Asthma

What is asthma?

Asthma is a breathing problem that makes it hard for air to get into the lungs.  When we breathe, air flows in and out of our lungs through airways.  Asthma causes airways to become smaller by tightening the muscles around them.  Asthma also causes the inside of the airways to swell and make too much mucus.  Less space and too much mucus in the airways cause an asthma flare which may include trouble breathing, wheezing, and or coughing.

Asthma and your Airways image

What causes asthma?

Asthma is caused by both genetic and environmental factors. If your relatives have asthma, you are more likely to have it too. Different things in the environment can also contribute to asthma. These include smoke, pollution, dust, mold, and pets.

Asthma Triggers Image

What are asthma symptoms?

A person having an asthma attack will often complain of feeling like they just can’t breathe or catch their breath.  They may have chest pain or tightness, and they can be heard wheezing and or coughing. Usually, the very FIRST sign of an asthma attack is coughing.

Asthma Sign and Symptoms image

What causes asthma attacks (flares)?

Asthma attacks can be triggered by many things. Some attacks are triggered by things like smoke, weather changes, or pollen. Sometimes attacks happen during exercise. Other times, attacks can happen because of a respiratory infection.

When you get sick you should follow your Asthma Action Plan! If you don’t have one ask your medical provider for an Asthma Action Plan!

Asthma Action Plain

How can you prevent an asthma attack?

The best way to prevent attacks is to know the triggers! Getting rid of dust, mold, and smoking is a good way to prevent asthma attacks. If you are allergic to cats or dogs you may need to find another home for them. If you take a controller medication, be sure to take it EVERY day!

How does the environment affect asthma?

The environment plays the biggest role in asthma. Pollution, smoking, dust, mold, and pollen can all make asthma worse. Some people are even affected by changes in the weather. Cigarette smoke is particularly tough on children’s lungs.

Everyone deserves to breathe smoke-free air at home.

How do you test for asthma?

A healthcare provider will examine your child and get a medical history from you. Sometimes, history alone is enough to diagnose someone with asthma. Older children may do a painless spirometry test, which looks at how well a patient breathes.  Younger children will not usually do a spirometry test.

test for asthma
This is a child performing a spirometry test. We cannot do this test until the child is at least 6 or 7 years old.

How do you know if a child needs a specialist for asthma?

Your child’s primary care provider will help you decide if you need a specialist. If your child’s asthma does not get better after using medications or he/she needs to use their rescue inhaler too much, they may need to see a specialist.

What medications can be used to treat asthma?

There are two main medications used to treat asthma. A rescue inhaler is used for an asthma attack.  ALL patients with asthma should have a rescue inhaler with them at all times. Some people also need to use a controller inhaler to help with swelling in the airway. It is very important to use the controller inhaler every day.

metered dose inhaler
This is a metered dose inhaler. It will deliver medication in spray form. They should always be used with a spacer.
respiratory inhalers
These are the most commonly used asthma inhalers.

Why do I need a spacer?

The spacer helps your child breathe in all of the medication. It makes sure that the inhaler medication makes it all the way into their lungs and doesn’t just sit in their mouth. We want to get that medication into the lungs so it can do its job!

spacer
Here is a spacer without a mask, this is used in older children.
spacer with mask
This is a spacer WITH a mask. This is used for younger children.

inhaler with mask

  • Video about how young children (0-6 years old) can correctly use an inhaler and spacer WITH A MASK.
  • Video about how older children and adults can correctly use an inhaler and spacer WITHOUT A MASK.

inhalers

If you don’t use a spacer, most of the medication will end up in your mouth and stomach (see picture above on the left). However, proper use of the spacer will make sure where most of the medication will end up in the lungs (see picture on the right), exactly where it belongs!

Types Rescue Inhalers

These medications are short-acting (they only works for 3-4 hours). They are helpful to treat shortness of breath, wheezing, and coughing.

