1. Learning to Monitor and Control Asthma

2. Hi! I’m Julie. I’m 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, I’ve learned how to care for myself so that I do the things that I love without getting sick. I want you to have the same experience. Today, I’ll share with a few tips on identifying triggers, taking the medications, and using the medication delivery devices correctly. To keep track of how I feel, I’ll show I track my condition and get the correct medical attention when needed. In no time at all, you’ll be able to track how you are doing. I hope you’re excited to learn how to control your asthma so you can live the life you want. Let’s get start. Introduction Click next to continue.

3. 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. 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. This is Lauren. She is a three year-old active toddler. A year ago Lauren’s 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 Lauren’s 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 Lauren’s 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 Lauren’s asthma is considered an ingested allergen. To prevent an asthma attack, Lauren needs to avoid milk and products with milk in them. If you need a refresher on what classifies an ingested allergen trigger, go back to the previous slide. Once you have a comfortable understanding, move forward to test your knowledge. 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.

6. Paul, 40-years old, works as a sales rep. for local TV advertisement. Two weeks ago, his manager left the company. Paul has been asked to work extra hours to help out. Paul has asthma and has had more attacks recently. Which trigger affects Paul’s 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. Click on the correct letter. Check your understanding Click next to continue.

7. Asthma Medication: Controllers and Relievers Asthma medications can be quite confusing. Pharmaceutical companies are always introducing new asthma drugs to the market. However, it’s 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. 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 types of medication in both categories. 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

8. Asthma Medication: Controllers There are five types of controllers. Controllers control asthma symptoms and prevent exacerbations. They are also called “maintenance medications.” They can’t stop or treat sudden or severe flare-ups. Once you start taking controllers, they should only be stopped as direct by your physician. Click each controller category to learn more.

9. Asthma Medication: Controllers There are five types of controllers. Controllers control asthma symptoms and prevent exacerbations. They are also called “maintenance medications.” They can’t stop or treat sudden or severe flare-ups. Once you start taking controllers, they should only be stopped as direct by your physician. Click each controller category to learn more.

10. Asthma Medication: Relievers There are three types of relievers. They are also known as “quick relief medications” or “rescue medication” for stopping asthma symptoms. You should use your relievers when you first notice symptoms or before exposure to a trigger, for example, before exercising. Click each controller category to learn more.

11. Julie’s 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. I’m one of the lucky ones. None the less, if I don’t keep on top of watching out for triggers and taking my medications, asthma make me sick. For a controller, I use Flovent®, an inhaled corticosteroids, with a spacer. I’ll talk about spacer later in this module. For a reliever, I use an albuterol inhaler.

12. What could go wrong for Paul? Paul is setting himself up for a medical emergency. First, regardless of how well life is going, you need to take your controller medication every day as prescribed by your physician. When exposed to a trigger (In Paul’s case extra stress) it is even more important to stick with the care plan that your physician has prescribed for you. The controller protects your body. It is likely that Paul will need his reliever medication to deal with the extra stress and not taking controller. Without his reliever medication, he may require emergency medical care to deal with an exacerbations. Recommendations for Paul: Take his controller as prescribed Refill his rescue medication prescription Paul’s Medications With the extra stress, Paul hasn’t been very diligent at taking his controller medication every day and his prescription for his rescue medication needs to refilled.

13. How could Shelby prevent her exacerbation while running? A.Run with a friend B.Take her rescue inhaler with her C.Call her parents when the attack starts What Would You Do? This is Shelby, age 15. Shelby was diagnosed with exercise-She has been directed by her doctor to take 2 puffs of her inhaler medication before exercise or other exerting activities. Shelby is an avid runner and has followed doctor's instructions about 2 puffs before running. However, she 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. She had a severe attack two miles from her home. Good job! The safest thing Shelby could do for herself is to take her rescue inhaler with her. While she could call for help, there’s 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 needs to take her rescue inhaler with her. While she could call for help, there’s 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

14. Insert medication Devices here

15. Controlling Your Asthma We’ve covered a lot of information, including triggers, medication, and medication devices. Now it’s 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. Let’s start by looking at an asthma control test.

16. Controlling and Monitoring Asthma Symptoms Hi. I’d 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. Brandon tries not to let asthma get in the way of playing soccer. Instead he has learned how to control his symptoms. Let’s explore the steps that you and Brandon need to take to monitor your asthma symptoms. Click next to continue.

17. 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. Brandon’s 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. Brandon’s 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 aren’t 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 aren’t 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 didn’t 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 didn’t feel up to playing soccer with his friends. 4 4 1 1 2 2 3 3 4 4 5 5 5 5 6 6 6 6 3 3 1 1 2 2 3 4 3 3 3 16 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.

18. Brandon’s 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: Brandon’s Score on the Asthma Tracker

19. Brandon’s 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: Brandon’s 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.

20. Step 3: Asthma Action Plan Brandon’s 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.

21. Controlling and Monitoring Asthma Symptoms Now let’s see how much you know. You will evaluate my symptoms and help monitor my condition. Here’s some additional information about me. I’m 25 years old and work as a human resource specialist. Over the past week, I haven’t been feeling well. For the past five nights, I’ve come home and sat on the couch, skipping my trip to the gym. When I pick up lunch, I feel short of breath. I’ve used my quick-relief inhaler everyday to help recover from shortness of breath. I’ve woken up in the middle of the night. I feel like my asthma is poorly controlled. Click next to continue.

22. 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 Julie’s condition. Julie is 25 years old and works as a human resource specialist. Over the past week, Julie hasn’t 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

23. Julie’s score from her Asthma Control Test was 10. Click on the of the graph below that correlates to Julie’s score. Step 2: Julie’s Score on the Asthma Tracker

24. Julie’s score from her Asthma Control Test was 10. Click on the of the graph below that correlates to Julie’s score. Step 2: Julie’s Score on the Asthma Tracker Incorrect. The green range is for scores 19- 25. Julie’s score is 10. Click on the blue arrow at bottom right of screen to try again.

25. Julie’s score from her Asthma Control Test was 10. Click on the of the graph below that correlates to Julie’s score. Step 2: Julie’s Score on the Asthma Tracker Incorrect. The orange range is for scores 15- 19. Julie’s score is 10. Click on the blue arrow at bottom right of screen to try again

26. Julie’s score from her Asthma Control Test was 10. Click on the of the graph below that correlates to Julie’s score. Step 2: Julie’s Score on the Asthma Tracker Correct! Good job! The red range is for scores 5-15. Click on the forward blue arrow bottom right of screen to see what Julie should do to control her asthma at this stage.

27. Select which stage of the Asthma Action plan Click the icon you believe is the correct action plan for Julie’s 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. Julie’s score is a 10 which puts her in the STOP stage. Julie should follow the steps below to manage her asthma.

28. You did a great job at evaluating my condition. Now that you’ve learned about and practiced monitoring and controlling asthma symptoms, you are ready to tackle your own asthma symptoms. I promise that if you follow the steps outlined in this training, you will feel better. Good luck! Asthma Action Plan