of inhalers and such

Asthma affects 1 in 5 kids in Singapore
2 types of medication: reliever (bronchodilator) and controller (steroids and anti-inflammatories)

Reliever: SABA lasts 4 hours(salbutamol) LABA lasts 12 hours(formoterol/Salmeterol)
Controller: Becotide (beclomethasone), Flicotide(fluticasone), Pulmicort/Inflamide (Budesonide)
Mixed: Symbicort (BF: budesonide, formoterol) seretide (SF salmeterol, fluticasone)
*note: symbicort may be used as rescue therapy as it formoterol has rapid onset of action
Route of administration: MDI, DPI, Turbuhaler, Acuhaler, Airchamber
Airchamber: space chamber (w or w/o O2 inlet) and aerochamber (fixed mask, cannot change its size)

Usage:
Air chambers are usually useful for young and the elderly
Generally masks are not used for those > 6 years old

Advice to people using MDIs with spacers:
1. shake to mix
2. fix to spacer
3. puff, deep breath, 6 deep breaths
4. remove MDI, shake once more, insert into spacer
5. puff, deep breath, 6 breaths

Advice to people using MDI without spacers:
1. shake to mix
2. breathe out first. Puff and inhale (look out for 'white smoke' at the sides' = poor technique)
3. inhale and hold 10s
4. breathe out and repeat

Advice on how to clean the spacer:
1. put in lukewarm water
2. do not scrub and cause scratches
3. 1-2 drops of dishwasher oap

Asthma assessment:
PEFR: repeat 3 x and take the best. plot on chart wrt height.

Little facts about symbicort: formoterol and budesonide
- Symbicort was used by our colleague as a rescue therapy
- 2 x morning and 2x night
- helps reduce need for ventolin
- can be used as rescue and maintenance
- maximum 12 puffs

INHALERS!
1. Blue: salbutamol (Ventolin, Salbulair?)
2. Purple: seretide 25/250 (salmeterol/fluticasone)
3. brown: beclotide (beclomethasone)
4. dark brown: pulmicort (budesonide)
5. orange: flixotide (fluticasone)
6. Green:?
7. Turbuhaler: symbicort (formoterol, budesonide)
8. White: Atrovent
9. White: inflamide (budesonide)
10. Acuhaler: 60 doses seretide (salmeterol, fluticasone)
11. flixonase: fluticasone intranasal spray
12. Nasonex: mometasone (steroid) intranasal spary