1.The application of peak flow rate meter.
It is important to evaluate and monitor the severity of asthma with objective pulmonary function indexes. Pulmonary function measurement is important as a method to diagnose asthma, analyze the severity of the disease, and guide the use of medication. However, patients must come to the hospital regularly to have their lung function checked in order to keep abreast of changes in their condition. Laboratory spirometers are bulky and not easy to monitor daily for patients, so simple, inexpensive and easy-to-grasp instruments must be available for monitoring.
In the past 20 years, a simple and easy to use “peak flow velocity meter” has been introduced and has been localized, so that patients can have their own peak flow velocity meter at home. The significance of measuring peak flow rate is to know the maximum expiratory flow rate, which is the most common simple lung function measurement for asthma patients. If you keep measuring your peak flow rate regularly every day and keep an asthma diary or chart, you can grasp the pattern of asthma attacks and adjust your medication according to the changes in peak flow rate, which will greatly reduce the number of attacks and the degree of attacks. Especially in the early stage of deterioration, it is difficult for the patient to detect it (you cannot judge the severity of asthma by your own feeling), if you can tell your doctor about the peak flow rate record, he will understand your condition. The patient and the doctor can also use this information to compare the effects of various treatments. If an asthmatic’s peak flow rate readings keep dropping and do not return to normal, the asthma can strike at any time. Additional treatment given early in the early stages of an asthma attack can stop the attack.
To measure peak flow rate, first set the peak flow rate pointer toward zero. Then hold the flowmeter with both hands, open your mouth and inhale heavily, then hold the mouthpiece in your mouth and blow out the gas with force at maximum speed and in the shortest possible time. Take note of the reading indicated by the pointer and do it 3 times in a row, while taking the best 1 value. Note that you must hold the mouthpiece with the lips of the mouth, do not leak around the gas, deep inhalation and blow out with force as soon as possible. The peak flow rate meter has its application importance, but not every asthma patient needs a peak flow rate meter. It is better to record the peak flow rate value at home if: asthma often causes cough and discomfort; there have been 3 asthma attacks in the past 1 year; there have been severe attacks in the past, requiring hospitalization or unconsciousness; all patients using aerosols (meaning 5 years old and above).
Measurements were usually taken in the morning and in the evening, and once before and once after the inhalation of the aerosol. In the morning, before inhalation, the measured peak flow rate is low because this is when asthma is at its worst. Then the medication is inhaled, and another measurement is taken 10-30 minutes after the inhalation. Based on the peak elevation, we know whether the medication is effective or not. By comparing the peak flow rate values in the morning with those in the evening, you can see how your asthma changes at different times of the day. If you have a cold, or if you are exposed to some allergic substance that makes your asthma symptoms worse, or if you have an asthma attack in the middle of the night, you should be monitored at least once a day, in the morning, in the middle of the day, in the evening (towards bedtime) or during an attack in the middle of the night. Each patient should know the expected value of peak flow rate he/she achieves and his/her own optimal value as a judgment of whether he/she has an attack or not. Also, the diurnal variability should be known, as it is the information that provides whether the asthma is well controlled and the severity of the disease.
Maximum PEF – minimum PEF
PEF variability= ────────────×100%
1/2 (highest PEF + lowest PEF)
The daily measured peak flow rate must not be less than 80% of the personal best or expected value, or the peak flow rate diurnal variability must not exceed 20%. In the event that the peak flow rate does not reach 80% of the expected value or the variation rate exceeds 20%, further dosing and hospital consultation should be performed. The personal best peak flow rate value is the highest peak flow rate value that can be achieved with 2 weeks of continuous monitoring when the asthma is well controlled. As the condition of asthma patients often changes, it is better to have an actual record of their peak flow rate and medication, and to keep a daily asthma diary, which is of great significance to grasp the patient’s morbidity pattern, guide the medication and prevent relapse.
2.Aerosol medication.
In the past 20 years, the drug treatment of asthma has progressed rapidly. Whether it is to calm asthma, or to prevent asthma drugs, there are inhalation dosage forms. Because inhalation therapy requires only a small amount of drug inhalation to reach the airway mucosa, thus reducing the adverse reactions caused by oral and intravenous administration, it is suitable for different types of asthma patients and is the drug of choice for the treatment of asthma.
Hand-controlled quantitative aerosol, such as salbutamol (Asthma), beclomethasone propionate (Bicodone), etc., because of the convenience of carrying, without special equipment, and the variety of drugs sprayed, can play a rapid expansion of the bronchi and the role of the fight against airway inflammation, has been widely used around the world, and is very popular. In recent years, due to the generation of storage canisters and other auxiliary tools, so that young children and elderly patients who will not synchronize the inhalation of aerosols, can also use aerosols. Commonly used fog cans are pear-shaped or shuttle-shaped, which are plastic cans with a volume of 500 ml to 750 ml. There are also those who use plastic bags folded to assist with inhalation tools (suction relief). For those younger than 3 years old, plastic mouth cups are also used, with holes punched in their bottoms to spray the medication into the container, and then the cup is placed over the child’s mouth and nose, and then the medication is sprayed in. As for the disc type (Biodisc) or vortex type (Promethazine) dry powder inhalation method is simple to operate and does not require simultaneous hand-to-mouth inhalation, easy to learn, easy to use, suitable for younger children over 3 years old and elderly patients who do not inhale synchronously.
