. You will
hear a ‘click & whoosh’ sound as the
medication is released. Ask your child to
continue breathing in until he/she has
taken a full breath.
7. Take the Autohaler out of your child’s
mouth and ask him/her to hold their
breath for 10 seconds before breathing
out gently.
8. Gently lower the lever.
9. Wait one minute and repeat the
procedure if another dose is required.
page 26The types of Delivery Devices for Medication and How to Use Them
Note: The delivery of the medication depends on a deep breath in to open the valve and
to release the medication. If you do not hear a ‘click & whoosh’ as your child breathes in,
the medication has not been released.
When to Clean Your Autohaler
>> Requires cleaning at least weekly
How to Clean Your Autohaler
>> Unclip and remove the mouthpiece cover, then rinse the mouthpiece in luke warm water
>> Leave to dry then replace the mouthpiece cover
>> Do NOT push a dry cloth or any other object into the mouthpiece
How to Assess if Your Autohaler is Empty
>> Remove mouthpiece cover. In the upright position, click grey lever upwards
>> Holding the Autohaler upside-down, tap the mouthpiece on the palm of your hand
>> If the Autohaler is NOT empty, you will hear a clear ‘click & whoosh’. You may also feel a
slightly cold sensation on your hand and see a puff of medication. If there is no ‘click &
whoosh’ or cold sensation, then the Autohaler is empty
As you cannot determine when your Autohaler is nearly empty, it is important to always
keep a spare Autohaler on hand.
page 27Asthma Parent Information
Accuhaler (appropriate age:
6 years and over)
How to Use an Accuhaler
1. Open the Accuhaler by placing thumb
in thumb grip and pushing right around
until a click is heard.
2. Slide lever on the right side of Accuhaler
until a click is heard. Medication is now
ready for inhaling.
3. Before placing the Accuhaler into your
child’s mouth, ask him/her to breathe
out gently. The child must not blow out
into the Accuhaler.
4. Place your child’s lips around the
mouthpiece.
5. Ask your child to take a breath in,
forcefully and deeply.
6. Remove Accuhaler from mouth and
hold breath for 10 seconds.
7. Breathe out slowly.
8. Place thumb in thumb grip and slide the
cover around until a click is heard.
9. If a second dose is required repeat the
above steps.
Note: The delivery of the medication
depends on a deep breath in. Most
children under the age of 6 are unable
to take a deep enough breath, and
therefore are unlikely to be able to use an
Accuhaler effectively.
page 28The types of Delivery Devices for Medication and How to Use Them
When to Clean Your Accuhaler
>> Requires cleaning at least once a week
How to Clean Your Accuhaler
>> Wipe mouthpiece with a dry cloth
>> Ensure Accuhaler is always kept dry as moist powder will block the Accuhaler
>> Always keep lid shut when device is not in use
How to Determine if Your Accuhaler is Empty
On the top of your Accuhaler is a number, which corresponds to doses left. When the number
falls to 5, another Accuhaler should be obtained.
page 29Asthma Parent Information
Nebulisers
A nebuliser is a pump used to give liquid
medication as a fine mist. Air is pumped
through the liquid under pressure to produce
a fine mist, which is then breathed in
through a mask or mouthpiece. Ask a nurse
to show you how to prepare the medication
for your child’s nebuliser.
Note: Nebulisers need only be used in
special circumstances and for very
young children.
page 30The types of Delivery Devices for Medication and How to Use Them
8 Points to Remember When Using a Nebuliser
1. Breathe through the mouth when taking medication. A mouthpiece is encouraged for
anyone over 5 years, and a mask for anyone under 5 years.
2. The pump will take approximately 10 minutes to deliver the medication. When the mist
stops, the mask/mouthpiece can be removed and the pump switched off.
3. After each use, rinse the mask/mouthpiece and bowl in hot soapy water and leave to dry.
Do not rinse tubing.
4. Store equipment in an airtight container.
5. Nebuliser bowls need to be replaced quarterly.
6. A pump should have a flow rate of at least 6 - 8 litres/min.
7. Service pump and check flow rate annually (contact Asthma Foundation of SA for your
nearest location).
8. Do not place nebuliser pump on the floor. This will increase the amount of dust drawn
through the machine.
page 31Asthma Parent Information Visits to Your Doctor and the Role of the Asthma Action Plan Overview Asthma control is a patient-parent-doctor partnership. It can take a few months to get your child’s treatment right. There is a great deal to discuss so be prepared for several visits. It is best to try to see the same doctor each time. Information is the key to management Good asthma management partly depends upon the information you can give your doctor. Giving a full picture of your child’s condition means your doctor is better able to plan management. This information can take many forms such as: >> The events leading up to an attack or worsening of your child’s condition >> Triggers that bring on your child’s symptoms >> Night symptoms >> Your child’s response to medication taken page 32
Visits to Your Doctor and the Role of the Asthma Action Plan
Ongoing review
Visit the same doctor on a regular basis to review your child’s condition and fine-tune the
management plan. At each appointment:
>> Prepare a list of questions. If you are uncertain about what you have been told, ask for
clarification or further explanation until you completely understand (See Asthma Patient
Checklist page 36)
>> Tell your doctor about any changes in your child’s condition and what you feel may have
caused them
>> If you have a long list of questions for your next visit, arrange for a longer appointment so
there is no need to rush
page 33Asthma Parent Information Action Plan An Asthma Action Plan is a response to worsening asthma in your child and explains step- by-step what to do when it occurs. It is important that the plan is individualised to suit the pattern and severity of your child’s asthma. The essential elements of an Action Plan are that you must: >> Be able to recognise worsening asthma >> Have an individualised plan >> Know how to obtain medical assistance quickly >> Have the Action Plan reviewed and, if necessary, modified following an acute asthma attack >> Bring your Action Plan with you to all review appointments Asthma Action Plans are based on symptoms alone in younger children. Sometimes, peak flow measurements are used for adolescents. This should be discussed with your young person’s doctor. It is important to understand that acute asthma attacks are frequently triggered by events beyond one’s control (e.g. colds or chest infections). It is important that your child’s teacher and carers are aware of his/her condition. They should be provided with clearly labelled reliever medication (blue/grey puffer), and a current Asthma Action Plan signed by your child’s doctor. It is wise to be a member of an ambulance fund in case your child is ever in need of urgent medical treatment and requires transportation to hospital. It is also worthwhile completing a recognised first aid course. page 34
Visits to Your Doctor and the Role of the Asthma Action Plan
Asthma First Aid
If you do not have an individualised asthma action plan and your child is having difficulty
breathing or his/her asthma is become worse, follow the Asthma First Aid Plan as shown below.
