to Prevent Falling Into the Fall Asthma Trap
The fall can be a busy time of year: back-to-school
for the kids, soccer moms (and dads) on the sidelines
‘coaching’ the coaches, friends tailgating
for their favorite teams, and week-end trips to catch
those last days of sun at the beach or to enjoy the
fall colors. Enjoyable times can be ruined by the misery
of allergies and asthma. The onset of ragweed and the
fall mold season in many areas of the country, and the
back-to school ‘cold’ epidemic can make
it a busy time for doctor’s offi ces, emergency
departments, and hospitals at this time of year.
months of September and October are peak times for asthma
attacks, especially in children. Fortunately, with planning,
most of these are preventable.
The National Heart, Lung, and Blood Institute (NHLBI)
“Expert Panel Report: Guidelines for the Diagnosis
and Management of Asthma” (2007) states the goal
of therapy is to control asthma. The Guidelines emphasize
reducing impairment by controlling symptoms of asthma
that may affect daily activities, and reducing risk
for exacerbations (asthma attacks).
There are steps you can take to reduce both impairment
Know your triggers and reduce your exposure. Reduce
exposure to allergens or other triggers
in the fall by following a few simple steps can help:
doing yard work, like raking leaves, wear a NIOSH N95
respirator mask (www. allergyzone.com) which will fi lter
out the small allergens and particulates that may trigger
asthma. According to the CDC wearing N95 masks will even
reduce the spread of viruses like the flu.
your heating and air conditioning system serviced. Install
a high effi ciency media filter with a MERV rating of
12 or 13 (www.allergyzone.com). Leave the fan on to
create a “whole house” air fi lter that
removes particles that may trigger asthma. Change the
fi lter every three months (with the change of the seasons)
to keep the air cleaner year round. Keep your windows
closed to keep pollen and mold outside.
daily pollen and mold counts available through the National
(www.aaaai.org/nab). Plan outdoor activities accordingly.
hands to prevent the spread of cold viruses that can trigger
asthma. Follow your Asthma Action Plan. Ask your healthcare
provider for a written asthma
medication plan. Th ose with persistent asthma should
take a daily controller medication.
most, this will be an Inhaled Corticosteroid (ICS).
All asthmatics should also have a
rescue medication to provide quick relief in the event
of an asthma attack. Educate yourself on the proper
use of your inhaler or nebulizer medications. ICS inhalers
may be either self-activated dry powder inhalers or
metered dose inhalers (MDI). Rescue medications are
all MDIs. Th e Guidelines recommend using a Valved Holding
(VHC) with MDIs. All MDIs are now being transitioned
to HFA type propellants. For these a non-electrostatic
VHC such as the PARI Vortex is ideal. For young children
or people who have trouble using an inhaler, a nebulizer
(such as the PARI LC) should be used. Both ICS and the
rescue medications are available in this form. Infants
and young children should use a mask when using either
the VHC or nebulizer. Avoid triggers, follow you asthma
action plans, and use devices to assure you get your
will make for a pleasant asthma free fall…but
unfortunately will not guarantee that
your team will win the Big Game.
“The Guidelines recommend
using a Valved Holding
Chamber (VHC) with MDIs.”
James L. Sublett, MD, FACAAI is Section Chief of Pediatric
Allergy at the
University of Louisville School of Medicine in Louisville,
Managing Partner of Family Allergy and Asthma, with
16 sites in Louisville,
Kentucky, and Indiana. He is a Clinical Investigator
with Family Allergy &
Asthma Research Institute and Founder and Chairman of
Allergy Zone, LLC,
a company that focuses on the development and marketing
of novel products
that provide relief for people with allergies and asthma.
Dr. Sublett also serves
on the Board of Regents Executive Committee for the
American College of
Allergy, Asthma, and Immunology, the ACAAI/AAAAI Joint
Task Force for
Asthma Quality Assurance, and the Editorial Board for
the Annals of Allergy,
Asthma, and Immunology.
Home Nebulizer Therapy
What is a nebulizer?
