Posts Tagged ‘plastic’

Over-the-Counter Remedies Vitamin E
Vitamin E, once considered a potential super-nutrient, has fallen out of favor as a preventive for heart disease or cancer viagra comercial with vcr . But back when it still looked ever so promising, a group of Italian dermatologists conducted a study to see if vitamin E could improve symptoms of eczema ecstacy lexapro . 295 It was single-blind; that is, the patients did not know who was getting the active treatment, but the doctors did sources side effects zoloft . The patients ranged in age Vita
This fat-soluble vitamin has been disappointing in studies of cancer or heart disease prevention stopped procardia labor . The natural form of vitamin E used in this study (alpha-tocopherol at 400 IU daily) was surprisingly effective in reducing the lesions and itching of eczema ibuprofen urticaria .
Side effects: Minor digestive upset is possible, but unlikely prescription plans that will cover valtrex . Downside: There has been only one study of this therapy for eczema biaxin pack description . Although vitamin E is inexpensive and relatively nontoxic, more studies to substantiate the benefit would be desirable does lipitor cause skin rash .
Cost: Approximately $3 to $8 a month
from 10 to 60 years old, and all had itching that had not been well controlled by their previous therapies how does naproxen sodium work .
The study lasted 8 months, and over the course of that time, the skin of fewer than 10 percent of the people taking vitamin E (400 IU daily) got worse pseudoephedrine hci 60mg . The skin of more than three-fourths of those on placebo had worsened antabuse breath odor . Conversely, almost half of the patients on vitamin E had excellent improvement, compared to only 1 (of 46) of those on placebo baby cannot keep prednisolone down . The investigators noted that the patients who had good results clinically also had marked reduction in the IgE levels that indicate allergic arousal of the immune system wat is lithium . They concluded that vitamin E might prove to be an excellent therapy for atopic dermatitis sie affects of drug diovan . Unfortunately, there are no other studies to confirm or refute these findings de effects of norvasc .
Topical Creams
Over the years, we have learned of a number of surprising remedies for itchy eczema facts and comparison of zyrtec . One is the old-fashioned moisturizing cleanser Noxzema west palm beach lasix center . Many people have written to say they had success easing the itching and even clearing up the rash after applying Noxzema to their eczema cellcept batten disease . Of course, nothing works for eczema all the time separating codeine from promethazine . But Noxzema is relatively low risk remeron tab . We suspect the herbal oils it contains may contribute to its effect clinical trial exelon . According to the manufacturer, camphor, menthol, and eucalyptus have given Noxzema “its redolent signature since 1914 buy accutane online .”
O fosinopril sodiun . I just had to let you know the success I’ve had with your suggestion to use Noxzema for eczema will lasix help with blood test . My 3year-old son has suffered with this skin condition on his legs and feet for 2 years caffeine gum addiction .
We treated it successfully with the prescription drug Elidel, but after learning of safety concerns, we checked with his doctor and stopped using it metronidazole for catas .
I tried many moisturizing creams to soothe his skin, but he cried and said they hurt levothyroxine purchasing . I started using Noxzema the day I read your article, and there were no tears 5 how sildenafil works .
His skin responded quickly and after 3 weeks almost aft traces of eczema are gone viagra vs kamagra . This advice has changed my young son’s life clozapine adverse event reporting post marketing .
A zoloft memory loss . We are certainly pleased to learn of your success toradol breastfeeding side effects . Lore has it that the name Noxzema was given after the product helped an early customer “knock” her eczema wellbutrin anger .
• 0 •
The mainstay of eczema treatment is a topical corticosteroid order tadalafil no prescription . In most cases, the doctor will prescribe a mild cream for
*** Noxzema
The brand now includes a number of different cleansers, but the one you want is the original, in the blue jar viagra paperweight . Apply it to the affected areas like you would a moisturizing cream olmesartan medoxomil . The herbal ingredients, camphor, menthol, and eucalyptus, may be helpful against itch, and the base cream is a good moisturizer allergic reaction to levaquin levaquin medication .
