1. You can make a difference in the health and welfare of a child with asthma Dr. Mourad A. Tadros FRCPCH (UK) MRCPI (Dublin) Member of ALS Group (UK) MD Pediatric Cairo University

2. Learning Objectives The scope of asthma Common asthma symptoms Potential asthma triggers The difference between quick-relief and controller medications for asthma How to manage an asthma episode How to respond to an asthma emergency The importance and components of an Asthma Action Plan

3. How Many Kids Have Asthma? 7 Million people in Egypt have asthma 4,630,010 adults have asthma. That’s equal to 1 in 10 adults. 2,369,990 children have asthma. That’s equal to 1 in 14 children.

4. The Good News  Asthma can be controlled!  Children with asthma are just like any other child!  Children with asthma can play sports and compete just like everyone else!

5. The Goal of Asthma Management “Children should live happy, healthy, physically active lives, without asthma symptoms slowing them down”

6. What is Asthma? A chronic disease that causes obstruction: Tightening of the muscles surrounding the airways. Swelling of the lining of small airways in the lungs. Airways that are overly sensitive to allergen and irritant triggers. Over production of sticky mucus clogging the airways.

7. Airway Obstruction

8. Symptoms A Lot Going On Beneath The Surface Airflow obstruction Bronchial hyperresponsiveness Airway inflammation

9. Truth Asthma can be cured in children, only controlled in adults Myth Asthma is not curable in children

11. Truth Controller medications work best when used daily. Use of daily Quick Relief (Salbutamol) inhalers is an indicator of poor asthma control Myth Asthma medication becomes ineffective if used regularly

12. Common Symptoms of Asthma  Frequent cough, especially at night  Shortness of breath or rapid breathing  Chest Tightness  Chest pain  Wheezing  Fatigue  Behavior changes

15. Every Child is Unique!  Wheezing and coughing are the most common symptoms.  No two children will have the exact same symptoms or the same trigger.  Every child who has a diagnosis of asthma should have access to a quick-relief inhaler!  Every child who has asthma should have an asthma action plan (AAP).

16. Asthma Action Plan Provides details on types of medications, when and how often to use What to do when symptoms worsen When to seek emergency help Form is completed by the child’s physician

17. Asthma Attacks and Episodes

18. What’s An “Episode”?  Occurs when a child is exposed to a trigger or irritant and their asthma symptoms start to appear.  This can occur suddenly without a lot of warning, or build up for several days before the symptoms begin.  Episodes are preventable by avoiding exposure to triggers and taking daily controller medications (if prescribed).

22. How Do I Handle An Asthma Episode On The Field/Gym? 1. Remain calm and reassure the child. 2. Check the child's asthma action plan or emergency card for actions. 3. Give “quick-relief” medication(s) if ordered and available.

23. Handling An Episode cont.. 4. Have the child sit up and breathe slowly - in through the nose, and out through pursed lips slowly. 5. Have the child sip room temperature, water/ fluids. 6. Contact the parent or guardian as necessary. 7. DO NOT leave the child unattended.

24. CALL Dr. Mourad if !!!  Lips or nail beds are bluish.  Child has difficulty talking, walking or drinking.  Quick relief medication (Salbutamol) is ineffective or not available.  Neck, throat, or chest muscles are pulling in (retracting).  Nostrils flare out when trying to breathe.  Obvious distress.  Altered level of consciousness/confusion.  Rapidly deteriorating condition.

28. Exercise Induced Bronchospasm (Exercise Induced Asthma)

35. Sports affecting Asthma Football Handball Basketball Running Cycling Swimming Squash

36. Preventing EIB Make sure your athletes give you an Asthma Action Plan - Keep it with you on a clipboard. Athletes should use quick-relief medication (Salbutamol) 15 -30 minutes before strenuous activity begins. Do warm-up (5-15 minutes) and cool-down exercises before and after activities. Check outdoor air quality levels - the local forecast Stay hydrated! Dehydration can exacerbate the issue. Do not allow other athletes to tease or berate the athlete having asthma symptoms.

38. Olympians A study in the November 1998 Journal of Allergy and Clinical Immunology found that –1 in 6 athletes representing the United States in the 1996 summer Olympics had asthma. –Thirty percent (30%) of the athletes with asthma took home team or individual medals. –They fared as well as athletes without asthma (28.7%) who earned team or individual medals. Kidsgrowth.com - www.kidsgrowth.org/resources/articledetail.cfm?id=1262

39. Pro’s Who Have Asthma  Isaiah Thomas – NBA  Jerome Bettis - NFL  Dominique Wilkins - NBA  Gary Roberts - NHL  Donnell Bennett - NFL  Amy Van Dyken - Olympic Gold Medalist (swimming)  Jackie Joyner-Kersee - Olympic Gold Medalist (track & field)  Greg Louganis - Olympic diver

41. Medications

43. Stepwise Approach for Managing Asthma in Children 0 to 4 Years of Age

44. Stepwise Approach for Managing Asthma in Children 5 to 11 Years of Age

45. Stepwise Approach for Managing Asthma in Children 12 Years of Age and Adults

46. Take Home Message Get and use an Asthma Action Plan Know symptoms and Peak Flow readings for each of the green-yellow-red zones. Take “controller” medicine daily. Avoid exposure to triggers. Find a healthcare provider you trust and go in for asthma check-ups at least twice a year. Tell your coach and teammates about your asthma.

47. Everyone Wins When An Athlete Plays Their Game To The Fullest!