ASTHMA TRAINING MODULE Lamar County School District 2012-2013 Annual Asthma Training Gina Whitehead, RN, MSN

Purpose Welcome to the Lamar County School District online asthma training tutorial. This course will be used to coordinate compliance with Mississippi Senate Bill 2393, the Comprehensive School Asthma Law and will provide an overview of asthma including causes, common triggers, signs and symptoms, and emergency treatment.

Objectives Upon completion of this training module, the learner will be able to: Identify causes of asthma Identify signs/symptoms of asthma Identify medications used to treat asthma symptoms and when to use them Identify proper technique in using rescue inhalers Emergency management

Assignments Log on to the Lamar County School District web-site and review the asthma learning tutorial. Complete Asthma Compliance form at the end verifying that you completed the training.

Impact of Asthma Each day in America, approximately . . . 63,000 people will miss school or work due to asthma 34,000 people will have an asthma attack 5,000 people will visit an emergency room facility due to asthma 1,300 people will be admitted to the hospital due to asthma 10 people will die from asthma Source: American Lung Association of Mississippi

Burden of Asthma in Mississippi 1 in every 14 adults have asthma -More women than men (8% v. 5%) 1 in every 10 children have asthma -About 2 children per classroom -More prevalent in African American children than Caucasian children (13% vs. 8%) -More prevalent in boys than girls (12% vs. 8%) Source: American Lung Association of Mississippi

Source: American Lung Association of Mississippi What is asthma? Normally, when we breathe, air (oxygen) moves in and out of our lungs. In order to get oxygen into our blood and tissues, it moves through several small airways called bronchial tubes. Bronchial tubes are lined with special cells that produce mucus, a sticky substance that helps carry waste particles out of the lungs. Smooth bands of muscle cover the outside of the bronchial walls (airways). Oxygen moves freely in and out when these muscles are relaxed. Source: American Lung Association of Mississippi

Source: American Lung Association of Mississippi What is asthma? When a person’s asthma is triggered, there is inflammation and increased mucus production in the airways. This causes the opening of the airways to become smaller, leaving less room for air (oxygen) to travel through easily. Source: American Lung Association of Mississippi

Normal Airway vs Occluded Airway

Asthma Symptoms Asthma symptoms may vary from person to person affecting each person differently. While some people with asthma may only present with a cough, others may have wheezing, chest tightness, or shortness of breath.

Asthma Triggers Persons with asthma are sensitive to certain environmental substances known as “triggers” that can irritate muscles around the airways causing them to constrict or tighten (bronchospasm). When these muscles tighten, airways become more narrow making breathing more difficult.

Common Asthma Triggers

Source: American Lung Association of Mississippi Other Asthma Triggers Other triggers include: Dust mites Illness (colds, flu, sinus problems) Air pollution (poor air quality control) Exercise Extreme weather conditions Anxiety or emotions such as laughing, crying, or emotional stress can cause an asthma attack. Source: American Lung Association of Mississippi

Extremely Cold Weather Breathing in cold air can cause the airways to constrict quickly. Persons with asthma who play sports in cold weather should take extra precaution by wearing a mask or a scarf to help warm the cold air. Warming up before starting practice or play helps reduce the likelihood of having an asthma attack due to breathing cold air.

Exercise Induced Asthma (EIA) Transient narrowing of the airways associated with: Physical exertion Coughing, wheezing or shortness of breath occurring within 10-15 minutes of starting exercise Source: American Lung Association of Mississippi

Managing Exercise Induced Asthma (EIA) Warm-up and cool-down periods help prevent or minimize exercise-induced asthma episodes. When a student experiences asthma symptoms, exercise should be temporarily modified to decrease the risk of further symptoms. Student may need to use quick-relief medication 10-15 minutes prior to activity and should always have access to his/her quick-relief medications. Source: American Lung Association of Mississippi

Asthma Medication People with asthma may have to take more than one type of medication. Since an asthma attack can happen anywhere at anytime, it is important to always have quick-relief medication with you wherever you go.