Side effects: Uncommon mucinex with clonidine . Discontinue use if it irritates the skin evista comprimidos .
Downside: There’s no scientific proof that this product will help eczema buy clonidine without prescription .
Cost: Approximately $4 to $6 for 14 ounces
Topical Hydrocortisone I Percent
Topical corticosteroid lotions, creams, and ointments are the mainstay of eczema treatment any difference between methocarbamol flexeril . This is the one that is available without a prescription, because it is less potent than prescription products carisoprodol china production . clozapine vs clozaril . It probably will help mild eczema sertraline hcl 100mg side effects . It may not be strong enough for moderate or severe conditions tetracycline 500mg strength .
The best way to use thislotion or cream is to apply it conscientiously for 3 to 7 days at a time rechargable aa lithium ion . Then take a break for several days amiodarone thyroid australia .
Side effects: Uncommon, but burning, itching, irritation, or dryness could occur where the product is applied does aygestin stop your period . Downside: Long-term use could lead to thinning of the skin novo levofloxacin side effects . This is a small -risk with the over-the-counter creams, but it should be kept in mind ibuprofen slow release r .
Cost: Approximately $3 to for a 1-ounce tube
use on the face and a more potent one for use elsewhere on the body carbatrol versus lamictal . Hydrocortisone 1 percent is available without a prescription and can be used for eczema cis diagnosis lipitor . We don’t suggest longterm use without checking in with the doctor, though lawsuits lithium heart failure valve damage . Even though the nonprescription cream is not very strong, it could still cause some thinning of the skin if it were used for many months flagyl use in cats .
Those who would prefer to avoid hydrocortisone cream may want to check out a product called CamoCare Soothing Cream order ivermectin merck online . It contains extract of chamomile flowers in an emollient base and has been helpful against eczema in one stud y gatifloxacin ophthalmic solution .296 Apparently, it has an effect comparable to low-dose hydrocortisone cream (0 effects side zyrtec .25 to 0 prednisone indications for use .5 percent), although it does not contain any steroid armada 4100 4200 lithium battery .
Another nonprescription ointment that has been put through a clinical trial is a homemade mixture of honey, beeswax, and olive Oil diamox hearing loss .297 This study was not as rigorous as we would like—not by a long shot how much caffeine in go fast . And honey, beeswax, and olive oil might just be too messy to be practical naltrexone and sertraline . But the Dubai dermatologist who ran the trial found that it had benefit for about 80 percent of the patients with eczema soma cruz genya arikado yaoi . That is almost the same as the percentage who respond well to topical steroid creams compazine box . So if you are in the mood for an experiment, get Soothing Cream
CamoCare his cream apparently was developed in Germany and is better known in Europe than in the United States natural sources of penicillin . German chamomile (Matricaria chamomille) contains an lithium grease plastic lubricant .oil called bisabolol that has been shown to have powerfulanti-inflam-matory action, comparable to that of the drug indomethacin imipramine 150 mg . That might explain its improvement of skin irritation drug recall china methotrexate .
Side effects: Some people are allergic to chamomile precose 50mg . Since individuals with atopic dermatitis may be especially susceptible to developing allergies, discontinue use immediately if the rash gets worse common side effects of paxil .
Downside: We know of only one study of CamoCare for eczema prevacid and children . In addition, it is relatively expensive is hydrochlorothiazide .
Cost: Approximately $10 to $14 for a 1-ounce tube lexapro withdrawal migrains .
out the blender and mix together equal amounts of honey, beeswax, and olive oil maximum dose topiramate 1600mg per day . Then see what it does for you psms and spironolactone . It should have no side effects, other than being sticky president ceo tricor systems inc . And it should not be overly expensive what is piroxicam .
