1. Asthma Catherine Crocker & Tricia McGinnity Paediatric Respiratory Nurse Specialist’s

2. Aims of session. What is asthma. Triggers. Signs and symptoms. Treatments including spacer technique. Recognising poor control. Managing asthma.

3. WHO - Definition of asthma This condition is due to inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they become easily irritated. In an attack, the lining of the passages swell causing the airways to narrow and reduce the flow of air in and out of the lungs.

4. Asthma - changes in airways

5. About Asthma It is common. Estimated that 5.4 million people in the UK have asthma, 1.1 million of those are children(Asthma UK). 1 in 11 children, therefore 2-3 children in every classroom It can be disruptive – sleep disturbance, poor concentration, stops participation in activities, growth & development

6. About Asthma It is long term. Variable condition that can be worse at certain times It is serious. Approximately 1,200 people in the UK die from asthma each year, 20-40 of these will be children It is estimated that 90% of deaths may be preventable.

7. Triggers Allergic Triggers Dust Animals Pollen Moulds Food Latex Non-allergic Triggers Infections Smoke Exercise Pollution/fumes Stress/emotion Hormones

8. Signs and symptoms Coughing. Shortness of breath. Wheezing. Tightness in the chest. Difficulty speaking in full sentences. Asthma varies in severity from child to child. Some children will experience an occasional cough or wheeze but others will have severe symptoms.

9. Treatments QuestionsResponses The “Transition: moving into adult care ” helped patients +family understand why they are starting RSG All agree The questionnaires were easy to understandAll strongly agree/agree RSG questionnaires helped focus clinic appt + address difficult issues All agree (1/62 disagreed) RSG helps ease the process of transitionAll strongly agree/agree Any questions that would help improve transition? All – No Time issues Relevance of some questions especially in patients with learning disabilities Reliever inhalers: Usually blue e.g.; Salbutamol Should be taken with symptoms. Essential treatment for treating exacerbations. Work by relaxing the muscles surrounding the narrowed airways. They do not reduce the inflammation. Preventer inhalers: Usually brown or orange e.g.; Beclomethasone / Fluticasone Protect the lining of the airway, reduces the inflammation. Airways are less likely to react when they come into contact with a trigger. Protective effect builds up over time, therefore need to be taken everyday.

10. Spacer technique. All children using a metered dose inhaler (MDI) should use a spacer. Check that the spacer is clean and not damaged Remove the inhaler cap, shake the inhaler and put it into the back of the spacer. Place the mouthpiece of the spacer in the mouth (or place mask securely over nose & mouth) Press the inhaler once to release a dose of the medicine Breathe in and out five times making the valve click each time Remove the spacer from the mouth Wait about 15 to 30 seconds before giving the next dose.

11. Managing asthma in schools & nurseries Pupils should have easy access to their reliever inhaler at all times. It should not be kept in a locked room or locked drawer. Every child should have an asthma action plan which should include details of medications, symptoms and what to do if child has an asthma attack. It should be simple & easy to access Believe the child & reassure.

12. What to do in an asthma attack Stay calm. Sit the child upright Help them take their inhaler 2 – 4 puffs After 5 minutes have symptoms improved? Yes. No. Inform parents If well could go back to class. A responsible adult should observe the child and act if condition returns or worsens. Inform parents If well could go back to class. A responsible adult should observe the child and act if condition returns or worsens. Give a further 6 – 8 puffs. Call 999. Call parents. While waiting for ambulance further doses can be given. Give a further 6 – 8 puffs. Call 999. Call parents. While waiting for ambulance further doses can be given.

13. Red flags Too breathless to talk Blue lips (cyanosis) Loss of consciousness or altered consciousness Agitation Complaining of a tight chest

14. Resources Asthma UK – Literature. Information packs for children, young people and adults to read. George Coller Memorial Fund & Education For Health collaboration created free educational resource. Asthma module for non healthcare professionals working with children. http://www.supportingchildrenshealt h.org. http://www.supportingchildrenshealt h.org https://www.monkeywellbeing.com/ Resources for schools & younger children ‘Monkey has asthma’. https://www.monkeywellbeing.com/ Parents. School nurse. GP. Practice nurse. Sally Griffin – Children’s Community Asthma Nurse (Southampton City). Paediatric Respiratory Nursing Team – Southampton Children’s Hospital.

15. Asthma control Uncontrolled – daily symptoms, disturbed sleep, using reliever daily or more often. Poorly controlled – day symptoms > 3 times a week, waking at night with symptoms >1 night a week. Using reliever > 3 times a week. Limitation on activities No / minimal symptoms, no asthma attacks, no use of reliever, no sleep disturbance, active!