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ASTHMA Presented by your School Nurse Presented by your School Nurse.

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1 ASTHMA Presented by your School Nurse Presented by your School Nurse

2 Asthma What is Asthma?

3 Asthma is a chronic respiratory disease. Inflammation plays a large role. Inflammation contributes to airflow problems. When an asthma attack occurs, the muscles of the bronchial tree become tight and the lining of the air passages swell, reducing airflow and producing the characteristic wheezing sound. Mucous production is increased.

4 Three levels of asthma Mild asthma: symptoms occur no more than twice a week. The attacks don’t last long, and they are alleviated quickly with medication. There are no symptoms between attacks. Mild asthma: symptoms occur no more than twice a week. The attacks don’t last long, and they are alleviated quickly with medication. There are no symptoms between attacks. Moderate asthma: symptoms occur almost every day and require an inhaler almost every time an attack occurs for symptom relief. Moderate asthma: symptoms occur almost every day and require an inhaler almost every time an attack occurs for symptom relief. Severe: symptoms are present most of the day every day. They restrict activity and they have often necessitated a hospital stay. Severe: symptoms are present most of the day every day. They restrict activity and they have often necessitated a hospital stay.

5 Several types of asthma Adult-onset asthma develops after the age of twenty. It is less common than asthma in children, and it affects women more than men. Adult-onset asthma develops after the age of twenty. It is less common than asthma in children, and it affects women more than men. Exercise-induced asthma involves symptoms that occur about 5-20 minutes after beginning an exercise that involves breathing through the mouth. Activities that require continuous activity that are played in cold weather are the most likely trigger for an asthma attack. Exercise-induced asthma involves symptoms that occur about 5-20 minutes after beginning an exercise that involves breathing through the mouth. Activities that require continuous activity that are played in cold weather are the most likely trigger for an asthma attack.

6 Nocturnal asthma occurs between midnight and 8 am. It is triggered by allergens in the home such as dust and pet dander or is caused by sinus conditions. Nocturnal asthma occurs between midnight and 8 am. It is triggered by allergens in the home such as dust and pet dander or is caused by sinus conditions. Occupational asthma occurs in response to a trigger in the workplace. These triggers include contaminants and allergens in the air and extremes of temperature or humidity Occupational asthma occurs in response to a trigger in the workplace. These triggers include contaminants and allergens in the air and extremes of temperature or humidity o

7 What are factors that can cause an attack?

8 Respiratory infection Respiratory infection Exercise Exercise Cold air Cold air Tobacco smoke Tobacco smoke Pollution Pollution Stress Stress Food Food Drug allergies Drug allergies Aspirin Aspirin Non-steroidal inflammatory Non-steroidal inflammatory In sensitive individuals, asthma symptoms can be triggered by inhaled allergens such as: allergens such as:  Pet dander  Dust mites  Cockroach  Molds  Pollen. Medicines can provoke an asthma attack in some patients. Asthma symptoms can also be triggered by:

9 Asthma affects 17.3 million people in the United States. Asthma is found in 3-5% of adults and 7-10% of children. Half the people with asthma develop it before age 10, and most develop it before age 30. Asthma symptoms can decrease over time especially in children. Asthma affects 17.3 million people in the United States. Asthma is found in 3-5% of adults and 7-10% of children. Half the people with asthma develop it before age 10, and most develop it before age 30. Asthma symptoms can decrease over time especially in children.

10 Who gets asthma? More than twice as many boys than girls, although boys are more likely to experience a decrease in symptoms as they reach adolescence. More than twice as many boys than girls, although boys are more likely to experience a decrease in symptoms as they reach adolescence. In adult onset asthma, however, twice as many women than men visit the ER and are admitted with asthma In adult onset asthma, however, twice as many women than men visit the ER and are admitted with asthma

11 Asthma affects all races worldwide, but it is more common in blacks and Hispanics Asthma affects all races worldwide, but it is more common in blacks and Hispanics Occupational asthma is most common in those who work with animals or animal- derived products and in industries such as plastics, rubber, chemical, textile, electronics, painting Occupational asthma is most common in those who work with animals or animal- derived products and in industries such as plastics, rubber, chemical, textile, electronics, painting

12 Printing, metalworking, baking and gardening Printing, metalworking, baking and gardening

13 Risk Factors for Asthma Smoking or living with a smoker is a major risk factor Smoking or living with a smoker is a major risk factor About 25% of children who have asthma have at least one parent who smokes About 25% of children who have asthma have at least one parent who smokes A family history of asthma. If one parent has asthma a person has a 25% chance of developing it. If both parents have asthma, a person has a 50% chance of manifesting it. A family history of asthma. If one parent has asthma a person has a 25% chance of developing it. If both parents have asthma, a person has a 50% chance of manifesting it.

