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Everyone is some one in:. Asthma: What all Parents, Teachers, Coaches and Students Need to Know Greg L. Ledgerwood MD, AAFP, ACAAI, AE-C Chair Practitioner.

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Presentation on theme: "Everyone is some one in:. Asthma: What all Parents, Teachers, Coaches and Students Need to Know Greg L. Ledgerwood MD, AAFP, ACAAI, AE-C Chair Practitioner."— Presentation transcript:

1 Everyone is some one in:

2 Asthma: What all Parents, Teachers, Coaches and Students Need to Know Greg L. Ledgerwood MD, AAFP, ACAAI, AE-C Chair Practitioner Support Washington Asthma Initiative Private Practice Brewster, Washington Presented to WIAA Annual Conference Summer, 2011

3 Let’s See What You Know About Asthma!

4 For an athlete whose asthma is well controlled, which is true? A. Only has asthma symptoms at night B. Can participate in sports like other athletes only if using albuterol 3 times/day C. Still has abnormal lung function D. Should never warm up before exercise E. None of the above

5 What happens in the airway of people whose asthma is poorly controlled? A. Swelling of the airways B. Excessive mucous production C. Spasm of the airway muscles D. Permanent loss of air capacity E. A., B., C correct F. All are correct

6 You should call 911 if an athlete is having which of the following? A. Rescue medication (albuterol) is not relieving the breathing difficulties or is not available B. Symptoms of anxiety and “air hunger” continue after albuterol use C. Pulse rate stays > 150 beats/minute D. Peak flow is moving into the “red” zone E. A., B., D. correct F. All of the above are correct

7 What is/are the recommended actions or treatment to avoid exercise induced asthma (EIA)?: T or F A. Albuterol should be used after an athlete has started wheezing B. Warming up adequately before exercise C. Take rescue medication minutes before activity D. Avoid those sports that cause the EIA

8 Athletes should return to competition only when they can breath easily and are free of asthma symptoms A. True B. False

9 Some athletes need to take medication every day to prevent asthma symptoms. These medications are call controller medications and should not be used in an emergency situation A. True B. False

10 What item(s) is/are used to evaluate lung function and provide information on asthma symptoms and medications? A. Peak flow meter B. Asthma action plan C. Nebulizer D. A and B only E. B and C only

11 Parents should always inform the coach that their child has asthma, provide him/her with an asthma action plan, and discuss when and under what situations to implement it A. True B. False

12 What is Asthma??? Asthma is an obstruction of the pulmonary (lung) system that is completely reversible (most of the time). Asthma is an obstruction of the pulmonary (lung) system that is completely reversible (most of the time). Untreated asthma that starts in childhood and goes untreated often cannot be distinguished from lung obstruction seen in a smoking individual Untreated asthma that starts in childhood and goes untreated often cannot be distinguished from lung obstruction seen in a smoking individual

13 Who has Asthma??? How many listening to this presentation think they have asthma? How many listening to this presentation think they have asthma? How many had asthma and “outgrew” it as an adult? How many had asthma and “outgrew” it as an adult? How many have had MD diagnosis of asthma? How many have had MD diagnosis of asthma? How many of you have had PFT’S (breathing tests)? How many of you have had PFT’S (breathing tests)?

14 Current Asthma Prevalence National Center for Health Statistics at Worst Cities: 1. St. Louis, MO 2. Milwaukee, WI 3. Birmingham, AL 4. Chattanooga, TN 5. Charlotte, NC

15 Child Asthma Prevalence United States: Source: NHIS; National Center for Health Statistics 12-Month Lifetime Attack Current

16 Current Asthma Prevalence among Current Asthma Prevalence among adults Source: – Behavioral Risk Factor Surveillance System (BRFSS),

17 Current Asthma Prevalence among Current Asthma Prevalence among adults Source: – Behavioral Risk Factor Surveillance System (BRFSS) Current Asthma Prevalence among Current Asthma Prevalence among adults

18 Source: – Behavioral Risk Factor Surveillance System (BRFSS)

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20 ASTHMA and it’s natural history is evolving; what do we know about asthma in our state?

