What You Need to Know

1. What You Need to Know for schools

2. Megan Becker, RRT,NPS,AE-C Respiratory Therapist North Country Hospital mbecker@nchsi.org

3. Learning Objectives Asthma 101 What You Need to Know was designed to provide basic information about asthma and its management. Upon completion of the course, the learner should be able to identify: • The scope of asthma • Common asthma symptoms • Potential asthma triggers • The difference between quick relief and controllermedications used in asthma management • How to manage an asthma episode • How to respond to an asthma emergency • The importance and components of an Asthma Action Plan

4. We will breathe easier when the air in everyAmerican community is clean and healthy. We will breathe easier when people are free from the addictivegrip of cigarettes and the debilitating effects of lung disease. We will breathe easier when the air in our public spaces andworkplaces is clear of secondhand smoke.We will breathe easier when children no longerbattle airborne poisons or fear an asthma attack. Until then, we are fighting for air.

5. Asthma in the U.S. • An estimated 25 million people currently have asthma (8% of population) • 7 million children have asthma • Asthma is one of the leading causes of school absenteeism • Asthma accounts for 14.5 million lost work days • Asthma is the third leading cause of hospitalizations among children under 15 • In 2007, 185 children and 3,262 adults died from asthma. • 3,262 adults died from asthma. • 3

6. Asthma in Vermont • 10 % or approximately of Vermont youth (under 18) have current asthma. • Approximately 1 in 10 students currently have asthma. • Twice as many middle school students with asthma smoke compared to those without asthma (9% compared to 4%). • A total of 19.5% of all middle school students and 24.3% of all high school students have ever been diagnosed with asthma. • Asthma rates were 44% higher among those children living in New England households in which there was reported to be a smoker. • Between 2000-2009 74 Vermonters have died due to asthma.

7. Asthma is… • A chronic inflammatory disorder of the airways • Inflammation (swelling) of the lining of the airways • Bronchoconstriction (tightening of the bands of smooth muscles surrounding the airways) which reduces the width of the airways • Excess mucus production that further narrows the airways

8. Normal Lung Tissue Asthma Color plates used with permission from Desjardins and Burton. ClinicalManifestations and Assessment of Respiratory Disease, 3E, Mosby, 1995

9. Myths and Truths About Asthma Truth Airways swelling is real, even if triggered by strong emotions Myth Asthma is only an acute disease, and you can outgrow it Myth Asthma is a psychological or emotional illness Truth Asthma is a chronic disease, and you do not outgrow it Truth Asthma cannot be cured, but can be controlled Myth Asthma is curable

10. Myths and Truths About Asthma Truth Daily asthma controller/ pre-exercise medications allow individuals to be active Myth Asthma limits a person’s ability to fully participate in sports Myth Asthma always limits normal activities Truth Well-controlled asthma should not limit exercise and individuals can fully participate in sports Myth Asthma medications and inhalers are addictive Truth Asthma medications and inhalers are not addictive

11. Myths and Truths About Asthma Myth People cannot die from asthma Myth Asthma medications become ineffective if used regularly Truth Children and adults die from asthma each year Truth Controller medications work best when used daily. Use of daily quick relief (Albuterol) inhalers is an indicator of poor asthma control.

12. Asthma Diagnosis • Assessment of Symptoms • Medical history • Physical exam • Spirometry test

13. Symptoms of Asthma • Wheeze • Difficulty breathing /shortness of breath • Cough • Tight chest/ chest pain • Retractions (neck area and/or muscles in ribs move inward with breathing), more noticeably in children

14. Asthma Classification • There are several different levels of asthma severity • Severity assessment forms the basis of the asthma treatment plan • Severity level determines the type, dose, and frequency of medications

15. Asthma Triggers Triggers cause asthma symptoms to begin or get worse. • Infections • Allergens • Irritants • Behaviors If you avoid asthma triggers, you may prevent asthma episodes and may require less medication to keep your asthma under control.

16. Respiratory Infections Are the #1 Trigger for Asthma Infections What Can You Do? Wash hands Keep hands away from face Get an influenza shot Use separate towels

17. Allergens • Cockroaches • Dust mites • Carpets/upholstery • Mold • Pollens • Weeds, grass, trees • Food/additives • Peanuts, shrimp, tree nuts, wheat, milk, soy, fish • Medical conditions • Latex • Gloves, balloons • Animals • Cats, Dogs, etc. • Birds, mice

18. Asthma/Allergy Connection • Strong link between asthma and allergies • Important to keep them under control • Some allergies affect the upper airway but can trigger an asthma episode in the lower airway • All asthma is not allergy-related, and not all allergies will cause an asthma episode • Allergens are identified and exposure is minimized to improve quality of life

19. Irritants • Smoke • Dust and chalk dust (when gloves are removed, and it is airborne) • Strong odors (perfume, markers that smell, air fresheners, cleaning chemicals, paint, etc.) • Cold (or very humid) air

20. Behaviors • Emotions (crying, laughing, shouting) • Exercise may be a trigger for asthma, but asthma should not limit physical activity • Smoking

21. Common Triggers Found at School • Dust and chalk • Strong odors (perfume, markers that smell, air fresheners, cleaning chemicals, paint, etc.) • Animals • Mold • Dust mites • Foods/additives • Latex(gloves, balloons)

22. Avoiding Asthma Trigger • Ask a person with asthma (or parents) to identify: • his/her triggers in order of severity and 2. steps the health care provider suggests to avoid possible triggers • In the case of children, continue to keep parents updated on actions you are taking to eliminate triggers.

