Asthma Medications & Devices

Asthma Medications & DevicesA guide to help people with asthma

Reliever medication (blue) 6

Preventer medication (autumn/desert colours) 7

Symptom controller medication (green) 8

Combination medication (purple or red & white) 9

Quick reference guideMedications

Quick reference guide

Spacers 12 Spacers and masks 13

Puffers 14 Accuhalers 18

Autohalers 22Turbuhalers 20

Devices

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Asthma Medications & Devices

Did you know ...Up to 90% of people on asthma medications do not use them properly1

Asthma medicationsAsthma medications play a vital role in keeping you well and free of asthma symptoms. Asthma medications work very well when taken properly. However, many people choose to use preventers for short periods only or when they are not feeling well, and end up relying on their blue reliever puffer for short term relief. This means many people with asthma put up with symptoms when they don’t need to and their every day life is affected. Making your medicine work for you is an important step in living well with asthma.

Taking your medicationEven if you think you are using your asthma medication properly, it is worth checking with your doctor, pharmacist or local Asthma Foundation. Learn the correct technique to give yourself the best chance of living well with asthma. Always check with your doctor or pharmacist if you experience side effects from medication or you think your medication is not working as it should.

Looking after

Looking after your asthma

Asthma Australia recommends that everyone with asthma should have an overall plan for managing their asthma. This should include things like a medication list, the goals that you and your doctor have agreed for your treatment, triggers, diet, exercise, regular review, and a written asthma action plan telling you what to do if your asthma is worsening. If you do not have an asthma action plan, speak to your doctor about this. A copy of the asthma action plan should be given to carers (for example childcare workers, school & preschool staff and relevant family members).

Medications reviewIf you have asthma it is recommended that you see your doctor for an asthma review at least twice a year. Check your asthma medication is working and that you are not having unnecessary asthma symptoms.

StorageCheck your medication expiry date and exact storage instructions. Most asthma medications require storage at room temperature, in dry areas. Do not leave asthma medication in your car.

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1. Bashati IA, Armour CL, Bosnic-Anticevich SZ, Reddel HK, Evaluation of a novel educational strategy, including inhaler based reminder labels, to improve asthma inhaler technique. Patient Educ. Couns 2008; 72: 26-33

Useful information

Common names Airomir, Asmol, Bricanyl, Ventolin

Commonly called blue reliever puffer

What it does Relaxes tight airway muscles

Keeps airways open for up to 4-6 hours

How long it takes to work

Very quickly Provides relief from symptoms within 4 minutes

How to take it Inhaled See the devices section to check that you are taking your medication properly

When to take it When you have symptoms

Symptoms may include: — Breathlessness — Wheezing — Tight chest — Persistent cough

Emergency Use a blue reliever puffer with a spacer for Asthma First Aid

Before exercise as prescribed

Exercise can trigger asthma. Speak to your doctor about managing your asthma so you can continue to exercise

Helpful to know Carry it with you always In case of symptoms, or for Asthma First Aid

If you are using your blue reliever puffer 3 times or more per week

See your doctor for an asthma review. Over-use of your blue reliever puffer for more than a couple of weeks may actually make your asthma worse

Common side effects Shakes, rapid heartbeatChildren can become restless

These will pass quickly. Speak to your doctor if concerned

Relievers - blue


Useful information

Common names Alvesco, Flixotide, Pulmicort, Qvar Intal Forte, TiladeSingulair Tablet

Corticosteroid Non-steroidNon-steroid tablet

What it does Reduces swellingReduces mucus

Preventers make airways less sensitive


Inhaled - starts to work within one day Singulair – within one day

Preventers can take days and even several weeks to fully work

How to take it Inhaled - Alvesco, Flixotide, Intal Forte, Pulmicort, Qvar, TiladeOral tablet - Singulair

See the devices section to check that you are taking your medication properly

When to take it Every day as prescribed Take your preventer every day as prescribed even if you feel well

Helpful to know The key to keeping well with asthma

Preventers are most effective if you take them every day as prescribed

Common side effects Inhaled Corticosteroid - possible side effects include oral thrush, voice change, sore mouth and throatIntal Forte and Tilade - cough after useSingulair – headaches and stomach upset

You can reduce these byusing a spacer with puffers.Always rinse, gargle and spit after using preventer medication.Clean your teeth after use.Speak to your doctor if you have any concerns about side effects

