Asthma Education For Teachers Jimmy Credo BSRC, RRT-NPS TCRHCC (928) 283-2430/2596

Healthy People 2010 Healthy People 2010 Healthy People is the prevention agenda for the Nation that was developed in 1997 during a consortium meeting. Healthy People objectives have been specified by Congress as the measure for assessing the progress of the Indian Health Care Improvement Act, the Maternal and Child Health Block Grant, and the Preventive Health and Health Services Block Grant. One of the objectives of Healthy People 2010 is to facilitates the development of a nationwide surveillance system to promote the development of uniform measures for both monitoring asthma and evaluating asthma interventions. The National Asthma Education Prevention Program (NAEPP) Developed the Asthma Goals for School Health in response to Healthy People 2010 congressional mandate.

NAEPP Asthma Goals For School Health Healthy school environment Enforce no smoking policies Reduce exposures to triggers Health services in school Provide full-time nursing services Train, supervise and delegate to health assistants Asthma education Provide asthma education for faculty and staff Supportive policies Identify student with asthma Provide access to medication Establish asthma management plan NAEPP

Gov. Janet Napolitano signed HB 2229 (4/11/05) Arizona House Bill 2229 Gov. Janet Napolitano signed HB 2229 (4/11/05) ALLOW THE POSSESSION AND SELF-ADMINISTRATION OF PRESCRIPTION MEDICATION FOR BREATHING DISORDERS IN HANDHELD INHALER DEVICES, BY PUPILS WHO HAVE BEEN PRESCRIBED THAT MEDICATION BY A HEALTH CARE PROFESSIONAL LICENSED PURSUANT TO TITLE 32. THE PUPIL'S NAME ON THE PRESCRIPTION LABEL ON THE MEDICATION CONTAINER OR ON THE HANDHELD INHALER DEVICE AND ANNUAL WRITTEN DOCUMENTATION FROM THE PUPIL'S PARENT OR GUARDIAN TO THE SCHOOL THAT AUTHORIZES POSSESSION AND SELF-ADMINISTRATION SHALL BE SUFFICIENT PROOF THAT THE PUPIL IS ENTITLED TO THE POSSESSION AND SELF-ADMINISTRATION OF THE MEDICATION. A SCHOOL DISTRICT AND ITS EMPLOYEES ARE IMMUNE FROM CIVIL LIABILITY WITH RESPECT TO ALL DECISIONS MADE AND ACTIONS TAKEN THAT ARE BASED ON A GOOD FAITH IMPLEMENTATION OF THE REQUIREMENTS OF THIS PARAGRAPH. www.azleg.state.az.us

What I need to know about asthma Asthma statistics Facts about asthma What is asthma? What happens during an asthma episode What can cause an asthma episode Early warning sign of an asthma episode What is an Asthma Action Plan?

What I need to know about asthma What to do if a child is having an asthma attack When to call the doctor Peak flow meters and how to use them Meter dose inhalers and how to use them Small volume nebulizer and how to use them Quick-relief and controller medicines, what are they? Exercise and asthma Resources available to me

Asthma Statistics 20.3 million Americans reported having asthma in 2001. 6.3 million children under 18 reported having asthma in 2001. There were 1.8 million asthma-related visits to emergency departments in 2000 (more than 728,000 of these involved children under 18).

Asthma Statistics There were 465,000 asthma-related hospitalizations in 2000 (214,000 of these involved children under 18). In 2000, 4,487 people died from asthma (223 of these were children under 18). Asthma accounts for 14 million missed school days annually.

