1. Asthma VIP Patient Education 11.9.2017
My Health Onsite
Asthma
VIP
Patient Education

2. Vital Investment Program (VIP)
Education Goals
Basic Disease Understanding
Disease Triggers & Smart Choices
Treatment & Technique
Warning Signs & Action Plans
Patient Responsibilities

3. Vital Investment Program (VIP)
VIP Education Goals
Basic Disease Understanding
Disease Triggers & Smart Choices
Treatment & Technique
Warning Signs & Action Plans
Patient Responsibilities

4. Asthma: Basic Disease Understanding
is a chronic (long-term) lung disease that inflames and narrows the airways.

5. is a sudden worsening of asthma symptoms
An asthma attack
is a sudden worsening of asthma symptoms
due to an abrupt, more extreme narrowing of the airways.

7. Airways are tubes that carry air into and out of the lungs. Trachea ←
Right & Left Main Stem Bronchi ←
Secondary & Tertiary Bronchi ← ←
Bronchioles
Alveoli (air sacs) ←

8. In healthy lungs,
the airway tubes and alveoli (air sacs) are
elastic / stretchy.
When we breathe in, air travels effortlessly through
the airway tubes to the air sacs, which fill up
with air, like small balloons.
When we breathe out, the air sacs easily deflate,
and the air goes back out of the body through
the airway tubes.

9. In healthy lungs, the airway tubes are wide open
for good air movement. ↓

10. ↓ ↓ However, during an asthma attack,
the muscles tighten around the tubes, narrowing the airways.
This is called bronchospasm. ↓ ↓

11. ↓ The inner walls of the tubes become inflamed
(swollen, thickened), further narrowing the airways. ↓

12. ↓ A thick, sticky liquid called mucus
is produced in larger quantities, further clogging up the airway. ↓

13. ↓ alveoli, Bronchospasm, inflammation, and mucus all contribute
to air getting trapped in tiny air sacks called
alveoli,
greatly hindering air exchange. ↓

14. Good air exchange is vital to moving oxygen into the blood
and on to the cells, tissues, and organs…
and to moving waste products like carbon dioxide out of the body.

15. This is called cyanosis.
Without good air exchange, parts of the body (like the lips and nail beds) start to turn blue or gray.
This is called cyanosis.

16. ← ← ← ← Eventually, cells, tissues, and organs start to suffer
and will ultimately die. ← ← ← ←

17. Asthma affects people of all ages,
but it most often starts during childhood.

18. Vital Investment Program (VIP)
VIP Education Goals
Basic Disease Understanding
Disease Triggers & Smart Choices
Treatment & Technique
Warning Signs & Action Plans
Patient Responsibilities

19. Asthma: Disease Triggers
Risk Factors
&
Triggers

20. Risk Factors Having a blood relative (such as
a parent or sibling) with asthma.
Having another allergic condition
(such as atopic dermatitis or hay
fever).

21. Risk Factors Having frequent respiratory infections as a child.
Being overweight

22. Risk Factors Being a smoker
Environmental Exposures (to second-hand smoke, third-hand smoke, air pollution, dust, smells, occupational chemicals/fumes, pets, pollens, bugs, etc.)

23. Triggers

24. Triggers – cont.
Stuffed toys
Down / feathers

25. Triggers – cont. Infections (flu, common cold) Hard laughing or crying
May be worse at night or early morning.

26. Avoid Triggers & Follow Your Treatment Plan
Asthma: Smart Choices
Avoid Triggers & Follow Your Treatment Plan

27. Vital Investment Program (VIP)
VIP Education Goals
Basic Disease Understanding
Disease Triggers & Smart Choices
Treatment & Technique
Warning Signs & Action Plans
Patient Responsibilities

28. Asthma: Treatment & Technique
Medications
may be prescribed to prevent asthma attacks or to treat worsening symptoms.
**Proper treatment makes a big difference in preventing
both short-term and long-term complications caused by asthma.

29. Always take all medications exactly as prescribed.
Know exactly what you take - drug name, dosage, instructions, & what
it’s for; make sure ALL of your Providers know, too - all prescriptions,
OTCs, herbs, & supplements. Keep a list or snap pictures with your cell.
Do not use medications past the expiration date.
Immediately inform your Provider of any concerning signs or symptoms.

