Asthma medication: Inhalers, spacers, peak flow, individual management plan for Medical Student OSCE
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Peak flow measurement to diagnose asthma:
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‘I understand you have had symptoms of a night cough and wheeze for a while, so I wish to carry out a peak flow test to rule out the possibility of asthma. Have you ever had one of these before? What do you understand by asthma? The peak flow meter measures how air flows out of your lungs, and tells how good your ability to push air out is.’
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Procedure:
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Pt standing
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Reset to zero. Place fresh mouthpiece
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Tell pt to inhale fully, then hold the meter with fingers not interfering with pointer, and make a tight seal with lips. Blow as hard and fast as possible out through meter – demonstrate to pt
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Best of 3. Best taken first thing in morning / just before going to sleep
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Check comprehension and ability to record in peak flow diary
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Check against standardised chart, taking into account age, sex and height
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Mention need for follow-up
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Inhaler technique
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‘Following the peak flow test, I suspect you ma be asthmatic. Understand asthma? Lung condition characterized by difficulty breathing: sensitive airways that narrow when irritated, causing wheeze and shortness of breath.
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Use drug salbutamol from inhaler to deliver to lungs, opens up the air passages. Today I wish to demonstrate how to use this. Any questions?’
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Procedure:
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Blue inhaler: salbutamol: shake before use
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Brown inhaler: preventer
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Check expiry date of medications
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Pt should fully exhale, while removing cap
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Co-ordinate inhaler (between thumb and index finger, finger presses canister) and deep breath in
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Hold breath 10s
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If another dose is needed, must wait at least 1 minute, so the medicine can mix with the propellant
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Check for comprehension, ask pt to demonstrate
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Further points
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Side effects (salbutamol) – fast heart rate, shakiness, headaches (?2 adrenergic agonist). Very safe, but if concerned seek medical advice
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Regularity – 2 puffs up to 4 times / day (as required)
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Seek help: blue (salbutamol) can be used when you have symptoms of wheeze or SOB. If you need more than 2 puffs 4/day, you may benefit from other medications, and must consult doctor.
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Confirm understanding, and mention need for follow-up to review symptoms
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Spacer device
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‘I understand you have recently been diagnosed with asthma and given an inhaler. Can you tell me what you understand by asthma and how you think the inhaler may help?
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Identify patient’s poor technique; explain need for spacer – ‘As you suffer from asthma it is important that you take the salbutamol to relieve your symptoms. As I feel you are having some difficulty using the inhaler due to your rheumatoid arthritis I recommend using this spacer device. It eliminates the need to co-ordinate the small inhaler with the breathing.’
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Procedure:
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Assemble spacer
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Shake inhaler, release 2 puffs into device
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Attach mouth with good seal; inhale and exhale deeply and slowly with mouth still attached, 3-4 times
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Check comprehension – ask to demonstrate
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Further points
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Device should be washed with warm water at least once a week and left to drip-dry. No detergents / materials to dry it – might produce static, reducing effectiveness.
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Storage – to prevent scratches
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Should be replaced after 6-12 months to ensure optimum function
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Check comprehension, check for questions, mention follow-up to review symptoms
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by: Admin
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Word Count: 883
Date: Fri, 22 Jan 2010 Time: 4:17 PM
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