21 The Burden of Asthma in Washington State 2008 Prevalence of lifetime asthma by grade and sex: 6 th % male, 13% female 8 th % male, 16% female 10 th ---18% male, 20% female 12 th ---20% male, 22% female

22 The Burden of Asthma in Washington State 2008 Prevalence of lifetime asthma by grade: Prevalence of lifetime asthma by grade:6th---15%8th---17%10th--19%12th---21%

23 The Burden of Asthma in Washington State 2008 Prevalence of CURRENT asthma by grade: Prevalence of CURRENT asthma by grade: 6 th ---7%: 8% male, 7% female 8 th ---8%: 8% male, 8% female 10 th --9%: 7% male, 11% female 12 th --9%: 7% male, 11% female African American youth 30% more Likely to have asthma than white youth

24 Variability of Untreated Asthma Time Symptoms Mild Severe Mild = green Moderate = yellow Severe = Red

25 Asthma in America  Survey. SRBI. December Students Over-estimate Their Asthma Control Of patients who report symptoms that meet NIH criteria for moderate-persistent asthma Of patients who report symptoms that meet NIH criteria for moderate-persistent asthma 61% still consider their asthma to be “well controlled” or “completely controlled” 61% still consider their asthma to be “well controlled” or “completely controlled” Of patients who report symptoms that meet NIH criteria for severe-persistent asthma Of patients who report symptoms that meet NIH criteria for severe-persistent asthma 32% still consider their asthma to be “well controlled” or “completely controlled” 32% still consider their asthma to be “well controlled” or “completely controlled”

26 Deaths in our state ( ) still primarily in the youth!!!

27 Asthma Information for You And Your Family

28 Early-Onset Asthma Infants colonized by bacteria at early age significantly more likely to wheeze at age 5 than other children* Infants colonized by bacteria at early age significantly more likely to wheeze at age 5 than other children* *N. Engl. J. Med. 2007;357:1545

29 Infection Early in Life and Asthma In male children, early life exposure to infection is associated with lung impairment as adults: In male children, early life exposure to infection is associated with lung impairment as adults: ~60% higher of overall mortality in adulthood ~60% higher of overall mortality in adulthood 2-fold increase in COPD mortality 2-fold increase in COPD mortality Significant increase in MD diagnosis of asthma in adulthood Significant increase in MD diagnosis of asthma in adulthood Thorax; BMJ; November, 2007 Glasgow University students; 4044 f/u in 2007

30 Asthma, Antibiotics, Antihistamines/Decongestants Recent study shows: Recent study shows: Antihistamine/decongestants plus NSAIDS given during severe lower respiratory track infection in first year of life increases risk of having asthma at age 6 by 2-fold!!! (50% vs 24%, P=.001) Antihistamine/decongestants plus NSAIDS given during severe lower respiratory track infection in first year of life increases risk of having asthma at age 6 by 2-fold!!! (50% vs 24%, P=.001) (No association with the use of antibiotics in the first year of life and the presence of asthma at age 6) Roberg, KA; Presentation AAAAI Annual meeting; Philadelphia, March 2008; Abstract #357

31 What about Vitamins/Nutrients? Recent evidence suggest that young students that are “relative” vitamin D deficient are twice as likely to develop asthma. Recent evidence suggest that young students that are “relative” vitamin D deficient are twice as likely to develop asthma.

32 The Burden of Asthma in Washington State 2008 Prevalence highest in Whitman, Cowlitz, Grays Harbor and San Juan counties Prevalence highest in Whitman, Cowlitz, Grays Harbor and San Juan counties Lowest in Adams, Grant, Chelan and Skamania counties Lowest in Adams, Grant, Chelan and Skamania counties WHY????????? WHY?????????

33 In Washington State in 2008, Asthmatic Students are: 2 ½ times more likely to 2 ½ times more likely to require emergency care require emergency care 2 times as likely to need 2 times as likely to need specialty care specialty care Almost 5 times more likely Almost 5 times more likely to require daily medications! to require daily medications!

34 Asthma Diagnosis and Treatment: Achieving Control There needs to be a concerted effort by all persons involved with the patient diagnosed with asthma: There needs to be a concerted effort by all persons involved with the patient diagnosed with asthma: Primary Care Providers Primary Care Providers Nursing staff Nursing staff Pharmacists Pharmacists School contacts: teachers, School contacts: teachers, coaches, etc. Parents, care givers Parents, care givers

35 Assessment & Monitoring Remember: Students with asthma and “apparent” normal daily function remain at risk for frequent acute asthma attacks if their asthma is not controlled!!! Students with asthma and “apparent” normal daily function remain at risk for frequent acute asthma attacks if their asthma is not controlled!!!

