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Learning to Monitor and Control Your Asthma Learning to Monitor and Control Asthma.

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1 Learning to Monitor and Control Your Asthma Learning to Monitor and Control Asthma

2 Learning to Monitor and Control Your Asthma Hi! Im Julie. Im here to share with you some basic information about controlling asthma. I was diagnosed with asthma when I was three years old. Throughout my life, Ive learned how to control my asthma so that I do the things that I love, like running, without getting sick. I want you to have the same experience. Today, you will review four things that you can do to control your asthma, including: Identify triggers Taking the right medication at the right time Use medication delivery devices correctly Track your asthma condition Throughout this training, Ill share with you how I control my asthma. Youll also get to see how others control their asthma. I hope youre excited to learn how to control your asthma so you can live the life you want. Lets get started. Introduction Click next to continue.

3 Learning to Monitor and Control Your Asthma The cause of asthma is a trigger. When an asthma patient comes into contact with an asthma trigger, the airways become inflamed, narrowed, and filled with mucus. Avoiding triggers is the easiest prevention and care tool. As you move onto the next slide, you will learn more about each trigger. There are six types of triggers: 1. Allergens: Indoor 2. Allergens: Outdoor 3. Allergens: Ingested 4. Irritants 5. Infections 6. Physical Activity Asthma Triggers Click next to continue.

4 Learning to Monitor and Control Your Asthma Allergens: Indoor Allergens are substances that some immune systems recognize as foreign. Allergens found in the house include dust mites, pets, cockroaches, and mold. Vacuuming carpets and upholstery can help. Use a vacuum with either a HEPA or allergen filter. If at all possible, replace the carpet with hard flooring. Allergens found outdoors include pollen, mold and mildew. Eggs, milk, soy, fish, corn, and peanuts are common culprits. Foods or drinks processed with sulfites or that contain sulfites such as dried fruits, fruit juices, and shell-fish (shrimp) may also trigger asthma symptoms. Avoid foods containing these products by reading the labels. Consider seeing an allergist for allergy testing. Americans spend up to 90% of their time indoors. Fumes from common household products can irritate the airway. Irritants that might trigger asthma include: smoke, smog, fragrances, aerosol sprays, fumes from household products and stress of strong emotions (divorce, death). Infections in the lungs or breathing tubes can trigger an asthma attach. The majority of infections are viral, such as a cold and the flu. Additionally sinus infections, bronchitis, and pneumonia can trigger asthma attacks. While physical activity can trigger an asthma attack it is important for asthma patients to remain active. Regular activity strengthens the heart and lungs, it is good for bone strength, and it helps the asthma patient maintain a healthy weight. Allergens: Outdoor Allergens: Ingested Irritants Infections Physical Activity If exercise is a trigger, the asthma patient should use the quick relief medication before an activity. Swimming is an excellent activity. However, indoor pools have higher levels of chlorine than outdoor pools. Chlorine may trigger an asthma attack in some people. Click on each trigger type to learn more about it. Trigger Types Click next to continue.

5 Learning to Monitor and Control Your Asthma This is Lauren. She is a three year-old active toddler. A year ago Laurens parents learned that she has asthma. After going through some tests, it was determined that Lauren has a milk allergy and this is the cause of her asthma. The trigger that causes Laurens asthma is considered an ingested allergen. To prevent an asthma attack, Lauren needs to avoid milk and products with milk in them. This is Lauren. She is a three year-old active toddler. A year ago Laurens parents learned that she has asthma. After going through some tests, it was determined that Lauren has a milk allergy and this is the cause of her asthma. The trigger that causes Laurens asthma is considered an ingested allergen. To prevent an asthma attack, Lauren needs to avoid milk and products with milk in them. The trigger that affects my asthma is physical activity. I know physical activity is important for our overall health and that as an asthma patient I need to stay active. Because I know what my asthma trigger is, I am able to control my asthma and be prepared for an oncoming attack. Case Demonstration Click next to continue. Click the enter key to learn about my little friend Lauren.

