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Respiratory News Update
Tips 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.
The 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 and risk:
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:

1. When doing yard work, like raking leaves, wear a NIOSH N95 respirator mask (www. 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.
Have your heating and air conditioning system serviced. Install a high effi ciency media filter with a MERV rating of 12 or 13 ( 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.

3. Check daily pollen and mold counts available through the National Allergy Bureau
( Plan outdoor activities accordingly.
4. Wash 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.
For 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 Chamber
(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 medications
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, Kentucky and
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 bromide (Atrovent®).
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 from home.

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.

Treatment procedure
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 the left..
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 dry.

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.

Compressor care

1. Cover the compressor with a clean cloth when not in use. Keep it clean by wiping it with a clean, damp cloth as needed.
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 supplier.
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.
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