WHAT YOU NEED TO KNOW:

What is a metered-dose inhaler and a spacer?

A metered-dose inhaler is a handheld device that gives you a dose of medicine as a mist. You breathe the medicine deep into your lungs to open your airways. A spacer is a tube that attaches to the mouthpiece of your metered-dose inhaler. The spacer helps make your inhaler easier to use. It also helps get the medicine into your lungs better. Your medicine stays in the spacer for a short amount of time. This allows you to breathe one deep breath. You can also breathe in and out at a normal rate up to 5 times. Your healthcare provider will teach you how to use your inhaler and spacer.

How do I use my inhaler with a spacer?

Practice using your inhaler and spacer. Your medicine will work best if you use them correctly. The steps below will help you use your inhaler and spacer correctly:

• Prepare your inhaler and spacer:

   ○ Remove the caps from your inhaler and spacer. Check to make sure there is nothing in the mouthpiece that could block the medicine from coming out.

   ○ Put the spacer onto the inhaler.

   ○ Shake the inhaler to mix the medicine.

   ○ Hold the inhaler upright, with the mouthpiece of the spacer pointing towards your mouth.

• Get ready to breathe in the medicine:

   ○ Keep your mouth away from the mouthpiece, and breathe out fully to clear your lungs.

   ○ Place the mouthpiece between your lips. Close your lips around the mouthpiece to form a seal and prevent a medicine leak. If you cannot put your mouth around the mouthpiece, your healthcare provider will give you a spacer with a mask attached. Hold the mask firmly to your face.

   ○ Press down the canister and breathe in slowly. This helps the medicine get into your lungs. Make sure to breathe in within 2 seconds of pressing down the canister.

   ○ Hold your breath for at least 5 seconds. This will help the medicine reach all parts of your lungs, including the smaller parts called the alveoli.

   ○ Breathe out slowly through pursed lips. This helps to keep your airway open and allows the medicine to be absorbed into more areas.

   ○ Repeat puffs of medicine as directed by your healthcare provider. Wait about 2 minutes between puffs. If you need to use a bronchodilator and a steroid inhaler, use the bronchodilator first. Wait 5 minutes then use the steroid inhaler.

   ○ Gargle with warm water to remove any leftover medicine from your mouth and throat.

How do I care for my inhaler and spacer?

Pull your inhaler and mouthpiece apart. Put the caps back on both. Clean your spacer and inhaler at least weekly. Remove the canister from your inhaler before cleaning. Wash your spacer and inhaler with warm soapy water. Rinse and allow to air dry. Make sure both are completely dry before using.

When should I seek immediate care?

• Your lips or nails turn blue or gray.

• The skin between your ribs or around your neck pulls in with every breath.

• You feel short of breath, even after you use your inhaler.

When should I contact my healthcare provider?

• You have to take more puffs from the inhaler than directed, in order to get relief.

• You run out of medicine before your next refill is due.

• You feel like your medicine is not making your symptoms better.

• You have questions or concerns about your condition or care.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

© 2017 Truven Health Analytics LLC All illustrations and images included in CareNotes® are the

copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

This information will help you to:

•      Learn about asthma

•      Understand the types of medicines used to treat asthma

•      Know when to seek medical care

What is asthma?

Asthma is a disease of the bronchioles, the tubes that carry air to the lungs.

When someone has an acute asthma attack, the airways get narrow and may fill with mucus. This makes it hard to breathe. For someone having an asthma attack, it’s like breathing through a narrow straw.

What are the symptoms of asthma?

Symptoms can be different between adults and children. They also vary among individuals. Depending on how fast and how serious the symptoms are, each asthma attack can be very different.

Early symptoms may include:

•      Coughing

•      Wheezing

•      Difficulty speaking

•      Chest tightness

•      Trouble breathing

•      Trouble exercising or playing

How will my doctor treat my asthma?

Inhalers and medicine delivery devices

Most asthma medicines are kept in a small, handheld device called an inhaler. To help the medicine reach the lungs more easily, your child may also use a spacer or a valved holding chamber as an add-on device. Most children can be taught to use inhalers directly or with the right spacer device.

A child who cannot use an inhaler may need to use a nebulizer. This device turns the liquid medication into a mist that can be inhaled through a mouthpiece or mask.