6 Learning to Monitor and Control Your Asthma Lets Look at Another Case Demonstration Paul, 40-years old, works as a sales rep. for local TV advertisement. He was diagnosed with asthma during college. His asthma seemed to get worse during mid-terms and finals. To stay on top of his asthma, Paul takes any opportunity to relax. This keeps is anxiety and stress in check. He also follows the medical directions his doctor has provided him. This has lessened his attacks over the years. Two weeks ago, Pauls manager left the company. Paul has been asked to work extra hours to help out. Paul has had more attacks recently. Click on the next slide to answer a question about Pauls asthma. Paul, 40-years old, works as a sales rep. for local TV advertisement. He was diagnosed with asthma during college. His asthma seemed to get worse during mid-terms and finals. To stay on top of his asthma, Paul takes any opportunity to relax. This keeps is anxiety and stress in check. He also follows the medical directions his doctor has provided him. This has lessened his attacks over the years. Two weeks ago, Pauls manager left the company. Paul has been asked to work extra hours to help out. Paul has had more attacks recently. Click on the next slide to answer a question about Pauls asthma. Not everyone has the same triggers. Click the enter key to meet my neighbor Paul, who also has asthma. He has a different trigger than both Lauren and I. Click next to continue.

7 Learning to Monitor and Control Your Asthma Which trigger affects Pauls asthma? A. Ingested B. Physical Activity D. Irritants C. Outdoor Allergen No, that is not the correct trigger. Try Again. Correct! The increased job stress and long workdays are an irritant to Paul and increases his asthma attacks. Now lets move on to learn about medications. Correct! The increased job stress and long workdays are an irritant to Paul and increases his asthma attacks. Now lets move on to learn about medications. Click on the correct letter. Check your understanding Click next to continue.

8 Learning to Monitor and Control Your Asthma Asthma Medication: Controllers and Relievers Asthma medications can be quite confusing. Pharmaceutical companies are always introducing new asthma drugs to the market. However, its a lot easier to keep track of the different kinds of medication if you remember that asthma medications fall into two categories of medications: controllers and relievers. Then within those two categories are several subcategories. Controllers are used daily to help prevent asthma attacks. Relievers are used whenever your asthma symptoms are exacerbated. They provide immediate relief. Below is a list of the subcategories of medication for both relievers and controllers. After you review this list, you will take a closer look at each medication category on the next page. Click next to continue. RelieversControllers Short-acting B2 agonistsInhaled corticosteroids Anticholinergic agentsLeukotriene modifiers Systemic corticosteroidsLong-acting B2 agonists Methylxanthines Omalizumab

9 Learning to Monitor and Control Your Asthma Asthma Medication: Controllers Controllers control asthma symptoms and prevent exacerbations.. Click each arrow to learn more. Controllers are also called maintenance medications. Controllers cant stop or treat sudden or severe flare-ups. Once you start taking controllers, they should only be stopped as direct by your physician. Click next to continue.

10 Learning to Monitor and Control Your Asthma Asthma Medication: Controllers There are five subcategories of controllers. While it may be easier to remember the brand names instead of the subcategory, you should remember that the different categories treat different asthma triggers. Click each controller category to learn more.

11 Learning to Monitor and Control Your Asthma Asthma Medication: Relievers Relievers are used to treat symptoms when they appear Click each arrow to learn more. Relievers are also known as quick relief medications or rescue medication for stopping asthma symptoms. Relievers should be used when you first notice symptoms or before exposure to a trigger, for example, before exercising. You should keep your reliever with you in a bag, backpack, or some place that you can access quickly. Click next to continue.

12 Learning to Monitor and Control Your Asthma Asthma Medication: Relievers There are three subcategories of relievers. Click each reliever category to learn more.

13 Learning to Monitor and Control Your Asthma Julies Medications Click next to continue. When I was a kid, I took more medications for my asthma than I do today. Some adults find that they are less sensitive to their asthma triggers than when they were kids. Im one of the lucky ones. None the less, if I dont keep on top of watching out for triggers and taking my medications, asthma make me sick. Controller – Daily Medication For a controller, I use Flovent®, an inhaled corticosteroids, with a spacer. Ill talk about spacers later in this module. Reliever – As-Needed Medication For a reliever, I use an albuterol inhaler. Generally, I use a generic prescription.

14 Learning to Monitor and Control Your Asthma Consequences for Non-Compliance What happens if I stop taking my medications? Well if I stop taking my controller, Ill probably feel OK for a few days. Then Ill start to feel sluggish and short of breath. At the gym, I run the risk of having an asthma attack. It can really be tempting to not take my controller medication, because Im feeling so well. I have to remember that the reason I feel so well is due to the controller.

15 Learning to Monitor and Control Your Asthma Which medication is a controller? A.Qvart® B.Prednisone C.Albuterol Pauls Medications Earlier we talked about how stress is a trigger for Paul. He needs to take a controller every day to help manage his symptoms. X X X Good job! Qvar® is the only controller in this list.Not quite. Qvar® is the only controller in this list.

