1. Learning to Monitor and Control Asthma

2. Introduction
Hi! I’m Julie. I’m here to share with you some basic information about controlling asthma.
I was diagnosed with asthma when I was three years old. Throughout my life, I’ve learned how to control my asthma so that I do the things that I love, like running, without getting sick. I want you to have the same experience.
Today , you will review four things that you can do to control your asthma, including:
Identify triggers
Taking the right medication at the right time
Use medication delivery devices correctly
Track your asthma condition
Throughout this training, I’ll share with you how I control my asthma. You’ll also get to see how others control their asthma.
I hope you’re excited to learn how to control your asthma so you can live the life you want. Let’s get started.
Click next to continue.

3. Asthma Triggers
The cause of asthma is a trigger. When an asthma patient comes into contact with an asthma trigger, the airways become inflamed, narrowed, and filled with mucus. Avoiding triggers is the easiest prevention and care tool.
There are six types of triggers:
1. Allergens: Indoor
2. Allergens: Outdoor
3. Allergens: Ingested
4. Irritants
5. Infections
6. Physical Activity
As you move onto the next slide, you will learn more about each trigger.
Click next to continue.

4. Allergens found outdoors include pollen, mold and mildew.
Trigger Types
Click on each trigger type to learn more about it.
Allergens: Indoor
While physical activity can trigger an asthma attack it is important for asthma patients to remain active. Regular activity strengthens the heart and lungs, it is good for bone strength, and it helps the asthma patient maintain a healthy weight.
Eggs, milk, soy, fish, corn, and peanuts are common culprits. Foods or drinks processed with sulfites or that contain sulfites such as dried fruits, fruit juices, and shell-fish (shrimp) may also trigger asthma symptoms. Avoid foods containing these products by reading the labels. Consider seeing an allergist for allergy testing.
Allergens are substances that some immune systems recognize as foreign.
Allergens found in the house include dust mites, pets, cockroaches, and mold. Vacuuming carpets and upholstery can help. Use a vacuum with either a HEPA or allergen filter. If at all possible, replace the carpet with hard flooring.
Americans spend up to 90% of their time indoors. Fumes from common household products can irritate the airway. Irritants that might trigger asthma include: smoke, smog, fragrances, aerosol sprays, fumes from household products and stress of strong emotions (divorce, death).
Allergens found outdoors include pollen, mold and mildew.
Allergens: Outdoor
Infections in the lungs or breathing tubes can trigger an asthma attach. The majority of infections are viral, such as a cold and the flu. Additionally sinus infections, bronchitis, and pneumonia can trigger asthma attacks.
Allergens: Ingested
If exercise is a trigger, the asthma patient should use the quick relief medication before an activity. Swimming is an excellent activity. However, indoor pools have higher levels of chlorine than outdoor pools. Chlorine may trigger an asthma attack in some people.
Irritants
Infections
Physical Activity
Click next to continue.

5. Case Demonstration
The trigger that affects my asthma is physical activity. I know physical activity is important for our overall health and that as an asthma patient I need to stay active. Because I know what my asthma trigger is, I am able to control my asthma and be prepared for an oncoming attack.
Click the enter key to learn about my little friend Lauren.
This is Lauren. She is a three year-old active toddler.
A year ago Lauren’s parents learned that she has asthma. After going through some tests, it was determined that Lauren has a milk allergy and this is the cause of her asthma.
The trigger that causes Lauren’s asthma is considered an ingested allergen.
To prevent an asthma attack, Lauren needs to avoid milk and products with milk in them.
Click next to continue.

6. Let’s Look at Another Case Demonstration
Not everyone has the same triggers. Click the enter key to meet my neighbor Paul, who also has asthma. He has a different trigger than both Lauren and I.
Paul, 40-years old, works as a sales rep. for local TV advertisement. He was diagnosed with asthma during college. His asthma seemed to get worse during mid-terms and finals.
To stay on top of his asthma, Paul takes any opportunity to relax . This keeps is anxiety and stress in check. He also follows the medical directions his doctor has provided him. This has lessened his attacks over the years.
Two weeks ago, Paul’s manager left the company. Paul has been asked to work extra hours to help out. Paul has had more attacks recently.
Click on the next slide to answer a question about Paul’s asthma.
Click next to continue.