ProAir HFA Inhaler
ProAir HFA Inhaler (Albuterol Sulfate)
Ventolin HFA Inhaler Albuterol Sulfate
Ventolin HFA Inhaler (Albuterol Sulfate)
Xopenex HFA Inhaler Levalbuterol Tartrate
Xopenex HFA Inhaler (Levalbuterol Tartrate)

How to Use Inhalers

  1. Remove the cap.
  2. Shake inhaler.
  3. Spray inhaler into the air (away from your face) three times by pressing down on the canister.  This is called priming.  Always prime your inhaler the first time you use a new one, or if you have not used it for more than two weeks.
  4. Attach the inhaler to your spacer (Watch videos below to learn the rest!).

Video about how young children (0-6 years old) can correctly use an inhaler and spacer WITH A MASK.

For a video about how older children and adults can correctly use an inhaler and spacer WITHOUT A MASK.

Important Things to Remember about Inhalers

  1. Only use the dose that your doctor tells you to use.
  2. This inhaler should not be used more than every 4-6 hours.
  3. If you are using your rescue inhaler more than 2 days a week or you feel like it isn’t helping, please call your medical provider.
  4. Make sure your inhaler is not expired (the date is written on the canister).
  5. There is a counter on the red part of the inhaler that will tell you how many sprays you have left.  When there are only 20 sprays left, it is time to ask for a refill.  Throw your inhaler away when the counter says zero.
  6. If you are using your rescue inhaler more than 2 days a week or you feel like it isn’t helping, please call your doctor.
  7. Make sure your inhaler is not expired (the date is written on the canister).
  8. There is a counter on the blue part of the inhaler that will tell you how many sprays you have left.  When there are only 20 sprays left, it is time to ask for a refill.  Throw your inhaler away when the counter says zero.

Types of Controller Medications

These medications are taken EVERYDAY to help PREVENT Asthma

Flovent Inhaler

This medication is a corticosteroid that helps with swelling of the airways. This is CONTROLLER INHALER.

Flovent Inhaler:

Asmanex Twisthaler Inhaler

This medication is a corticosteroid that helps with swelling of the airways. This is CONTROLLER INHALER.

Asmanex Twisthaler Inhaler

How to Use Your Asmanex Twisthaler Inhaler

  1. Hold the inhaler straight with the colored part on the bottom.
  2. Twist the dial on the bottom to prepare the dose (the dose will be ready when cap is removed).
  3. Face away from the inhaler and breathe out.
  4. Inhale from the inhaler steadily, then hold your breath for 10 seconds.
  5. Turn away from the inhaler and breathe out.
  6. Rise your mouth and spit out.

Video on how to use your Diskus inhaler.

Important Things to Remember about Your Asmanex Twisthaler Inhaler

  1. This is NOT a rescue inhaler!   It will not treat sudden wheezing, coughing, or shortness of breath.  Asmanex is a controller inhaler.
  2. You cannot use a spacer with your twisthalter
  3. Never breathe into the mouthpiece
  4. Brush teeth after using!
  5. Store in  a dry place at room temperature

Pulmicort Flexhaler

(Budesonide Inhalation Powder)

This medication is a corticosteroid that helps with swelling of the airways. This is CONTROLLER.

Pulmicort Flexhaler Budesonide Inhalation Powder
Pulmicort Flexhaler (Budesonide Inhalation Powder)

How to Prime Your Pulmicort Flexhaler

  1. Prime your flexhaler every time you get a new one.
  2. Twist off the cover.
  3. With one hand, hold the inhaler upright by the brown grip on the bottom.  Use your other hand to hold the inhaler around the middle (stay away from the mouthpiece).
  4. Twist the brown grip until it will not turn anymore.
  5. Twist the brown grip in the opposite direction until it will not turn anymore.
  6. You should hear a click when you twist in one direction or the other.
  7. Again, twist the brown grip until it will not turn anymore.
  8. Again, twist the brown grip in the opposite direction until I will not turn anymore.
  9. Your inhaler is now primed.

See more about how to use your Pulmicort Flexhaler.