16 Learning to Monitor and Control Your Asthma What could happen if Paul doesnt take his medication? A.Hell be extra sleepy over the weekend. B.Hell be OK since he has built up a tolerance to his triggers. C.Hell have an asthma attack. Pauls Consequence Good job! Not only is Paul setting himself up for an asthma attack, without his reliever he may need emergency medical attention to treat the attack. Not quite. Not only is Paul setting himself up for an asthma attack, without his reliever he may need emergency medical attention to treat the attack. X X X With the extra stress, Paul hasnt been very diligent at taking his controller medication every day and his prescription for his rescue medication needs to refilled.

17 Learning to Monitor and Control Your Asthma Which medication is a reliever? A.Foradil® B.Singulair® C.Proventil® What Would You Do? Good job! Proventil® is the only drug in this list that is a reliever. Its a brand-name drug of albuterol.Not quite. Proventil® is the only drug in this list that is a reliever. Its a brand-name drug of albuterol. X X X This is Shelby, age 15. Shelby was diagnosed with exercise-induced asthma. She has been directed by her doctor to take two puffs of her reliever before exercise or other exerting activities.

18 Learning to Monitor and Control Your Asthma What could happen if Shelby doesnt take her medication? A.Shell be fine. The cold weather will make it easier to rrun B.She could have an asthma attack. C.She could catch a cold from the cold air. Shelbys Consequence Despite her doctors direction, Shelby has not followed instructions to take her rescue medication on her runs in case of emergency. Last week Shelby ran in very cold weather at night without her rescue inhaler. Good job! Shelby could have an asthma attack. The safest thing Shelby could do for herself is to take her rescue inhaler with her. While she could call for help, theres no guarantee that help would arrive in time. Shelby was lucky on this day. She called her parents when the attack started. They were able to get to her in time. Not quite. Shelby could have an asthma attack. Shelby needs to take her rescue inhaler with her. While she could call for help, theres no guarantee that help would arrive in time. Shelby was lucky on this day. She called her parents when the attack started. They were able to get to her in time. X X X

19 Learning to Monitor and Control Your Asthma Hi there, remember me? Im Julie, your asthma trainer. Do you remember earlier in our conversation I mentioned I use a couple of devices to deliver my medications? I told you Id talk about these later in this training, and here we are! My asthma medications need to have the best chance of getting into my lungs. For a controller medication, I inhale corticosteroids with a spacer. For a reliever during an attack, I use an albuterol inhaler. Unless youre an asthmatic, these probably mean nothing to you, so let me introduce you to these devices and a couple of other common ones. Then youll get to see how different people use different devices for their asthma. Click on the arrow to your right and here we go!

20 Learning to Monitor and Control Your Asthma Click on each picture below to learn more about each device This device is called a Meter Dose Inhaler (MDI). They deliver medications as sprays, and are sometimes called puffers. This is called a spacer and it attaches to an MDI to maximize medication to the lungs. It also helps reduce side effects. This spacer with a mask is best for small children or people who cant use the regular spacer with mouthpiece. A nebulizer, depicted here, delivers rescue medications in a fine mist. It is usually only used in acute situations or urgent care facilities. This device is called a Dry Powder Inhaler (DPI) and delivers a powered medication. The powder must be inhaled quickly and deeply, something a child over the age of 7 usually should be able to do correctly.

21 Learning to Monitor and Control Your Asthma This is a picture of the medical device that I use to inhale my controller medications. I put the spacer mouthpiece in my mouth, pump the MDI which releases a meter-dose amount into the chamber. I then breath in and hold it for 10+ seconds. The chamber helps me maximize the amount of medication I get into my lungs. Meter Dose Inhaler (MDI) with medication canister inside Spacer mouthpiece Chamber

22 Learning to Monitor and Control Your Asthma Now remember that I said I use something different for my reliever meds when I have an attack? What I use to relieve an asthma attack is just an inhaler (MDI) without the spacer. It looks like this picture below. Its more convenient to carry in a purse or pocket than the an MDI with the spacer. This feature makes it great for active young people, like my friend Shelby, pictured below.

23 Learning to Monitor and Control Your Asthma Hi, Im Shelby and Im 15 years old. I was diagnosed with exercise-induced asthma two years ago. I was directed by my doctor to take 2 puffs of my controller medication through an inhaler (MDI) with a spacer before exercise or other exerting activities. I also am supposed to carry my reliever medication with me on my runs. Based on what youve learned about each of the medical devices for delivery of asthma medications so far, click on which two do you think I use? Meter-Dose Inhaler (MDI) MDI with spacer MDI with mask Dry-Powder Inhaler (DPI) Nebulizer Correct! She uses the MDI w/ spacer for controller meds and the MDI alone to take on runs for rescue meds. Correct! She uses the MDI w/ spacer for controller meds and the MDI alone to take on runs for rescue meds. Incorrect. MDI w/ mask is for small children. Incorrect. DPIs are powders usually used for children. Incorrect. Nebulizers are used in urgent care facilities.