Quick-relief or “rescue” medicines

These medicines are also called bronchodilators. They help to open the bronchioles, making it easier to breathe. Used to treat an acute asthma attack, rescue medicine should be used when asthma symptoms first occur. 

The most common rescue medicine used is albuterol (Ventolin).

Long-term controller maintenance medicines

Controller medicines are used daily to keep asthma under control, reducing the severity and frequency of attacks.

Types of controller medicines include:

1. Inhaled corticosteroids 

These medicines help to decrease swelling and inflammation, making asthma attacks less frequent. They are usually taken every day, even if your child is not experiencing any symptoms.

Examples include Flixotide and Pulmicort.

2. Long-acting bronchodilators  

These help keep the airways from narrowing. They are usually used along with inhaled corticosteroids.

An example includes Seretide.

Oral steroids

Your doctor may recommend steroids taken by mouth (in pill or liquid form) if the asthma is not well controlled. They reduce inflammation and can help the airways become more responsive to inhalers. Steroids usually start to work within about six hours so are not used in acute attacks. Your child should continue to take quick-relief and long-term controller medications while taking oral steroids.

What else do I need to know about asthma?

Follow all instructions you have been given about treating and controlling asthma, including:

•      Recognizing and avoiding asthma triggers

•      Having an asthma action plan with your health care provider

•      Knowing how to use inhalers and related medicine delivery devices 

•      Knowing how to care for, store, and clean the inhaler mouthpiece, face mask, spacer, and valved holding chamber

•      Knowing how to refill prescriptions

When should I seek emergency care?

If your child has any of these warning signs, call 120 or seek emergency medical care immediately.

When your child has been diagnosed with asthma, it is important that he or she is monitored by a healthcare provider. Be sure to take your child to all follow-up healthcare appointments.

Sore throats are common. A sore throat is often a throat infection or pharyngitis.

Sore throats are usually caused by 2 types of germs—viruses and bacteria. Most sore throats are caused by viruses. Only 10% of sore throats are caused by bacteria. 

You or your child has seen the doctor and is likely to have a sore throat caused by a virus.

Do I need antibiotics?

If your sore throat is caused by a virus, you do not need antibiotics. A sore throat caused by viral infection gets better on its own with at-home care, usually within five to ten days.

What medicines will my doctor give me? 

Your doctor will most likely give you medication and lozenges to relieve your throat pain or discomfort. Depending on your symptoms, doctor may also give you medicines to relieve running nose and cough.

What about alternative remedies?

There are limited evidences on what works and what does not for common alternative remedies. Some of these remedies may not be safe. Check with your doctor before using them.

What are the things I can do at home to feel better?

DOs

•      Get plenty of sleep and avoid talking

•      Drink plenty of fluids to keep your throat moist. This helps with swallowing and prevents dehydration

•      Drink soothing beverages and eat soft foods

•      Gargle with salt water several times a day to help relieve throat pain

•      Add moisture to the air in your home. Use a cool-mist humidifier or vaporizer. Be sure to clean it daily

DON'Ts

•      Avoid spicy foods or acidic foods that irritate your throat

•      Avoid smoking or secondhand smoke

How much salt should I put in my salt water gargle?

About 1/4 to 1/2 a teaspoon (1.5 to 3.0 g) of salt in one cup (250 ml) of warm water.

When can I return to work? When can my child return to school?

You can resume your usual activities as soon as you feel better. Wear a mask if the air pollution is bad to prevent further throat discomfort.

How can I avoid getting a sore throat again?

Reduce your chance of having a viral infection by exercising regularly and eating healthily.

Also practice good hand washing habits, washing your hands with soap and water to prevent the spread of infection.

When should I see my doctor again?

Please contact your doctor if your sore throat does not improve within two days or if you have a fever. 

Also contact your doctor if you have the following symptoms: 

•      Difficulty swallowing

•      Drooling (especially for children)

•      Trouble talking or opening your mouth

•      Hoarseness lasting more than two weeks

•      Body aches, joint pain, or earache

•      Skin rash

•      Nausea or vomiting

•      Constant sleepiness or tiredness

•      Increased thirst or dry and sticky mouth with less urine than usual (one wet diaper or void in six hours) or total lack of tears when crying

When do I need to go to the hospital or emergency department?

