MANAGEMENT OF ASTHMA SPRING Presented by:

Transcription

1 MANAGEMENT OF ASTHMA SPRING 2013 Presented by: Lusia Fomuso PharmD candidate 2014 Olivia Sibailly PharmD candidate 2014 Kimberly Biedka PharmD candidate 2014 Dr. Donna Bartlett PharmD CGP RPh Massachusetts College of Pharmacy and Health Sciences University

2 Objectives Define asthma and describe it s signs and symptoms. Identify risk factors and common triggers of asthma attacks. Discuss treatment goals in asthma management. Go over available treatment options, devices and cost savings. Outline the importance of proper usage of inhalers. Go over new technology on asthma.

3 What is Asthma? Asthma is a disorder where a person s airways become inflamed which causes the lungs to swell and narrow, obstructing airflow.

4 Risk Factors Having a blood relative who has asthma (Genetics). Having another allergic condition, like allergic rhinitis (hay fever). Being a smoker or exposure to secondhand smoke. Being overweight. Exposure to occupational triggers, for example hairdressing, manufacturing or farming chemicals. Low birth weight.

5 Prevalence of Asthma

6 Complications of Asthma Avoidable asthma complications lead to about 4,000 deaths each year. The annual cost of asthma is estimated to be nearly $18 billion. Reduced ability to exercise. Severe coughing which can lead to urinary incontinence. Chest pain due to air leaking out of damaged lungs (Pneumothorax). Lack of sleep due to nighttime symptoms. Interruption of daily activities. 1. Missing work or school due to asthma attacks. 2. Hospitalization and increased cost.

7 Signs and symptoms Wheezing (High-pitched whistling sound). Cough with or without phlegm or mucus. Shortness of breath. Chest tightness. Determination of severity Number of times you wake up at night. Frequency of symptoms and use of medication. How the symptoms affect daily activities.

8 Triggers Tobacco smoke Exercise Animals (pet) Hair Pollen Changes in weather Dust Emotions like anxiety or stress Mold Chemicals in the air or in food Respiratory infections, like a common cold Some medications like aspirin and ibuprofen

9 ASTHMA AND EXERCISE Exercise or prolonged physical activity can lead to an asthma attack. Shortness of breath while exercising. Unusual tiredness during exercise. Chest tightness or cough. Use rescue inhaler Albuterol (ProAir HFA) about 10 to 15 minutes before exercise to prevent airways from contracting during exercise.

10 ASTHMA IN THE ELDERLY Symptoms of asthma are usually more severe in the elderly Not the same as COPD. Symptoms of asthma are more reversible. Symptoms of COPD are usually linked to a history of smoking in the patient. Influenza vaccination yearly is recommended.

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12 Goals of therapy Provide relief during an asthma attack. Preserve the normal function of the lungs. Prevent loss of function of the lungs by preventing the frequency of asthma attacks. Minimize side effects due to medication therapy. Improve ability to take part in exercise and other daily activities.

13 Lifestyle changes are important Avoid exposure to triggers like smoke. Cover beddings to reduce exposure to dust mites. Keep windows close to keep triggers like pollen out. Have a trigger-free zone. Change air filters in air vents. Vacuum carpets often preferably with HEPA vacuum cleaners.

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15 Rescue medication- Albuterol For fast relief because it opens the airways (Bronchodilator). Used during an asthma attack so only used when needed. Other brands include 1. Proventil HFA 2. Ventolin HFA 3. Xopenex Can be used before exercise.

16 How to use ProAir HFA Remove cap. Shake the inhaler for 5 seconds. Sit up straight and firmly hold the canister. Tilt head back and completely breathe out. Put the inhaler in your mouth. Press down on the inhaler and breathe in slowly and deeply. Hold your breath for 10 seconds or for as long as tolerated. If you require a second puff, wait about a minute before using it to allow the initial dose to open up airways. * Timing is key.

17 Maintenance medications For prevention and control. Used to prevent the flare-up of asthma symptoms (Anti-inflammatory meds). Usually used daily.

