Transcript Marcia Winston PPT

Asthma Medication Administration
Marcia Winston, MSN,CPNP,AE-C
[email protected]
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)
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
EPR-3 Classification of Asthma Severity
Determines treatment
Each age group (0-4 years of age, 5-11 years of age and 12adult)
Six steps
Long-term control: preferred and alternative
Step 1 Intermittent asthma
Step 2-6 Persistent asthma
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
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
Medications to Treat Asthma
Two major categories of medications are:
Long-term control
Quick relief
QVAR/beclomethasone dipropionate HFA
40mcg, 80mcg/inhalation
Pulmicort Flexhaler/budesonide
90 mcg and 180 mcg/inhalation
Pulmicort Respules/budesonide
0.25mg/2ml, 0.5mg/2ml and 1mg/2ml nebulizer suspension
Alvesco (ciclesonide)
80 mcg, 160 mcg/inhalation
Flovent HFA/fluticasone propionate
44mcg, 110mcg, 220mcg/inhalation
Asmanex Twisthaler/mometasone furoate
110mcg, 220mcg/inhalation
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
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*
Medication Administration
 Oral
 Metered dose inhaler (MDI) and
spacer
 Dry powder inhaler(DPI)
 Air Compressor/Nebulizer
 Injection
Asthma Devices:
Medication Administration
Metered dose inhalers (MDIs) w/CFC propellant have been discontinued
Maxair (pirbuterol) will be off the market in 2013
Asthma Devices:
Medication Administration
Metered dose inhalers (MDIs) w/ HFA (as of 2008)
require maintenance: priming and rinsing
Medication Administration
 One way valve holding chambers
Medication Administration
Dry powder inhalers (DPI)
Medication Administration
 Nebulizer/air compressor
Medication Administration
 Nebulizer/air compressor
InCheck Dial: Measures Inspiratory flow rate
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
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
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
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