How to Use Your Pulmicort Flexhaler

  1. Hold your inhaler so it is standing upright.
  2. Twist off the cover.
  3. Keeping the inhaler upright, hold it around the middle (stay away from the mouthpiece).
  4. Twist the brown grip until it will not turn anymore.
  5. Twist the brown grip in the opposite direction until it will not turn anymore.
  6. You should hear a click when you twist in one direction or the other.  This means your medication is loaded and ready.
  7. Do NOT shake.
  8. Breath out as much as you can BUT NOT into the inhaler.  If you blow air into the inhaler you will have to load the medication again.
  9. Put the mouthpiece into your mouth and seal with your lips.
  10. Breath in as deeply as you can.
  11. Repeat steps 3-10 if the medical provider tells you to take another dose.
  12. Put cover back on inhaler.
  13. Rinse your mouth and or brush your teeth to get rid of extra medication in your mouth that can cause an infection.

Cleaning your Pulmicort Flexhaler

  1. Only wipe the outside of the mouthpiece with a dry tissue once a week.
  2. NEVER get your inhaler wet.

Important Things to Remember about Your Pulmicort Flexhaler

  1. This is NOT a rescue inhaler!   It will not treat sudden wheezing, coughing, or shortness of breath.  Pulmicort is an controller inhaler.
  2. You cannot use a spacer with your flexhaler.
  3. Never breathe into the mouthpiece
  4. Brush teeth after using!
  5. Store your inhaler in a dry place at room temperature
  6. There is a dose counter under the mouthpiece that tells you how many doses are left.  The numbers will change about every five doses.  Refill before the dose counter reads zero, and when it does, throw it away.

Video on how to use your Pulmicort Flexhaler.

Flovent Diskus Inhaler

This medication is a corticosteroid that helps with swelling of the airways. This is CONTROLLER INHALER.

Flovent Diskus Inhaler

How to Use Your Flovent Diskus Inhaler

  1. Open your Diskus inhaler by pushing the thumbpiece as far as it will go and until the mouthpiece is visible
  2. Slide the lever until you hear a “click”
  3. Breathe in the medication
  4. Hold your breath for 10 seconds after inhaling
  5. Close the Diskus

Video on how to use your Diskus inhaler.

How to Clean Your Flovent Diskus Inhaler

Clean the mouthpiece using a dry cloth. Do not put the Diskus into water!

Important Things to Remember about Your Flovent Diskus Inhaler

  1. Do not use more often than is prescribed
  2. Flovent is not a rescue inhaler! It will not treat sudden wheezing, coughing, or shortness of breath.  It is a controller inhaler.
  3. Make sure to hold the Diskus upright
  4. Do not push the lever more than once
  5. You cannot use a spacer with a Diskus inhaler
  6. Store the inhaler in a dark, dry space
  7. Rinse your mouth after taking!

Advair Diskus Inhaler

A combination medication that contains both inhaled corticosteroid and long-acting beta2-agonist.  It is a CONTROLLER INHALER that helps with both swelling and wheezing and coughing.

Advair Diskus Inhaler

How to Use Your Advair Diskus Inhaler

  1. Open your Diskus inhaler by pushing the thumbpiece as far as it will go and until the mouthpiece is visible
  2. Slide the lever until you hear a “click”
  3. Breathe in the medication
  4. Hold your breath for 10 seconds after inhaling
  5. Close the Diskus
  6. Rinse your mouth

Click here for a video on how to use your diskus inhaler.

How to Clean Your Advair Diskus Inhaler

Clean the mouthpiece using a dry cloth. Do not put the Diskus into water!

Important Things to Remember about Your Advair Diskus Inhaler

  1. Make sure to hold the Diskus upright
  2. Do not push the lever more than once
  3. You cannot use a spacer with a Diskus inhaler
  4. Store the inhaler in a dark, dry space
  5. Rinse your mouth after taking!

Dulera Inhaler

A combination medication that contains both inhaled corticosteroid and long-acting beta2-agonist.  It is a CONTROLLER INHALER that helps with both swelling and wheezing and coughing.

