How to take my asthma / COPD puffers

Getting the technique right is essential to make sure your puffers get medication to the right parts of the lung.


Click here for metered dose inhalers *** these need a spacer*****

How to use a Standard MDI (puffer) and Spacer - National Asthma Council Australia

These include:

  • Airomir (salbutamol)

  • Alvesco (ciclesonide)

  • APO-Salbutamol (salbutamol)

  • Asmol (salbutamol)

  • Atrovent (ipratropium)

  • Flixotide and Flixotide Junior (fluticasone propionate)

  • Flutiform (fluticasone propionate)

  • Intal and Intal Forte (sodium cromoglycate)

  • Qvar (beclomethasone)

  • Seretide (fluticasone propionate plus salmeterol)

  • Tilade (nedocromil sodium)

  • Ventolin (salbutamol)

Other videos for different devices can be found here at the Asthma Council website -

How-to videos - National Asthma Council Australia

How to prepare for a specialist visit?

Prepare for your appointment

  1. Bring a list of your medications or photos of your tablets

  2. Bring you GP’s name and clinic details so we can write a report to your GP after the consultations

  3. Bring any recent scans in hard copy or reports if you don’t have the scans yourself

  4. Write down any questions you have about the appointment and your symptoms

  5. Bring the name and clinic details of any other specialists you see

  6. Try to jot down any important dates/details that might come to mind like

    • when did the symptoms start?

    • what medications have you and your GP tried so far, when did these start?

    • when scans were performed?

  7. Find out if you can bring a support person or family member to the appointment

  8. If you have a CPAP machine, bring it with you. Remember to empty the water chamber prior!

  9. If you use any inhalers, bring these with you.

  10. Confirm with the clinic if the appointment is in person or on the phone. Things do change a lot currently with the COVID-19 restrictions.

What should I do if my CPAP mask is leaking?

At least half of people will have trouble starting CPAP therapy.

Mask leak is one of the most common issues. A lot of the time, leak can be due to lack of cleaning and maintenance.

CPAP_Mask_headgear_frame

Here are some tips on mask cleaning.

Mask cushion

– wash daily with warm soapy water and place to dry

– do not leave out in direct sun

– do not bleach

Mask headgear

– wash weekly with laundry detergent and hang to dry in the shade

– hand washing is best

– if washing in a machine, put in a pillow case or ‘delicates’ bag

Mask frame

– wash weekly with warm soapy

CPAP_Mask_tubing
 

Check out this video from the NHS about fitting a full face mask:

What is Obstructive Sleep Apnoea (OSA)

In OSA, when our muscles relax in sleep there is collapse of the back of the throat due our big tongues and floppy muscles.  If the collapse is very mild then snoring will occur from vibration of the tissues.  If more significant obstruction occurs, air cannot pass down into the lungs causing blood oxygen levels to fall.  The fall in blood oxygen is detected by our brains, causing us to be woken briefly from sleep, and a temporary surge in adrenaline.  As we wake, tone is put back into our tongue and flopping muscles, opening the airway and allowing oxygen to get down into the lungs.  But as we drift off to sleep the process occurs over and over again.  Sleep is unrefreshing as our brains are being woken and our health suffers as a result of the poor quality sleep and adrenaline surges. 

Obstructive sleep apnoea is really very common.  In the USA it is estimated at 6% of the adult population has sleep apnoea.  Australian data estimates there are more than 774,590 people living with OSA and that number is increasing every year. 

 

The only way to diagnose OSA is with a diagnostic sleep study.  This is important to be done properly to grade the severity of OSA and the position in which it occurs.  The severity of OSA is graded by the number of times breathing is interrupted per hour. 

  • Normal sleep – fewer than five interruptions per hour
  • Mild sleep apnoea – between 5 and 15 interruptions per hour
  • Moderate sleep apnoea – between 15 and 30 interruptions per hour
  • Severe sleep apnoea – more than 30 interruptions per hour.

