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Respiratory Care

That’s a pretty significant statement, but it’s absolutely true. More than 17 million Americans are afflicted with asthma, a reactive airway disease triggered by any number of stimuli. The condition causes the tiny muscles inside the lungs to contract under certain stresses, closing off the millions of tiny breathing tubes and making inhalation a grueling exercise.

And the stimuli that cause an asthma attack can be almost anything: overexertion, pollen, allergies, dust mites, stress, animal dander and plant spores are just a handful of hundreds of triggers asthmatics must face every day.

Last year, more than 6,000 people died as a direct result of asthma. And some startling statistics show how the condition is striking the population:

• The greatest increase in the death rate from asthma is in those 65 years of age and older.
• Hospitalization rates for asthma patients was nearly four times higher for non-Caucasians.
• Females have a disproportionately higher death rate from asthma than do men.
• Asthma is more prevalent in western Europe and North America than other parts of the world, and is more common in urban areas than rural ones.

Running almost parallel to asthma are allergies – a condition that can be triggered by a number of irritants, and can range in severity from merely annoying to potentially deadly. The most common allergies in the population today are generally airborne, resulting from pollen, dust, and other allergens produced by plants. While easy to identify through testing, allergies are very difficult to stop completely; although some dissipate or decrease in severity with age, many more continue unabated.

• Asthma affects approximately 17.3 million Americans; 5 million of which are under the age of 18. It is indiscriminate – it affects people of all ages, genders and races.
• Between 1979 and 1989, the percent of the U.S. population diagnosed with asthma increased by 60%. Since 1980, the overall asthma population has more than doubled.
• By 2020, the Pew Environmental Health Commission predicts there will be more than 29 million Americans with asthma.
• Over 6,000 people died from asthma in the U.S. in 1999. An equal number of additional deaths had "asthma-related complications" listed as a contributing cause of death – bringing the total to more than 12,000.
• More than half a million people were hospitalized due to asthma-related problems.
• The greatest increase in the asthma death rate has occurred in those older than 65 years of age.
• In 1998, there were 13.9 million asthma-related visits to hospital clinics and private physician offices – 5.8 million of those were for children. An additional 2 million asthma-related visits were made to hospital ER’s.
• In 1992, the hospitalization rate for asthma patients was almost four times higher for non-whites as compared to whites.
• The death rates due to asthma are higher among males than females.
• Asthma is more prevalent in U.S. and Western Europe than in other parts of the world.
• More asthma patients reside in urban areas rather than rural areas.
• On a daily basis: 23% of people with asthma experience shortness of breath; 29% have an asthmatic-related cough; and 16% experience chest tightness due to an asthma attack.
• Seventy-eight percent of those with asthma are awakened at least once a week by an asthma episode (5% are awakened nightly by episodes).
• In a month’s time, 32% of those with asthma have episodes so severe, their ability to speak or walk are affected.

   

  

  The survey findings about asthma are particularly important because of the number of American households affected. The population prevalence of asthma found by the survey is consistent with previous government estimates that about one in 15 Americans, or roughly 17 million people, currently suffer from asthma.

  Those numbers increase dramatically when coupled with the figures for family members with asthma. The total for both categories covers more than 40 percent of the population and provides you a large potential customer base, including parents of small children with asthma or a primary caregiver for an elderly person with asthma.

• Each year more than 50 million Americans suffer from allergic diseases. They affect more than 20 percent of the US population.
• Allergies are the 6th leading cause of chronic disease in the United States, costing the health care system $18 billion annually.
• Two estimates of allergy prevalence in the United States are 9 percent and 16 percent. The prevalence of allergic rhinitis has increased substantially over the past 15 years.
• Approximately 16.7 million office visits to health care providers each year are attributed to allergic rhinitis. As many as 35.9 million people may have seasonal allergic rhinitis.
• Chronic sinusitis is the most commonly reported chronic disease, affecting 12.6 percent of people (approximately 38 million) in the United States in 1996. It is indiscriminate – it affects people of all ages, genders and races.
• In 1996, estimated U.S. health care expenditures attributable to sinusitis were more than $5.8 billion.
• Increased absenteeism and reduced productivity due to allergies cost US companies more than $250 million annually.
• There is an association between sinusitis and asthma. The incidence of sinusitis in asthmatic subjects ranges from 40 to 75%.

