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Improper Home Nebulizer Use Boosts Asthma Risk

Over-reliance on these devices could raise odds of fatal attack, experts warn

TUESDAY, Oct. 24, 2006 (HealthDay News) -- Devices called home nebulizers have been a boon to asthma care. But a new study shows that, if used improperly, they can also lead to serious asthma complications, even death.

These machines turn medications into fine, inhaled droplets. But researchers at Michigan State University concluded that when home nebulizers aren't used according to the National Asthma Education and Prevention Program (NAEPP) guidelines, they may actually contribute to some people's deaths.

"Widespread prescription and use of home nebulizers in asthma may have the unintended consequence of contributing to over-reliance on bronchodilators and inadequate use of inhaled steroids," the authors concluded.

The result could be "a subsequent delay in seeking medical care during an acute exacerbation and poor management of chronic asthma," the Michigan team wrote.

"At-home nebulizers are not a panacea," agreed Dr. Jonathan Field, director of the Allergy and Asthma Clinic at New York University Medical Center/Bellevue in New York City. Field, who was not involved in the current research, said that people using nebulizers and even inhalers sometimes tend to only use their "rescue" medications -- also called bronchodilators -- when they're having asthma symptoms.

"But, when you're using a bronchodilator, the cat's already out of the bag," said Field. "People need to understand that asthma can flare at any time; there's always the potential for bad asthma. That's why preventive medications are there to help you."

As many as 20 million Americans, including about 9 million children, have asthma, according to the Allergy and Asthma Network/Mothers of Asthmatics (AANMA). Nearly 2 million Americans visit the emergency room each year due to their asthma. And, despite advances in treatment, more than 4,000 people die annually as a result of asthma complications, reports AANMA.

Home nebulizers are small machines that transform liquid medication into a mist form that can be inhaled deep in to the airways. Both rescue and preventive medications are available in forms that can be nebulized.

For the current study, the Michigan researchers looked at all asthma deaths that occurred between 2002 and 2004 in people between the ages of two and 34 years old.

During that time period, 86 people in the specified age group died as a result of their asthma, 38 of them children. Fifty-two people who died had a home nebulizer. The researchers found that 30 of those people used their machine regularly -- between once a week to six times a day. Two out of three people who used their nebulizers regularly were prescribed either inhaled or oral steroids, but one out of three was using them as directed.

Nearly half of those who died also had a peak flow meter -- a device that measures current lung function. People with asthma are supposed to regularly monitor their airway strength using this device. If the numbers drop below a certain number (a number your doctor will let you know based on your average peak-flow readings), then it's either time to contact your doctor or add additional medication.

All of this information is included in an asthma action plan -- a written record of the steps an individual asthmatic needs to take when their asthma worsens. People with asthma need to work with their health care providers to set up their asthma action plan before their asthma flares so they know exactly what to do, experts say.

Although 38 of the people who died had peak flow meters, only 8 used it daily, the researchers found. Just nine out of the 52 people with nebulizers had written asthma action plans.

Results of the study were to be presented Tuesday at the American College of Chest Physicians annual meeting, in Salt Lake City.

Field said that people with home nebulizers may feel they can handle their asthma flare on their own. "When someone goes to the ER, they get nebulized, so people may think, 'If I have one at home, why should I go in?'" But, he said, if an asthma exacerbation is serious enough, people may need mechanical ventilation or other treatments.

Carol Odnoha, director of pediatrics, maternity and newborns for the Visiting Nurse Service of New York, said that over-reliance on rescue medications is a big problem. "Most patients with asthma should be on controller medications. They prevent attacks and also prevent the lung condition from getting worse," she said.

Another factor that could improve asthma treatment is increased use of asthma action plans.

"Many asthma patients don't have asthma action plans. Sometimes, it may be that the patient just isn't following it, but other times, the provider may not be using it," she said.

"Regularly monitoring asthma status is key, so you know when it's getting worse that it's time to take action," she added.

More information

Visit the Allergy and Asthma Network/Mothers of Asthmatics' Web site to learn more about using home nebulizers.

SOURCES: Jonathan Field, M.D., director, Allergy and Asthma Clinic, New York University Medical Center/Bellevue, New York City; Carol Odnoha, R.N., director, pediatrics, maternity and newborns, Visiting Nurse Service of New York, New York City; Oct. 24, 2006, presentation, American College of Chest Physicians annual meeting, Salt Lake City
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