Asthma: Hazard Reduction and Inhaler

00:00 All right. Let’s talk about hazard reduction because this is something people can forgot about.

00:04 First of all, spirometry is absolutely indicated for the diagnosis of asthma.

00:10 Even five-year-olds should be able to try it.

00:14 And that's important because it cinches the fact that there's some kind of reversibility in terms of their FEV1 with the use of a short-acting beta agonist.

00:25 So, overall, the treatment goals for asthma: reduce impairment associated with the illness and reduce the number of exacerbations.

00:33 And that means finding triggers and allergens.

00:35 So, this might be pets.

00:37 It might be certain pollens or other plant products at certain times of the year, but avoiding those triggers is key.

00:48 And if it's persistent asthma, it's always worth considering allergy testing.

00:55 And the best approaches to avoiding triggers are multifaceted.

00:59 So, that might mean a mask at certain times, plus avoidance of the cat.

01:04 There's different ways.

01:06 So, usually, when it’s multipronged as an effort to reduce triggers, that’s going to be the most effective.

01:12 And simple things like wearing a mask or a scarf can make a big difference in exercise-induced bronchoconstriction.

01:18 I didn’t necessarily know this. Maybe it’s because I’m from California.

01:20 We don't have that much cold weather, but wearing a mask or a scarf can really help.

01:24 If a child, in particular, has exercise-induced bronchoconstriction, shouldn’t limit their play.

01:30 We don't want these kids sitting on the sidelines, avoiding physical activity.

01:34 And, in fact, it may be a sign when they have persistent exercise-induced symptoms that it's time to begin a controller medication.

01:42 Step up from just a beta agonist alone, short acting, to using a corticosteroid to control their symptoms a little better day to day.

01:51 Okay.

01:51 How do you use this inhaler? Well, it’s an inhaler.

01:54 What’s that hard, right? Well, this is a study of 73 children between 2 and 18 years and they all had an asthma exacerbation.

02:01 They were tested on their use of their metered-dose inhaler, or MDI, only 45% can use it appropriately.

02:07 We provide spacers, like this little girl here has a spacer.

02:10 That should allow for easier use of the MDI.

02:14 Unfortunately, this sample, it didn't improve things at all.

02:17 44% still were misusing their MDI.

02:21 And they also noted that 17% of kids who were told to be using their peak flow meters were actually doing so.

02:27 These are kids with more moderate to severe asthma and they weren’t following through on the recommendations.

02:33 And that must get better with age, right? You get older, you get wiser, you know how to take care of yourself.

02:39 Well, this is 450 adults presenting to the in emergency department.

02:42 So, similarly, patients who probably have less control are coming to the emergency department.

02:47 Guess what their rate of improper metered-dose inhaler use was? 45%.

02:52 So, nothing had improved between the time they were kids with asthma to when they were adults with asthma.

02:58 They misused their MDIs at pretty much the same rate.

03:02 Why? A lack of education, in the first place, about how to use the inhaler appropriately and not seeing somebody regularly and follow-up to help reinforce those lessons.

03:12 And improper MDI use is a serious business.

03:16 It’s associated with a higher asthma symptom score and it’s associated with more frequent visits to the emergency department.

03:23 Therefore, bringing in the inhaler and showing me as a physician how they're using it is a critical part of asthma management.

03:32 And I try to do that on the majority of visits if I can.