1. Asthma power point

2. Asthma:  Accounts for 14 million lost school days annually 3  Is the most common chronic disease causing absence from school 2  Is the leading cause of hospitalizations among children under 15 2  1 in 13 school children have asthma 1  6.3 million children under 18 have asthma 1 1 Asthma Prevalence, Health Care Use, and Mortality, 2000-01, National Center for Health Statistics, CDC 2 Morbidity and Mortality Report, National Center for Health Statistics (NCHS), U.S. CDC, 2003 3 Surveillance for Asthma - United States, 1980-99, MMWR Surveillance Summaries, CDC, March 29, 2002

3. This Means.. In a class of 30 children, you can expect 2 to 3 students WILL have asthma! 2 to 3 students WILL have asthma!

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

5. Impact Of Asthma On Students School Performance :  Poorly controlled asthma has a negative impact on school performance in both academic achievement and physical education

6. Impact Of Asthma On Students cont... Psychosocial: Psychosocial:  Poor self-esteem  Anxiety about asthma  Fear of becoming ill at school  Anxiety about exercise at school  Fear of being different

7. What Is Asthma? Asthma is a chronic disease that causes: Asthma is a chronic disease that causes: Tightening of the muscles surrounding the airways (Bronchoconstriction/spasm) Tightening of the muscles surrounding the airways (Bronchoconstriction/spasm) Swelling of the small airways (bronchioles) Swelling of the small airways (bronchioles) Over production of sticky mucus in the airways Over production of sticky mucus in the airways

9. Normal Bronchiole Inflamed Bronchiole with Mucus

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

11. What Causes Asthma?  Asthma may be caused by genetic, immune and/or environmental factors, and is often associated with eczema (scaly skin patches) and allergies  Researchers do not understand all of the causes of asthma or its increasing prevalence  It boils down to “We just don’t really know for sure”

12. What Causes Asthma cont..  Of the 17 million asthma sufferers in the US, 10 Million (approx. 60%) have allergic asthma. 3 million of those are children 1  Exposure to certain allergens trigger asthma symptoms to begin  Exposure to certain irritants can also set an asthma episode in motion 1 National Institute of Environmental Health Sciences

13. Triggers And Irritants Copyright 2004, 3M Pharmaceuticals

14. Common Allergens (Triggers)  Seasonal pollens  Animal dander /saliva/urine  Dust mites  Cockroaches/mice/rat droppings and urine  Mold  Some medications  Some foods  Strong emotional feelings

15. Common Irritants (Triggers)  Exercise  Cold air  Chalk dust  Viral/upper respiratory infections  Air pollution  Tobacco smoke or secondhand smoke  Chemical irritants and strong smells  Strong emotional feelings  Diesel fumes  Cleaning supplies

16. Every Child Is Unique!  Wheezing and coughing are the most common symptoms -but-  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 rescue inhaler!  Every child who has asthma should have an asthma action plan at school (AAP)

17. Handling Asthma Episodes

18. What’s An “Episode”?  An asthma 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 brew for days before the symptoms emerge  Episodes are preventable by avoiding exposure to triggers and taking daily controller medications (if prescribed)

19. How Do I Handle An Asthma Episode At School? 1. Remain calm and reassure the child 2. If you know what triggered their episode, move the child away from it 3. Have the child sit up and breathe slowly- in through the nose, out through pursed lips 4. Contact the school nurse for assistance or whomever is responsible for providing medications in the nurses absence

20. Handling An Episode cont.. 5. If you are responsible for medications, check the child's asthma action plan, emergency care plan or medication card for actions 6. Give “rescue or reliever” medications if ordered and available (some students carry their own asthma inhalers with them) 7. Have the child sip room temperature water/ fluids 8. Contact the parent or guardian as necessary -AND-

21. Do NOT Leave The Child Alone!

22. Call 911 if..  Lips or nail beds are bluish  Child has difficulty talking, walking or drinking  Quick relief or “rescue” meds (albuterol) is ineffective or not available  Neck, throat, or chest muscles are pulling in (retracting)  Nasal flaring occurs when inhaling  Obvious distress  Altered level of consciousness/confusion  Rapidly deteriorating condition

23. Exercise Induced Asthma

24. What Is Exercise Induced Asthma (EIA)? Tightening of the muscles around the airways (bronchospasm) Tightening of the muscles around the airways (bronchospasm) Distinct from “chronic” asthma in that it does NOT cause swelling and mucus production in the airways Distinct from “chronic” asthma in that it does NOT cause swelling and mucus production in the airways Can be avoided by taking pre-exercise medications and by warming up/cooling down Can be avoided by taking pre-exercise medications and by warming up/cooling down

25. EIA - What Happens?  Symptoms include coughing, wheezing, chest tightness and shortness of breath  Symptoms may begin during exercise and can be worse 5 to 10 minutes after exercise  EIA can spontaneously resolve 20 to 30 minutes after starting  Can be avoided by doing the following:

26. Preventing Exercise Induced Asthma (EIA) Become familiar with Asthma Action Plans, pre- exercise medication orders and or health care plan Become familiar with Asthma Action Plans, pre- exercise medication orders and or health care plan Student should use reliever (Albuterol) 15 -30 minutes before activity Student should use reliever (Albuterol) 15 -30 minutes before activity Do warm-up/ cool-down exercises before and after activities Do warm-up/ cool-down exercises before and after activities Check outdoor ozone/air quality levels Check outdoor ozone/air quality levels www.aqi.pca.state.mn.us/hourly/ www.aqi.pca.state.mn.us/hourly/ Never encourage a child to “tough it out” when having asthma symptoms Never encourage a child to “tough it out” when having asthma symptoms