A nebulizer changes liquid medicine into fine droplets
(in aerosol or mist form) that are inhaled through a
mouthpiece or mask. Nebulizers can be used to deliver
bronchodilator (airway-opening) medicines such as albuterol
(Ventolin®, Proventil® or Airet®) or ipratropium
A nebulizer may be used instead of a metered dose inhaler
(MDI). It is powered by a compressed air machine and
plugs into an electrical outlet. Portable nebulizers,
powered by an internal battery or cigarette lighter,
are available for individuals requiring treatments away
Nebulizer care guidelines
Your home care company will show you how to use the
nebulizer. You will need the following supplies to give
the nebulizer treatment:
• Air compressor
• Nebulizer cup
• Mask or mouthpiece
• Clean eye droppers or other measuring devices
to dispense the medication.
1. Place the air compressor on a sturdy surface that
will support its weight. Plug the cord from the compressor
into a properly grounded (three prong) electrical outlet.
2. Wash your hands with soap and warm water, and dry
completely with a clean towel.
3. Carefully measure the medicine exactly as you have
been instructed. Use a separate, clean measuring device
(eyedropper or syringe) for each medicine.
4. Remove the top part of the nebulizer cup, as shown
to the left.
5. Place your medicine in the bottom of the nebulizer
cup, as shown to the right.
6. Attach the top portion of the nebulizer cup and connect
the mouthpiece or face mask to the cup.
7. Connect the tubing to both the aerosol compressor
and nebulizer cup.
8. Turn on the compressor with the on/off switch. Once
you turn on the compressor, you should see a light mist
coming from the back of the tube opposite the mouthpiece
as shown to the left.
9. Sit up straight on a comfortable chair.
10. If you are using a mask, position it comfortably
and securely on your face as shown to the right.
11. If you are using a mouth piece, place it between
your teeth and seal your lips around it as shown to
12. Take slow, deep breaths through your mouth. If possible,
hold each breath for two to three seconds before breathing
out. This allows the medication to settle into the airways.
13. Continue the treatment until the medication is gone
(about seven to 10 minutes).
14. If you become dizzy or feel "jittery,"
stop the treatment and rest for about five minutes.
Then continue the treatment, but try to breathe more
slowly. If these symptoms continue with future treatments,
inform your health care provider.
15. Turn the compressor off.
16. Take several deep breaths and cough. Continue coughing
and try to clear any secretions you might have in your
lungs. Cough the secretions into a tissue and dispose
of it properly.
17. Wash your hands with warm water and soap, and dry
them with a clean towel.
Care of nebulizer
Cleaning and disinfecting your equipment is simple, yet
very important. Cleaning should be done in a dust- and
smoke-free area away from open windows. Here is how to
clean your equipment:
1. After each treatment, rinse the nebulizer cup with
warm water, shake off excess water and let it air dry.
2. At the end of each day, the nebulizer cup, mask, or
mouthpiece should be washed in warm, soapy water using
a mild detergent, rinsed thoroughly, and allowed to air
Note: There is no need to clean the tubing that connects
the nebulizer to the air compressor.
Do not put these parts in the dishwasher.
3. Every third day, after washing your equipment, disinfect
the equipment using a vinegar/water solution or the disinfectant
solution your supplier suggests.
To use the vinegar solution, mix 1/2 cup white vinegar
with 1-1/2 cups of water. Soak the equipment for 30 minutes
and rinse well under a steady stream of water. Shake off
the excess water and allow to air dry on a paper towel.
Always allow the equipment to completely dry before storing
in a plastic, zipper storage bag.
1. Cover the compressor with a clean cloth when not in
use. Keep it clean by wiping it with a clean, damp cloth
2. Do not put the air compressor on the floor either for
treatments or for storage.
3. Check the air compressor's filter as directed. Replace
or clean according to the directions from your equipment
4. Always have an extra nebulizer cup and mask or mouthpiece
in case you need it.
5. Store your medicines in a cool, dry place. Check them
often. If they have changed color or formed crystals,
throw them away and replace them with new ones.
6. All equipment for your nebulizer therapy can be obtained
through your equipment supplier.
Important: Unplug the compressor
before cleaning it.