7. Check your understanding
Which trigger affects Paul’s asthma?
Click on the correct letter.
A. Ingested
No, that is not the correct trigger. Try Again.
B. Physical Activity
No, that is not the correct trigger. Try Again.
C. Outdoor Allergen
No, that is not the correct trigger. Try Again.
D. Irritants
Correct! The increased job stress and long workdays are an irritant to Paul and increases his asthma attacks.
Now let’s move on to learn about medications.
Click next to continue.

8. Asthma Medication: Controllers and Relievers
Asthma medications can be quite confusing. Pharmaceutical companies are always introducing new asthma drugs to the market. However, it’s a lot easier to keep track of the different kinds of medication if you remember that asthma medications fall into two categories of medications: controllers and relievers. Then within those two categories are several subcategories.
Controllers are used daily to help prevent asthma attacks. Relievers are used whenever your asthma symptoms are exacerbated. They provide immediate relief. Below is a list of the subcategories of medication for both relievers and controllers.
After you review this list, you will take a closer look at each medication category on the next page.
Relievers
Controllers
Short-acting B2 agonists
Inhaled corticosteroids
Anticholinergic agents
Leukotriene modifiers
Systemic corticosteroids
Long-acting B2 agonists
Methylxanthines
Omalizumab
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9. Asthma Medication: Controllers
Controllers control asthma symptoms and prevent exacerbations..
Click each arrow to learn more.
Controllers are also called “maintenance medications.”
Controllers can’t stop or treat sudden or severe flare-ups.
Once you start taking controllers, they should only be stopped as direct by your physician.
Click next to continue.

10. Asthma Medication: Controllers
There are five subcategories of controllers. While it may be easier to remember the brand names instead of the subcategory, you should remember that the different categories treat different asthma triggers.
Click each controller category to learn more.

11. Asthma Medication: Relievers
Relievers are used to treat symptoms when they appear
Click each arrow to learn more.
Relievers are also known as “quick relief medications” or “rescue medication” for stopping asthma symptoms.
Relievers should be used when you first notice symptoms or before exposure to a trigger, for example, before exercising.
You should keep your reliever with you in a bag, backpack, or some place that you can access quickly.
Click next to continue.

12. Asthma Medication: Relievers
There are three subcategories of relievers.
Click each reliever category to learn more.

13. Julie’s Medications
When I was a kid, I took more medications for my asthma than I do today. Some adults find that they are less sensitive to their asthma triggers than when they were kids. I’m one of the lucky ones. None the less, if I don’t keep on top of watching out for triggers and taking my medications, asthma make me sick.
Controller – Daily Medication
For a controller, I use Flovent®, an inhaled corticosteroids, with a spacer. I’ll talk about spacers later in this module.
Reliever – As-Needed Medication
For a reliever, I use an albuterol inhaler. Generally, I use a generic prescription.
Click next to continue.

14. Consequences for Non-Compliance
What happens if I stop taking my medications? Well if I stop taking my controller, I’ll probably feel OK for a few days. Then I’ll start to feel sluggish and short of breath. At the gym, I run the risk of having an asthma attack. It can really be tempting to not take my controller medication, because I’m feeling so well. I have to remember that the reason I feel so well is due to the controller.

15. Paul’s Medications X X X Which medication is a controller?
Earlier we talked about how stress is a trigger for Paul. He needs to take a controller every day to help manage his symptoms.
Which medication is a controller?
Qvart®
Prednisone
Albuterol X X X
Not quite. Qvar® is the only controller in this list.
Good job! Qvar® is the only controller in this list.

16. Paul’s Consequence X X X
With the extra stress, Paul hasn’t been very diligent at taking his controller medication every day and his prescription for his rescue medication needs to refilled.
What could happen if Paul doesn’t take his medication?
He’ll be extra sleepy over the weekend.
He’ll be OK since he has built up a tolerance to his triggers.
He’ll have an asthma attack. X X X
Not quite. Not only is Paul setting himself up for an asthma attack, without his reliever he may need emergency medical attention to treat the attack.
Good job! Not only is Paul setting himself up for an asthma attack, without his reliever he may need emergency medical attention to treat the attack.

