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Asthma: Hazard Reduction and Inhaler

by Charles Vega, MD
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    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.


    About the Lecture

    The lecture Asthma: Hazard Reduction and Inhaler by Charles Vega, MD is from the course Chronic Care.


    Included Quiz Questions

    1. Consider starting an inhaled corticosteroid (controller medication).
    2. Increase frequency of use of short-acting beta agonist.
    3. Recommend to avoid the trigger (sport and activity) and consider quitting the team.
    4. Perform allergen skin-testing.
    5. Prescribe a spacer for the patient to pick up at the pharmacy.
    1. To decrease impairment and frequency of exacerbations
    2. To limit use of short-acting beta agonists as much as possible
    3. To be exclusively on a controller medication (inhaled corticosteroid) without need for beta agonists
    4. To be completely symptom (cough) free
    1. Identification and multifaceted avoidance of allergens
    2. Prescribing a spacer for pick up at the pharmacy.
    3. Exercising in cooler/cold environments
    4. Telling patients to use a peak flow meter at time of diagnosis
    5. Instructing patients to avoid all excessive exercise, activity, or play that trigger symptoms

    Author of lecture Asthma: Hazard Reduction and Inhaler

     Charles Vega, MD

    Charles Vega, MD


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