Preventers - autumn/desert colours

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Useful information

Common names Oxis, Serevent GreenSometimes called long acting beta-agonists

What it does Relaxes tight airway muscles

Keeps airways open for up to 12 hours


Varies — up to 30 mins Oxis – works within minutesSerevent – up to 30 mins

How to take it Inhaled Must always be prescribed for use with a corticosteroid preventer See the devices section to check that you are taking your medication properly

When to take it Every day as prescribed Always use with prescribed preventer medication

Helpful to know Prescribed for people who have asthma symptoms even with regular preventer use – must always be used with a corticosteroid preventer

For example, if a person always takes their preventer, but continues waking at night with asthma symptoms, the doctor may also prescribe a symptom controller, as it can keep airways open for longer than blue reliever medication

Common side effects Shakes, rapid heartbeat, headaches

These will pass quicklySpeak to your doctor if you are concerned

Symptom Controllers - green


Combinations - purple or red & white

Useful information

Common names Seretide (Flixotide and Serevent)Symbicort (Pulmicort and Oxis)

PurpleRed and whiteSometimes called combination preventers

What it does Combination medication =Preventer (reduces swelling + reduces mucus) + symptom controller (relaxes tight airway muscles)

Preventers make airways less sensitive Symptom controllers keep airways open for up to 12 hours


Preventer – within one daySymptom controller – varies with type – up to 30 mins

Preventers can take weeks to work fully. Symptom controllers work to keep airways open for longer periods

How to take it Inhaled See the devices section to check that you are taking your medication properly

When to take it Every day as prescribed For Symbicort – SMART*Take your combination medication as prescribed

Helpful to know Prescribed for people who have asthma symptoms even with regular preventer use

Speak to your doctor if you regularly take your preventer and continue to have regular symptoms

Common side effects As for preventer and symptom controllers

Speak to your doctor if you are concerned

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* SMART – Symbicort Maintenance and Reliever Therapy Protocol – Some people over the age of 12 may have Symbicort prescribed as both their reliever and preventer under strict guidelines. Speak to your doctor or pharmacist about this.

DevicesAsthma medicines come in a range of different shaped containers (devices). Some asthma medicines come in more than one type of device. This means you can work with your doctor to choose the the combination of medicine and device that works best for you.

If you find the device tricky to use, or you are not sure if you are using it properly,

always ask for help. Your doctor, pharmacist or local Asthma Foundation can help you.

By using the device properly and taking medication as prescribed, you are giving yourself the best chance of reducing asthma symptoms and living well with asthma.


Checklist Importance Solution/optionsAge Very young children are not

physically able to use all device types.

For puffers, very young children will need to use a spacer and mask. Children should always use a spacer and puffer. If you use a spacer with your puffer, you are giving yourself the best chance of benefiting from your asthma medicine

Breath intake Some devices require you to take in a deep, forceful breath. Not everyone is able to do this

Before you are prescribed a new asthma medicine, ask your doctor to check that you can use the device correctly

Hand strength Some people find their hands are weaker eg frail, arthritis

Look for a device that requires little hand strength, such as an Autohaler, or if you are using a puffer, ask about obtaining a Haleraid from your pharmacy

Coordination For puffers, do you have trouble co-ordinating the start of your breath in with pressing the puffer?

Look for a device that is easy for the person to use, preferably without assistance

Technique Most people can use any device when they are shown how – talk to your doctor to work out what options there are

Explore optionsWatch someone teach the correct device technique.Have a go using the device until you are confident you have mastered the steps

Review Regular check-ups are necessary to look at symptoms, how the medication is working and check device technique

Communicating with your doctor is important to living well with asthma

Haleraids are a type of device that make it easier to use a puffer.

Examples of Haleraids u

Key points to consider when choosing a device

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What is a spacer?Spacers assist with taking asthma medication. Spacers are only needed withpuffers. Spacers are usually plastic andcylinder shaped; at one end, a puffer is inserted, and the other end goes in yourmouth.A spacer helps you take medication by reducing the amount of medicine that lands in your mouth and allowing more to go down into your lungs where it is needed.

Choosing your spacerSpacers come in different sizes and shapes. Small spacers are useful for children and can be used by everyone (including adults) with their blue reliever puffer when out and about. However, for preventer medicine, some small spacers may not deliver enough medicine to the lungs.