Prescription Options
Doctors are most likely to prescribe some form of corticosteroid (cortisone-like) cream or ointment for eczema bipolar zyprexa . That’s because around 80 percent of patients with atopic dermatitis seem to respond well to these prescription creams pseudoephedrine extraction method . Fewer than 40 percent of those patients improve on a placebo cream or ointment 298 That’s why topical corticosteroids are so widely used avapro high blood pressure medicine .
If your doctor has given you a prescription fora corticosteroid, be sure to get the details on how to use it ivax pharm prozac . Using too strong a preparation on the face can have negative consequences zoloft theraputic level . The skin may become thin and tear or bruise easily, and blood vessels may become prominent guidelines for warfarin therapy . In fact, some people with eczema need two different formulations—a fairly strong one for hard-to-treat areas like the hands and a relatively mild one for eczema on the face fentanyl interaction with ultram . Keep in mind, too, that overuse of topical corticosteroids can thin the skin goldline enteric asprin 81mg .
People sometimes worry about steroid side effects from such creams jshua and abilify . It’s not impossible that side effects typically as-
**** Topical Steroids
One or more topical steroid preparations—a cream or an ointment—will probably be the dermatologist’s first choice to control eczema ld50 asprin . It helps significantly in most cases manufacturer information on prednisone .
Follow the directions carefully soma heightened climax . The cream may need to be applied two or three times daily diclofenac sodium 75mg 3ml injection . Do not put a strong steroid on the face, or any steroid cream near the eyes is kamagra illegal uk . Ask your doctor about “pulsing” the use of cream—applying it for 3 to 7 consecutive days and then stopping for several days 17 b estradiol . Adults may be able to use such products for just a few days a week levaquin and colstridium .
Side effects: Stinging, burning, irritation, itching, peeling Downside: Long-term use or application over a large part of the body, especially under a close covering, could thin the skin, lead to marks on the skin, or (most serious) result in side effects similar to those from oral prednisone lithium 450 mg 900 mg .
Cost: Depends upon the specific steroid the doctor selects cephalexin dose for dogs . These drugs can be expensive lamisil and exacerbation of psoriasis . Inquire about a generic version, which may cost much less amoxicillin and indications and uses .
sociated with steroid use might occur, but it is very unlikely unless the area treated is large and has been covered with some kind of bandage or “occlusive dressing withdrawel from zoloft .” Be very careful in applying this kind of treatment barringer wc and minocycline . It may indeed help the skin, but it must not be overdone prevacid for oral suspension ingredients .
Atopiclair
In 2005, the FDA approved a nonsteroidal cream for eczema excellent results taking effexor . Atopiclair is a prescription product that contains a number of botanical extracts in an emollient base taylor lithium scale . Like CamoCare, it contains bisabolol, but Atopiclair also contains a vitamin E—like compound, a licorice root derivative, and an extract of grapeseed, along with shea nut butter celecoxib evaluation . A gel containing licorice extract had earlier shown promise for treating atopic dermatitiS testosterone mesterelone .299
Elidel and Protopic
The frustration of trying to control eczema, a condition that may not respond to the usual anti-inflammatory treatments, has led doctors to explore other treatment options cholesterol pravachol . The de-Clair
This nonsteroidal cream is significantly better than a simple moisturizer at alleviating itch and reducing rash gabapentin and erection problems . It should be applied two or three times a day shell shrimp cytoxan .
Side effects: Local irritation
Downside: People allergic to any of the ingredients, including nuts, should avoid Atopiclair does citalopram .
Cost: Approximately $85 to $95 for lMgram tube
velopment of immune-modulating treatments to prevent the rejection of transplants led some dermatologists to think about modulating the immune reaction at the level of the skin carisoprodol 2444 imprint . After all, eczema does seem to be linked to an immune reaction gone a bit haywire, comparable to hay fever allegra versace 2007 . It turns out that there are two compounds that can be applied topically to dampen the immune response allegra of ri . They are Elidel (pimecrolimus) and Protopic (tacrolimus) seroquel xr versus seroquel .
