What to Do
Use a Peak Flow Meter
Often a person’s doctor will have him or her use a peak flow meter to decide how well their asthma is under control. A peak flow meter measures how fast air comes out of the lungs when a person breathes out forcefully. This measure is called “peak expiratory flow” or PEF. It is important for a person to know what their PEF is when they are able to breathe relatively normally.
A person’s PEF might drop hours or even days before asthma problems occur. Regular use of a peak flow meter helps a person recognize early changes that might be signs of worsening asthma. When problems arise and the PEF changes, the person can adjust their medicine (under doctor directions) or take other steps before their symptoms get worse. The National Heart, Lung, and Blood Institute (NHLBI) recommends measuring the PEF during the following times:
The doctor or home health nurse will explain how to know if a person’s asthma is controlled. Usually they use a system of asthma zones: Green, Yellow and Red.
Green Zone – The asthma is well controlled. The PEF is 80 to 100 percent of the person’s personal best. Example – if a person’s personal best is 420, the Green Zone is 336 to 420.
Yellow Zone – Asthma is flaring up or poorly controlled. PEF is 50 to 80 percent of a person’s personal best. Example – if a person’s personal best is 420, the Yellow Zone is 210 to 336.
Red Zone – Asthma is severe. Need emergency care. The PEF is less than 50 percent of a person’s personal best. Example – if a person’s personal best is 420, the Red Zone is less than 210.
Help the person keep a daily record of their PEF measurements and report them when they visit their doctor. If a person is in a Yellow Zone – he or she needs to adjust medicines according to doctor’s instructions. If the person is in a Red Zone – call their doctor immediately.
When to Use a Spacer
A person with poor hand-breath coordination benefits from using a spacer. A spacer traps medicine released from an MDI and suspends it in the spacer until the person breathes in. A regular MDI fits easily into the end of a spacer. When breathing with a spacer, less medicine deposits on the back of the person’s throat and more reaches the lung’s airways. Some spacers have a one-way valve that activates when a person breathes, which removes the need for good hand-breath coordination.
Counting Doses
A person who uses an inhaler needs to know how to count doses if their device does not have an automatic counter. Failure to do so might result in the person using an empty inhaler when they are having a sudden breathing problem. To track doses:
- Note the first day the person uses a new inhaler on a calendar.
- Note on the label the number of inhalations in the canister (example: 200 inhalations per MDI).
- Note the number of inhalations used per day (Example: 2 inhalations at a time, 3 times a day, equals 6 inhalations per day).
- Divide the total number of inhalations in the canister by the number of inhalations needed per day to determine number of days inhaler should last. (Example: 200/6 = 33 days of 3 times-a-day dosing).
- Mark on calendar the date inhaler will be empty; obtain a refill a few days before.
Trouble Shooting
As a caregiver, your job is to be sure the person is taking an inhaled medicine as prescribed. Sometimes a person will either take too much or too little medicine. Here are common problems you should watch for.
- Incorrect activation: This occurs when a person presses an MDI canister before taking a breath. Taking a breath and pushing down on the canister should be done at the same time so that the drug carries down to the lungs with the breath.
- Forgetting to shake the inhaler: The drug is in a suspension, and therefore particles may settle. If the inhaler is not shaken, it will not deliver the correct dose of the drug.
- Not waiting long enough between puffs: The whole process for using an inhaler must be repeated to take a second puff, otherwise an incorrect dose may be delivered, or the drug may not travel deep into the lungs. Usually a person must wait 30 to 60 seconds between doses of the same medicine. When taking two different medicines, take one medicine and then wait 2 to 5 minutes before inhaling the second medicine.
- Failure to clean an MDI valve: Particles of medicine may jam up the valve in the canister mouthpiece unless it is cleaned regularly. This causes failure to get 200 puffs from one inhaler.
- Failure to observe whether the inhaler is actually releasing a spray: If it is not, this should be checked with the pharmacist.
How to Act in the Event of an Asthma Attack
Usually a person with asthma will have early warning signs of an asthma attack. Increased wheezing, coughing and tightness of the chest for example, alerts a person to the need to take a dose of their quick-relief medicine by inhaler.
However, symptoms can worsen. All of the following symptoms are indications that the person needs to seek emergency care as soon as possible:
- Wheezing while breathing both in and out
- Constant coughing
- Difficulty breathing
- Breathing very fast
- Chest Retractions (skin over chest pulls in as the person breathes)
- Shortness of breath
- Difficulty talking in complete sentences
- Becoming pale
- Becoming anxious
- Blue lips or fingernails called cyanosis