24 Learning to Monitor and Control Your Asthma Im an avid runner and follow doctor's instructions about 2 puffs before running. However, last week I chose to carry my phone instead of my rescue inhaler medications with me on my run. I ran in very cold weather that night and had a severe attack two miles from home. I couldnt breath. I was able to text my parents to come get me. They took me to an Emergency Room and I was given a breathing treatment there. Choose which device below Shelby would use in the specific circumstance listed. A. B. 1. Before a runABC. 2. During attack 3. At Emergency Room A A B B C. No. This doesnt have a spacer. Correct. This inhaler with spacer is what Im directed to use before runs. No. This is a nebulizer Correct. This inhaler is small and convenient to carry on runs in case of attack.. No. This is a nebulizer No. This MDI with spacer is too big to pack on a run. Correct. A nebulizer is used in E.R.s for acute attack treatment No. This is an MDI (meter-dose inhaler). It doesnt deliver as much medicine as a nebulizer. No. This is an MDI with spacer and cant deliver as much medicine as a nebulizer

25 Learning to Monitor and Control Your Asthma So now that youve seen a few of the medical devices and which circumstances they are used, Id like you to meet Brandon. Youll learn more about Brandon in later segmentsmostly about his triggers and how to figure his Asthma Tracker and Asthma Control Plan. For right now, just click next to learn more about the specific medical device he uses and why.

26 Learning to Monitor and Control Your Asthma Hi there, Im Brandon! Im 8 years old and love soccer. Im super active and dont like to be bogged down with a bunch of stuff in my pockets that gets in the way of my play time. Im going to let you practice what you know about medical devices here. Youve already learned about 3 devices and 2 spacers. If youre feeling a little fuzzy on those, you can refer to the previous slides for a refresher. But, back to me. You already know enough about me and asthma devices by now to have a pretty good idea of which of the following devices I carry with me. Go ahead, give it a try and click on one, Ill be sure to let you know if youre right or not! No, this is a mask for babies and kids 7 and under. Try again. No, this is a nebulizer and used in urgent care facilities. Not for little boys pockets. Try again. No, this is a spacer with mouthpiece and inhaler. Its too big to carry this device around. Try again. Correct! great job! This Dry-Powder Inhaler (DPI) is perfect in size Im old enough to use correctly

27 Learning to Monitor and Control Your Asthma Controlling Your Asthma Weve covered a lot of information, including triggers, medication, and medication devices. Now its time to pull all that information together and talk about how you can monitor your own asthma symptoms and identify when you need to step up your care. Lets start by looking at an asthma control test.

28 Learning to Monitor and Control Your Asthma Controlling and Monitoring Asthma Symptoms Id like to introduce you to Brandon. Brandon is eight years old. Let me tell you a few things about Brandon. His favorite sport is soccer, his best friend is Joshua, he loves pizza, and he has asthma. His main triggers are seasonal allergies. Brandon tries not to let asthma get in the way of playing soccer. Instead he has learned how to control his symptoms. Lets explore the steps that you and Brandon need to take to monitor your asthma symptoms. Click next to continue.

