Every year on May 7 is the World Day to combat bronchial asthma. This disease is very common: according to medical statistics, in developed countries, every fifth person suffers from it. The main link in the treatment of this disease is the correct use of inhalers – devices that allow to deliver medication where they are needed, namely to the small bronchi. How to use them correctly and what are the most common mistakes people make?
How to treat bronchial asthma in the XXI century
Gone are the days when asthma attacks stopped by adrenaline injections, forced to breathe steam from a saucepan and even injected a temperature-raising medication (yes, fever helps reduce bronchial obstruction). Today, the main link in the treatment of this chronic disease is the use of topical preparations that a person inhales through his nose or mouth. A huge plus of this therapy is its topical nature. The active ingredient gets to where it is needed, namely to the bronchial mucosa. It has a local effect, slightly absorbed and penetrates into the central bloodstream, as a result, it has almost no systemic or general effect.
To alleviate the plight of asthma patients, various methods of drug delivery were invented, allowing inhalation to be done quickly, comfortably and conveniently. Considering that a considerable percentage of patients are children and the elderly, the devices were gradually upgraded so that everyone could use them, regardless of age, level of intelligence and memory.
However, doctors are concerned that about a quarter of patients make serious mistakes during inhalation. As a result, less active substance enters their airways than is necessary. This leads to asthma getting out of control, increasing the number of attacks. Consider the basic methods of drug delivery and the rules that all asthma patients need to know.
Nebulizer – effective delivery of drugs directly to the target
The first prototype of the modern nebulizer appeared in 1820. They sprayed water vapor, a pair of resins, various antiseptics and used mainly for the treatment of patients with tuberculosis. The principle of the nebulizer is the grinding of fluid particles to microscopic, which can penetrate to the bronchi of the smallest caliber.
Advantages of nebulizers:
- No need to force a breath or hold your breath. A person simply breathes through a mask or mouthpiece, as he usually does.
- No need to combine inhalation with a click on the case, that is, it is technically easier to use.
- It can be used in seriously ill people and small children, provided that it is possible to agree with them and calm them down.
- The nebulizer is used for emergency care, effective even when the patient is in asthmatic status.
- The device allows you to apply different medication, even several at the same time (for example, Berodual with Lasolvan).
What mistakes make when using nebulizers
- The use of drugs without dilution, when necessary (Berodual, Lasolvan), or with dilution, if it is not necessary (Pulmicort). Usually, the doctor makes clear recommendations as to whether the medicine should be diluted with saline, how many drops of medicine should be poured into the reservoir. Do not engage in amateur.
- Reapply the same solution. If, after inhalation, liquid remains in the reservoir for a certain time, it should be discarded. During the next procedure, it is necessary to prepare a new solution.
- Use of the compressor nebulizer in a prone position. It is not intended for this. If therapy is required for a bed patient or a severely weakened patient, it is worth purchasing ultrasound.
- The use of solutions not intended for inhalation through the nebulizer. A solution of adrenaline, naphazoline, xylometazoline, prednisone, a decoction of herbs, pieces of boiled potatoes, essential oils are not used for this in any case. To do this, there are special dosage forms – solution for inhalation through a nebulizer, as you can always find the corresponding inscription on the package with the drug.
In order to avoid all common mistakes, before using it is worth familiarizing yourself with the instructions for the nebulizer. Do not ignore this point: you can find a lot of useful information in it. Also inside the package with the drug contains information on how to properly dilute it. If something is not clear, you should ask the doctor.
Dosed aerosol inhalers
Metered-dose aerosol inhalers (DAIs) are a modern method of delivering a drug that is compact and suitable for use not only at home but also outside it. If it is impossible to take a nebulizer with you to work or travel, then such an inhaler will not take up much space in your purse. Make one or two inputs can be quickly and completely unnoticed by others. This makes the treatment effective and comfortable. In the form of DAI, a large number of drugs prescribed for asthma are produced: bronchodilators, corticosteroids and combination remedies.
What rules must be followed when applying a metered-dose aerosol inhaler? It is necessary to consistently perform the following points.