If a child is having difficulty breathing and it is unknown whether that child has asthma, no harm
is likely to result from giving reliever medication as a first aid measure. In this situation call an
ambulance immediately by dialing 000 (triple zero).
Asthma First Aid Plan
1. Sit the person upright and give reassurance.
2. Do NOT leave the person alone.
3. Without delay give 4 separate puffs of a blue reliever. 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. If no spacer is available, use the puffer alone.
4. Wait 4 minutes. If there is little or no improvement repeat steps 3 and 4.
5. If there is still no improvement call an ambulance immediately by dialing 000 (triple zero).
6. Continuously repeat steps 2 and 3 while waiting for the ambulance.
Asthma First Aid Plan adapted from the Asthma Pocket Guide produced by the Asthma
Foundation of SA.
page 35Asthma Parent Information
Patient Checklist
Do you understand what asthma is?
Ask your doctor/nurse to explain what happens in your child’s airways, and what is
happening during an asthma attack.
Do you know what triggers your child’s asthma?
Asthma affects people in different ways, but it is helpful to think back over what
occurred just prior to your child’s attacks (e.g. when visiting a friend with a live-in
pet). If this factor affects your child the same way again, it can be classified as a
trigger and should be avoided.
Do you know the names of your child’s asthma
medications?
Ask your doctor/nurse to write down the names of your child’s medications and the
part they play in controlling asthma.
Do you know how much medication your child
should take?
Knowing when to increase or change your child’s medication can be a vital factor
in controlling asthma and leading an active lifestyle. Discuss each medication your
child has been prescribed. Ask the doctor to explain any side effects that may occur.
Do you know the name of your child’s RELIEVER
medication and how it helps?
Short acting ‘reliever’ medication is used for immediate relief in the event of an
attack (it generally comes in a blue/grey coloured container).
Do you know the names of your child’s PREVENTER
medications?
These medications need to be taken daily and it may be some weeks before
improvement is noticeable. They are of NO BENEFIT in an acute attack
(they are generally in an Autumn-coloured container). Some preventers
come as tablets.
page 36Patient Checklist
Do you know how your child’s preventer medication works?
Ask the doctor/nurse to tell you what each medication does in controlling asthma.
If your child uses a puffer, Turbuhaler or spacer, has the
doctor/nurse checked your child’s technique recently?
Using these devices incorrectly can make you believe your child is receiving medication
when he/she is not, and could lead to ineffective treat-ment. Have the doctor/nurse observe
your child use the device to see if it is being used correctly.
Do you know the signs and symptoms that indicate your
child’s asthma is becoming worse? These include:
>> A dry cough that keeps coming back
>> Any shortness-of-breath after minor physical activity
Discuss the above with your doctor/nurse and any other signs and symptoms that could
indicate a worsening of your child’s condition.
Do you know what to do when an asthma attack occurs?
Ask your child’s doctor/nurse to go through all the steps in detail.
Do you have an Action Plan?
Ask your doctor to write one for your child.
Do you have an Asthma Plan for school or childcare?
Ask your doctor to write one for your child.
Do you know which doctor is going to manage your child’s
asthma after discharge from hospital?
Do you have a contact number for the doctor and hospital?
Does the hospital have your contact details?
page 37Asthma Parent Information Notes References used in preparing this information National Asthma Council, Asthma Management Handbook 2006 Asthma Australia, Asthma in the Under 5s 2005 National Asthma Council, Asthma and Infant Bedding 2005 National Asthma Council, Asthma And Allergy 2005 Useful websites www.nationalasthma.org.au www.asthmaaustralia.org.au www.asthmasa.org.au www.allergy.org.au Asthma Foundation of SA and the Women’s and Children’s Hospital provide information and support for people with asthma If you are having difficulties with your child’s asthma or you are unsure about your child’s Management Plan, consult: Your Child’s Doctor Phone: Breathe Better Healthline Phone: 1800 645 130 For all Emergencies, Ambulance Phone: 000 (triple zero) For First Aid Courses St John Ambulance Phone: (08) 8306 6900 Australian Red Cross Phone: 1800 246 850 page 38
For more information The Women’s and Children’s Hospital 72 King William Road North Adelaide SA 5006 Office Hours: Respiratory Clinical Practice Consultant Phone: (08) 8161 7000 After Hours: Paediatric Emergency Department Phone: (08) 8161 7000 Asthma Foundation of SA 300 South Road Hilton SA 5033 Telephone: (08) 8238 9300 Breathe Better Healthline Telephone:1800 645 130 www.asthmasa.org.au Non-English speaking: for information in languages other than English, call the interpreting and Translating Centre and ask them to call The Department of Health. This service is available at no cost to you, contact (08) 8226 1990. © Department of Health, Government of South Australia. All rights reserved. ISBN: 0 975781 2 8 Printed December 2008.
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