1. Linda Cherry Community Respiratory Practitioner.
Asthma
Linda Cherry
Community Respiratory Practitioner.

2. What is Asthma
Asthma is a long-term condition that affects the airways.
In Asthma the airways are more sensitive to irritants such as pollen, dust, pets, cigarette smoke, fog, plaster dust, chest infections and even changes in the weather.
There is no cure for Asthma but it can be controlled.

4. Irritants cause the airways to swell, narrow and produce mucus

5. Main Symptoms Coughing Wheezing / chest tightness Breathlessness
Difficulty in breathing in or out
Increase in mucus production this narrows the airways further.
Symptoms may be mild, moderate or severe.
These symptoms may come and go.

6. How is Asthma diagnosed?
Can be difficult as Asthma symptoms can vary from day to day.
Taking a history is important: includes night to day variation, exercise, triggers & current medications.
Also important is family history, hayfever,eczema or food allergies.

7. Tests
Peak Flow
Spiromety/ reversability

8. Treatment Is based on history, PEFR and spirometry results.
Trial of preventative inhaled therapy
(Steriod) for 6-8 weeks.
Or a course of oral steriods for 2 weeks.
PEFR is recorded twice a day whilst treatment in progress.
spirometry repeated at the end of trial.

9. On going treatment Step wise approach.
Preventer inhaler (steriod) Main treatment for Asthma. Prevents and reduces any inflammation within the airways.
Combination inhaler (steriod +reliever) relieves symptoms of asthma and reduces inflammation in the airways.
Severe asthma – may need antibiotics and steriods.

10. Yearly reviews
Yearly Asthma reviews to check inhaler techniques, spacers, PEFR & spirometry .
Any symptoms over the last month,such as breathlessness, disturbed sleep at night and use of rescue medication.
How many inhalers have been prescribed since last Asthma review.
Complete / update Asthma Action Plan.
What to do in an emergency.

12. IMPROVING INHALER TECHNIQUES Respiratory Team Scarborough Hospital
“Assessing inhaler technique should happen at the first prescription and then be reassessed regularly throughout primary, community and secondary care services “
NICE COPD Quality Statement
“An assessment of inhaler technique to ensure effectiveness should be routinely undertaken and
formally documented at annual review”
National Review of Asthma Deaths (May 2014)
7 Steps
Metered Dose Inhalers
Metered Dose Inhaler with Spacer
Dry Powder Inhalers
1 Remove mouthpiece cover
2 Prepare: Shake the inhaler
3 Breathe out as far as possible
4 Place inhaler in mouth and close lips around it
5 As you breathe in press canister and continue breathing in slow and steady
6 Remove inhaler from mouth and hold breath for up to 10 seconds
7. Wait a few seconds before repeating dose if necessary. Replace mouthpiece cover.
1. Remove cap
2 Prepare: shake inhaler and insert into spacer through hole at the end
3. Breathe out gently as far as is comfortable
4. Place spacer mouthpiece in mouth and close lips around it
5. Press canister down and breathe normally for 5 breaths in and out
6. Remove spacer from mouth
7. Wait a few seconds and repeat if necessary Replace mouthpiece cover.
1. Prepare the inhaler device (remove cap)
2. Prepare or load the dose
3. Breathe out fully and gently, but not into the inhaler
4. Place inhaler mouthpiece in mouth and seal lips around mouthpiece
5. Breathe in quick and deep
6. Remove inhaler from mouth and hold breath for up to 10 seconds
7. Wait a few seconds and repeat if necessary. Replace cap
Acknowledgement:
Anna Murphy, Senior Pharmacist, Leicester
Owner: K Braviner and L Francis , Respiratory Unit Scarborough v1 May 2017

13. Spacer devices

14. Is asthma a serious condition?
Tragically, three people die every day because of asthma attacks and research shows that two thirds of asthma deaths are preventable. 
The reassuring fact is that most people with asthma who get the right treatment - and take it correctly - can manage their symptoms and get on with what they want to do in life.