- Opening the inhaler,
- Shaking its contents thoroughly;
- Deep breath;
- Proper positioning of the device and head: the aluminum can of the inhaler should be directed up and away from you a little, you should throw your head back (contact of the mouthpiece of the inhaler with the oral cavity is necessary);
- Slow breath;
- The need to press the inhaler at the beginning of the breath;
- Breath hold for about 10 sec .;
- Slow exhalation.
These rules are becoming a serious obstacle to the use of this type of inhalers in children under 5 years of age, elderly people and unconscious people.
Spacers for asthma patients
An improved model of metered-dose aerosol inhalers can be called spacers. They contain a special balloon that is put on the inhaler, and it is through him that a person takes a breath. In it, the temperature of the aerosol becomes higher, moreover, the synchronism between pressing on the case of the inhaler and inhaling is facilitated, which is very important for children and the elderly. In addition, large particles are deposited in the spacer, and small particles penetrate into the patient’s airways and have their effect there.
All these points give spacers an advantage over standard aerosol inhalers. The technique of using them is the same, except that after the procedure it is necessary to rinse the balloon with clean water to avoid accumulation of particles of the drug in it.
Dosed inhalation aerosol inhalers
Beclazon-Eco is a drug that has a more modern form of drug delivery. The principal difference from the previous ones is that the patient can take a breath, and the device is activated automatically. That is, the patient does not need to coordinate the process of inhaling with pressing the case of the inhaler. This greatly facilitates the use, especially in older people who have problems with fine motor skills and memory.
Respimat – a new perfect delivery
The drug Spiriva is produced in an improved form, which is called respima. After the purchase you need to carefully read the instructions, prepare it for the first use. Everything is written very clearly and clearly in the document. After he is ready, you need to bring it to your lips, take a deep breath first, and then inhale while pressing the release button. Next, you need to hold your breath as much as possible, preferably at least 10 seconds, and then exhale.
Despite the fact that the use of respimate is not fundamentally different from the classical AIDs, it has functional advantages: it makes the particles most suitable for deep penetration into the small bronchi, a minimum of the drug remains in the throat and trachea. Also on the case there is a dose counter, which will show in time when it is necessary to go to the pharmacy for a new medicine, and it will not end unexpectedly for the patient.
Metered Powder Inhalers
In powder inhalers, the medicine is in powder form, the release of which is activated by the patient’s breath. Powder inhalers are usually easy to use and compact. The easiest system is the diskhaler. However, the inhalation procedure requires certain skills: shaking the device, opening it (or pressing the starting valve) and then breathing in. To overcome the resistance of the particles of the inhaler, a relatively high inspiratory velocity (about 60 l / min) is necessary, which can make it difficult to use powder inhalers in children and patients with inspiratory spasm.
Some topical corticosteroids are available as powder inhalers. The use of some requires certain intellectual abilities: in the reservoir of the inhaler you need to put a disk in which there are compartments with medicine. Before inhalation, the patient must press on the body to feel a puncture, and then take a sharp and strong breath. This is necessary so that the powder does not settle in the mouth and pharynx, but it is in the lower respiratory tract.
These manipulations require special training, for this reason, powder inhalers are not suitable for small children and elderly people suffering from a violation of fine motor skills, Parkinson’s disease, after suffering a stroke with paresis of the upper extremities.
The global strategy GOLD in the 2017 version indicates that if it is impossible to teach the patient how to use the inhaler, it may be necessary to replace the delivery device. However, before that, it is worthwhile to send the patient to the school of patients with bronchial asthma, who are in some clinics, so that he will be taught all the subtleties of using the devices that are assigned to him. If a child is sick with asthma, then all the necessary information should be obtained by his parents. Children usually grab everything quickly enough, so after a few procedures they will learn to do everything correctly.
Given the enormous prevalence of this disease, doctors rush to comfort patients: asthma is a disease that can be effectively controlled today. Compliance with all the rules will allow such people to live an absolutely normal life and not be afraid of attacks.