Parents of children with eczema were very pleased to have these effective treatments made available so they would not have to rely so heavily on potent corticosteroid creams to keep their youngsters comfortable meloxicam taken with tylenol . They were alarmed, however, when the FDA issued a warning that these immune-suppressing drugs might increase the risk of children developing cancer, especially lymphoma order tadalafil ups online . Such cancers are rare in kids, so it will probably be years before it is possible to assess how serious this potential risk really is no prescription german pharmacy prednisone . But weighing red, itchy skin against a potentially lethal disease suggests that these drugs should be used only when other treatments have not worked bupropion high .
Another topical cream for treating eczema is called MimyX cream diflucan used to treat tenia capitas . It is available by prescription, but does not contain a steroid homotaurine campral gabapentin . Clinical trials showed that it can reduce the size of areas affected by eczema and extend the period between flare-ups seroquel too sedating for bipolar . Side effects appear to be local, such as irritation or itching viagra lawsuit . The manufacturer, Stiefel Laboratories, suggests that MimyX could be used on a regular basis without danger prednisone for t12 to l2 fracture . Because it was approved relatively recently, however, there are no good long-term safety data hydroxyzine withdrawl .
This immune-suppressing cream is significantly better than a simple moisturizer asprin 110mg . It is approved for use in adults and in children older than age 2 gabapentin and migraine .
Side effects: Local irritation, burning, stinging, itching, infections, seizures
Downside: Long-term use is discouraged because there is a possibility that it increases the risk of cancer cheap no prescription tramadol . When application of the cream is discontinued, however, a high proportion of patients regress to pretreatment condition,
Cost: Approximately $65 to $80 for a 30-gram tube of 0 phytosterol testosterone .03 percent ointment, the only strength approved for use in children
Other Approaches
A number of other possible treatments may have some benefit for people suffering from atopic dermatitis generic ultram tramadol 50 mg . Some of them are pretty straightforward and well accepted, whereas others are on the wacky side find how to use viagra . Here’s a brief summary:
1 terbutaline ol1 inhalation compounding pharmacy . Heliotherapy can you take zoloft with lorpressor . This means: Get some sunshine on your skin tramadol ultram hci . Sunburn is bad, of course, but a couple of weeks of moderate sun exposure seems to make eczema better combivir indications . 300 This almost sounds like a prescription for a tropical vacation! Be forewarned, though, that some of the medicines used to treat eczema could make skin more sensitive to sunburn clomid and ovulating pain twin . This is a worry particularly with Elidel and Pro-topic paxil cr 125 mg .
2 trazodone and insomnia . Ultraviolet light therapy carisoprodol b carisoprodol . This probably explains why sunshine is beneficial jeffery m allegra . Exposure to ultraviolet A in the dermatologist’s office can help alleviate eczema symptoms treatment rheumatoid arthritis sulfasalazine . Stubborn cases may improve with the addition of a psoralen gel or bath before the light exposure generic drugs atorvastatin . This is similar to a standard treatment for psoriasis buy cheap kamagra . The dermatologist will probably recommend it if she thinks it will be helpful caverta side effect . Although it is usually administered in the office or hospital, a portable unit used at home can be equally effective concerta adhd caffeine adhd theadhdspecialist com .- 301
3 dilantin and lasiz . Balneotherapy digoxin and elderly . Immersion in salts derived from the Dead Sea, followed by exposure to ultraviolet B, can be helpful, especially if eczema is chronic and widespread interactions of imitrex and celexa . This effect was first observed in people actually bathing in the Dead Sea, but it is no longer necessary to go there lithium cr123a . Some dermatologists offer this type of therapy in their treatment suites clindamycin doxycycline bordatella . One big drawback is that it takes a lot of time zoloft seroxat side effects .302,303
4 order sumatriptan mail . Hypnotherapy claritin acrylic coffee cup price . Both hypnosis and self-hypnosis can help 3 people cope with eczema, especially with its terrible itch excessive testosterone acne .
