Talking to Your Patients' Families about Asthma

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According to the latest statistics from the Indiana Department of Health, more than 140,000 Hoosier children (8.4 percent) have asthma. Young children (infants to 4 years old) have the highest rate of emergency department visits. Here's what you need to know to help keep your patients' asthma in check.

SUCCESSFUL ASTHMA MANAGEMENT PLANS

Successful treatment means developing an asthma management plan with your patient's family that allows them to take an active role in their child's care.

Most children (and adults) who have asthma can successfully manage their symptoms by following their plans and having regular checkups.

Successful plans focus on the following goals:

• Preventing daily coughing and wheezing
• Reducing exercise limitation
• Maintaining normal daily activity levels, including participation in sports and extracurricular activities
• Preventing worsening of asthma symptoms and reducing the need for urgent office visits, emergency room visits or hospitalizations
• Providing optimal medications with minimal to no side effects
• Meeting the families' and patients' expectations of complete asthma care

The Riley Asthma Care Team uses a comprehensive educational approach to asthma management that can help patients and their families take control of their asthma. For more information, call 317-688-5700.

RECENT NEWS ABOUT INHALERS

HFA Inhalers

Any of your patients who are no longer using chlorofluorocarbon (CFC)-propelled albuterol inhalers and are now using hydrofluoroalkane (HFA)-propelled ones such as Proair HFA Inhalation Aerosol, Proventil HFA Inhalation Aerosol, Ventolin HFA Aerosol and Xopenex HFA Aerosol may need some reminders about the differences:

• HFA-propelled albuterol inhalers may taste and feel different (softer) than the CFC-propelled albuterol inhalers.
• It is important to both prime and clean the HFA-propelled inhaler in order to prevent blockage in the inhaler that could block the medicine from reaching the lungs. Each inhaler has different instructions; therefore, it is important to help your patients and their parents understand the directions.

FDA Panel Recommendations

In December 2008, an FDA advisory panel recommended that the agency remove salmeterol xinafoate (Serevent®) and formoterol fumarate (Foradil®) from the market. As part of the compound class of long acting beta 2-agonists (LABAs), they have been linked to an increase of fatal asthma attacks. The FDA ordered black box warnings on the drugs in 2006, indicating that they should only be taken with inhaled corticosteroids (ICS). If LABAs are not combined with ICS, the risk of death increases.

The panel also recommended that other LABAs that have steroids mixed into them, such as fluticasone propionate and salmeterol (Advair®) and budesonide/formoterol fumarate dihydrate (Symbicort®) remain on the market. The FDA has yet to rule on the panel's recommendation.

Michael Tsangaris, MD

Associate Professor of Clinical Pediatrics
Pulmonary and Critical Care
Indiana University School of Medicine

317-688-5700
mtsangar@iupui.edu