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Family Health Magazine
PHARMACY CARE

Asthma Medications
Details on dosage

The majority of people with asthma are using some form of inhaled medication that is breathed into the lungs. Inhaled medications are recommended first, and work better than oral tablets. Asthma medication can be divided into two categories: controllers (preventers), and the relievers. Both are available as inhalation devices.

Controllers are long-term control medications that are taken daily. They prevent symptoms and help manage asthma. These inhalers must be used every day, even if you feel well. When you feel good, it means the medication is working to keep inflammation or swelling down. If you stop using it, inflammation and asthma symptoms can return.

Relievers are taken only when needed. Most are short-acting bronchodilators. They give quick relief when an asthma attack occurs. Relievers relax the tight muscles around the airways. They do not help reduce inflammation. If you use your reliever more than three times a week, this suggests your asthma is poorly controlled and needs to be reassessed. Asthma should not interfere with your quality of life.

New inhalers now combine a controller and a long-acting reliever all in one device. If you have to use more than one inhaler, this may be more convenient for you. You can discuss this with your doctor.

The three most popular types of devices used are the MDI (metered dose inhaler or puffer), the Turbuhaler™, and the Diskus™. These last two devices are breath-activated. All devices have advantages and disadvantages and contain different medications. Work with your doctor to choose the one best suited to you.

The metered dose inhaler (MDI)

The MDI has two parts. The canister holds the medication, while the ‘boot’ houses the canister. The drug is combined with a propellant that helps force medication particles out of the canister. This device is the most difficult to use. Proper timing and co-ordination is needed to get the medication into the lungs rather than in the mouth or back of the throat. It is estimated that as many as 80 per cent of patients do not use MDIs properly.

Follow these steps to use your MDI correctly:

• Remove the cap. Make sure the mouthpiece is clear of debris. To keep the mouthpiece clear, cap it closed. Don’t throw the cap out!
• Stand or sit completely upright. Lying down or hunching over limits the amount of air and medication entering your lungs.
• Tilt your head up slightly - look at the point where the wall meets the ceiling.
• Shake the MDI – most MDIs require shaking. This ensures an even dose of medication.
• Breathe as big a breath out through your mouth as you can. Place the mouthpiece between your teeth, taking care not to block the flow of medication. Close your lips around it. Make sure the inhaler is straight up. (This may not look as cool as using it upside down, but the MDI wasn’t designed to deliver a proper dose upside down.)
• Take a slow, deep breath. As you are inhaling, push the canister all the way down to give one dose. Remember, the idea is to draw the medication into your lungs and not to spray the back of your throat.
• Hold your breath for a count of five to ten, then exhale slowly. This ensures the medication has time to settle in your lungs, rather than being exhaled out.

If you are doing a second dose, wait 30 seconds and follow the steps once again. Never press the canister twice during one procedure, as the second puff will be mostly propellant and very little medication. You will go through your puffer faster this way without using all of the medication in it.

f you get a lot of medication in your mouth or on your tongue, or if you have trouble using the inhaler, consider trying an inhaler chamber.

MDI with a spacer/air chamber (AeroChamber™ or OptiChamber™)

These chambers are designed to be used with a MDI. They take over the co-ordination of breathing in and pressing the canister at the same time. They are very easy to use. They are recommended for all children under the age of seven who use a MDI. They are also suggested for people who have trouble co-ordinating the dose, for those with arthritis, and for someone experiencing an asthma attack. They are available with a mouthpiece or mask that goes over the mouth and nose.

The chamber allows the person to comfortably inhale the dose after it has been loaded into the chamber. It may take two to three breaths to clear the chamber of a single dose. For infants and young children, allow five to six breaths. If a whistle is heard while using the chamber, breathing is too fast. Slow breathing down until the whistle stops.

Using a chamber with your device will improve the amount of medication being delivered into your lungs. The chamber also lowers the amount of medication wasted in your mouth and back of the throat. Even if your technique is perfect without a chamber, you will still get more medication in the airways when using one!

The use of a MDI plus a chamber is generally considered more efficient and effective than using a nebulizing device.

Breath-activated devices: Turbuhaler™ and Diskus™

Breath-activated means that rather than having a propellant push medication out of a device, you inhale to draw or suck the medication in. The device is much easier to use than a MDI, as you do not have to co-ordinate pressing and inhaling. It may also be a better device for someone bothered by propellants, or who gets a lot of medication deposited in the mouth. Since medication is delivered in powder form, these are also called dry powder inhalers.

Using these devices is very easy and most children over the age of five can use dry powder. The steps are similar for both devices, though they look completely different.

• Remove or slide back the cover.
• Load a single dose into the device. Do not shake.
  Turbuhaler™: Turn the grip as far as it will go counter-clockwise (do not force). Then, turn it clockwise (the opposite direction) as far as it will go. You will hear and feel a click. The Turbuhaler™ is ready to use.
  Diskus™: Slide the lever away from you with your thumb until you hear a click. The Diskus™ is ready to use.
• Stand or sit completely upright and tilt your head up slightly.
• Breathe out fully.
• Hold the discus level with the large label on top.
• Place the mouthpiece between your teeth and close your lips. Breathe in quickly and deeply through your mouth.
• Remove the inhaler from your mouth and hold your breath for a count of five to ten.

If a second dose is required, repeat steps two to six. These medications are sensitive to moisture, so remember to cover the mouthpiece when done. You can wipe lipstick or debris off the cover with a soft cloth, but do not wet or submerge these devices to clean them.

When using a dry powder inhaler, you are inhaling very tiny amounts of dry powder. Unlike the MDI, you will often not taste or feel the dose depending on the device. Rest assured that you did get a full dose of medication.

With the Turbuhaler™ a rattling sound may be heard in the bottom of the device. This is not medication, but rather a desiccant that keeps moisture out. When running low of medication, people often mistake the rattle for medication left in the device. An indicator window lets you know when you are running low. The Diskus™ counts down the exact number of doses you have left. Make sure to get your prescription refilled before you are completely out.

With proper teaching, everyone can use all the inhalation devices correctly. It is important to reassess and reinforce the way you use your inhaler device from time to time. If you are unsure whether you are using your device correctly, ask your pharmacist for instructions and a demonstration. Many pharmacies have demos of the various devices, and you can watch them to decide which will work best for you.

Together with your doctor and your pharmacist, you can determine the device that best fits your needs. It is nice to know you have options!