5 ditropan $4 . Music bioidentical testosterone cream for women . Listening to Mozart—but, oddly enough, not to Beethoven—reduced the size of a wheal that rose on the skin in response to a specific allergen challenge in people with eczema and latex allergy allegra’s window songs . 305 This is probably the most peculiar of the therapies we have come across, but the study used quite objective measures (IgE production, size of wheal) that presumably are not easily manipulated availability of viagra in new zealand .
Conclusions
Eczema, or more precisely atopic dermatitis, is an itchy skin condition that is often chronic testosterone and vaginal cancer . Besides the itch, skin affected by eczema may develop a rash with liquid-filled bumps cymbalta lower dosages . Skin-fold areas, such as the back of the knees, seem to be especially susceptible to the rash ct angiogram lopressor san antonio . Eczema is often accompanied by generalized dry skin, and the patient may also have asthma or hay fever domperidone in infants .
There’s no cure for eczema, although sometimes it does go away for a period of time levothroid interactions . No treatment works all the time or for everyone, so people are understandably on the lookout for something that might work better than what they have already tried 18 v lithium ion . Eczema is quite common in young children, and parents need to be especially vigilant in weighing the benefits against the risks of various therapies they might use for their kids nexium and polyps .
• Avoid prolonged exposure to water or any irritating chemicals, including soap or detergent caffeine birth defect . After washing hands or bathing, apply a moisturizer within 3 minutes of patting the skin dry acomplia price .
• A person with a documented food allergy that makes eczema worse should avoid that food paxil vs effexor . Eggs may be a culprit for young children what’s anastrozole .
• Probiotics can help in some instances 1967 neonatal exposure to depo provera . Look for a high-quality supplement with viable organisms price cefpodoxime compare . Lactobacillus GG and L pravastatin 20mg . fermentum have done well in studies aleve competitor .
• Fatty acid supplements providing gamma-linolenic acid (such as evening primrose oil, borage oil, or black currant seed oil) help some individuals, but have not performed well in clinical trials insomnia paxil cr . One exception is hemp seed oil, although the data on it are limited to one study topamax and glaucoma . It might be worth a try effect of ibuprofen on blood pressure .
• Cut table sugar and simple starches out of your diet vasotec blood pressure medicine . A low-glycemic-index approach might be worth trying, though will
there is no scientific evidence that it wicontrol eczema female zantac de .
• According to anecdotal reports, eating salsa may ease eczema symptoms increase of depression with zoloft . If you like spicy foods, go for it can lamictal help depression .
• Drinking 4 cups of oolong tea daily was shown in one study to help eczema that wasn’t responding to other treatments albuterol and nebulizer . It is easy and nontoxic, so it would be worth a try woman on viagra .
• Vitamin E capsules did very well in one study of people with atopic dermatitis caffeine levels pop . Check with your doctor first if you are a smoker or at high risk of heart disease; some large studies suggest vitamin E might increase your risk of serious complications claritin dose . For others, there is very little risk in a short-term personal trial to see if it helps your skin tobacco and depakote .
• Apply Noxzema—the original formula in the blue jar—to the affected areas clomid use after laproscopy . The herbal ingredients, camphor, menthol, and eucalyptol, may soothe itching what is citalopram hydrobromide . Be alert for increased irritation, though avandia image .
• Over-the-counter hydrocortisone cream (0 promethazine hcl suppository .5 or 1 percent) may help if the eczema is mild lithium etek .
• CamoCare Soothing Cream is available without a prescription and may ease itching, redness, and inflammation toradol opiod .
• Blend up a batch of honey, beeswax, and olive oil for a homemade salve that may help celexa anxiety depression . It sounds sticky, though yaz spironolactone .
