1. A STHMA MANAGEMENT IN CHILDREN AND THE ROLE OF THE NURSE SPECIALIST Amanda Jones Paediatric Respiratory Nurse Specialist Childrens Community Team

2. A LL A BOUT A STHMA 5.2m people in UK receive treatment for asthma Most Common childhood disease in UK 1 in 10 children have asthma Equates to 1.4 million Most children develop asthma before 8yrs old Over half before the age of 3yrs 80,000 admissions to hospital each year 34,000 were children An estimated 75% of these are avoidable

3. A LL A BOUT A STHMA Approx 3,000 attendances to Urgent Care in Bolton for children Approx 350 children required admission 1,300 deaths from asthma each year in UK 29 children each year in UK 90% of deaths are preventable

4. HOW DO WE MANAGE ASTHMA IN CHILDREN www.brit-thoracic.org.uk/asthma-guideline British Thoracic Society Guidelines Scottish Intercollegiate GuidelinesNetwork NICE Guidelines

8. T HE ROLE OF THE NURSE SPECIALIST Autonomous practitioners who are accountable for a caseload of children providing highly specialist nursing skills, knowledge and expertise for children and their families in the management of asthma across all stages of the illness Involved in the development of clinical services and act as a specialist resource in collaboration with partnership agencies, locally, regionally and nationally

9. S UPPORTING THE C HILD & F AMILY Successful asthma management can only be achieved by the child/family & health professional working together in partnership to achieve optimum control Experience and Knowledge of a full Assessment, implementing treatment and reviewing the child is important, but the key to success is educating the family on an ongoing basis

10. E DUCATING THE CHILD /F AMILY What is Asthma Trigger Avoidance Understanding of Medications Importance of compliance Correct Inhaler Technique What to do during an URTI What to do in an emergency Self Management Plan Management in nursery, school, etc Who to contact

11. I NHALER TECHNIQUE IS IT IMPORTANT ? To gain control of symptoms To improve deposition of medication Ensure patient receives correct dose of treatment Encourage compliance of treatment To adminster reliever during an acute episode

12. I NHALER TECHNIQUE Every consultation is an opportunity to check inhaler technique Families often receive conflicting advice from various settings Families can pick up bad habits over a period of time

13. I NHALER D EVICES USED AT HOME

14. S PACERS

15. I NHALER DEVICES IN SCHOOL

16. I NHALERS IN S CHOOL

17. S ELF MANAGEMENT PLANS E VIDENCE Personalised plans have been shown to improve health outcomes, esp for those in secondary care and those who have had a recent exacerbation Reduction in unscheduled GP visits Reduction in hospital admissions Reduction in days off work and school Reduction in nocturnal symptoms Improves compliance Reduction in deaths

18. SMP IN PRACTICE Every asthma consultation is an opportunity to review, reinforce and extend knowledge and skills A consultation for an URTI is an opportunity to rehearse with the family their self management in the event of their asthma deteriorating An acute consultation offers the opportunity to determine what action the patient has already taken and what ongoing support is required Education is an ongoing process, is every ones role and is not a single event

19. C OLD V IRUSES Biggest trigger esp for under 5’s Advice to commence regular reliever at first signs (2-4 puffs) four times a day If no improvement after 24-48 hrs, can increase reliever to 4-6 puffs, but must seek review, prob require a course of oral steroids Under 2yrs- 10mgs, 2-5yrs- 20mgs, over 5yrs 30- 40mgs for 3 /5 days In Emergency can have 10 puffs but must seek urgent review ASAP – contact 999 Advise to have Flu vaccine every year if taking inhaled steroids

20. H OW CAN WE ACHIEVE T HIS IN B OLTON Consistent advice esp during acute symptoms and URTI Support from Childrens Respiratory Nurses to provide education etc Provision of Childrens Community Nurses to support children at home with acute symptoms Use of Guidelines to ensure correct treatment/devices Bolton respiratory Pathway Leaflets- After your wheezy episode and After your asthma attack

21. A ND TO F INISH Always Remember Inhaler technique is just like driving, you pick up bad habits over time…….would you pass your test again? Asthma Management without education & written action plans is like flat pack furniture without instructions!