Breathe Easy

Approximately 25 million Americans are living with asthma, according to the Asthma and Allergy Foundation of America (AAFA). The chronic lung disease is characterized by airflow obstruction and can cause breathing difficulty. Symptoms include chest tightness, shortness of breath or rapid breathing, and wheezing. In severe cases, the disease can be life threatening.

Asthma can be caused by allergies, smoking, cold air, exercise, infection, mold, fumes and more. However, not all asthmatics are affected by every trigger, which is why determining the cause behind flare-ups is important for effective management.

Respiratory therapists play a major role in managing patients with asthma, determining frequency of exacerbations and potential triggers, as well as helping to verify the asthmatic patient is receiving appropriate treatment.

Diagnosing Asthma in Children & Adults
Shirley Payne, RRT-NPS, RPFT, AE-C, respiratory care practitioner at Methodist Charlton Medical Center in Dallas, noted that childhood asthma is not a different disease from asthma in adults, but children do face unique challenges. While many children with asthma develop symptoms before the age of five, Payne said diagnosing asthma can be tricky in young children. Non-specific symptoms found in infants or young children may be a history of recurrent bronchitis, bronchiolitis or pneumonia, a persistent cough with colds and/or recurrent croup or rattling in the chest.

Both childhood asthma and adult-onset asthma share many of the same triggers. For asthma patients of any age, exposure to one of their triggers can cause a flare or asthma attack.

“Children diagnosed with asthma typically have intermittent symptoms. Sometimes allergens set off an asthma attack, and sometimes they do not. With adults, however, symptoms are typically persistent. Daily treatments are often required in order to keep asthma symptoms and flares under control,” she explained.
Effects of an asthma attack can escalate quickly, so it is important to treat symptoms as soon as they become apparent, said Payne.

Inhalers: ‘A Mainstay of Treatment’
Asthma can be an unpredictable condition and attacks may occur at any time. For this reason, inhalers are very important, said Talisa White, external affairs manager at Asthma and Allergy Foundation of America.

There are two types of inhalers: one for daily control and one for occasional quick-relief/rescue. “For people with moderate to severe asthma, controller inhalers can be used daily to lessen frequency and severity of episodes over time,” she explained.

Controller medications are those that are used every day to maintain normal lung function. These can include inhaled gluco-corticosteroids, inhaled long-acting beta-agonists (LABA), leukotriene modifiers, mast cell stabilizers or combination drugs (corticosteroids plus long-acting bronchodilators).

Quick-relief inhalers (or “rescue inhalers”) dilate the airway, decrease airway resistance and allow breathing to improve. They are used to treat immediate symptoms of an asthma attack as they occur. White stated that most quick-relief inhalers contain a short-acting beta-agonist (SABA) medication that works by relaxing bronchial smooth muscle in the lung, opening airways and allowing more oxygen in as you breathe. The most common SABA used for quick-relief of asthma symptoms is called albuterol.
“Inhalers are a mainstay of treatment. They are used both urgently when acute symptoms are present, and chronically to minimize inflammation and thereby reducing attacks,” remarked Jonathan Altus, MD, FCCP, co-director of pulmonary and critical care at South Nassau Communities Hospital, Oceanside, NY.

Keeping Track of Doses
In the past, patients would simply count and keep track of doses themselves. Many patients also possess more than one rescue inhaler keeping some at home, work and school.

“It is far too hard to keep track and easy to lose count of the exact number of remaining doses,” said White.

In fact, in a national AAFA survey of nearly 600 adult asthma patients, nearly half of respondents reported their rescue inhaler was empty when needed at least once in the past, requiring one out of 10 patients to go to the emergency room and one out of five to go without treatment during the asthma attack.

That is why a dose counter-a component of an inhaler device that tells the patient how many doses of medicine have been used and/or remain in the inhaler-is important.
“A dose counter is a sure way to keep accurate account of the number of doses left in inhalers,” said White. “Patients can always feel comfortable knowing how much medicine they have left, giving them plenty of time to get refills so they are always equipped.”

‘Know Your Count’
In early March, the Asthma and Allergy Foundation of America (AAFA) launched a national awareness campaign along with Teva Respiratory, called Know Your Count. The national public service announcement (PSA) campaign is aimed at raising awareness of the seriousness of asthma and educating asthma patients and caregivers about the importance of keeping track of the remaining doses in their rescue inhalers.

It features award-winning singer and actress, Kristin Chenoweth, who is speaking publicly for the first time about the impact her asthma has had on her professional career and busy lifestyle-and how she confidently controls her asthma using medications with dose counters.

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To raise awareness and educate, the campaign offers a comprehensive website ( that explains the importance of dose counters and offers a better understanding about asthma.

The ‘Important Role’ of Education
Dr. Altus noted that respiratory therapists should instruct patients on how to use inhalers and nebulizers, and educate them on the many facets of the disease.

“It is crucial for asthmatics to become educated on their disorder, both to avoid triggers and to ensure knowledge of when and how to use the inhalers,” he said.

Amanda Zeid, BS, RRT, RCP, respiratory therapy department team leader at The Ohio State University’s Arthur G. James Cancer Hospital, explained that education may also include informing the patient about asthma as a chronic disease, teaching and verifying correct medication administration technique, identifying and managing symptom triggers, instructing on the use of peak flow meters and creating an asthma action plan.

“Once the patient is placed on the correct medications, the respiratory therapist plays an important role in education,” concluded Zeid.

Beth Puliti is a frequent contributor to ADVANCE.

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