29 Learning to Monitor and Control Your Asthma In the final rating, you need to rate your overall asthma control. Reflect on the week and how you felt. Be as objective as you can. Your score will help you take the appropriate action to control your symptoms. Now that you have scored each question, you need to total your score. Brandons total score is 16. With a final score you are ready to track your progress. Now that you have scored each question, you need to total your score. Brandons total score is 16. With a final score you are ready to track your progress. Did you use your quick-relief medication this week? How often? If you are using your quick-relief medication too much, this may be a sign that your symptoms arent under control. Brandon used his quick-relief medication a couple times after trying to play soccer. His score is three. Did you use your quick-relief medication this week? How often? If you are using your quick-relief medication too much, this may be a sign that your symptoms arent under control. Brandon used his quick-relief medication a couple times after trying to play soccer. His score is three. How often did asthma symptoms wake you up in the middle of the night or a bit earlier than normal? Sometime, it is hard to remember what happens in the middle of the night. You might want to ask someone that lives with to help keep track. Brandon woke up in the middle of the night twice. His score is three. How often did asthma symptoms wake you up in the middle of the night or a bit earlier than normal? Sometime, it is hard to remember what happens in the middle of the night. You might want to ask someone that lives with to help keep track. Brandon woke up in the middle of the night twice. His score is three. Over the past week, do you remember being short of breath? Did you ever stop what you were doing to catch your breath? Brandon was short of breath at least twice. This is what stopped him from playing soccer with his friends. His score is four. Over the past week, do you remember being short of breath? Did you ever stop what you were doing to catch your breath? Brandon was short of breath at least twice. This is what stopped him from playing soccer with his friends. His score is four. Think back over you week. Were you able to do everything that you wanted to do? Write the corresponding number in the score box. In our example, Brandon gives himself a score of three. There were a couple of times during the week that he didnt feel up to playing soccer with his friends. Think back over you week. Were you able to do everything that you wanted to do? Write the corresponding number in the score box. In our example, Brandon gives himself a score of three. There were a couple of times during the week that he didnt feel up to playing soccer with his friends Step 1: Asthma Control Test Each week you need to evaluate your asthma status. This is the first step in deciding if you need to change anything in your asthma protocol to keep asthma symptoms under control. Click each number to learn more.

30 Learning to Monitor and Control Your Asthma Brandons score from his Asthma Control Test was 16 (slide 2). See below how that has been marked with an X. Click on the X below to see what Brandon should do next. Step 2: Brandons Score on the Asthma Tracker Note how the X is in the yellow range of this graph. Yellow means that Brandon is in the CAUTION stage of the Asthma Action Plan. The next slide will show you what actions Brandon must take to control his asthma when in the CAUTION stage. X

31 Learning to Monitor and Control Your Asthma Step 3: Asthma Action Plan Brandons ACT score of 16 puts him in the CAUTION stage of the Asthma Action Plan. Click on the Caution icon to learn more about what it means to be in this stage. Patients continue to take their controller medicine. Quick relief medicine is either additional dosages or a stronger medicine. If asthma symptoms are starting to appear, asthma patients modify their care to the Step Up Therapy zone.

32 Learning to Monitor and Control Your Asthma Controlling and Monitoring Asthma Symptoms Now lets see how much you know. You will evaluate my symptoms and help monitor my condition. Heres some additional information about me. Im 25 years old and work as a human resource specialist. Over the past week, I havent been feeling well. For the past five nights, Ive come home and sat on the couch, skipping my trip to the gym. When I pick up lunch, I feel short of breath. Ive used my quick-relief inhaler everyday to help recover from shortness of breath. Ive woken up in the middle of the night. I feel like my asthma is poorly controlled. Click next to continue.

33 Learning to Monitor and Control Your Asthma Check Your Knowledge: Asthma Control Test Using your best judgment, enter a score for each question and total her score. Click each the info button to review Julies condition. Julie is 25 years old and works as a human resource specialist. Over the past week, Julie hasnt been feeling well. For the past five nights, she has come home and sat on the couch, skipping her trip to the gym. When she picks up her lunch, she feels short of breath. She has used her quick- relief inhaler everyday to help recover from shortness of breath. On three separate nights, Julie has woken up in the middle of the night. She feels like her asthma is poorly controlled. i i X X i i

34 Learning to Monitor and Control Your Asthma My score from the Asthma Control Test was 10. Click the circle correlates with my score. Step 2: Julies Score on the Asthma Tracker Incorrect. The green range is for scores My score is 10. Try again. Incorrect. The orange range is for scores My score is 10. Try again. Correct! Good job! The red range is for scores Click the next button to see what I should do to control my asthma at this stage.

35 Learning to Monitor and Control Your Asthma Select which stage of the Asthma Action plan Click the icon you believe is the correct action plan for my situation. If medicine is not working, breathing is very difficult, and the patient cannot walk, play or talk easily. Then it is time to increase quick relief medicine and seek medical care. That is correct. My score is a 10 which puts me in the STOP stage. I should follow the steps below to manage my asthma.

36 Learning to Monitor and Control Your Asthma You did a great job at evaluating my condition. Now that youve completed this training, I hope you were able to learn the four things that you can do to control your asthma: Identify triggers What is the cause Taking the right medication at the right time What your doctor has prescribed Use medication delivery devices correctly Using equipment correctly Track your asthma condition Monitoring your symptoms I know from personal experience as an asthma patient, that you can live the life that you want. I promise that if you follow the steps outlined in this training, you will feel better. Asthma does not have to hold you back! Good luck! Summary


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