• Use prescription steroid creams according to the physician’s instructions effects of gabapentin and alchohol . Don’t use a potent steroid on the face, or for too long a time health and wellness caffeine health product . “Pulsing” the dose—applying the cream for 3 to 7 days straight, then not using it for a time—may help zyrtec over the counter patenet . Ask your doctor azithromycin pharmacy .
• Drugs such as Protopic (tacrolimus) or Elidel (pimecrolimus) may be helpful as back-up treatment if the steroid creams stop working or don’t work well enough long term use of carisoprodol .

Using inhalers
The value of using an inhaler rather than taking tablets or syrup is explained on p. 141 for steroids. The same principle applies to all drugs.
The oldest type of inhaler is the ‘puffer’ or aerosol inhaler, properly called a ‘pressurised metered-dose inhaler’ or MDI. It delivers the drug as a fine, moist, spray. In addition, there are now many devices that deliver drugs in dry-powder form.
If you or your child find the aerosol inhalers difficult, you may do better with a dry-powder inhaler. Your doctor should have several different inhalers available for you to try out, to see which one suits you best.
When you are given an inhaler you must be shown how to use it by a doctor or asthma nurse. A great many asthma patients have a ‘poor inhaler technique’, and get too little of the drug as a result. This often leads to their asthma getting out of control. The advice given here for using inhalers is no substitute for proper training, and should only be used to supplement what your doctor or asthma nurse has told you.
When using an aerosol inhaler or MDI, remember to shake the inhaler well or you will not get the right dose. Your in-breath must coincide exactly with pressing the canister down: this is the part that many people find difficult. You must breathe in slowly and deeply, otherwise you do not get much of the drug into your airways.
Many asthmatics stop inhaling the moment the
spray from the aerosol inhaler hits the back of the
throat. The spray contains a propellant, which
makes it very cold, and there is a natural reflex
response to this cold liquid which stops inhalation.
This response may be impossible to control. If so,
you need a dry-powder inhaler (see right), or a
spacer to use with your aerosol inhaler (see p. 162).
Breath-operated aerosol inhalers such as the
Autohaler can be useful for those who find ordinary
aerosol inhalers too hard to use. With these devices, you do not have to push the canister down because your in-breath triggers the release of the drug. Take care not to block the air-intake holes with your hands and don’t stop breathing when you hear the inhaler click. (If there is no click, start again and breathe in more forcefully this time.)
One hazard with aerosol inhalers is that, when almost empty, they produce no drug – just the propellant. Although they still ‘puff’ normally, they are not effective. It may be hard to tell when your inhaler is running low. Ask your doctor or asthma nurse for advice about this.
Many asthmatics find dry-powder inhalers such as the Spinhaler, Rotahaler, Diskhaler, Accuhaler, Clickhaler and Turbohaler are the easiest to use. They have no aerosol device, so none of the problems associated with the coldness of the propellant.
On the other hand, nothing pushes the drug into your mouth and lungs with a dry-powder inhaler: you have to do all the work yourself. This means you have to breathe in quite hard and fast. During a severe asthma attack you may not be able to breathe in hard enough to get a good dose of the drug. Some asthmatics have an aerosol inhaler as well, often combined with a spacer (see p. 162), for use during severe attacks.
For the parents of asthmatics, who want to keep an eye on how much of a drug is being used, most of the dry-powder inhalers allow you to do so.
Arthritis and inhalers
Those who suffer from arthritis in their hands often find inhalers difficult to use. There are several aids now available to help with this problem – ask your doctor or asthma nurse about these.
Do hold your breath
Whichever type of inhaler you use, it is important to give the drugs a chance to do their work. After inhaling, and when your lungs are full, you should hold your breath for at least ten seconds. Then breathe out, but wait at least another 30 seconds before breathing in again.
Side effects from non-drug ingredients
There are other ingredients in inhalers, besides the drug, and they occasionally cause side effects.