One of the best monitoring devices on the market (and the item recommended for this program) is the AsthmaMentor by Respironics. By using the AsthmaMentor peak flow meter, your patients will be better equipped to monitor the status of their asthma. AsthmaMentor's built-in AutoZone System will automatically calculate color-coded peak flow zones based upon your patient's personal best reading. Therefore, the following personalized Action Plan becomes very easy to follow:

Green Zone (80-100% of your personal best)

Yellow Zone (50-80% of your personal best)

Red Zone (less than 50% of your personal best)

Most metered dose inhalers are quite similar in shape and size. The following are directions that apply to most inhalers:

1. Shake the inhaler well before each use, and then remove cap from the mouthpiece.
2. Record your inhalations as they are taken, as this is imperative to quality care.
3. If the inhaler has not been used for a month or more, you should test spray to ensure effective delivery. Thereafter, this does not need to be performed prior to each use.
4. Exhale through the mouth in order to empty the lungs.
5. Position the inhaler one or two inches away from your open mouth
6. Press down firmly on top of the metal canister with the index finger while breathing in deeply and slowly through your mouth.
7. After breathing in the medication, continue to inhale as fully as possible, and hold your breath for five to ten seconds to allow the medicine to work completely.
8. Wait 30-60 seconds and shake your inhaler again. The above steps should be repeated for each inhalation as prescribed by your physician.

After administering your medication, it is important to clean your inhaler correctly. Remove the metal canister and clean the plastic case and cap by rinsing in warm water. Be sure to keep the metal canister dry. After drying the plastic case and cap, replace the canister with a twisting motion.

Using a spacer device greatly increases the delivery of asthma medication to the lungs - the only place the medication works. Oftentimes, patients using poor or incorrect delivery methods with their metered dose inhaler won't get the medication into their lungs. The dose will adhere to the teeth, tongue, windpipe or the stomach - all places where the medication does no good at all.

Using a spacer device allows for proper inhalation of the medication to the patient and delivers nearly 100% of the dose to the lungs. It also allows the compressed gas propellants from the canister to dissipate prior to inhalation.

Follow these simple directions when using a spacer device:

1. Correctly insert inhaler into rear of spacer device, making sure that the fit is snug.
2. Place the mouthpiece on your tongue and wrap lips tightly around it (assuming a mask is not used).
3. Spray one puff into the spacer.
4. Breathe in slowly taking three to five seconds.
5. If possible, hold your breath for 10 seconds.
6. Remove the chamber from your mouth and exhale.
7. Wait at least 30 seconds between each new puff of medicine.

Treatment should take between 4 and 12 minutes, depending on the efficiency of the patient's nebulizer cup. If the patient does not feel better after the treatment or if symptoms return in less than four hours, the patient's treatment plan needs to be re-evaluated for effectiveness. Follow these instructions when educating the patient about their nebulizer:

1. Measure the prescribed amount of saline or cromolyn and place liquid in the nebulizer cup.
2. Measure the prescribed amount of medication and add to saline or cromolyn.
3. Infants and children under one year of age should use nebulizer masks designed for infants and children. All other patients should use a mouthpiece for greater effectiveness. After attaching all necessary components, the nebulizer should be started.
4. Place mouth around mouthpiece (or attach mask) and breathe slowly, 10 to 20 times a minute, if possible.
5. After inhaling for prescribed amount of time, clean tubing and mouthpiece as directed.

One group of people who can benefit from using a mask are very small children. Young children often have difficulty grasping the proper inhalation method without the aid of a mask. Using a mask with a child makes learning the proper technique easier as time goes on.

A second group of beneficiaries includes the elderly population. Reasons for using a mask with this population varies - some like the comfort and east a mask provides, while others have diminished motor skills that makes holding an inhaler steady in front of their mouth a difficult task. Older patients are familiar with the procedure for insuring medication delivery, so using a mask shouldn't interfere with this population.

Masks are also designed to be used with treatment via a compressor and nebulizer. Attached to the nebulizer, it makes for the most efficient inhalation of medication delivered through a compressor system.

There are a wide variety of masks in a number of sizes designed to fit the specific needs of the patient.

Adult kits contain slightly different materials and are designed to increase compliance with a planned management regimen. The Asthma Pack III from Respironics (featured in this program) contains a peak flow meter and record book for daily monitoring, a valved holding chamber for increased effectiveness of the medication, a self-help book, and a carrying case for their asthma tools. Also included is a short videotape showing the features and benefits of using the various other tools in conjunction with their prescribed medicine.

Though different in contents, asthma management kits for kids and adults have the same goal in common: to instruct about the condition, to increase comfort with it, and to provide the tools to help the patient conduct effective treatments.

Instruct the patient with the following directions to help analyze their asthma lifestyles:

1. Via the Internet, go to this website: http://www.allergy.mcg.edu/lifequality/index.html
2. Answer the 20 short questions
3. Decide whether a quick, free phone call could lead to a better quality of life.

Information provided by Healthtouch Online®. All Rights Reserved.
Leader Drug Stores.

Information provided by Healthtouch Online®. All Rights Reserved.
Leader Drug Stores.