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Asthma Worse When Nebulizers Improperly Used
< Oct. 25, 2006 > -- Home nebulizers have revolutionized asthma care. But a new study shows that, if used improperly, they can also lead to serious asthma complications, even death.
These machines turn medications into fine, inhaled droplets. But researchers at Michigan State University concluded that when home nebulizers are not used according to the National Asthma Education and Prevention Program (NAEPP) guidelines, they may actually contribute to some people's deaths. The results of the Michigan State University study were presented this week at the annual meeting of the American College of Chest Physicians.
Home nebulizers are small machines that transform liquid medication into a mist form that can be inhaled deep into the airways. Both rescue - quick relief - and preventive medications are available in forms that can be nebulized.
"Widespread prescription and use of home nebulizers in asthma may have the unintended consequence of contributing to over-reliance on bronchodilators and inadequate use of inhaled steroids," the study authors conclude.
Having a home nebulizer may delay getting proper care and result in poor management of the condition.
"At-home nebulizers are not a panacea," agrees Dr. Jonathan Field, director of the Allergy and Asthma Clinic at New York University Medical Center/Bellevue in New York City. Dr. Field, who was not involved in the current research, says that people using nebulizers and even inhalers sometimes tend to only use their "rescue" medications when they are having symptoms, instead of using daily preventive meds to keep the asthma under control. Having a regular schedule for prescribed medications can help to prevent an asthma crisis.
As many as 20 million Americans, including about 9 million children, have asthma, according to the Allergy and Asthma Network/Mothers of Asthmatics (AANMA). Nearly 2 million Americans visit the emergency room each year due to their asthma. And, despite advances in treatment, more than 4,000 people die annually as a result of asthma complications, reports AANMA.
For the current study, the Michigan researchers looked at all asthma deaths that occurred between 2002 and 2004 in people between the ages of two and 34 years old.
During that time period, 86 people in the specified age group died as a result of their asthma, 38 of them children. Fifty-two people who died had a home nebulizer. The researchers found that 30 of those people used their nebulizer regularly - between once a week to six times a day.
Two out of three people who used their nebulizers regularly were prescribed either inhaled or oral steroids, but only one out of three was using them as directed. Instead they used mainly the bronchodilators or "rescue" medications. One explanation could be the immediately noticeable effect from bronchodilators, which inhaled steroids do not have.
Nearly half of those who died also had a peak flow meter - a device that measures current lung function. People with asthma are supposed to regularly monitor their airway strength using this device. If the numbers drop to a certain level (a number your doctor will let you know based on your average peak-flow readings), then it is either time to contact your doctor or add additional medication. This type of understanding between patients and physicians can be the difference in life or death for some.
Although 38 of the people who died had peak flow meters, only 8 used it daily, the researchers found. Just nine out of the 52 people with nebulizers had written asthma action plans.
Dr. Field says that people with home nebulizers may feel they can handle their asthma flare-ups on their own. "When someone goes to the ER, they get nebulized, so people may think, 'If I have one at home, why should I go in?'" But, he says, if an asthma attack is serious enough, people may need mechanical ventilation or other treatments.
Asthma action plans - specific steps to take when asthma worsens - help patients and physicians stay on the same page in terms of what action to take regarding asthma treatment during various circumstances. The action plan concept is relatively new, however, and will likely benefit more asthma sufferers when it becomes more widely used.
Always consult your physician for more information.
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Asthma is a chronic, inflammatory disease in which the airways become sensitive to allergens (any substance that triggers an allergic reaction). Several things happen to the airways when a person is exposed to certain triggers:
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The lining of the airways becomes swollen and inflamed.
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The muscles that surround the airways tighten.
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The production of mucus is increased, leading to mucus plugs.
All of these factors will cause the airways to narrow, thus making it difficult for air to go in and out of your lungs, causing the symptoms of asthma.
Sometimes, the only symptom is a chronic cough, especially at night, or coughing or wheezing that occurs only with exercise. Some people think they have recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma.
Persons with asthma have acute episodes when the air passages in their lungs become narrower, and breathing becomes more difficult. These problems are caused by an over-sensitivity of the lungs and airways.
Breathing becomes harder and may hurt. There may be coughing. There may be a wheezing or whistling sound, which is typical of asthma. Wheezing occurs because of the rush of air which moves through the narrowed airways.
Quick-relief asthma medication quickly relaxes the muscles in and around the airways that tighten during an asthma attack. The sooner a person takes quick-relief medication at the onset of asthma symptoms, the faster the asthma will be back under control.
Although quick-relief medications may relieve symptoms, the relief may only last about four hours. It is important to note that quick-relief asthma medications do not keep symptoms from recurring.
When using more and more of the quick-relief asthma medications to obtain relief, the asthma may become uncontrolled and an adjustment of the long-term asthma control medication may be necessary.
Always consult your physician for more information.
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