Aerosol inhalers are the worst offenders. They can contain up to five non-drug ingredients, such as propellants and surfactants. Some asthmatics are sensitive to one of these, and respond with coughing or bronchospasm when they inhale them.
If inhaled in large amounts, the propellants in aerosol inhalers can give a mild ‘high’, and asthmatic teenagers and their friends may - very rarely - begin abusing inhaled beta-2 relievers. Parents should be alert for the possibility of such problems, but not worry unduly.
Dry-powder inhalers do not need propellants or surfactants, so they are suitable for anyone who develops a sensitivity to these. However, they may contain lactose, or milk sugar, in addition to the drug. Enough lactose is deposited in the mouth and swallowed to provoke symptoms, such as diarrhoea and wind, in people who suffer from severe lactose intolerance (see box on p. 79). Trace amounts of milk proteins in the lactose may be a problem for people with severe milk allergy.
CFCs and inhalers
Aerosol inhalers have long contained CFCs, which are very inert gases (at ground level) and perfectly safe to inhale. Unfortunately, they cause serious damage when they reach the ozone layer high above the earth, so they are being phased out in asthma inhalers, as they are in all aerosols. Other propellants, called hydrofluoroalkanes (HFAs), are being introduced to take their place. The spray from an HFA inhaler may taste and feel different, but it should do exactly the same job as a CFC inhaler: the drug it contains remains the same. Research suggests that these new propellants are very safe, but tell your doctor if your reaction to your inhaler seems to change suddenly.
These new propellants deliver medication more efficiently into the lungs, so that usually only half the previous dose is required. Unlike CFC-type inhalers, they will deliver a constant dose until empty. In addition, they are not affected as much by below-freezing temperatures.
Inhale - then clean your teeth
Asthmatic children are more prone to dental decay than other children, and inhalers are suspected of causing the problem. No one knows, as yet, exactly which ingredient of the inhalers is the culprit - it could be a drug, or a non-drug additive such as a propellant. Alternatively, the fact that the spray from some inhalers is slightly acidic could explain this side effect. Brushing the teeth after using the inhaler, or just rinsing out the mouth with water, is recommended as a preventive measure.
Using spacers
A spacer is a large empty chamber that can be fitted to an aerosol inhaler (a puffer or MIDI). to make it more effective and easier to use. The aerosol spray goes into one end of the spacer, and the asthmatic breathes it in from the other end.
When using a spacer, you can breathe normally: you don’t have to take all the drug in at once. or hold your breath after you’ve inhaled. But you should try to breathe as deeply as possible, and hold your breath for up to ten seconds if you can.
Note that spacers are for use with aerosol inhalers only. Spacers allow the aerosol propellant (see p. 161) to evaporate, leaving tiny airborne droplets of the drug to be inhaled. Once the propellant has evaporated, these droplets are no longer cold, so the reflex response that stops inhalation is avoided.
During an asthma attack, spacers are immensely valuable because they allow you to get some of the drug into your airways even though you are unable to take a deep breath. There is a collapsible spacer, called the E-Z Spacer, which folds up into a plastic case small enough to be slipped into a pocket. In a severe asthma attack, having such a spacer could save your life.
In an emergency, if no spacer is available, you can improvise one (see p. 100).
Babies and small children, who cannot yet coordinate the in-breath with pushing the aerosol canister down, need spacers for everyday use. There are spacers designed for children under two years, with masks that fit over the nose and mouth.
When using a spacer, shake the inhaler and then spray it into the spacer once only. Inhale within five seconds. During an asthma attack, you can add another dose from the inhaler every ten seconds, until the attack begins to subside, but keep a count of how many puffs you use (see p. 100).
For a young child, shake the inhaler well, and fit it to the spacer. Put the mouthpiece into the child’s mouth, or put the mask on. Tell the child to breathe in and out steadily. Listen for the clicking of the valve on the spacer - this shows that it is opening and closing. When the child’s breathing is regular, puff a single dose into the spacer. The child should breathe in and out 5-8 times.