14 Having allergies, including any hayfever and eczema. It is not known why some people have alleriges and some don’t, but allergies can be inherited Having allergies, including any hayfever and eczema. It is not known why some people have alleriges and some don’t, but allergies can be inherited Having allergies or severe viral infections before the age of three Having allergies or severe viral infections before the age of three Living in the inner city or in a low income group Living in the inner city or in a low income group

15 Being exposed to mice and cockroach waste products Being exposed to mice and cockroach waste products Frequently being exposed to triggers Frequently being exposed to triggers

16 What are the symptoms of asthma? Wheezing, usually begins suddenly, is episodic, may be worse at night or in the early morning Wheezing, usually begins suddenly, is episodic, may be worse at night or in the early morning Aggravated by exposure to cold air Aggravated by exposure to cold air Aggravated by exercise Aggravated by exercise Aggravated by heartburn Aggravated by heartburn Resolves spontaneously Resolves spontaneously Relieved by bronchodilators (drugs that open the airways) Relieved by bronchodilators (drugs that open the airways) Cough with or without sputum production Cough with or without sputum production Shortness of breath Shortness of breath Breathing that requires increased work Breathing that requires increased work Intercostals retractions (Pulling of the skin between the ribs when breathing) Intercostals retractions (Pulling of the skin between the ribs when breathing)

17 Additional Symptoms Nasal flaring Nasal flaring Chest pain Chest pain tightness in chest tightness in chest abnormal breathing pattern, breathing out takes twice as long as breathing in. abnormal breathing pattern, breathing out takes twice as long as breathing in.

18 Asthma Symptoms What to look for if a child is having difficulty breathing? What to look for if a child is having difficulty breathing? Respiratory Rate >40 worrisome Respiratory Rate >40 worrisome Are they having nasal flaring? Are they having nasal flaring? Do you see neck muscles sinking in? Do you see neck muscles sinking in? Are they pulling in their ribs? Are they pulling in their ribs? What can be done to help control asthma? What can be done to help control asthma? If you cannot cure it there are steps to control it. If you cannot cure it there are steps to control it.

19 Tools used to detect asthma One way is through peak flow meters. One way is through peak flow meters. With this meter you can see when you are breathing well, which is you personal best, and when you are not at your personal best, steps you can take to prevent an attack. With this meter you can see when you are breathing well, which is you personal best, and when you are not at your personal best, steps you can take to prevent an attack. These readings are categorized into zones. These readings are categorized into zones.

20 Flow meter reading Green Zone – 80% of personal best denotes good control Green Zone – 80% of personal best denotes good control Yellow zone- 50 – 80% of personal best, caution need to use an inhaler Yellow zone- 50 – 80% of personal best, caution need to use an inhaler Red Zone - <50% of personal best denotes severe asthma exacerbation, need to use medicines, call MD, or go to ER. Red Zone - <50% of personal best denotes severe asthma exacerbation, need to use medicines, call MD, or go to ER.

21 Prevention Avoid known allergens, exposure to cigarette smoke, air pollution, dust, remove carpet from bedrooms, vacuum regularly. Remove pets from patients bedroom. May need to be allergy tested. Avoid known allergens, exposure to cigarette smoke, air pollution, dust, remove carpet from bedrooms, vacuum regularly. Remove pets from patients bedroom. May need to be allergy tested.

22 There are two basic kinds of medications for controlling asthma: Long term control medications – used on a regular basis to prevent attacks, not for treatment during an attack Long term control medications – used on a regular basis to prevent attacks, not for treatment during an attack 1. Inhaled steroids – examples are Azmacort, Vanceril, Aerobid, Flovent prevent inflammation. 2. Quick relief or rescue medications – used to relieve symptoms during an attack short acting bronchodilators such as Proventil Ventolin, xopenex, and others Prevention

23 Prevention Patients with mild asthma may use relief medication as needed. Those with persistent asthma should take control medications on a regular basis to prevent an attack from occurring. A severe asthma attack requires a medical eval., and may require hospitalization, oxygen and intravenous medication. Patients with mild asthma may use relief medication as needed. Those with persistent asthma should take control medications on a regular basis to prevent an attack from occurring. A severe asthma attack requires a medical eval., and may require hospitalization, oxygen and intravenous medication.

24 In conclusion, education needs to be tailored to meet the patient’s individual and family needs. Need to know factors responsible for an attack. Environmental control of allergies. Medication use, when to take. How often? Home peak flow monitoring. In conclusion, education needs to be tailored to meet the patient’s individual and family needs. Need to know factors responsible for an attack. Environmental control of allergies. Medication use, when to take. How often? Home peak flow monitoring. What to do if symptoms worsen? What medications to add or increase? Develop a written action plan with child and family to cover these issues. What to do if symptoms worsen? What medications to add or increase? Develop a written action plan with child and family to cover these issues. Have proper supply of medications at home, school, or setting where child attends. Have proper supply of medications at home, school, or setting where child attends. Goal of therapy is to maintain normal activity. Goal of therapy is to maintain normal activity.


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