17. What Would You Do?
This is Shelby, age 15. Shelby was diagnosed with exercise-induced asthma. She has been directed by her doctor to take two puffs of her reliever before exercise or other exerting activities.
Which medication is a reliever?
Foradil®
Singulair®
Proventil® X X X
Not quite. Proventil® is the only drug in this list that is a reliever. It’s a brand-name drug of albuterol.
Good job! Proventil® is the only drug in this list that is a reliever. It’s a brand-name drug of albuterol.

18. Shelby’s Consequence X X X
Despite her doctor’s direction, Shelby has not followed instructions to take her rescue medication on her runs in case of emergency. Last week Shelby ran in very cold weather at night without her rescue inhaler.
What could happen if Shelby doesn’t take her medication?
She’ll be fine. The cold weather will make it easier to rrun
She could have an asthma attack.
She could catch a cold from the cold air. X X X
Good job! Shelby could have an asthma attack. The safest thing Shelby could do for herself is to take her rescue inhaler with her. While she could call for help, there’s no guarantee that help would arrive in time.
Shelby was lucky on this day. She called her parents when the attack started. They were able to get to her in time.
Not quite. Shelby could have an asthma attack. Shelby needs to take her rescue inhaler with her. While she could call for help, there’s no guarantee that help would arrive in time.
Shelby was lucky on this day. She called her parents when the attack started. They were able to get to her in time.

19. Hi there, remember me. I’m Julie, your asthma trainer
Hi there, remember me? I’m Julie, your asthma trainer. Do you remember earlier in our conversation I mentioned I use a couple of devices to deliver my medications? I told you I’d talk about these later in this training, and here we are!
My asthma medications need to have the best chance of getting into my lungs. For a controller medication, I inhale corticosteroids with a spacer. For a reliever during an attack, I use an albuterol inhaler.
Unless you’re an asthmatic, these probably mean nothing to you, so let me introduce you to these devices and a couple of other common ones. Then you’ll get to see how different people use different devices for their asthma. Click on the arrow to your right and here we go!

20. Click on each picture below to learn more about each device
This device is called a Meter Dose Inhaler (MDI). They deliver medications as sprays, and are sometimes called “puffers”.
This device is called a Dry Powder Inhaler (DPI) and delivers a powered medication. The powder must be inhaled quickly and deeply, something a child over the age of 7 usually should be able to do correctly.
This is called a spacer and it attaches to an MDI to maximize medication to the lungs. It also helps reduce side effects.
A nebulizer, depicted here, delivers rescue medications in a fine mist. It is usually only used in acute situations or urgent care facilities.
This spacer with a mask is best for small children or people who can’t use the regular spacer with mouthpiece.

21. This is a picture of the medical device that I use to inhale my controller medications. I put the spacer mouthpiece in my mouth, pump the MDI which releases a meter-dose amount into the chamber. I then breath in and hold it for 10+ seconds. The chamber helps me maximize the amount of medication I get into my lungs.
Meter Dose Inhaler (MDI) with medication canister inside
Spacer mouthpiece
Chamber

22. Now remember that I said I use something different for my reliever meds when I have an attack? What I use to relieve an asthma attack is just an inhaler (MDI) without the spacer. It looks like this picture below. It’s more convenient to carry in a purse or pocket than the an MDI with the spacer. This feature makes it great for active young people, like my friend Shelby, pictured below.