36 What can Teachers do? Know which students have asthma Know which students have asthma Have general idea of the different types of asthma Have general idea of the different types of asthma Understand what triggers affect asthma Understand what triggers affect asthma Understand asthma “action” plans Understand asthma “action” plans Recognize how the classroom may contribute to asthma flares Recognize how the classroom may contribute to asthma flares When to be concerned When to be concerned

37 Asthma occurs in all age groups Myth: You do not “out grow” asthma in most cases Myth: You do not “out grow” asthma in most cases Male children more apt to have asthma until puberty Male children more apt to have asthma until puberty Obesity in females increases asthma risk Obesity in females increases asthma risk Highest percentage of asthma occurs in the school-aged population Highest percentage of asthma occurs in the school-aged population

38 Asthma Myths Asthma Myths Exercise should be avoided! Exercise should be avoided! People with asthma should People with asthma should not participate in sports not participate in sports Use of medications before/during exercise/games should be prohibited Use of medications before/during exercise/games should be prohibited If athletes just run more, they will “out- condition” their asthma If athletes just run more, they will “out- condition” their asthma

39 Asthma types Intermittent: often mild or occurring with infections Intermittent: often mild or occurring with infections Persistent: mild, moderate, severe Persistent: mild, moderate, severe Exercise induced (EIA) Exercise induced (EIA)

40 Asthma triggers Infection Infection Environmental irritants/allergens Environmental irritants/allergens Cold air Cold air Exercise: particularly Exercise: particularly running, swimming, biking running, swimming, biking Smoking Smoking Any strong odor Any strong odor

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42 “School Irritants” “School Irritants” Animals in classroom Animals in classroom Dust or mold in the classroom Dust or mold in the classroom Overuse of perfumes/hairsprays Overuse of perfumes/hairsprays Smoke or other noxious fumes Smoke or other noxious fumes Physical activity Physical activity Others? Others?

43 Exercise-induced Asthma (EIA) All coaching and training staff need to be able to recognize symptoms of asthma. All coaching and training staff need to be able to recognize symptoms of asthma. Desiccation (rapid drying) of the airway principle cause. Desiccation (rapid drying) of the airway principle cause. Ignorance/lack of recognition can result in a life-threatening event with a student. Ignorance/lack of recognition can result in a life-threatening event with a student. Understanding of the disease creates a win/win environment. Understanding of the disease creates a win/win environment.

44 EIA (continued) Symptoms seen with EIA Symptoms seen with EIA Coughing after running, both early in “season” and after “adequate” conditioning Coughing after running, both early in “season” and after “adequate” conditioning Frequent muscle cramping: so-called “side- aches” Frequent muscle cramping: so-called “side- aches” Lactic acid build-up Lactic acid build-up Poor performance during practice and games Poor performance during practice and games Oxygen debt Oxygen debt “Dogging it” “Dogging it” Increase in symptoms during cold weather participation (sport specific) Increase in symptoms during cold weather participation (sport specific)

45 Asthma Medications Inhalers Inhalers Quick-acting: albuterol Quick-acting: albuterol Controller type: salmeterol, formoterol, steroids, cromolyn Controller type: salmeterol, formoterol, steroids, cromolyn Oral medications Oral medications Singulair® Singulair® Steroids Steroids Theophylline Theophylline

46 When to be concerned In Students with Asthma Repetitive coughing Repetitive coughing Fever Fever During infectious disease seasons During infectious disease seasons Rapid heart rate/breathing rate Rapid heart rate/breathing rate Complaints of air hunger Complaints of air hunger “Color” changes particularly with lips or finger tips “Color” changes particularly with lips or finger tips

47 Action Plans All asthma students All asthma students should have one. should have one. Are steps that a person Are steps that a person will initiate with asthma will initiate with asthma flare or in anticipation of flare or in anticipation of asthma symptoms. asthma symptoms.

48 Action Plan (cont) Steps: Steps: STAY CALM!!! STAY CALM!!! Repeat medication (inhaler) as frequently as needed Repeat medication (inhaler) as frequently as needed If respiratory distress not improving quickly (5 minutes, or so) consider calling EMT services If respiratory distress not improving quickly (5 minutes, or so) consider calling EMT services Use oxygen if available Use oxygen if available Continue monitoring vital signs: pulse rate, breathing rate, color of digits Continue monitoring vital signs: pulse rate, breathing rate, color of digits Contact appropriate “emergency services” Contact appropriate “emergency services”

49 Coaching/Trainer Action Plan Know which of your athletes have asthma Know which of your athletes have asthma Recognize when is an athlete “in trouble”! Recognize when is an athlete “in trouble”! Know what medications are available Know what medications are available Steps to consider when concerned: Steps to consider when concerned: Stop activity Stop activity Check vital signs Check vital signs Let student/athlete administer own meds— remember they should also know what to do Let student/athlete administer own meds— remember they should also know what to do Have someone else call for assistance Have someone else call for assistance

50 Influenza Prevention, It will be VERY important that all teachers/coaches and student athletes get annual influenza vaccine this year. It will be VERY important that all teachers/coaches and student athletes get annual influenza vaccine this year.