18 HOW TO USE THE ADVAIR DISKUS Open, Click, Inhale. Hold inhaler upright and flat. Place thumb on grip and push the slider away from you until it snaps in place. Slide the lever away from you until a click is heard. Breathe out fully. put the mouthpiece in the mouth and breathe in deeply and quickly. remove the inhaler and hold breath for 10 seconds or as long as tolerated. Close the slider. Rinse mouth and spit. Manufactures have detailed videos on their website about correct use of the inhaler.

19 ASSESSMENT OF THERAPY A 4 question, 4 point survey which looks at: Daily activities. Waking up at night. Patients assessment of control of symptoms. Use of rescue medication. 0 points = well-controlled 1-2 points = not well controlled 3-4 points = very poorly controlled

20 ASSESSMENT OF THERAPY

21 Interesting facts about Asthma Asthma was discovered by Hippocrates a Greek physician in BC. The first treatment for asthma was? Owl s blood in wine. (by Dr. Galen a Greco-Roman Doctor)

22 What is a nebulizer A device that produces a fine mist from liquid medication to be inhaled. Inhaled bronchodilators like albuterol and inhaled steroid medication like Pulmicort, can be given this way. Used for younger patients and patients who are unable to properly use hand-held inhalers. Albuterol nebulizer solution

23 Spacers: Why they are important For complete delivery of medication. For children and the elderly since timing is not an issue when using these. Common brands: 1. Aerochamber 2. Optihaler 3. Easivent

24 Peak flow meter A peak flow meter is a simple device to measure how quickly you can move air out of your lungs. It measures the force of breath out of the lungs. Find your personal best when feeling well since values are very individualized. Green No action needed. Yellow Use rescue inhaler and watch symptoms or call your doctor. Red Use rescue inhaler and seek immediate medical attention. Talk to your physician and have a specific plan of action.

25 Insurance copayment tiers Tier 1- generics Tier 2- preferred brands Tier 3- non-preferred brands Almost all of the inhalers like ProAir HFA, Advair Diskus, Qvar, and Flovent HFA have no generics and fall under tier 2. Using mail order services could save up to $120 each year for each inhaler prescription.

26 COST SAVINGS The albuterol nebulizer solution is on the; $4.00 list for both Wal-Mart and Target. $3.00 list for Price chopper. One of the main ways to minimize cost with asthma medication is to use the medication properly.

27 Importance of proper use Better management of asthma symptoms. Reduced cost from frequent refills and doctor s visits. Decreased episodes of hospitalization.

28 Order of use during an attack The rescue inhaler comes first (ProAir HFA). Inhale one puff. Wait about 1 to 5 minutes to allow the inhaled dose to open the airways. Inhale a second puff if needed. Maintenance inhalers or medication will not provide fast relief during an asthma attack. Use only if the attack happens at the time when a dose was scheduled.

29 Priming Priming is inhaler specific. Check your inhaler s instructions to see if it requires priming. The instructions will also include directions on how to prime your inhaler, if needed. For example, for ProAir HFA, shake the inhaler well and release 2 to 3 test sprays into the air away from the face. When to prime the ProAir HFA; Before first use of the inhaler. If the inhaler has not been used for more than 2 weeks. This is to clear any blockage in the inhaler due to medication build up.

30 Care of the Inhaler Cleaning your inhaler is inhaler specific. Inhalers with canisters should be washed by running warm water through the empty mouthpiece at least once a week. To clean inhalers like Advair Diskus, wipe the mouthpiece with a dry tissue. Do not put in water.

31 Helpful Tips Keep a log of your symptoms. Use ProAir before exercise to reduce the risk of an asthma attack. Rinse mouth and spit after use of steroid containing inhalers to avoid fungal infections. Examples include; 1. Flovent HFA 2. Pulmicort inhaler

32 Asthma and technology

33 Asthma and technology

34 Asthma and technology

35 References Asthma American Lung Association United States Environmental Protection Agency hma_facts Vollmer WM, Markson LE, O Connor E, et al. Association of asthma control with health care utilization and quality of life. Am J Respir Crit Care Med.1999;160:

36 Thank You OLIVIA SIBAILLY, PHARMD CANDIDATE /7 - DIABETES DR. DONNA BARTLETT, PHARMD, CGP, RPH (DONNA.BARTLETT@MCPHS.EDU) Questions?