Call the ambulance or go to the nearest hospital right away if you have: 

•      Chest pain

•      Difficulty breathing

•      Shortness of breath

With reference to www.uptodate.com

Upper respiratory infection (URI), also known as the common cold, is caused by a group of viruses. They can be passed between people by sneezing, coughing, and touching surfaces with the viruses on them. You can become infected if the lining of your eyes, nose or mouth comes in contact with the virus when you rub your nose or touch your face with contaminated hands. The usual symptoms are nasal congestion, runny nose and sneezing. 

The common cold weakens your immune system and at times leads to a new viral infection or bacterial infection. This can cause other serious problems such as sinusitis, infection of the middle ear, and pneumonia. Thus it is important that you take good care of yourself when you get the common cold to prevent these problems.

Do I need antibiotics?

Antibiotics are not useful for treating the common cold. If fact, taking antibiotics when not needed can negatively affect your health. The common cold gets better on its own with at-home care over time, even without any treatment. 

What medicines will my doctor give me? 

Depending on your symptoms, your doctor may give you medicines to relieve your runny nose, nasal congestion, cough, pain, or fever.

What can I do at home to feel better?

DOs

•      Get plenty of rest

•      Drink lots of fluids to keep the lining of your nose and throat moist

•      Add moisture to the air in your home. Use a cool-mist humidifier or vaporizer and be sure to clean it daily

DON'Ts

•      Avoid smoking or secondhand smoke

•      Avoid blowing your nose forcefully

When can I return to work? When can my child return to school?

You can resume your usual activities at least 24 hours after your fever totally subsides and when you feel better. Wear a mask if you still have a cough or runny nose, and practice good hygiene etiquette, like covering your mouth when sneezing or coughing to prevent the spread of infection.

How can I prevent getting a URI again?

Reduce your chances of getting a viral infection by exercising regularly and eating healthily.

Good hand washing habits, like washing your hands with soap and water before eating or after touching dirty surfaces, can prevent the spread of infection. 

Alcohol-based hand rubs are a good alternative for disinfecting hands if a sink is not available. Ensure that you thoroughly wash every part of your hands.

When should I see my doctor again?

Please contact your doctor if you have: 

•      Worsening symptoms after 3 to 5 days

•      A fever of 38.5°C or above lasting more than three days

•      Nasal congestion that does not improve over 14 days

•      Signs or symptoms of an ear infection - pain, ear discomfort, discharge from ear, difficulty hearing, fussiness (children), etc.

•      Severe body aches, joint pain

•      Rash

•      Nausea or vomiting

When do I need to go to the hospital or emergency department?

Call the ambulance or go to the nearest hospital right away if you have: 

•      Chest pain

•      Difficulty breathing

•      Shortness of breath

•      For children:

  ○  Increased irritability or decreased responsiveness

  ○  Poor oral fluid intake

What is this test?

This test detects and identifies bacteria from a culture of sputum. This test is used to help diagnose possible bacterial causes of respiratory tract infections such as community acquired pneumonia.

Why do I need this test?

Laboratory tests may be done for many reasons. Tests are performed for routine health screenings or if a disease or toxicity is suspected. Lab tests may be used to determine if a medical condition is improving or worsening. Lab tests may also be used to measure the success or failure of a medication or treatment plan. Lab tests may be ordered for professional or legal reasons. You may need this test if you have: 

•    Acute chest syndrome

•    Acute exacerbation of pulmonary cystic fibrosis

•    Aspiration pneumonitis

•    Community acquired pneumonia

•     Pneumonic plague

How should I get ready for the test?

Before a sputum sample is collected, you may be asked to drink more fluids. Drinking more fluids may help you produce a sputum sample.

For this test, a sputum sample is obtained before taking an antibiotic. Tell your doctor if you are taking any medications at the time of the test.

How is the test done?

Sputum is mucus that is secreted by the airways and lungs. To collect a sample of sputum, you may be asked to cough forcefully, and spit out sputum into a container. If you are unable to produce a sputum sample, you may need to have the sample induced. To induce a sputum sample, a doctor will prepare a solution in a nebulizer for you to inhale. You will be asked to inhale the solution over a period of time, which may last up to 20 minutes. You will then be asked to cough and spit out sputum into a container.

How will the test feel?

The amount of discomfort you feel will depend on many factors, including your sensitivity to pain. Communicate how you are feeling with the person doing the test. Inform the person doing the test if you feel that you cannot continue with the test.