Choosing a spacer depends on the medication type, your personal preference, budget and advice from your doctor, pharmacist or local Asthma Foundation.

Why use a spacer?It is recommended that all puffers are used with a spacer

— There are fewer side effects from the medication

— It is easier to use as it requires less coordination than a puffer alone

— More medication is inhaled into the lungs

The diagram below shows the difference between how much medication goes into the lungs, with and without a spacer.

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Spacers - what you need to know


Throat

Lungs

Stomach

MasksSome spacers can be used with masks. Very young children may require a mask to ensure as much asthma medication as possible is breathed into their lungs. This is also useful for others who have difficulty taking their medication. Spacers are not for sharing

Spacers are made for single person use to stop the spread of infectious disease – each person should have their own spacer, which they can wash and reuse as shown below.

Cleaning your spacerPlastic spacers must be prepared before first use so they will work correctly. To prepare your spacer, wash it in warm water with detergent. Do not rinse it. Leave it to air dry.

Clean your spacer the same way every month. Make sure you put the spacer back together again correctly after it is dry.

Masks can be washed in the same way.

Spacer storageSpacers should be stored in the following way. After they have been washed in warm water and detergent, and allowed to air dry, they should be stored in a paper (not plastic) bag, to minimise static.

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How to use a puffer and spacer

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Remove cap from puffer

Shake puffer well

Attach puffer to end of spacer

Place mouthpiece of spacer in mouth and ensure lips

seal around it

Breathe out gently

Press down on puffer canister once to fire medication

into spacer

Breathe in and out normally for 4 breaths

or

Breathe in slowly and deeply, hold for up to 10 seconds and breathe

out gently away from mouthpiece

To take more medication, shake puffer and repeat steps 2 - 4

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How to use a spacer and mask


Shake puffer well

Attach puffer to end of spacer

Gently place mask over mouth and nose so there are no gaps

around the edges

Breathe out gently

Press down on puffer once to fire medication into spacer

Breathe in and out normally for 4 breaths

or

Press down on puffer once to fire medication into spacer, then breathe

in slowly and deeply, hold for a few seconds and breathe out gently

To take more medication, shake puffer and repeat steps 2 - 4

How to use a puffer

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Hold puffer upright and shake well

Breathe out away from the puffer

Tilt the chin upward to open your airways

Put the puffer mouthpiece in mouth and create a seal with lips

Start to breathe in through mouth, then fire one puff of medication and continue

to breathe in steadily and deeply

Remove puffer from mouth, close mouth and hold breath for 10 seconds

Breathe out gently away from mouthpiece

Replace cover

To take more medication, repeat steps 1 to 3


Using a spacer with a puffer will minimise side effects and deliver medication more effectively to your lungs.

Puffers require good coordination so it is important to press down on the canister and breathe in at the same time.

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How to clean a puffer

1 Remove metal canister. Do not place in water

2 Wash the plastic casing only. Rinse mouthpiece through top and bottom under warm running water for at least 30 seconds. Wash mouthpiece cover

3 Allow to air dry

4 Reassemble

*Intal Forte and Tilade puffers should be washed every day and allowed to dry for more than 24 hours before re-use.

Preventer and combination puffers must never be wet or washed: they should only be wiped with a dry tissue.

Reliever puffers* require cleaning every week to prevent blockage from a build up of medication.

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How to use an AccuhalerAccuhalers contain medication as a dry powder.

Hold accuhaler by its base in one hand

Place thumb of other hand on thumb grip

Open Accuhaler by pushing thumb grip around until it clicks

Slide lever until it clicks

The medication is now loaded

Breathe out away from the Accuhaler

Put mouthpiece in mouth ensuring good seal is formed

Breathe in steadily through mouth

Remove Accuhaler from mouth then hold breath for up to 10

seconds, then breathe out gently away from Accuhaler

If another dose is required, push lever back to starting position

and repeat steps 2 to 4

When finished, close Accuhaler


How to look after an Accuhaler

How to look after an Accuhaler

— Avoid breathing into the Accuhaler — Always keep it dry — Keep it closed when not being used — Wipe the mouthpiece with a clean dry tissue

If you are using an Accuhaler for dispensing your medication, it is important that it DOES NOT get wet. If it requires cleaning, use a dry clean cloth to wipe the device — specifically the mouthpiece

How can I tell when the Accuhaler is empty?