3.The correct use of aerosol.
To make the best effect of hand-controlled quantitative aerosol drug, we must know how to use it correctly. Before use, you should read the instructions well, and ask the doctor or nurse to teach, or verify whether the patient is using it correctly. This is because even if the inhalation method is correct, only about 10% of the spray can enter the airway and have an effect. To use the aerosol correctly, each of the following steps must be carefully followed.
(1) Open the cap and shake the inhaler well.
(2) Exhale as much as possible, then put the nozzle into your mouth, wrap your lips around the inhaler, and make a deep and slow inhalation while pressing the inhaler hard.
(3) Remove the inhaler, hold your breath for 10 seconds or as long as possible, and then exhale slowly.
(4) If another inhalation is to be made, allow an interval of 1 minute or more before repeating steps (2) and (3) above.
(5) Put the cap back on the nozzle after use.
4. Reduce and stop asthma preventive medicine.
Asthma is a chronic disease that requires long-term preventive treatment. However, asthma patients and their families often have to ask: “When can I reduce or stop the medication completely?” Most patients need to keep taking their medication morning and night, and it does bother them. They look forward to the day when they don’t need their medication and don’t have to carry it with them when they go out. Some patients are afraid of the corticosteroids that are part of their inhaled medications. They have a fear that inhaled corticosteroids will have the same side effects as oral systemic hormones. Therefore, when the disease is not fully controlled, they reduce or stop the medication on their own, often with excessive anxiety and anxiety. In fact, many children’s asthma can be cured by the time they reach adulthood, especially during adolescent development, when asthma will gradually decrease.
Under what circumstances should medication be reduced and stopped? First of all, the condition must be well controlled, for example, no coughing and suffocating in the middle of the night, and no symptoms after exercise or when performing greater physical activities. It is also not so bad that some special smell causes cough or asthma attack. In addition, the variability of the peak flow rate values in the morning and evening should not differ by 15%. If the medication is used, there is already only one preventive drug (sodium cromoglycate, beclomethasone propionate), and when the disease has been stable for 3 to 6 months, the medication can be gradually reduced. It is better not to reduce the medication in the season when the patient has good allergies or in winter.
Start treatment of asthma with short-acting bronchodilators and prophylactic drugs. When the symptoms are controlled, the bronchodilators can be gradually discontinued and applied as needed during attacks instead. After six months of taking prophylaxis, the medication can be gradually reduced according to the condition and under the guidance of the doctor. Children often need to use prophylactic medication for 1 to 2 years. In severe patients and adults, longer time is needed. As for some patients who are uncooperative with medication, stopping and using at times, having asthma attacks or not well controlled at all, the medication can be used for a longer time.
5. Whether asthma can be cured.
Because the cause of asthma is complex and the pathogenesis is not yet clear, there is no cure. The current therapeutic goals are to reduce the number of attacks; to reduce the degree of attacks; to prevent and control attacks; and to keep the growth and development of the child unaffected. For the vast majority of children with asthma, this goal can be achieved with systematic treatment. In the case of adults, their quality of life will also be greatly improved. However, many parents of sick children believe that “children with asthma will naturally get better when they reach adolescence, and it does not matter whether they are treated or not”. These misconceptions have caused many children with asthma to lose a favorable time for treatment. In fact, the rate of childhood asthma developing into adult asthma is still very high, up to 60%-70%, and at the lowest, 5%-10%. According to the statistics in Hong Kong, more than 5% of children suffer from asthma, while only 0.5% of adults do. Therefore, 9 out of 10 children can be cured. However, many parents of affected children are too anxious and worry when their children’s asthma is just controlled by medication: “Will there be side effects or failure if the medication is used for too long? When will the asthma be cut off?” In fact, asthma is one of the most prevalent chronic diseases in children. The main thing is to be able to control it early in the onset; to follow the doctor’s instructions to take the medication; and to recognize the management of asthma. This will make the painful situation of the child’s coughing and wheezing disappear, and not miss school due to asthma attacks, and not disrupt the family’s sleep at night due to asthma attacks. In this way, the psychological stress of the patient and the family will be greatly reduced. In addition to relieving the symptoms of an asthma attack, the main treatment for asthma is to reduce the airway reactivity by inhaling corticosteroids or sodium cromoglycate during the remission period. The medication is administered for 2 to 3 years, perhaps longer in severe cases, but most children will be cured by adolescence.