23. Simple, Low-cost Modifications for Schools • Institute tobacco-free laws for schools and school property • Institute a fragrance-free environment policy for the school building • Maintain good indoor air quality • Use odor-free cleaning chemicals • Reduce or eliminate exposure to classroom pets • Use fragrance-free markers • Reduce or eliminate chalk dust • Use vinyl gloves (non-latex products); allow only mylar balloons • Use HEPA-filtered vacuum cleaners if your school has carpet

24. Getting Help From the Professionals • It is important to see his/her health care provider regularly. He/she can help track triggers and work to find the right medicines to control asthma symptoms. • Someone with asthma should see their health care provider once every 3 to 6 months, even when they are feeling well, and more often when experiencing breathing problems.

25. Goals of Therapy • Maintain near-normal pulmonary function • Prevent acute episode of asthma • Minimize emergency department visits and hospitalizations • Avoid adverse effects of asthma medications • Control chronic and nighttime symptoms • Maintain normal activity levels, including exercise

26. For Students/Athletes with Asthma • Talk with your health care provider • Explore the benefits of pre-medication • Have your rescue medication with you at all times

27. Controller and Quick Relief Asthma Medications

28. Asthma Medications • Controllers (anti-inflammatory) • Help prevent an asthma episode • Are taken daily • Does not eliminate the need for quick relief medications • Quick relief medications (inhaled bronchodilators) • Fast-acting • Relieve symptoms during an asthma episode • As needed basis

29. Controller Medications • Can be inhaled or taken orally • Decrease swelling and inflammation in the airways • Control symptoms • Prevent asthma episodes • Will not help during an asthma episode or in emergencies Take controller medication(s) every day, even when feeling well!

30. Quick Relief Medication • Also called reliever or rescue medication • Relieves asthma symptoms quickly • Relaxes airways muscles • Use when asthma symptoms first appear and/or before exercise, as indicated by health care provider

31. Small Children Can Get Their Medications By…… • Using a metered-dose inhaler with spacer and mask • Using a nebulizer

32. Inhaler with Spacer/Holding Chamber and Mask 4.Press 5. Six breaths 6. Repeat, as prescribed • Shake • Put together • Seal

33. Nebulizer 1. Sit upright 3. Place in mouth or seal face mask 2. Add medicine and turn on 3. Breathe normally

34. Nebulizer Cleaning Techniques • Disconnect nebulizer from tubing, disassemble, and briefly wash in warm soapy water. • Rinse nebulizer parts and shake off excess water. • Place nebulizer parts on a towel or dish rack, and allow to air dry. Keep parts out of the reach of children. Reassemble the clean nebulizer, and place in a cool dry place.

35. 1. Shake Inhaler with Spacer/Holding Chamber 5. Breathe in slowly 2. Put together 6. Hold your breath 3. Breathe out 7. Wait and repeat, as prescribed 4. Press

36. Autohaler 1. Hold upright 4. Breathe out 7. Hold your breath • Flip up lever 5. Put in mouth 8. Wait and repeat, as prescribed 3. Shake 6. Breathe in

37. 4. Breathe in steadily and deeply 1. Open Diskus 5. Close 2. Click 6. Rinse 3. Breathe out

38. 1. Hold upright 5. Put in mouth 9. Breath out Flexhaler 2. Remove cover 10. Repeat, as prescribed 6. Breathe in fast and deep 3. Twist to the right and twist back to the left until it clicks 7. Remove from mouth 11. Rinse 4. Breathe out away from mouthpiece 8. Hold your breath 12. Replace

39. 1. Hold upright • Breathe in fast and deep 9. Repeat, as prescribed Twisthaler 6. Remove from mouth 2. Twist cap to the right 10. Rinse 7. Hold your breath • Breathe out away from mouthpiece 11. Replace 8. Twist cap to the left and click closed 4. Put in mouth

40. More on Medications • Know when the medication expires • Check the inhaler for the date • Do not use once expired • Know how many doses have been used • Some inhalers have dose counters on them-Pay attention to those • Some inhalers need to be manually counted • Place a piece of tape on the inhaler • Write the date you start using the MDI on the tape • Place a hash mark on the tape for each dose • Count the hash marks often to make sure you still have doses remaining

41. Oral Steroids Treat Severe Swelling in Your Lungs • Take during or after severe flare-up • Take only as prescribed by health care provider

42. What is a Peak Flow Meter? • Hand-held device • Measures how much air flows from your lungs in one fast blast • Used by patients with moderate to severe persistent asthma

43. Why Should Someone With Asthma Use a Peak Flow Meter? • To become aware of changes in breathing • To catch breathing problems early • To identify when to take quick relief medication • To identify when to call health care provider or seek emergency care

44. When to Use a Peak Flow Meter • Every morning, if indicated by health care provider • During an asthma episode

45. 1. Slide to the bottom of the scale 4. Note number How Do You Use a Peak Flow Meter? 2. Breathe deeply while standing 5. Repeat two more times 6. Record highest number 3. Blow hard and fast

46. Basic Asthma Management • Remain calm and reassure the person while providing assistance • Stop the person’s physical activity and make sure he/she remains calm • Remove the person from exposure to known asthma triggers

47. Actions to Take For an Asthma Episode • Have someone stay with person • Follow the person’s Asthma Action Plan • Make certain quick relief medicine is available and used properly • Observe person to ensure he/she improves • Communicate with emergency contacts if the person with asthma has experienced breathing difficulties while engaging in physical activity

48. Activity Can Continue When… • Wheezing has resolved • There is no chest tightness • There is not shortness of breath • Person is able to speak in complete sentences • Person is able to freely walk around • Person’s peak flow rate is 80% predicted or better

49. Asthma Action Plan

50. Use of an Asthma Action Plan • For children, have the parent/guardian and health care provider complete an Asthma Action Plan • For children, send a copy of the Asthma Action Plan to the child’s care provider, school, and/or coach • Keep on hand and in an accessible location in case of an emergency