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Asthma Medication Administration Marcia Winston, MSN,CPNP,AE-C winstonm@email.chop

Asthma Medication Administration Marcia Winston, MSN,CPNP,AE-C winstonm@email.chop.edu The Children’s Hospital of Philadelphia Division of Pulmonary Medicine. Clinical Management of Asthma. NIH NHLBI NAEPP Expert Report 3 released in 2007 (1991, 1997, 2002).

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Asthma Medication Administration Marcia Winston, MSN,CPNP,AE-C winstonm@email.chop

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  1. Asthma Medication Administration Marcia Winston, MSN,CPNP,AE-C winstonm@email.chop.edu The Children’s Hospital of Philadelphia Division of Pulmonary Medicine

  2. Clinical Management of Asthma NIH NHLBI NAEPP Expert Report 3 released in 2007 (1991, 1997, 2002)

  3. Level of Severity-EPR-3 To be determined at time of Diagnosis to Initiate Treatment Classification of level severity is based on assessment of: • Number of days/week symptoms occur • Number of night awakenings/month • Interference with normal activity • Peak Flow (PEFR) or FEV1 (forced expiratory volume in 1 second) • Exacerbations requiring oral corticosteroids

  4. EPR-3 Classification of Asthma Severity Determines treatment Each age group (0-4 years of age, 5-11 years of age and 12-adult) Six steps Long-term control: preferred and alternative Step 1 Intermittent asthma Step 2-6 Persistent asthma

  5. EPR-3: Goals of Therapy: Control of Asthma • REDUCE IMPAIRMENT • Prevent chronic and troublesome symptoms (in the daytime, at night, or after exertion) • Maintain (near) normal pulmonary function • Maintain normal activity levels (including exercise) • Infrequent use of SABA </= twice a week NOT including pre-treatment of EIB • Satisfy and meet patient/families expectations

  6. EPR-3: Goals of Therapy: Control of Asthma • REDUCE RISK • Prevent recurrent: Exacerbations E.R. visits Hospitalizations • Prevent loss of lung function/for children prevent reduced lung growth • Provide optimal pharmacotherapy with minimal or no adverse effects of therapy

  7. Medications to Treat Asthma Two major categories of medications are: • Long-term control • Quick relief

  8. QVAR/beclomethasone dipropionate HFA40mcg, 80mcg/inhalation

  9. Pulmicort Flexhaler/budesonide90 mcg and 180 mcg/inhalation

  10. Pulmicort Respules/budesonide0.25mg/2ml, 0.5mg/2ml and 1mg/2ml nebulizer suspension

  11. Alvesco (ciclesonide) 80 mcg, 160 mcg/inhalation

  12. Flovent HFA/fluticasone propionate44mcg, 110mcg, 220mcg/inhalation

  13. Asmanex Twisthaler/mometasone furoate110mcg, 220mcg/inhalation

  14. Medications to Treat Asthma:Quick-Relief • Used in acute asthma episodes, relieve symptoms Generally they are short-acting beta2-agonists: albuterol (ProAir HFA, Proventil HFA, Ventolin HFA) levalbuterol pirbuterol ipratropium • Systemic corticosteroids

  15. Asthma: Under Control or Out of Control? Baylor Rule of Twos: • Take quick relief medicine > 2 times/week • Wake up at night due to asthma > 2 times/month • Refill quick relief inhaler prescription more than 2 times/year *one albuterol MDI=200 puffs/medicine=100 two puff doses*

  16. Medication Administration • Oral • Metered dose inhaler (MDI) and spacer • Dry powder inhaler(DPI) • Air Compressor/Nebulizer • Injection

  17. Asthma Devices:Medication Administration Metered dose inhalers (MDIs) w/CFC propellant have been discontinued Maxair (pirbuterol) will be off the market in 2013

  18. Asthma Devices:Medication Administration Metered dose inhalers (MDIs) w/ HFA (as of 2008) require maintenance: priming and rinsing

  19. Medication Administration • One way valve holding chambers

  20. Medication Administration Dry powder inhalers (DPI)

  21. Medication Administration • Nebulizer/air compressor

  22. Medication Administration • Nebulizer/air compressor

  23. InCheck Dial: Measures Inspiratory flow rate

  24. Medication Administration Air Compressor and Nebulizer: As per Rubin & Fink, “Aerosol Therapy for Children” • Home versus hospital: not the same • No published data supports the use of the blow-by technique • Aerosol deposition studies suggest that virtually no drug enters the airway • If not using a mouthpiece then the mask should be close fitting • If the mask is not close fitting or patient is crying aerosol deposition can also be affected Respiratory Care Clinics of North America 7:2 June 2001

  25. Asthma Out of Control*Frequent flyers*(symptoms, ER, hospital, over use of albuterol) • Assess and re-assess: • Observe patient’s medication administration technique, equipment and medications • Ask directly about adherence, “How often do you miss a dose of your long-term control medicine?” • Ask about the environment: pets and ETS. • Consider alternative diagnosis/comorbid conditions

  26. Managing Asthma:Sample Asthma Action Plan Describes what medicines to use and actions to take when well and when symptomatic/for attacks and emergency instructions National Heart, Lung, and Blood Institute

  27. Resources • Association of Asthma Educators-AAE: www.asthmaeducators.org • National Asthma Education and Prevention Program (EPR3 Guidelines) www.nhlbi.nih.gov/about/naepp/index.htm

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