All right. Let’s talk about hazard reduction
because this is something people can forgot about.
First of all, spirometry is absolutely
indicated for the diagnosis of asthma.
Even five-year-olds should be able to try it.
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.
So, overall, the treatment goals for asthma: reduce
impairment associated with the illness
and reduce the number of exacerbations.
And that means finding triggers and allergens.
So, this might be pets.
It might be certain pollens
or other plant products
at certain times of the year,
but avoiding those triggers is key.
And if it's persistent asthma,
it's always worth considering allergy testing.
And the best approaches to
avoiding triggers are multifaceted.
So, that might mean a mask at certain times,
plus avoidance of the cat.
There's different ways.
So, usually, when it’s multipronged
as an effort to reduce triggers,
that’s going to be the most effective.
And simple things like wearing a mask or a scarf
can make a big difference in
I didn’t necessarily know this.
Maybe it’s because I’m from California.
We don't have that much cold weather,
but wearing a mask or a scarf can really help.
If a child, in particular,
has exercise-induced bronchoconstriction,
shouldn’t limit their play.
We don't want these kids sitting on
the sidelines, avoiding physical activity.
And, in fact, it may be a sign
when they have persistent
that it's time to begin a controller medication.
Step up from just a beta agonist alone, short acting,
to using a corticosteroid to control their
symptoms a little better day to day.
How do you use this inhaler?
Well, it’s an inhaler.
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.
They were tested on their use
of their metered-dose inhaler,
or MDI, only 45% can use it appropriately.
We provide spacers, like this
little girl here has a spacer.
That should allow for easier use of the MDI.
Unfortunately, this sample,
it didn't improve things at all.
44% still were misusing their MDI.
And they also noted that 17% of kids
who were told to be using their peak
flow meters were actually doing so.
These are kids with more moderate to severe asthma
and they weren’t following
through on the recommendations.
And that must get better with age, right?
You get older, you get wiser, you know
how to take care of yourself.
Well, this is 450 adults presenting
to the in emergency department.
So, similarly, patients who probably have less
control are coming to the emergency department.
Guess what their rate of improper
metered-dose inhaler use was?
So, nothing had improved between the time they were
kids with asthma to when they were adults with asthma.
They misused their MDIs at pretty much the same rate.
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.
And improper MDI use is a serious business.
It’s associated with a higher asthma symptom score
and it’s associated with more frequent
visits to the emergency department.
Therefore, bringing in the inhaler
and showing me as a physician
how they're using it is a critical
part of asthma management.
And I try to do that on
the majority of visits if I can.