30. ↓ Bronchodilators – SABA, LABA, & Anticholinergics
are medicines that help relax the muscles around your airways to open them up. ↓

31. Bronchodilators - SABA
Rescue Inhalers
SABA (short-acting beta2-adrenergic
agonists) for quick relief of sudden
symptoms; these bronchodilators act quickly but
don’t last long. Take these as needed.
EXAMPLES:
Albuterol Sulfate (Proair HFA, Proair RespiClick, Proventil HFA, Ventolin HFA)
Metaproterenol (Alupent, Metaprel)
Levalbuterol (Xopenex HFA)
Pirbuterol (Maxair Autohaler)
**HFA stands for Hydrofluoroalkane, a propellant used for inhalation. These inhalers do not release CFFs (chlorofluorocarbons) that are dangerous for the ozone layers
Albuterol sulfate for nebulizer (AccuNeb)
Levalbuterol HCl for nebulizer (Xopenex)

32. Bronchodilators - LABA
Controller Inhalers
LABA (long-acting beta2-adrenergic
agonists) for longer control of symptoms;
these bronchodilators last a long time but
don’t act quickly. Take these regularly.
EXAMPLES:
Salmeterol (Serevent)
Formoterol (Foradil)
Formoterol for nebulizer (Perforomist)

33. Bronchodilators - Anticholinergics
are medicines that relax the airways and prevent them from getting narrower; they may protect the airways from bronchospasm and reduce the amount of mucus produced by the airways.
EXAMPLES:
Ipratropium Bromide HFA (Atrovent HFA)
Tiotropium Bromide Inhalation Powder (Spiriva HandiHaler)

34. ↓ Anti-inflammatories
are medicines that help reduce inflammation (swelling) in the airways, mucus production, and airway sensitivity to triggers. They largely include corticosteroids. ↓

35. Anti-inflammatories – Corticosteroids
Inhaled corticosteroids (ICS) are used to
reduce inflammation (swelling) in the airways.
EXAMPLES:
Beclomethasone (Qvar)
Budesonide (Pulmicort)
Ciclesonide (Alvesco)
Flunisolide (Aerospan HFA)
Mometasone (Asmanex Twisthaler)
Fluticasone (Flovent HFA)
Fluticasone propionate (Flonase)

36. Anti-inflammatories - Corticosteroids
Oral and injectable corticosteroids are
systemic, which means they are delivered
to your entire body, not just your lungs.
EXAMPLES:
Orapred
Prednisone
Prednisolone
Dexamethasone
Methylprednisone

37. Leukotriene Modifiers
are medicines that block the effects of leukotrienes, immune system chemicals that cause asthma symptoms; they can help prevent symptoms for up to 24 hours.
EXAMPLES:
Montelukast (Singulair)
Zafirlukast (Accolate)
Zileuton (Zyflo)
**In rare cases, montelukast is linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. See your doctor right away if you have any unusual reaction.

38. ⁺ Combinations: Bronchodilator LABA + corticosteroids EXAMPLES:
Advair Diskus (salmeterol + fluticasone)
Dulera (formoterol + mometasone)
Symbicort (formoterol + budesonide)
Breo (vilanterol + fluticasone) ⁺

39. ⁺ Combinations: Bronchodilators: SABA + Anticholinergic EXAMPLES:
Combivent Respimat soft mist inhaler (Albuterol + Ipratropium Bromide)
DuoNeb (Albuterol + Ipratropium Bromide) ⁺

40. Delivery Devices - Inhalers
are hand-held, portable devices that deliver medication to your airway. They consist of a pressurized canister containing medication that fits into a boot-shaped plastic mouthpiece.

41. Metered Dose Inhaler (MDI) –
Medication is usually released by pushing the canister into the boot; in some cases, medication automatically releases when you inhale. This device does not require a deep, fast, inhaled breath.
Many MDIs have counters so that you know how many doses remain; if there is no counter, you’ll need to track the number of doses you’ve used or purchase a separate electronic dose counter.

42. MDI with Spacer –
Children and older adults may need to add a spacer to make it easier to inhale the full dose. The spacer holds medication in a tube after it is released from the canister. This allows you to inhale more slowly, increasing the amount of medication that reaches the airway. Spacers require a prescription.

43. MDI with Spacer and Face Mask –
Infants, small children, and elderly who can’t use the typical mouthpiece may use a face mask to ensure the right dose of medication reaches the airway.

44. Dry Powder Inhaler –
This device requires a deep, fast, inhaled breath, with no accidental breathing out (which can blow away the medicine). High humidity can cause the medication to clump. Some devices require cocking. Some devices require loading capsules before each use.

45. Delivery Devices - Nebulizers
This device turns liquid medication into a fine
mist breathed in through a mouthpiece
or a mask worn over the nose and mouth.
It is used for those who can’t use an
inhaler and for people needing larger
doses of medication.

46. Delivery Devices - Nose/Nasal Sprays
Nasal sprays can be used in combination with other asthma medications to reduce inflammation in the lungs and help provide asthma relief. Although the delivery methods can vary, most nasal sprays work by instilling a fine mist into the nostril by way of a hand-operated pump mechanism.