The symptoms of OSA are variable but include

  • Unrefreshing sleep
  • Waking with morning headache
  • Waking through the night with snoring, gasping or chocking
  • Sleepiness during the day

What are lung function tests and how can I prepare?

Respiratory function tests (RFTs), also known as lung function tests are performed so that you and your doctor can understand how well your lungs are working.  These tests are essential in the diagnosis of suspected lung disease and in monitoring your response to treatment. 

There are a few components of the test, each determining different characteristics of your lung’s health.  The three most commonly performed tests are spirometry, lung volumes and gabs diffusion.  

Spirometry

This test requires you to blow out through a mouth-piece hard and fast.  It is essential in the diagnosis of chronic obstructive pulmonary disease (COPD) and asthma.  To get accurate results, the test is usually repeated at least 3 times with a rest between each blow.  This test is then often repeated after a dose of salbutamol (Ventolin) puffer to see if there is any difference. 

Lung volumes

This involves getting into our clear glass box called “The body box”.  It is like a clear telephone box and the door is shut only a short time while you perform some special breathing techniques with your scientist next to you.  If you have trouble with claustrophobia please talk to your scientist prior to the test. 

Gas diffusion

This test involves taking some deep breaths of a special gas mixture with a few breath holds.  It is quick and easy to do, but you need to avoid smoking prior to the test because this interferes with the test results. 

Other important respiratory tests that your doctor may request are

  1. Bronchial provocation test
  2. Cardiopulmonary exercise test
  3. Skin prick testing
  4. Shunt study
  5. High Altitude Simulation Test

Blog posts on these tests will follow, so check back soon!

Depending on what tests your doctor performs, the respiratory function tests will take between 30-45 minutes and will be at all times supervised by a Respiratory Scientist. 

 

What are normal results for lung function tests?

Laboratories are able to compare your results from huge data sets of health normal people from all around the world, of all ages, heights, weights, ethnic background and gender.  So your results will be compared with the normal standard data of people matched for your height, weight, age, gender and ethnicity.   Your own lung function can be tracked over time to help see if you have had a change.

 

What should I do to get the best results?

  • Do not smoke for at least 1 hour before the test.
  • Do not drink alcohol for at least 4 hours before the test.
  • Do not exercise heavily for at least 30 minutes before the test.
  • Do not wear tight clothing that makes it difficult for you to take a deep breath.
  • Do not eat a large meal within 2 hours before the test.

     

    What medications should I stop before the test?

    Where can I get more information?

    Check out these good links:

    1. Australian Lung Foundation http://lungfoundation.com.au/wp-content/uploads/2013/12/Lung-Function-Tests1.pdf
    2. American Thoracic Society  https://www.thoracic.org/patients/patient-resources/resources/pulmonary-function-tests.pdf
    3. Australian Asthma Foundation  https://www.nationalasthma.org.au/living-with-asthma/resources/patients-carers/brochures/asthma-lung-function-tests

    This cough is driving me nuts

    coughpic

    Chronic Cough

    What is a chronic cough?

    An occasional cough helps to protect your lungs by expelling unwanted material and this is normal. However, a chronic cough is one that persists for a number of weeks, and produces sputum or blood, disturbs your sleep, or affects school or work should prompt a referral to your GP or a lung specialist.

    Causes of a chronic cough  

    There are a number of causes of chronic cough. Some of these include:

    1. Postnasal drip. When your nose or sinuses produce extra mucus, it can drip down the back of your throat and trigger your cough reflex.

    2. Asthma. An asthma-related cough may come and go with the seasons, appear after an upper respiratory tract infection, or become worse when you're exposed to cold air or certain chemicals or fragrances. In one type of asthma (cough-variant asthma), a cough is the main symptom.