There are 60 doses of medication in an Accuhaler. A dose counter on the side of the Accuhaler will show you how many doses remain.

The last 5 show up in RED

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How to use a TurbuhalerTurbuhalers contain medication as a dry powder that requires deep inhalation to get medication into the lung.

Unscrew and lift off cap

Hold Turbuhaler upright

Twist coloured base around all the way, and then back all the

way

Breathe out gently away from Turbuhaler

Do not blow into it

Put mouthpiece in mouth ensuring a good seal is formed with lips

Breathe in through mouth forcefully and deeply

Remove Turbuhaler from mouth before breathing out gently away

from the mouthpiece

Replace cap

To take more medication, repeat steps 2 to 4


Turbuhaler notes

— It is very important to hold the Turbuhaler upright when you are twisting the base, otherwise you will not get the dose

— You will not get a higher dose by twisting the coloured base more than once at the same time

— The rattling you hear when you shake the Turbuhaler is the drying agent built into the coloured base of the Turbuhaler and is not the medication

How should I clean a Turbuhaler?

If you are using a Turbuhaler for dispensing your medication, it is important that it DOES NOT get wet. If it requires cleaning, use a dry clean cloth to wipe the device - specifically the mouthpiece.

How can I tell when a Turbuhaler is empty?

The indicator on the side of the device will either highlight the doses left in the device (Symbicort) or appear in red to indicate that it is nearly empty (Bricanyl, Pulmicort and Oxis).

You will need to check regularly to see if the red mark has appeared in the window, or how many doses remain.

Empty

Empty

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How to use an AutohalerAutohalers are breath activated so the need for coordination is reduced.

Shake Autohaler to mix medication and propellant

Remove cover from Autohaler mouthpiece

Hold Autohaler in upright position without blocking vents at base

Lift grey lever at the top of the device

Breathe out away from Autohaler

Tilt chin up, put mouthpiece in mouth, closing lips firmly around it

Breathe in through mouth steadily and deeply. Keep on breathing in when you

hear a click The Autohaler will fire a dose of

medication automatically

Remove Autohaler, close mouth and hold breath for up to 10

seconds

Breathe out gently away from mouthpiece

Return grey lever to original position

Repeat steps 1 to 5 if another dose is needed


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How can I tell when the Autohaler is empty?— Load the Autohaler by holding it upright and lifting up the grey lever— There is a small sliding lever on the bottom of the Autohaler. Slide the lever across— If the Autohaler does not fire any medication, it is empty

How to look after an Autohaler — Remove mouthpiece and rinse the mouthpiece in warm water

(Airomir only - Do not wash Qvar) — Leave it to air dry, then replace mouthpiece cover — Do not push anything into the mouthpiece as this may cause damage

NebulisersNebulisers convert liquid medication into a fine mist inhaled through a mouthpiece or mask. The air-flow and pressure of your nebuliser should be checked regularly (at least once a year). Depending on use, disposable nebuliser bowls may need replacing regularly, according to the manufacturer’s instructions. It is advisable to always have a spare bowl. Nebuliser filters should be changed regularly and the machine serviced according to the manufacturer’s instructions.

Used correctly, a puffer and spacer are just as effective as a nebuliser. A nebuliser is sometimes recommended by the doctor if using a puffer and spacer is difficult for someone. For more information, talk to your doctor, pharmacist or local Asthma Foundation.

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General medication information

Getting rid of medicines you don’t needYou can return expired or empty medications to your pharmacist for safe disposal.

PrescriptionsMost asthma medications require a prescription. Ask your doctor if you need a repeat prescription to make sure you don’t run out.

Most blue reliever medications can be bought over the counter, but you should still make sure your doctor knows when and how you are using these. If you are using your blue reliever medication 3 times or more per week, speak to your doctor as this is a sign that you are not well or your medication may need to be changed.

Find out more about your medicationsAsthma medications come with Consumer Medicine Information which can be provided by any pharmacist or doctor, or you can find them and other information about medications online at nps.org.au

Find out more about asthmaAsthma Australia provides a range of resources in both hard copy and online to assist people with asthma.

Your local Asthma Foundation has trained staff available to assist with any questions you have regarding asthma for yourself, someone you care for, or people you work with.

You can also ask about community education and training programs.

