Conquering asthma

Conquering asthma

AS discussed in last week’s article, the success of Asthma control lies predominantly on the correct use of the Inhaler (Peipi). Incorrect technique when taking inhaled medications frequently prevents patients with asthma from receiving the maximal benefit from their medications. This week we delve more into effective use of inhalers and home-made spacer mostly used by children.

Quick steps on appropriate use of the Asthma inhaler:

  • Take the cap off your inhaler and shake it vigorously for a few seconds.
  • Hold the inhaler with your index finger on top of the canister and thumb on the bottom of the plastic mouthpiece.
  • Sit up straight or stand up. Tilt your head back slightly and breathe out all the way.
  • Open your mouth wide, and place the inhaler in your mouth, between your teeth, tongue flat
  • Breathe in and out one time.
  • Press the metal canister down and breathe as deeply as you can for about 3 to 5 seconds
  • Hold your breath for 5 to 10 seconds, then breathe out slowly using your mouth.
  • Wait at least a minute, then repeat for the second puff if your doctor has prescribed 2 puffs.
  • Replace the cap on your inhaler when you’re finished. If your inhaler contains a steroid, gargle and rinse your mouth with water after each use to avoid oral thrush.

Please note that if you’ve successfully inhaled the medicine, you shouldn’t notice a strong chemical taste in your mouth — although a small after-taste is normal.

A modified 500ml plastic bottle spacer

Various commercially produced spacers exist but expense have restricted their use in resource-limited settings. A modified 500 ml plastic bottle can be an effective spacer for therapy in children of all ages.

How to make the bottle spacer

  • Wash the bottle with soap and water and air dry for a minimum of 12 hours
  • Make a wire mould similar in size and shape to the mouthpiece of the Metered Dose Inhaler (MDI) Peipi
  • Heat the mould and hold in position on the outside of the base of the plastic bottle until the plastic begins to melt (~10 seconds). Rotate the mould and reapply to the bottle until the mould melts through to make a hole.
  • While the bottle is still warm, insert the MDI (Peipi) into the hole to ensure a tight fit between the MDI and bottle spacer.

How to use the bottle spacer

  • Insert the MDI into the hole at the base of the bottle spacer.
  • Hold the neck of the bottle spacer in the child’s mouth, simulating a mouthpiece and making it easier to direct the aerosol into the airways
  • Give the child a single puff of the MDI with the spacer, followed by normal breathing, and repeat until the desired amount of medicine is given.

Key points to note

  • Most patients with asthma do not use their inhalers properly, and most have not had their technique checked or corrected by a health professional
  • Incorrect inhaler technique when using maintenance treatments increases the risk of severe flare-ups and hospitalisation for people with asthma
  • Among other causes, poor asthma symptom control is often due to incorrect inhaler technique
  • Incorrect inhaler technique when using inhaled corticosteroids increases the risk of side-effects like dysphonia (hoarse voice), and oral thrush.
  • Inhaler technique should always be checked before considering stepping up medication or assuming treatment failure.

Retsélisitsoe Nkhahle

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