    3. Gastroesophageal reflux disease (GORD). This is a common condition where stomach acid flows back into the tube that connects your stomach and throat (oesophagus). The constant irritation can lead to chronic coughing. The coughing, in turn, worsens GORD — a vicious cycle.

    4. Infections. A lingering cough post a viral or bacterial infection can occur.

    5. Blood pressure drugs. Angiotensin-converting enzyme (ACE) inhibitors, which are commonly prescribed for high blood pressure and heart failure, are known to cause chronic cough in some people.

    6. Chronic bronchitis. This is an inflammation of your major airways (bronchial tubes) can cause a cough that brings up colored sputum. Most people with chronic bronchitis are current or former smokers and may have other smoking related lung problems.

    Other less common causes include:

    • Aspiration (food in adults; foreign bodies in children)

    • Bronchiectasis (damaged airways)

    • Bronchiolitis

    • Cystic fibrosis

    • Laryngopharyngeal reflux (stomach acid flows up into the throat)

    • Lung cancer

    • Nonasthmatic eosinophilic bronchitis (airway inflammation not caused by asthma)

    • Sarcoidosis (collections of inflammatory cells in different parts of your body, most commonly the lungs)

    Risk factors for a chronic cough

    Being a current or former smoker is one of the leading risk factors for chronic cough. Frequent exposure to secondhand smoke also can lead to coughing and lung damage.  Women tend to have more-sensitive cough reflexes, so they're more likely to develop a chronic cough than are men.

    When to see a doctor

    See your doctor if you have a cough that lingers for weeks, especially one that brings up sputum or blood, disturbs your sleep, or affects school or work.  Ask your GP for a referral to your local Respiratory Department for a consultation with a lung specialist

    Why am I always breathless?

    Shortofbreaht.jpg

    We’ve all felt puffed running to the bus, but shortness of breath doing every day activities may not be normal.  Breathlessness, sometimes called dyspnoea, is an uncomfortable sensation of breathing discomfort.  It can occur acutely or chronically. 

    There are lung, heart, blood, muscular and fitness causes of breathlessness.  Sudden onset shortness of breath may be a medical emergency and require ambulance/ hospital admission to investigate for causes including pneumonia, collapsed lung (pneumothorax), asthma attack, fluid in the lungs (pulmonary edema) and heart attack (myocardial infarction). 

    If you have shortness of breath develops and stays over weeks to months you should book in to see your GP for investigation and management to begin.  Common lung causes include asthma and emphysema which are both conditions characterized by inability of the lungs to adequately empty air, sputum/phlegm production and wheeze. 

     

    The most common heart problem causing chronic shortness of breath is heart failure, a condition where damage to the heart causes inability to pump adequate blood around the body to meet demands.  Other common causes that need investigating and ruling out are anemia and deconditioning. 

     

    My approach when seeing patients with chronic shortness of breath is to take a careful history regarding:

    1. Duration of symptoms, what else was going on around the time the symptoms started

    2. Severity of breathlessness - using either the "New York Heart Association" classification system or the "Medical Research Council" Dyspnoea score

    3. Related symptoms e.g. chest pains, cough, sputum production

    4. Pattern of symptoms e.g. Asthma is often worse around change of season, spring with exposures to pollen, winter and upper respiratory tract infections

    5. Symptoms of heart failure e.g. waking up in the night gasping for breath, swelling in ankles

    6. Possible causes of anaemia e.g. blood in bowel motions or heavy periods

    7. Cigarette smoking history

    8. Childhood history of lung infections

    9. Any "Red Flag symptoms" e.g. coughing blood, chest pains

    Past medical history and current medications are crucial pieces of the puzzle.  

    Examination and Investigations are both  important and usually guided by the history that has been given.  Ultimately once a differential diagnosis or working theory of what is going on has been formed, a trial of treatment is sometimes appropriate.  

     

    I think it is really important that if things are not getting better once a trial of treatment has been started, that other rarer causes, such as pulmonary hypertension be considered.  

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