Asthma Statistics Asthma among Native Americans and Alaskan Native???????? Indian Health Services (IHS) – Developed The Asthma Register Program (Specific to each tribe) Intertribal Councils of Arizona – Asthma Education Programs Alaskan Natives – Asthma Registry Program, Asthma Education Programs

Asthma Facts Asthma affects all ages and race Many people do not know they have asthma Asthma is unpredictable Asthma is not a psychological disease Asthma is serious and can be life threatening Asthma responds well to medication

Asthma Facts Asthma is not contagious Asthma cannot be cured, it can only be controlled Asthma may get less severe as some people get older, but it doesn’t disappear Asthma differs from person to person People with asthma can and should exercise Wheezing doesn’t mean you have asthma

Asthma and Children It has been estimated that asthma will disappear in 30 – 50% of children (especially males) at puberty but often reappears in adult life Childhood asthma is more prevalent in boys than in girls More females than males develop asthma during puberty and continues as such Up to 2/3 of children with asthma continue to suffer through puberty and adulthood Childhood asthma must never be ignored in hopes of the child “OUT GROWING IT”

What is asthma? Asthma is a CHRONIC lung disease that affects people of all ages and race. It is caused by inflammation (swelling) of the lining of the airways (windpipes). The inflammation causes the airway to narrow (constrict) and makes it difficult to breathe. The lungs produces excessive mucus further narrowing the airways.

What is asthma? Asthma often begins in childhood (it is frequently associated with an allergic reaction) however, it can develop at anytime in life. Currently there is no cure for asthma. It is a breathing problem that a person has to live with for the rest of his/her life. With proper care asthma can be controlled and allows a person to live a full normal life.

What is Asthma? Asthma is a disease that: Is chronic Produces recurring episodes of breathing problems Coughing Wheezing Chest tightness Shortness of breath Cannot be cured, but can be controlled

Cost of Asthma Quality of life (sick most of the time if not controlled) Education (Leading cause of school absences) Over 14 million school day missed Work Productivity (parents, other caretaker) Hospital/ER Visits $13 Billion dollars

Challenges of Asthma Complex disease Changes over lifetime (mild, moderate, severe) Multiple settings (different triggers) Lack of confirmed case definitions Data availability (skewed, not specific) Conflicting results (RAD, Bronchitis) Unpredictable course Mild, Moderate, Severe

What happens during an asthma (attack) episode? When a person has trouble breathing because of asthma, the problem is in the airways of the lungs. The airways become narrow because they are swollen. This is caused by: Tightening of the muscles around the airways; Swelling of the lining of the airways; The lungs produces mucus that clogs the small airways.

What happens during an asthma (attack) episode? The airways become: smaller (spasm) inflamed (swollen) traps air Produces extra mucus

What happens during an asthma episode? Breathing gets harder as the person tries to force air through the narrower airways. The air the person breathes may make a wheezing or whistling sounds, and may cause them to cough or spit up mucus. Asthma episode is a problem that can be life threatening if not taken care of right way.

What can cause an asthma episode? Asthma episode is caused by certain factors known as triggers. Asthma triggers differ from child to child. These triggers falls into 3 general categories: Allergens Irritants Physical Conditions

What Makes Asthma Worse? Allergens – are the most common cause of asthma attacks. They are usually inhaled. Allergens include but are not limited to: Warm-blooded pet dander (dogs, cats, birds, and small rodents) House dust mites Cockroaches Pollens from grass and trees Molds (indoors and outdoors)

What Makes Asthma Worse? Irritants – things that a person can be exposed to: Cigarette smoke, wood smoke, wood dust Scented products such as hair spray, cosmetics Cleaning products such as glass cleaners, bathroom cleaners, laundry detergents Strong odors from fresh paint or cooking Automobile fumes and air pollution Chemicals such as pesticides and lawn treatments

What Makes Asthma Worse? Physical Conditions: Infections in the upper airways, such as colds (a common trigger for both children and adults) Exercise (exercise induced asthma) Strong expressions of feelings (crying, laughing) Changes in weather and temperature, cold air, humid air Heartburn

Early warning signs of asthma episode An asthma episode begins slowly. Most children feels warning signs when an episode is starting. Often times an asthma episode is precipitated by a cold or a flu.