23. Meter-Dose Inhaler (MDI)
Hi, I’m Shelby and I’m 15 years old. I was diagnosed with exercise-induced asthma two years ago. I was directed by my doctor to take 2 puffs of my controller medication through an inhaler (MDI) with a spacer before exercise or other exerting activities. I also am supposed to carry my reliever medication with me on my runs. Based on what you’ve learned about each of the medical devices for delivery of asthma medications so far, click on which two do you think I use?
Correct!
She uses the MDI w/ spacer for controller meds and the MDI alone to take on runs for rescue meds.
Meter-Dose Inhaler (MDI)
Correct!
She uses the MDI w/ spacer for controller meds and the MDI alone to take on runs for rescue meds.
MDI with spacer
Incorrect.
MDI w/ mask is for small children.
Incorrect.
DPI’s are powders usually used for children.
MDI with mask
Incorrect.
Nebulizers are used in urgent care facilities.
Dry-Powder Inhaler (DPI)
Nebulizer

24. I’m an avid runner and follow doctor's instructions about 2 puffs before running. However, last week I chose to carry my phone instead of my rescue inhaler medications with me on my run. I ran in very cold weather that night and had a severe attack two miles from home. I couldn’t breath. I was able to text my parents to come get me. They took me to an Emergency Room and I was given a breathing treatment there.
Choose which device below Shelby would use in the specific circumstance listed. C. A. B.
Correct.
This inhaler with spacer is what I’m directed to use before runs.
No. This doesn’t have a spacer.
No. This is a nebulizer
1. Before a run A B C.
Correct.
This inhaler is small and convenient to carry on runs in case of attack..
No. This is a nebulizer
No. This MDI with spacer is too big to pack on a run.
2. During attack A B C.
No. This is an MDI (meter-dose inhaler). It doesn’t deliver as much medicine as a nebulizer.
Correct.
A nebulizer is used in E.R.’s for acute attack treatment
3. At Emergency Room A B C.
No. This is an MDI with spacer and can’t deliver as much medicine as a nebulizer

25. So now that you’ve seen a few of the medical devices and which circumstances they are used, I’d like you to meet Brandon. You’ll learn more about Brandon in later segments—mostly about his triggers and how to figure his Asthma Tracker and Asthma Control Plan. For right now, just click next to learn more about the specific medical device he uses and why.

26. No, this is a mask for babies and kids 7 and under .
Hi there, I’m Brandon! I’m 8 years old and love soccer. I’m super active and don’t like to be bogged down with a bunch of stuff in my pockets that gets in the way of my play time. I’m going to let you practice what you know about medical devices here. You’ve already learned about 3 devices and 2 spacers. If you’re feeling a little fuzzy on those, you can refer to the previous slides for a refresher. But, back to me. You already know enough about me and asthma devices by now to have a pretty good idea of which of the following devices I carry with me. Go ahead, give it a try and click on one, I’ll be sure to let you know if you’re right or not!
No, this is a mask for babies and kids 7 and under .
Try again.
No, this is a nebulizer and used in urgent care facilities. Not for little boy’s’ pockets. Try again.
No, this is a spacer with mouthpiece and inhaler. It’s too big to carry this device around. Try again.
Correct! great job! This Dry-Powder Inhaler (DPI) is perfect in size I’m old enough to use correctly

27. Controlling Your Asthma
We’ve covered a lot of information, including triggers, medication, and medication devices. Now it’s time to pull all that information together and talk about how you can monitor your own asthma symptoms and identify when you need to step up your care.
Let’s start by looking at an asthma control test.

28. Controlling and Monitoring Asthma Symptoms
I’d like to introduce you to Brandon. Brandon is eight years old. Let me tell you a few things about Brandon. His favorite sport is soccer, his best friend is Joshua, he loves pizza, and he has asthma. His main triggers are seasonal allergies. Brandon tries not to let asthma get in the way of playing soccer. Instead he has learned how to control his symptoms.
Let’s explore the steps that you and Brandon need to take to monitor your asthma symptoms.
Click next to continue.

