Asthma

Question 1

What happens to your body when you have asthma?

Answer 1

• Harmless foreign substance (allergen)
• Causes immune cells called B cells to produce a
  substance called IgE
• IgE can bind to inflammatory cells called mast cells and
  eosinophils (cause inflammation in airway)
• When you are exposed to an allergen, IgE gets cross
  linked by the allergen molecule
• Inflammatory cascade
• Patient experiences this as difficulty breathing

Question 2

What are the three inhalers involved in treating asthma?

Answer 2

• RELIEVERS
  Provides relief from acute asthma by causing broncho-dilation
  -PREVENTERS
  Combat the disease progression by their anti inflammatory action
  -COMBI-INHALERS
  Preventers and relievers

Question 3

What do you do if someone is using their reliever inhaler more than 2x a week, in the middle of the night or more than four times in 24h?

Answer 3

Patient needs to see their GP because their asthma is not being managed effectively
May need reminding the importance of their preventer inhaler to stop the disease progression

Question 4

How can I improve my inhaler technique?

Answer 4

• Sit up straight and tilt chin slightly upwards to help the
  direction of particle be as straight as possible
• Stay as still as you can - reduces amount of directions
  particles
  need to change
• Shake the device
• Breathe out slowly until you feel your lungs are empty
• Put end in mouth and depress trigger
• As you depress trigger, breathe in slowly and deeply
  until lungs feel full
  *Breathe in slowly to decrease the speed of the particles and this decreases their momentum so they are more likely to get into lungs and not just on back of throat
• Hold breath for up to 10s after
  *Stops particles getting deposited in wrong place
• Breathe out

Question 5

What are the consequences of bad technique?

Answer 5

• Relievers
  Patient gets no immediate relief from their
  breathlessness so they might overdose to try and
  compensate
• Preventers
  The disease progresses without the patient realising
  and the patient gets worse

Question 6

Why might a spacer help you?

Answer 6

Spacers mean you do not have to time your inhalation perfectly with depressing the trigger, because they hold the drug in a chamber to slow down the particle movement into your mouth
Also ensures the particles do not just end up on roof of mouth or back of mouth

Question 7

Patient presenting with a sore throat

Answer 7

Immunosuppression can occur at the back of the mouth, giving chance for oral candida to cause a fungal infection

• Use miconazole gel to treat any oral thrush
• Wash mouth after using your inhaler

Question 8

How else could I improve my asthma?

Answer 8

• Stopping smoking
• Avoiding secondhand smoke where you can
• Weight loss
• Asthma action plans
• Using proper inhaler technique
• Breathing exercise programmes