Contact your local Asthma Foundation 1800 ASTHMA (1800 278 462) asthmaaustralia.org.au

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Sit the person upright— Be calm and reassuring— Do not leave them alone

Give 4 puffs of blue reliever puffer medication— Use a spacer if there is one— Shake puffer— Put 1 puff into spacer— Take 4 breaths from spacerRepeat until 4 puffs have been taken

Remember: Shake, 1 puff, 4 breaths

Wait 4 minutes— If there is no improvement, give 4 more puffs

as above

If there is still no improvement call emergency assistance (DIAL OOO)*— Say ‘ambulance’ and that someone is having an

asthma attack— Keep giving 4 puffs every 4 minutes until

emergency assistance arrives*If calling Triple Zero (000) does not work on your mobile phone, try 112

To find out more contact your local Asthma Foundation 1800 ASTHMA (1800 278 462) asthmaaustralia.org.au

Call emergency assistance immediately (DIAL 000)— If the person is not breathing— If the person’s asthma suddenly becomes worse, or is not improving — If the person is having an asthma attack and a puffer is not available— If you are not sure if it’s asthmaBlue reliever medication is unlikely to harm, even if the person does not have asthma

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Treatment of acute asthmaIf you are very unwell and have little response to relievers, your doctor may prescribe a short course of oral steroids in liquid or tablet form (Prednisolone/Prednisone). This is used to reduce the swelling in the airways and quickly improve asthma in an acute attack or when symptoms persist.

When used in short courses of 3-5 days, oral steroids are generally free of significant side effects, but some patients experience temporary mood changes, weight gain, or worsening of diabetic control. They may cause side effects when used in high doses for weeks to months at a time, or when more frequent short courses are used.

The risks of not taking this treatment when needed are far more serious than any side effects. If you are concerned, discuss this with your doctor.

Asthma First Aid Asthma Australia provides community education and training for Asthma First Aid (see next page).

We encourage everyone to learn Asthma First Aid.

Asthma Emergency Kits Asthma Emergency Kits provide basic equipment and instructions to assist someone during an asthma attack.

Your local Asthma Foundation can provide education and training for Asthma First Aid.

Asthma Emergency Kits are available from your local Asthma Foundation.

Sit the person upright— Be calm and reassuring— Do not leave them alone

Give 4 puffs of blue reliever puffer medication— Use a spacer if there is one— Shake puffer— Put 1 puff into spacer— Take 4 breaths from spacerRepeat until 4 puffs have been taken

Remember: Shake, 1 puff, 4 breaths

Wait 4 minutes— If there is no improvement, give 4 more puffs

as above

If there is still no improvement call emergency assistance (DIAL OOO)*— Say ‘ambulance’ and that someone is having an

asthma attack— Keep giving 4 puffs every 4 minutes until

emergency assistance arrives*If calling Triple Zero (000) does not work on your mobile phone, try 112

To find out more contact your local Asthma Foundation 1800 ASTHMA (1800 278 462) asthmaaustralia.org.au

Call emergency assistance immediately (DIAL 000)— If the person is not breathing— If the person’s asthma suddenly becomes worse, or is not improving — If the person is having an asthma attack and a puffer is not available— If you are not sure if it’s asthmaBlue reliever medication is unlikely to harm, even if the person does not have asthma

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All Asthma Australia information is endorsed by our Medical and Scientific Advisory Committee and is consistent with the National Asthma Council Australia clinical guidelines.

Asthma Australia information does not replace professional medical advice. People should ask their doctor any questions about diagnosis and treatment.

©Asthma Australia 2013

This work is licensed under the Creative Commons Attribution-NonCommercial 3.0 Australia License.To view a copy of this license, visit http://creativecommons.org/licenses/by-nc/3.0/au/ or send a letter toCreative Commons, 444 Castro Street, Suite 900, Mountain View, California, 94041, USA.

This brochure has been developed for the community by Asthma Australia.

It provides information about:

—Asthma Medications & Devices —Using asthma medication to keep you well —Using asthma devices properly —How to look after your device

Other Asthma Australia brochures:

—Asthma Basic Facts —Under 5s —Seniors —Live well checklist —Could it be asthma? —10 Things to tell/ask your doctor

To find out more about asthma contact your local Asthma Foundation

1800 ASTHMA (1800 278 462) asthmaaustralia.org.au

Translating and Interpreting Service 131 450

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Asthma Medications & Devices