Early warning signs of asthma episode (cont.) The pattern of signs and symptoms of asthma varies from child to child but watch for any of these: ·        Dry cough ·        Feeling tired (not wanting to play) ·        Feeling sad, angry ·        Trouble sleeping ·        Stuffy nose, runny nose, watery eyes

Early warning signs of asthma episode (cont.) ·        Sneezing, itchy throat ·        Stomachache ·        Headache ·        Fast heartbeat ·        Tight chest ·        Shortness of breath or fast breathing ·        Wheezing, noises when breathing ·        Ear pain ·        Drop in peak flow meter scores

What are the symptoms of asthma? Shortness of breath Wheezing Tightness in the chest Coughing after physical activity or at night Cough that lasts more than a week Waking at night with asthma symptoms (a key marker of uncontrolled asthma)

Early warning signs of asthma episode (cont.) These symptoms can be: ·        Seasonal or year round ·        Sudden or gradual ·        Nighttime or daytime ·        Only at certain places, such as the daycare, school, grandma’s house, etc.

What is an Asthma Action Plan? An Asthma Action Plan is a written plan that tells a person what to do in case of an asthma episode. It is a written instruction that provides specific instructions from the doctor to the patient. Each child should have a copy of the Asthma Action Plan in the school to assist teachers during an asthma episode.

Asthma Action Plan The Asthma Action Plan addresses; Triggers outline signs and symptoms of worsening asthma personal best peak flow specify routine medications Specify medications required for emergencies and how to monitor response to them Indicate emergency contacts

Asthma Action Plan

What to do if a child is having an asthma attack If the child feels an asthma attack is coming on, he/she should stop and rest. Remain calm and reassure the child. Remove the child from the environment. Perform peak flow measurements (if able). If the child is in the YELLOW ZONE follow the asthma action plan. If the child is in the RED ZONE call the doctor immediately. If necessary, administer his/her quick-relief medications. If there’s no relief from his/her symptoms, call the doctor.

When to call the doctor Wheezing that does not get better after using the quick-relief medicines Headaches, trouble seeing or thinking Fast heartbeat or fast breathing Chest pain or chest tightness Weakness, trouble exercising, weak voice, can’t speak in sentences Breathing so hard that the skin between the ribs, above the breastbone and above the collarbone pulls in when he takes a breath Bluish color of the lips and or nail bed

When to call the doctor Low peak flow meter scores that do not improve after taking quick-relief medicines Using quick-relief medicines more than every 4 hours or 3 times a day Hard coughing, too much mucus Changes in mucus color from white or clear to yellow, green, gray or bloody Yellow or milky-looking mucus from nose that last longer the 7 days. Misses activities often (such as school, play, sports) due to asthma Fever

How do we know if the child’s asthma is under control? Diminished in signs and symptoms of asthma Coughing, shortness of breath, wheezing Maintaining normal activity level Ability to exercise and/play with no signs and symptoms Decreased use of rescue medications Decrease in school absences, emergency room/clinic visits Maintain (near) normal pulmonary function/Peak Flow Maintain in the green zone of their Asthma Action Plan

Peak Flow Meter A small device that measures how well air moves out of the airways. It can detect trouble before symptoms show up. Changes in the peak flow scores may tell you if the child is improving or getting worse. Peak flow should be performed while the person is standing.

How to use a peak flow meter The child should be standing. Remove any food or gum from the child’s mouth. Slide the arrow to the bottom of the numbered scale. Take a slow deep breath and blow into the peak flow meter as hard and as fast as the child can. Repeat step 3 and 4 two more times. Write down the highest score. Compare the score with the score on the Asthma Action Plan.

Metered Dose Inhaler A metered dose inhaler (MDI) is a small hand-held device that allows the child to breath in a fine mist of medicine. A spacer is a holding chamber that holds the medicine before the child takes in a slow breath. Always use a spacer when using an inhaler, this will help get the right amount of medicine from each puff.

How to use an Inhaler Make sure the child is standing. Remove the cap. With the inhaler in the upright position, insert the mouthpiece of the inhaler into the spacer. Shake the inhaler and spacer well right before each puff. Put the mouthpiece of the spacer into the child mouth. Ensure the child seals his lips around the mouthpiece and, when ready, gently breathe out. Start to slowly breathe in, press down on the inhaler to release 1 puff of the medicine.