27. Medications

28. Medication: Determined By Severity Level Classification 1. Mild Intermittent Reliever only prn Reliever only prn 2. Mild Persistent Controller and reliever Controller and reliever 3. Moderate Persistent Controller plus long-acting bronchodilator and reliever 4. Severe Persistent Controller plus long-acting bronchodilator and reliever

29. Two Categories Of Medications Controller Medications Controller Medications  Taken every day to prevent swelling in the lungs Reliever or Rescue Medications Reliever or Rescue Medications  Taken only when needed to relieve symptoms  Or to prevent exercise induced asthma from developing (taken before strenuous exercise)

30. Controller Medications Keep swelling and mucus from developing in the lungs Keep swelling and mucus from developing in the lungs Must be taken EVERY day even when the child is not having symptoms Must be taken EVERY day even when the child is not having symptoms Inhaled corticosteroids (ICS’s) are the most common and effective way to control asthma Inhaled corticosteroids (ICS’s) are the most common and effective way to control asthma Help prevent asthma exacerbations from developing! Help prevent asthma exacerbations from developing!

31. Rescue Or Reliever Medications Are taken when asthma symptoms are appearing (asthma episode) Are taken when asthma symptoms are appearing (asthma episode) Are taken 15-30 minutes before strenuous exercise/activity by children with EIA Are taken 15-30 minutes before strenuous exercise/activity by children with EIA Do NOT reduce or prevent swelling from developing in the lungs Do NOT reduce or prevent swelling from developing in the lungs May be carried in school by a student only IF approved by the doctor, school nurse and parent! May be carried in school by a student only IF approved by the doctor, school nurse and parent!

32. Picture courtesy of American Lung Association of the Inland Counties CA 2004

33. Typical Spacers/Holding Chambers

34. Spacers Or Holding Chambers Most MDI’s (metered dose inhalers) must be used with a spacer or holding chamber Most MDI’s (metered dose inhalers) must be used with a spacer or holding chamber  This device attaches to the MDI and allows the user to breathe in more medication effectively  The physician must write an order for it when prescribing your reliever medication  Dry powder inhalers do NOT require spacers

35. How MDI Technology Works

36. How To Use Your Inhaler

37. How To Use: Metered Dose Inhalers w/Spacers 1. Stand up (or sit up straight) 1. Stand up (or sit up straight) 2. Shake the inhaler well to mix up the medicine 2. Shake the inhaler well to mix up the medicine 3. Remove the cap and check the spacer/inhaler for foreign objects 3. Remove the cap and check the spacer/inhaler for foreign objects 4. Insert the inhaler into the spacer 4. Insert the inhaler into the spacer 5. Exhale all your air out fully 5. Exhale all your air out fully 6. Before inhaling, put the mouthpiece of the spacer into your mouth, over your tongue and between your teeth. Close your lips around it while tilting your head and the inhaler back slightly 6. Before inhaling, put the mouthpiece of the spacer into your mouth, over your tongue and between your teeth. Close your lips around it while tilting your head and the inhaler back slightly

38. Using An MDI Cont.. 7. Press down on the inhaler canister and breathe in slowly and deeply through your mouth 8. Hold your breath for 10 seconds, exhale normally 9. If using a “reliever”, wait 1-2 minutes between puffs 10. Repeat starting with #5 if a 2 nd puff is ordered 11. Rinse your mouth and spit after using a “controller” inhaler

39. Minnesota Inhaler Law

40. MN Asthma Inhaler Law Summary (2001)  Allows MN students to self-carry and administer inhalers  In order for a child to carry his/her inhaler at school, authorization and signatures from the following individuals are required: Child’s health care provider Child’s health care provider Parent/guardian Parent/guardian Assessment and approval of the school nurse (if present in district) Assessment and approval of the school nurse (if present in district)  Be sure to check and follow policies and procedures in local school district

41. Para Professionals Role Identify students with asthma Identify students with asthma Distribute & collect communication forms Distribute & collect communication forms In the health office the RN may delegate specific tasks such as: In the health office the RN may delegate specific tasks such as:  Documenting asthma visits by completing or initiating student asthma records  Asking about symptoms & check PFM levels  Providing episodic care to students with asthma symptoms including medication administration  Communicating with parents regarding asthma care/episodes

42. Communicate With The NURSE Communicate With The NURSE You are the eyes and ears for the nurse You are the eyes and ears for the nurse Be aware of students with asthma and their typical symptoms Be aware of students with asthma and their typical symptoms  Help remind students to pre-medicate before exercise Always document clearly and neatly what you see, hear and what the student tells you Always document clearly and neatly what you see, hear and what the student tells you Call the nurse with questions or urgent situations Call the nurse with questions or urgent situations If you don’t know- ask! If you don’t know- ask! Don’t be afraid to call 911 in emergencies Don’t be afraid to call 911 in emergencies

43. Tools To Help Manage Asthma

44. Peak Flow Meters (PFM)

45. Peak Flow Meters  Measures how well the student’s lungs are doing at that moment  Associated with the Green-Yellow-Red system of managing asthma symptoms  Congruent with asthma action plans  Helps students and families self-manage asthma

46. Asthma Action Plan (AAP)

47. Asthma Action Plan Zones Green Zone : All Clear/Breathing Good/Go Green Zone : All Clear/Breathing Good/Go –No asthma symptoms and/or –Peak flow 80-100% Predicted or Personal best Yellow Zone: Caution/Slow Down Yellow Zone: Caution/Slow Down –Some asthma symptoms and/or –Peak flow 50-80% Predicted or Personal best Red Zone: Medical Alert/Stop Red Zone: Medical Alert/Stop –Severe asthma symptoms and/or –Peak flow < 50% Predicted or Personal best