Priming a spacer
Prime a new spacer, or one that has been washed, by firing the inhaler into it about five times. Do this before you actually need to use the spacer.
The drug will coat the spacer walls, due to an electrostatic charge on the plastic. You won’t be able to see the drug as it forms a very thin coating.
When you come to use the spacer, no more of the drug will stick to the spacer walls, because they are already coated, so the full dose will be available for you or your child to inhale.
Priming new spacers is particularly important when the asthmatic is a young child, because there may be some delay between firing the inhaler and the child actually getting a proper lungful of the drug. The longer the delay, the more chance the drug has to stick to the unprimed spacer walls.
A spacer can be used on a baby while it is asleep, which may make life easier for you both. If you need to use the spacer while the baby or toddler is awake, stroke the mask against the child’s cheek first. Keep smiling and talking so that the situation doesn’t seem so frightening. If the baby does start to cry, keep the mask in place: crying will bring on a deep in-breath which is just what is needed.
For an older child, decorating the spacer with coloured stickers can make it appear less daunting. Try to make using the spacer seem like a game. If this fails, don’t get into a battle with the child – leave it a while and try again later.
Playing with the spacer when feeling well will help the child to see it as something familiar, not as a frightening piece of equipment associated with asthma attacks.
Nebulisers
A nebuliser delivers high doses of asthma drugs in an easily inhaled form. It is generally used for severe asthma only, or in an emergency to relieve asthma attacks.
A nebuliser can be attached to an oxygen cylinder, which enriches the air–drug mixture with oxygen. This is useful in severe asthma.
The only people who need to have a nebuliser at home for emergencies are those with brittle asthma, whose condition can deteriorate very suddenly and sharply.
For routine use, only a very small minority of asthmatics require a nebuliser. They include:
• Those with such severe asthma that they depend on large doses of drugs to control their symptoms
• Very small children or elderly people with severe asthma, who have difficulty using inhalers. For them, a nebuliser may be the easiest way to take their drugs.
The fact that the hospital’s nebuliser is so effective in an emergency gives it a special mystique for many people, who assume that nebulisers are a magical cure for asthma. Nebulisers are widely advertised in specialist publications for asthmatics and, while they are expensive, they can look like the answer to a prayer. Many asthmatics, or their parents, mistakenly believe that owning a nebuliser would be the answer to all their problems. In fact the nebuliser only works so well because it delivers a much higher dose of the reliever drug – a dose which also carries a higher risk of side effects. This high-dose treatment should not be used on a regular basis unless it is absolutely essential. No one should buy a nebuliser without first discussing the matter with their doctor.
Asthmatics who own a nebuliser should have detailed written instructions from a doctor about when and how to use it, and how much of the drug to put in. One hazard of owning a nebuliser is that it may give you a false sense of security during emergencies, and delay you from getting expert medical help when you need it. If the nebuliser is for emergency use you should be told the exact signs that indicate a need to use it and – no less important – the signs that show the attack is out of control and needs hospital treatment.
Take care, when using a nebuliser, not to allow the mist to escape and settle on the face or eyes. Regular exposure to steroid mist can cause cataracts in the eyes, and thinning of the skin on the face. Anti-cholinergics (see p. 156) can cause glaucoma if they come into contact with the eye. The mask must fit very tightly. As an additional precaution, place a scarf around the upper edge of the mask to cover any gaps. Wash the face after using the nebuliser for steroids.
Keep off the cough mixture
Coughing can be a useful reaction in asthma, evicting mucus from the lungs. But in some asthmatics the cough does not produce mucus and seems to be no more than a reflex reaction to the airway inflammation. This type of cough can be debilitating, but it is not a good idea to treat it with cough mixture which has no benefit and may mask the seriousness of the asthma. Tackling the airway inflammation with preventer drugs such as steroids is the best course. Simple expectorants, which loosen mucus, may be of value – ask your pharmacist about these.