Generally, collection of a sputum sample is not painful. If the sample is induced, the coughing may be uncomfortable.

What should I do after the test?

After a sputum sample is collected, call the doctor if you experience a new onset of pain in your throat, trouble swallowing, or if you are coughing up blood.

CARE AGREEMENT: 

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

© 2017 Truven Health Analytics LLC

What is an upper respiratory infection? 

An upper respiratory infection is also called a common cold. It can affect your nose, throat, ears, and sinuses. 

What causes a cold? 

The common cold is caused by a virus. There are many different cold viruses, and each is contagious. This means the virus can be easily spread to another person when the sick person coughs or sneezes. The virus can also be spread if you touch something that a person with a cold has touched. You are more likely to get a cold in the winter. Your risk of getting a cold may be increased if you smoke cigarettes or have allergies, such as hay fever.

What are the signs and symptoms of a cold? 

Cold symptoms are usually worst for the first 3 to 5 days. You may have any of the following:

•      Runny or stuffy nose

•      Sneezing and coughing

•      Sore throat or hoarseness

•      Red, watery, and sore eyes

•      Fatigue 

•      Chills and fever

•      Headache, body aches, or sore muscles

How is a cold treated?

There is no cure for the common cold. Colds are caused by viruses and do not get better with antibiotics. Most people get better in 7 to 14 days. You may continue to cough for 2 to 3 weeks. The following may help decrease your symptoms:

•      Decongestants help reduce nasal congestion and help you breathe more easily. If you take decongestant pills, they may make you feel restless or cause problems with your sleep. Do not use decongestant sprays for more than a few days

•      Cough suppressants help reduce coughing. Ask your doctor which type of cough medicine is best for you

•      NSAIDs, such as ibuprofen, help decrease swelling, pain, and fever. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your doctor if NSAIDs are safe for you. Always read the medicine label and follow directions

•      Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how much to take and how often to take it. Follow directions. Read the labels of all other medicines you are using to see if they also contain acetaminophen, or ask your doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly. Do not use more than 4 grams (4,000 milligrams) total of acetaminophen in one day

How can I manage my cold? 

•      Rest as much as possible. Slowly start to do more each day

•      Drink more liquids as directed. Liquids will help thin and loosen mucus so you can cough it up. Liquids will also help prevent dehydration. Liquids that help prevent dehydration include water, fruit juice, and broth. Do not drink liquids that contain caffeine. Caffeine can increase your risk for dehydration. Ask your doctor how much liquid to drink each day

•      Soothe a sore throat. Gargle with warm salt water. This helps your sore throat feel better. Make salt water by dissolving ¼ teaspoon salt in 1 cup warm water. You may also suck on hard candy or throat lozenges. You may use a sore throat spray

•      Use a humidifier or vaporizer. Use a cool mist humidifier or a vaporizer to increase air moisture in your home. This may make it easier for you to breathe and help decrease your cough

•      Use saline nasal drops as directed. These help relieve congestion

•      Apply petroleum-based jelly around the outside of your nostrils. This can decrease irritation from blowing your nose

What is pneumonia?

Pneumonia is an infection in your lungs caused by bacteria, viruses, fungi, or parasites. You can become infected if you come in contact with someone who is sick. You can get pneumonia if you recently had surgery or needed a ventilator to help you breathe. Pneumonia can also be caused by accidentally inhaling saliva or small pieces of food. Pneumonia may cause mild symptoms, or it can be severe and life-threatening. 

What increases my risk for pneumonia? 

•      A cold or the flu

•      Health conditions, such as heart or lung disease

•      A weakened immune system caused by HIV, cancer, or steroid use

•      Recent hospitalization

•      Smoking

•      Excess alcohol use

•      Older age

What are the signs and symptoms of pneumonia? 

•      Fever or chills

•      Cough

•      Shortness of breath or rapid breathing

•      Chest pain when you cough or breathe deeply

•      Headache

•      Vomiting

•      Fatigue or confusion

How is pneumonia diagnosed? 

Your healthcare provider will listen to your lungs. Tell him or her if you have other health conditions. Give your provider a complete list of all medicines you have taken recently. You may need any of the following: 

•      Blood tests may show signs of an infection or the bacteria causing your pneumonia. Blood tests can also show how much oxygen is in your blood