Dulera Inhaler

How to Use Your Dulera Inhaler

  1. Remove the cap.
  2. Shake inhaler.
  3. Spray inhaler into the air (away from your face) three times by pressing down on the canister.  This is called priming.  Always prime your inhaler the first time you use a new one, or if you have not used it for more than two weeks.
  4. Attach the inhaler to your spacer (Watch videos below to learn the rest!).
  • Video about how young children (0-6 years old) can correctly use an inhaler and spacer WITH A MASK.
  • Video about how older children and adults can correctly use an inhaler and spacer WITHOUT A MASK.

How to Clean Your Dulera Inhaler

Clean once a week by wiping the mouthpiece with a dry q-tip or Tissue.

Important Things to Remember about Your Dulera Inhaler

This is NOT a rescue inhaler!   It will not treat sudden wheezing, coughing, or shortness of breath.  Dulera is a controller inhaler.

QVAR

Inhaler

This medication is a corticosteroid that helps with swelling of the airways. This is CONTROLLER INHALER.

QVAR Inhaler

How to Use Your QVAR Inhaler

  1. Remove the cap.
  2. Shake inhaler.
  3. Spray inhaler into the air (away from your face) three times by pressing down on the canister.  This is called priming.  Always prime your inhaler the first time you use a new one, or if you have not used it for more than two weeks.
  4. Attach the inhaler to your spacer (Watch videos below to learn the rest!).
  • Video about how young children (0-6 years old) can correctly use an inhaler and spacer WITH A MASK.
  • Video about how older children and adults can correctly use an inhaler and spacer WITHOUT A MASK.

How to Clean Your QVAR inhaler

Clean the mouthpiece using a dry cloth. Do not put the Diskus into water!

Important Things to Remember about Your QVAR inhaler

QVAR is not a rescue inhaler! It will not treat sudden wheezing, coughing, or shortness of breath.  It is a controller inhaler.

How to Clean Your Metered Dose Inhaler

  1. Remove the cap.
  2. Pull the metal canister out of the plastic piece of the inhaler (called the actuator).
  3. DO NOT get the metal canister wet.
  4. Run water from the top out through the bottom while counting to thirty.
  5. Flip actuator upside-down, then run water from the bottom out through the top.
  6. Make sure that no medication is stuck to the inside of the actuator.
  7. Shake off extra water and let the actuator dry overnight.
  8. In the morning, put the canister back into actuator.
  9. Prime the inhaler by giving it 2 sprays into the air pointing away from your face.
  10. Now your inhaler is ready to use.

Cleaning Your Metered Dose Inhaler

Cleaning Your Metered Dose Inhaler

Video about how to clean your metered-dose inhaler and spacer.

How to Clean Your Spacer

Clean the spacer once a week by soaking in warm soapy water for 15 minutes. Rinse under water and set out overnight to dry.

How to Clean Your Spacer

Video about how to clean your metered-dose inhaler and spacer.

Program Information

  • Location: 1207 Chestnut Street, Philadelphia, PA 19107 - 5th Floor

  • Phone: 215-525-8600. Fax: 215-567-1012

  • Contact: Dr. Mario Cruz

  • Email: pediatrics@fight.org

  • Hours: Monday through Friday: 9am-5pm<br>We see also see patients on the 2nd Saturday of each month.

Spotlight On

Karam Mounzer, MD

Dr. Mounzer identified two major gaps in the care of patients with HIV/hepatitis C (HCV) co-infection, and the complexity of multidrug-resistant HIV treatment. He is involved with many clinical trials focusing on drug development and better understanding of HIV immunopathogenesis with the Wistar Institute. He is involved in teaching and mentoring.

Learn More about Spotlight On
Dr. Karam Mounzer

Dr. Mario Cruz

Dr. Mario CruzDr. Cruz is a board certified pediatrician who serves as the Medical Director for our Pediatrics and Adolescent Health Center. He has presented and/or published in the fields of community violence and domestic violence prevention, quality improvement, behavioral health, curriculum development and mentorship. In 2019 he received the Greater Philadelphia Social Innovation Award for Innovations in Healthcare.


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