This inflammation causes the ducts are more sensitive and responsive to a contraction causing further narrowing. This blockage of air which can be more or less important depending on the sensitivity of the individual, the stimulus intensity or how you feel before “contact” makes the person with asthma have shortness of breath, cough, feeling of pressure whistling in the chest and breathing is important that asthma is well controlled to try to eliminate or reduce the number and intensity of crises and pursue a life as normal as possible.

2 .- Information on the treatment:
For the patient perform the correct use of treatment should distinguish between drugs that relieve and reduce inflammation. know you have to take daily medication but is feeling well. You will know what are the side effects and solutions to reduce patient anxiety. Be told what are the guidelines for further treatment. Influence on the positive effects of medication. We must also check the compression of the patient.

2.1. Preventive Medication: Anti-inflammatory:
These drugs help prevent or reduce inflammation and congestion of the airways. Therefore reduce the hypersensitivity and help prevent attacks. However, do not stop an attack already begun. There are two types of anti-inflammatory:

- Corticosteroids: They protect the airways against irritants and allergens. There are two routes of administration: inhaled, most commonly used are to be administered regularly to be effective. The oral form of pills or syrup, administered for a few days if the airways are very congested.

- No steroids: They protect the airways against allergens. Helps prevent seizures caused by exercise. Always be administered by inhalation.

2.2. Symptomatic medication: Bronchodilators:
Its function is to relax the muscles around the airways, expanding and making breathing easier. There are two types of bronchodilators:
- Fast-acting bronchodilators: They act quickly to open airways, making breathing easier soon, help stop an attack begun, also help to prevent seizures caused by exercise. Usually administered by inhalation.
- Long-acting bronchodilators: They act more slowly than fast-acting, but better for longer. You can use regularly. Prevent night attacks. They prevent the attacks caused by exercise, can be inhaled (preferably) or oral.

3 .- Proper Use of Inhalers:

Using the inhaler without camera
1 .- Remove the lid and shake the spray.
2 .- Add the air through the nose and mouth.
3 .- Hold spray upright with the mouthpiece on the bottom.
4 .- Put your mouth around the mouthpiece and press lips tightly, starting to take all the air out of, slowly through your mouth.
5 .- Just taking the air, press the spray once and keep taking air.
6 .- Hold your breath as long as possible (around 10 seconds).
7 .- Add the air through your mouth slowly.
8 .- If inhalation has to wait at least another 30 seconds.

Using the inhaler with camera:
1 .- Join the two sides of the camera by matching the overhang on one side with the groove of the other.
2 .- Remove the lid and shake the spray.
3 .- Meter spray nozzle in the existing zone to that end, on the side of the inhalation chamber.
4 .- Put your mouth around the mouthpiece of the inhalation chamber, to keep this flat.
5 – Pour a little air and press the spray. Then take all the air that can be slow.
6 – Hold your breath as long as possible (around 10 seconds)
7 – Pour the air through your mouth slowly.
8 – If you have to do some other inhalation wait at least thirty seconds.

Turbuhaler system:
1 – Unscrew and remove the white cover that covers the Turbuhaler.
2 – Hold the inhaler upright with the screw rotating at the bottom.
3 – Load the dose by turning the screw rotating first to the right and then left until it clicks.
4 – Place the mouthpiece between your teeth, close your lips on it and breathe
strongly and deeply, hold their breath for 5-10 seconds.

Accuhaler System:
1 – Prepare the correct dosage.
2 – Open the lid which will be discovered with the mouthpiece and move the lever to the other side and you’re ready for the taking.
3 – Place your mouth around the mouthpiece of the device and take all the air that can quickly through the mouth.
5 – Remove the device from the mouth and hold your breath as long as possible (around 10 seconds).
6 – Pour the air through your mouth slowly.
7 – If inhalation has to wait at least another 30 seconds.

4. Precipitating factors and preventive measures:

4.1. Triggers:
1 – Viral Infections.
2 – inhaled allergens: pollens, mites and pets.
3 – Exposure to nonspecific irritants: snuff, smoke, odors, paints, perfumes, varnishes, cleaning spray air fresheners and insecticides.
4 – Emotions: laughter, tears, fear, nervousness and stress.
5 – Drugs: aspirin, NSAIDs, beta blockers and others.
6 – Change of weather: cold, heat, storms and rains.
7 – Exercise.

4.2 .- triggers preventive measures:
House dust: dust mites:
The materials are made many objects strongly attracted to dirt, element where the mites, this is one of the allergens.
You can take simple measures that can reduce the number of dust mites:
1 – Clean the dust with a damp cloth or vacuuming. The patient did not enter the room during cleaning.
2 – Clean the filters, heat and air conditioning at least once a month.
3 – Avoid carpets, rugs and upholstered chairs.
4 – Avoid stuffed toys and plush, ensuring that they are made of wood or anti-allergic material.
5 – The curtains should be washable cotton or plastic.
6 – Avoid duvets or pillows or wool and use foam pillows and acrylic duvets tissue.
7 – Sheets or flax or tergal pajamas.
8 – Do not save or woolen blankets in the closet.
9 – The bed linen is washed with water at 60 ° C.
10th – Reduce humidity at least 50%.
11 – Do not use shoes or leather gloves lined.

Pollen:
1 – During the time of pollination avoid cutting the grass and out to the countryside and gardens.
2 – Keep windows and doors closed.
3 – Avoid having plants to flourish.
4 – Do not ride a motorcycle, bicycle and in the car with the windows closed it.
5 – Avoid the exits to the street in the peak pollination and use sunglasses and mask.
6 – Before bedtime moisten the atmosphere of the room.

Pets:
1 – Keep pets out of the house.
2 – Wash dogs and cats once a week.
3 – Avoid approaching them.