How to use an Inhaler 6. Instruct the child to breathe in slowly and deeply to fill the lungs. Instruct the child to hold his breath for 5 to 10 seconds, this allows the medicine to get deep down into the his lungs. If the child is to take more than one puff, wait 1 minute and then repeat steps 3 and 7.

Small Volume Nebulizer A small volume nebulizer is a device that uses forced air to turn medication into a fine mist. The mist is breathed in through a mask or mouthpiece. A nebulizer may be recommended if the asthma symptoms is so severe that it is hard for the child to take breaths deep enough for an inhaler to be effective.

How to use a Nebulizer Add the medication to the nebulizer. Attach the mouthpiece or mask to the nebulizer. Connect the nebulizer to the machine and turn the machine on. Have the child put the mouthpiece in his mouth and instruct the child to breath in and out through his mouth. If the child is able, have the child take slow deep breaths every 3 to 4 breaths. Continue until all medication in the cup is used up.

What are quick-relief medicines? Quick-relief (rescue) medicines relaxes bronchial muscles so that air can move in an out of the lungs easier. These are medicines (bronchodilators) that work best for relieving coughing, wheezing and shortness of breath. The child should begin to breathe easier within 30 minutes of taking a bronchodilator.

Quick-relief medicines If exercise is one of the child’s trigger, it will be written in the Asthma Action Plan to administer quick-relief medicines 15 to 30 minutes before the child starts to exercise or play. The child should have his/her quick-relief medicines with him/her at school. If this is not permitted, it should be readily available to the child if needed.

What are controller (long-tern-control) medicines? Controller medications are medicines that are used to achieve and maintain control of persistent asthma These medicines are taken daily on a long-term basis They include: Anti-inflammatory (corticosteroids) agents (Flovent, Prednisolone) Long-acting bronchodilators (Serevent) Leukotriene modifiers (Singulair)

Exercise and Asthma A child can stay active even if he/she has asthma. Most children with asthma can be just as active as other children. They do not have to limit their activities if they stick with their treatment plans. With good asthma control, a child should be able to play the sports he/she enjoys. Encourage exercise – it can boost their lung power and improve their general health. If exercise is one of the trigger, it will be written in the Asthma Action Plan to administer his medicines 15 to 30 minutes before he starts to exercise or play.

Exercise and Asthma To help prevent any asthma episode, have the child: Take his quick-relief medication 15 – 30 minutes prior to exercise, Warm up and stretch, In cold weather, cover his mouth and nose with a scarf, muffler or ski mask Cool down after an exercise Modify activity or substitute with less strenuous option

Resources (Local and State) Tuba City Regional Health Care Corporation Respiratory Therapy Department (928) 283-2596 Pediatric Clinic (928) 283-2679 Emergency Room (928) 283-2662/2661 Inter Tribal Council of Arizona Tribal Asthma Risk Reduction Program (602) 258-4822 Arizona Asthma Coalition Arizona Department of Health (asthma Control Program) (602) 542-1886 www.azasthma.org Arizona American Lung Association Northern Arizona Branch (Phoenix) 102 W. McDowell Road Phoenix, AZ 85003-1299 Phone: (602) 258-7505 Fax: (602) 258-7507 E-mail: infophoenix@lungaz.org

Resources (National) Allergy and Asthma Network/Mothers of Asthmatics 1-800-878-4403 www.aanma.org American College of Allergy, Asthma and Immunology 1-800-842-7777 www.allergy.mcg.edu American Lung Association 1-800-586-4872 www.lungusa.org Asthma & Allergy Foundation of America (AAFA) 1-800-727-8462 www.aafa.org Lung, Line, National Jewish Medical Research Center 1-800-222-5864 www.njc.org National Institute of Allergy and Infectious Disease 1-301-496-5717 www.niaid.nih.gov National Asthma Education and Prevention Program National Heart, Lung and Blood Institute 1-301-592-8573 www.nhlbi.nih.gov

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