Short-Term Asthma Medication Short-term medications are commonly referred to as “rescue” or quick-acting” medications because they work fast and act immediately to relieve asthma symptoms. Albuterol and Xopenex are two short-term or “rescue” medications that are commonly seen in the school setting.

Long-Term Asthma Medication Advair is a common long-term asthma medication taken daily to help control asthma symptoms. These medications come in the form of inhaled corticosteroids and are not commonly used during the school day. These medications DO NOT work in the event of an asthma attack and it is important that all caregivers understand the difference the the differences between these medications!

Using Rescue Inhalers Step 1. Take off the cap and shake inhaler rapidly. Step 2. Blow air out all the way. Step 3. Place inhaler just outside mouth pointing toward the back of the mouth. Step 4. As you start to breathe in, press down on the canister and take a slow, deep breath in. Step 5. Hold your breath while counting to 10. Step 6. Release your breath and breathe normally. Step 7. Wait one to two minutes. Step 8. Repeat the procedure for each additional prescribed puff, beginning with Step 1.

Holding Chambers

Asthma Action Plans (AAP) An asthma action plan or AAP is an instruction plan formulated for students with asthma by their healthcare provider instructing what to do and what medications to take depending on their symptoms. AAPs are based on a color-coded warning system: GREEN = Go (Symptoms are controlled) YELLOW = Caution (Symptoms are present) RED = Danger (Symptoms do not go away and get worse) Each color includes specific instructions as to what to do depending on the student’s symptoms.

Asthma Action Plans (AAP)

Peak Flow Meter A peak flow meter is a simple device that can be used to evaluate lung function. It works by measuring the air a person can blow during the first second and can be a useful tool in helping a person monitor their asthma symptoms.

Asthma Action Steps When asthma symptoms begin: Have the student STOP what they are doing and remain calm. Stay with the student and send someone for help and rescue medication. NEVER leave the student alone.

Asthma Symptoms Requiring Immediate Action Early clues that an asthma episode is occurring: Coughing (cannot stop coughing) Wheezing (may not always be heard) Shortness or gasping for breath Chest pain or chest tightness Skin that is pale, flushed, ashen, or bluish Unable to speak in complete sentences Source: American Lung Association of Mississippi

Call 9-1-1 if any one of the following occur: Rescue medications are not working (symptoms are not improving and getting worse) or no rescue medication is available – or Nurse/designee or parent/guardian is not available - or Lips and/or nail beds are blue – or Student is having difficulty talking, walking or struggling to breathe – or If you are unsure what to do. Patient may cardiac arrest or respiratory arrest if not quickly reversed. Call 911 and be prepared to initiate CPR if needed!

Asthma Myths You Can’t Die From Asthma Health Messages: Deaths from asthma do occur although they are rare. Persons who have died did not have asthma under control. Working closely with your healthcare provider to develop an individualized plan will help keep asthma under control. Source: American Lung Association of Mississippi

Asthma Myths Asthma Medications are Unsafe Health Messages: Asthma medications are safe when used as directed. Corticosteroids are not the same as steroids that some athletes take and are not considered dangerous. Source: American Lung Association of Mississippi

Asthma Myths Asthma is all in Your Head Health Messages: Asthma is a real, physiological condition. There is a genetic basis for asthma. Stress can make asthma symptoms worse, but does not cause someone to develop asthma. Asthma should not keep someone from living an active, normal life. Source: American Lung Association of Mississippi

Asthma Myths You Can Outgrow Asthma Health Messages: Half of all children with asthma have no symptoms by the time they reach age fifteen. Asthma symptoms can reappear at any age. Source: American Lung Association of Mississippi

What to do if an Asthma Episode Occurs Review the student’s Asthma Action Plan Have student sit upright Slow, deep controlled breathing Administer quick-relief inhaler Reassure student and remain calm Contact School Nurse or Parent/Guardian NEVER leave student alone! Source: American Lung Association of Mississippi

Goal of Treatment Goal of treatment is to recognize and treat asthma symptoms early and prevent attacks!

Asthma Verification Compliance Please Click Here to Verify That You Have Watched This Presentation. (You may have to login to your Lamar County School District Email account to access this file.)