29. Step 1: Asthma Control Test
Each week you need to evaluate your asthma status. This is the first step in deciding if you need to change anything in your asthma protocol to keep asthma symptoms under control. Click each number to learn more. 1 1 3 2 2 4 3 3 3 4 4 3 5 5 3
Did you use your quick-relief medication this week? How often? If you are using your quick-relief medication too much, this may be a sign that your symptoms aren’t under control.  
Brandon used his quick-relief medication a couple times after trying to play soccer. His score is three.
Now that you have scored each question, you need to total your score.
Brandon’s total score is 16. With a final score you are ready to track your progress.
How often did asthma symptoms wake you up in the middle of the night or a bit earlier than normal? Sometime, it is hard to remember what happens in the middle of the night. You might want to ask someone that lives with to help keep track. 
Brandon woke up in the middle of the night twice. His score is three.
Over the past week, do you remember being short of breath? Did you ever stop what you were doing to catch your breath?
Brandon was short of breath at least twice. This is what stopped him from playing soccer with his friends. His score is four.
In the final rating, you need to rate your overall asthma control. Reflect on the week and how you felt. Be as objective as you can. Your score will help you take the appropriate action to control your symptoms.
Think back over you week. Were you able to do everything that you wanted to do? Write the corresponding number in the score box. 
In our example, Brandon gives himself a score of three. There were a couple of times during the week that he didn’t feel up to playing soccer with his friends. 6 6 16

30. X Step 2: Brandon’s Score on the Asthma Tracker
Brandon’s score from his Asthma Control Test was 16 (slide 2). See below how that has been marked with an “X”. Click on the X below to see what Brandon should do next. X
Note how the “X” is in the yellow range of this graph. Yellow means that Brandon is in the CAUTION stage of the Asthma Action Plan. The next slide will show you what actions Brandon must take to control his asthma when in the CAUTION stage.

31. Step 3: Asthma Action Plan
Brandon’s ACT score of 16 puts him in the CAUTION stage of the Asthma Action Plan. Click on the Caution icon to learn more about what it means to be in this stage.
If asthma symptoms are starting to appear, asthma patients modify their care to the Step Up Therapy zone.
Patients continue to take their controller medicine. Quick relief medicine is either additional dosages or a stronger medicine.

32. Controlling and Monitoring Asthma Symptoms
Now let’s see how much you know. You will evaluate my symptoms and help monitor my condition.
Here’s some additional information about me. I’m 25 years old and work as a human resource specialist. Over the past week, I haven’t been feeling well. For the past five nights, I’ve come home and sat on the couch, skipping my trip to the gym. When I pick up lunch, I feel short of breath. I’ve used my quick-relief inhaler everyday to help recover from shortness of breath. I’ve woken up in the middle of the night. I feel like my asthma is poorly controlled.
Click next to continue.

33. i i X Check Your Knowledge: Asthma Control Test
Julie is 25 years old and works as a human resource specialist. Over the past week, Julie hasn’t been feeling well. For the past five nights, she has come home and sat on the couch, skipping her trip to the gym. When she picks up her lunch, she feels short of breath. She has used her quick-relief inhaler everyday to help recover from shortness of breath. On three separate nights, Julie has woken up in the middle of the night. She feels like her asthma is poorly controlled.
Using your best judgment, enter a score for each question and total her score. Click each the info button to review Julie’s condition. X

34. Step 2: Julie’s Score on the Asthma Tracker
My score from the Asthma Control Test was 10. Click the circle correlates with my score.
Incorrect. The green range is for scores My score is 10. Try again.
Incorrect. The orange range is for scores My score is 10. Try again.
Correct! Good job! The red range is for scores Click the next button to see what I should do to control my asthma at this stage.
Allyson and Rachel,

35. Select which stage of the Asthma Action plan
Click the icon you believe is the correct action plan for my situation.
That is correct. My score is a 10 which puts me in the STOP stage. I should follow the steps below to manage my asthma.
If medicine is not working, breathing is very difficult, and the patient cannot walk, play or talk easily.
Then it is time to increase quick relief medicine and seek medical care.

36. Summary You did a great job at evaluating my condition.
Now that you’ve completed this training, I hope you were able to learn the four things that you can do to control your asthma:
Identify triggers
What is the cause
Taking the right medication at the right time
What your doctor has prescribed
Use medication delivery devices correctly
Using equipment correctly
Track your asthma condition
Monitoring your symptoms
I know from personal experience as an asthma patient, that you can live the life that you want. I promise that if you follow the steps outlined in this training, you will feel better. Asthma does not have to hold you back!
Good luck!