Fungi:
1 – Avoid stains in the house.
2 – Aerate and bleach to clean the kitchen and bathroom.
3 – Keep making sure the laundry is dry.
4 – Leave your shoes or sneakers out of the room.

Exposure to nonspecific irritants:
1 – Do not smoke and avoid smoking in places where you are asthmatic.
2 – Do not use air fresheners or insecticide spray.
3 – Avoid perfumes and scented wipes.
4 – Do not use talcum powder.
5 – Avoid the presence of asthma in places where there are paints, varnishes and solvents.
6 – Do not use cleaning products that emit a great smell like ammonia or heavy water,
7 – Avoid using the presence of smoke and exhaust fumes.

Infections:
1 – Vaccinations.
2 – Genital hygiene.
3 – Avoid contact with infected persons.

5. Peak expiratory flow measurements:
We explained that the way to know when it is right or when starting a crisis is by the presence of discomfort and this requires knowing objectively and use and peak expiratory flow meter. We taught the measurement and found that it has learned the technique properly. The FME is the speed at which you can blow air out of the lungs with one breath.

Rules for using the peak expiratory flow meter.
1 – Put the display to zero.
2 – standing or sitting up straight.
3 – Hold the meter horizontal to the ground without clogging the air outlet.
4 – Put the mouthpiece in the mouth closing the lips around meter.
5 – Blow forcefully and more quickly than you can. Remove the meter from your mouth.
6 – The marker will have moved on the scale, remember the number and put the score back to zero.
7 – Repeat the test two more times and record the highest number three in his diary or chart.

6. Self-registering:
We record the log and explain how you have to cover each of the sections.

- Objective assessment of ocular symptoms, nasal, cough, cough with exercise, wheezing, fatigue, fever, absenteeism and health care.
- Medications you have taken.
- Graphics where recorded peak expiratory flow.
In the successive visits on the record that the patient brings you explain the meaning of your chart, we explained that good control is when no symptoms and all values of the FME are high and there are no variations between morning and night and few days to others. When the patient is well controlled and we know which is your best value we perform a grated yellow record sheet in 80% of your personal best, indicating that above the grate is low is good and if it starts to not be well.

Registration also helps us to increase medication adherence by increasing the patient’s motivation to improve their record to see how the taking of medication or can be seen as the peak expiratory flow decrease the symptoms of a trigger or discontinuation decreases the FME.

7. Self:
We should promote patient autonomy and teach how to act early before the deterioration of their asthma.
Will be based on measuring the FME. There will be three areas of asthma control:

- Green area: no problems, the FME is between 80-100%. The patient takes the medication every day, your asthma is well controlled.
- Yellow Zone: Caution means, where the WEF is between 50-80%. If no action is taken there is a danger of getting into a serious crisis.
- Red Zone: Medical Alert.: Where FME is less than 50%. Maximum danger zone means that the crisis is serious. Requires a hospital.

We will teach how to act before a crisis at home:
1 – Be calm and relaxed.
2 – Take a breath cómada position (sitting or leaning forward).
3 – Monitor your asthma symptoms (coughing, wheezing, difficulty breathing, etc.)..
4 – Start medication at home. It is generally recommended the use of Ventolin taking four puffs separated by one minute. Repeat the same dose every 20 minutes until a maximum of 12 breaths in 1 hour. If no improvement go to a health center. If improvement Ventolin 2 puffs every 4 hours until improvement.

Exercise is recommended even for people with asthma, but knowing at all times the limits imposed by the disease and making sure not violent and prolonged exertion.

Stress is a cause of asthma, so it has to be fought, which also contribute to maintaining the overall health of the organism. Seasonal changes increase the cases of allergies, colds and asthma. Ask your doctor about getting vaccinated every year as a preventive measure.

Avoid indoor, perform breathing exercises, sleep with two pillows if you have trouble breathing at night and try to identify the agents that cause breathing difficulties. These agents can be certain metals, animal hair, pollen, wool, food, etc..

The first attacks of asthma usually occur in childhood, although it is not uncommon that affects adults who had never had respiratory problems. Asthma in children can be triggered by a cold. Also influence the onset of the disease hereditary factors and the fact that the child has parents who smoke. Recent studies indicate that children who have received lengthy treatment with antibiotics during their first year of life are more likely to have asthma.

As in the case of adults, emotional tension, sudden temperature changes and environmental pollution, are agents that can trigger the onset of asthma.

Asthma is a disease that can be controlled with proper therapy and care to avoid extrinsic causes that provoke it. Even so, it is almost impossible to prevent asthma attacks.

These crises are accompanied, others of dyspnea or shortness of breath, coughing, bronchial irritation increases, mucus, wheezing, bronchial spasms and, occasionally, fever.

Asthma is a frequent cause of absenteeism from school and work, preventing sleep and causes fatigue. Deaths from asthma are relatively few, but severe cases of asthma present a serious impediment to a normal life. The patient with asthma should follow the treatment virtually all life to keep the disease controlled.

To monitor the development of asthma is to undergo regular medical checks, including four basic tests: measurement of peak respiratory capacity, spirometry to monitor the airway obstruction, bronchodilator, which measures the ability to breathe after inhaling a bronchodilator, and methacholine test, noting the bronchial hyperactivity caused by this bronchoconstrictor.

Also common allergy skin tests, which consist of small dose inoculation of potential allergens to test the reaction they have on the patient.

Asthma therapy depends on its severity in each patient, but generally fall into two groups: preventive treatment and rescue. Both are based on inhaled corticosteroids, steroids and bronchodilators.

Preventative treatments are applied once or twice daily, while the rescue are those who are called upon when a crisis occurs. The characteristics of each other based on the severity of the disease.