47. Allergy Treatments
help reduce the body’s sensitivity to a particular allergy-causing substance / allergen; this can help reduce allergy-induced asthma attacks.
EXAMPLES:
Allergy shots (immunotherapy)
Omalizumab (Xolair)
Other allergy treatments help reduce the body’s response to allergens (Antihistamines)
Diphenhydramine (Benadryl)
Cetirizine (Zyrec)
Fexofenadine (Allegra)
Hydroxyzine (Atarax, Vistaril)
Azelastine (Astelin, Astepro)
Intranasal steroids
EXAMPLE:
Fluticasone propionate (Flonase)

48. Diagnosing
Physical Exam
Lab Work
Chest X-ray

49. Diagnosing Questionnaire – Asthma Control Test
Pulmonary Function Test (PFT)

50. Skin Allergy Testing
Skin prick, scratch, injection, or patch testing help determine allergies by the reaction of a person's skin to different substances

51. RadioAllergoSorbentTest (RAST) is a blood test used to determine the substances you are allergic to.

52. Monitoring
Peak Flow Meter
O2 Sat

53. Asthma / Allergy Specialist
If your symptoms are difficult to control, you may be referred to an
Asthma / Allergy Specialist

54. Vital Investment Program (VIP)
VIP Education Goals
Basic Disease Understanding
Disease Triggers & Smart Choices
Treatment & Technique
Warning Signs & Action Plans
Patient Responsibilities

55. Asthma: Warning Signs
Asthma Attacks
Worsening Asthma

56. Signs and Symptoms of an Asthma Attack
Coughing
Wheezing (a whistling type sound when breathing)
Shortness of Breath / Difficulty Breathing or Catching Your Breath
Chest Tightness

57. Signs and Symptoms of Worsening Asthma
Increase in number of times symptoms
awaken you at night
keep you from participating in school,
work, sports, or recreational activities

58. Worsening Asthma – cont.
Increased shortness of breath or difficulty
breathing or catching your breath, even
with minimal activity (may be evident on
Peak Flow Meter)
Increased use of rescue inhaler or
nebulizer medications; rescues may not
seem to work as well as they used to

59. Worsening Asthma – cont.
Emergency room visits or hospitalizations
for severe asthma attacks
Side effects from long-term use of some
medications used to stabilize severe asthma
(oral corticosteroids – cataracts, high blood
sugar, increased risk of infections,
osteoporosis, fractures, suppressed adrenal
gland hormone production, thin skin,
bruising and slower wound healing;
inhaled corticosteroids – oral thrush,
hoarseness)

60. Asthma: Action Plans Severe asthma attacks can be life-threatening.
Work with your doctor to determine
what to do when your signs and symptoms worsen
and when you need to seek emergency treatment.

61. Contact your doctor
If you think you have asthma. If you have frequent coughing or wheezing that lasts more than a few days, see your doctor. Treating asthma early may prevent long-term lung damage and help keep the condition from worsening over time.
To monitor your asthma after diagnosis. If you know you have asthma, work with your doctor to keep it under control. Good long-term control helps you feel better from day to day and can prevent a life-threatening asthma attack.
If your asthma symptoms get worse. Contact your doctor right away if your medication doesn't seem to ease your symptoms or if you need to use your quick-relief inhaler more often. Don't try to solve the problem by taking more medication without consulting your doctor. Overusing asthma medication can cause side effects and may make your asthma worse.
To review your treatment. Asthma often changes over time. Meet with your doctor regularly to discuss your symptoms and make any needed treatment adjustments.

62. Asthma Emergencies – Go to the ER Immediately if you experience:
Rapid worsening of wheezing or shortness of breath
Little or no improvement even after using a “rescue inhaler”
Shortness of breath when you are doing minimal or no physical activity

63. Vital Investment Program (VIP)
Education Goals
Basic Disease Understanding
Disease Triggers & Smart Choices
Treatment & Technique
Warning Signs & Action Plans
Patient Responsibilities

64. Asthma: Patient Responsibilities
You are the leader of your healthcare team.

65. Reduce Risk Factors – manage allergy symptoms and respiratory infections, maintain a healthy body weight, quit tobacco, avoid environmental exposures such as second-hand smoke, third-hand smoke, air pollution, occupational chemicals/fumes, pets, pollens, bugs, dust, strong odors, fungus/spores, stuffed toys, down/feathers, etc.
Be Aware of Other Triggers – cold air, anger, stress, exercise, hard laughing/crying, worsening at night or early morning

66. Follow All Treatment Protocols –
Take Controller Medications / LABAs/ Anticholinergics/Leukotriene Modifiers
regularly to help control symptoms and prevent asthma attacks
Take Rescue Medications /SABAs
only as needed, to treat exacerbations (quickly worsening symptoms / asthma attacks); do not delay taking a rescue inhaler when needed

67. Keep All Appointments with your Provider, lab or other test center, Nurse Educator, Asthma/Allergy Specialist; contact your Provider sooner if your symptoms are getting worse or you have any concerns
Seek Immediate Medical Attention for:
rapid worsening of wheezing or shortness of breath
little or no improvement even after using a “rescue inhaler”
shortness of breath when you are doing minimal or no physical activity

68. Asthma: Patient Responsibilities
Please reach out to us.
We are here for YOU.