51 Washington State Legislature has Taken an Active Role in Asthma Care in our Schools!

52 Current Washington State’s Rules and Regulations In 2004, The Asthmatic/School Children’s Treatment and Health Management Act of 2004 was enacted into law. In 2004, The Asthmatic/School Children’s Treatment and Health Management Act of 2004 was enacted into law. In May of 2011: WA Asthma Initiative will Focus on Development of “Asthma Friendly Schools” for ALL Schools in our State In May of 2011: WA Asthma Initiative will Focus on Development of “Asthma Friendly Schools” for ALL Schools in our State

53 Washington State Asthma Initiative As of 2006/2007, students are allowed to carry their own inhalers and epinephrine As of 2006/2007, students are allowed to carry their own inhalers and epinephrine They may use when they feel it is needed They may use when they feel it is needed School personnel need to become familiar with the medications and side effects School personnel need to become familiar with the medications and side effects Albuterol: rapid heart rate, shakiness Albuterol: rapid heart rate, shakiness Epinephrine: rapid heart rate, shakiness, nausea, vomiting, increase BP Epinephrine: rapid heart rate, shakiness, nausea, vomiting, increase BP

54 Asthma Registry Are “mandated” for ALL schools in Washington State beginning school year Are “mandated” for ALL schools in Washington State beginning school year Several “pilot” school districts have begun their registry—more in development Several “pilot” school districts have begun their registry—more in development Will require continuous updating Will require continuous updating Will eventually improved asthma care and hopefully decrease the number of “emergencies” for all students Will eventually improved asthma care and hopefully decrease the number of “emergencies” for all students

55 More Information about State Asthma Plan WAI web page: asthma initiative WAI web page: asthma initiative DOH Asthma Program webpage: DOH Asthma Program webpage:

56 Are Our Students With Asthma Achieving Good Control?

57 Guidelines for the Diagnosis and Management of Asthma—Update on Selected Topics NIH, NHLBI. May 2007 (reprint). NIH publication NIH Goals of Asthma Therapy Minimal or no symptoms day or night [ Minimal use of inhaled rescue (albuterol):<2 uses per week] Minimal or no symptoms day or night [ Minimal use of inhaled rescue (albuterol):<2 uses per week] Minimal or no exacerbations (flares) Minimal or no exacerbations (flares) No limitations on activities; no missed school/work No limitations on activities; no missed school/work Maintain (near) normal breathing tests Maintain (near) normal breathing tests Minimal or no adverse effects from medications Minimal or no adverse effects from medications

58 Are There Tools That Teachers/ School Nurses Can Use to Help Assess Asthma Control? Asthma Control Test

59 Asthma Control Test ™ (ACT) 1.In the past 4 weeks, ho much of the time did your asthma keep you from getting as much done at work, school or at home? 2.During the past 4 weeks, how often have you had shortness of breath? 3.During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night, or earlier than usual in the morning? 4.During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)? 5.How would you rate your asthma control during the past 4 weeks? Score Patient Total Score Copyright 2002, QualityMetric Incorporated. Asthma Control Test Is a Trademark of QualityMetric Incorporated.

60 3210 Childhood Asthma Control Test Childhood Asthma Control Test Questions Completed by Child age 4-11 yrs 3. Do you cough because of your asthma? 4. Do you wake up during the night because of your asthma? How is your asthma today? 2. How much of a problem is your asthma when you run, exercise or play sports? 3210 It’s a big problem, I can’t do what I want to do.It’s a problem and I don’t like it.It’s a little problem but it’s okay. It’s not a problem Yes, all of the time.Yes, most of the time.Yes, some of the time.No, none of the time Yes, all of the time.Yes, most of the time.Yes, some of the time.No, none of the time SCORE 3210 Very badBadGoodVery Good

61 Childhood Asthma Control Test Questions Completed by Parent/Caregiver 5. During the last 4 weeks, on average, how many days per month did your child have any daytime asthma symptoms? 5 Not at all 6. During the last 4 weeks, on average, how many days per month did your child wheeze during the day because of asthma? 7. During the last 4 weeks, on average, how many days per month did your child wake up during the night because of asthma? days/mo days/mo days/mo 0 Everyday days/mo 5 Not at all days/mo days/mo days/mo 0 Everyday days/mo 5 Not at all days/mo days/mo days/mo 0 Everyday days/mo TOTAL

62 Upper Methow Valley Spring, 2010 Questions


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