News-Sentinel.com

Thursday, 05/04/2000

ASTHMA: THE BATTLE TO BREATHE

Medical specifics

Medication and equipment

Asthma medicines fall into two main categories: preventive – also called controllers – and rescuers, which are the bronchodilators. Preventive medications are anti-inflammatories that help prevent or reduce the swelling within the air passages. The airways become less reactive or twitchy. Bronchodilators do not affect the lining inside the airways. These medications relax the muscles around the airways, keeping the walls of the tubes wider for air flow. Medications can be dispensed using any of these devices:

Nebulizer — An electric, aerosol machine used to get asthma medication deep into the lungs. It uses a spray-like device to change liquid medication into a fine mist. Nebulizers with masks are used with children too young to use an inhaler.

Metered-dose inhaler — Delivers a metered amount of medication directly into your lungs. The medicine is kept in a pressurized canister and released in the form of a spray or mist.

Spacer — A spacer is a device that attaches to your inhaler and improves the effectiveness of administering the medication. As you inhale, the column of medicine passes quickly through the mouth and throat to the lungs. A spacer may decrease coughing, gagging and mouth irritation, such as yeast infections, that can occur with some inhaled medications.

Peak flow meter — is used to monitor how well the lungs are functioning. The patient blows into the mouthpiece and a gauge on the device registers the amount of air exhaled. This device is vital for accurately monitoring how well an asthmatic is doing.

InspirEase — a device used by children and people with difficulty holding their breath. The patient inflates the plastic bellows and sprays medicine into it. Then the patient inhales, hold his breath for a count of 5 and then exhales into the device. The device is helpful for young children who have difficulty differentiating between breathing in and breathing out.

Diskhaler — a dry powder inhaler. The medicine is kept in a series of little pouches on a disk. The Diskhaler punctures the pouch and the drug is inhaled through the mouthpiece. It can be used by adults and children over age 6.

Serevent Diskus — Dry powder, long-acting bronchodilating medication is contained in 60 blisters on a foil strip. The patient presses a lever that punctures the blister, allowing the drug to be inhaled through the mouthpiece.

Sources: American Academy of Allergy and Immunology; American Medical Association; Asthma Information Center

Lung tests

According to guidelines of the National Heart Lung and Blood Institute of the National Institutes of Health, if asthma is suspected, physicians should take lung function measurements.

An oximeter is attached to the patient's finger to read blood oxygen levels. For those over age 4 or 5, a peak flow reading — measuring the amount of air in exhalation — is recommended.

A more precise test, called spirometry, which tests how quickly a patient exhales, is recommended at the time of initial assessment. It is also given at intervals after asthma treatment is initiated and symptoms have stabilized.

Peak flow meter

Like a thermometer measures degrees of fever, the peak flow meter is a device used to measure lung function. The amount of air exhaled is called expiratory flow, and asthmatics record their best exhalation among three tries, tracking daily changes in the airway. Children under age 4 or 5 cannot effectively use a peak flow meter.

Red zone

Danger; below 50 percent of your personal best. Use your inhaled bronchodilator, or rescue medication, and contact your physician immediately.

Yellow zone

Caution. Your peak flow is 50-79 percent of your personal best. Your airways may be narrowing and you need to follow your doctor's treatment plan for this zone, which may include an increase in dosages and types of medications.

Green zone

Doing well. Your peak flow is 80-100 percent of your personal best. You are relatively symptom-free and have the "green light" to continue with your current asthma management program.