Presentation on theme: "Asthma Basics For Para Professionals"— Presentation transcript:
1 Asthma Basics For Para Professionals Minnesota Department of HealthAsthma Program
2 MDH Asthma Program Staff PresenterSusan Ross RN, AE-CMDH Asthma Program Staff
3 Minnesota Department Of Health Asthma Website: www. health. state. mn Minnesota Department Of Health Asthma Website:The Minnesota Department of Health has a website containing information for school personnel as well as for the general public. The site contains links to a variety of informational websites and has a special section just for kids.
4 As You View This Program.. Consider how many people you know who have asthma?How will you use the information you receive here today?How can you help students prevent their asthma symptoms from appearing?How can you help improve asthma management at your school?While in school, caring for children who have asthma is not just he school health offices/ Nurses responsibility- it’s everyone's job to assure the safety and welfare of each child and that includes children who suffer from asthma.Do you know anyone who has asthma?What do you think you will learn from this program today?How can you help your school health office/ Nurse keep kids with asthma in school and able to participate in all aspects of school activity?
5 Asthma: Accounts for 14 million lost school days annually3 Is the most common chronic disease causing absence from school2Is the leading cause of hospitalizations among children under 1521 in 13 school children have asthma16.3 million children under 18 have asthma11 Asthma Prevalence, Health Care Use, and Mortality, , National Center for Health Statistics, CDC2 Morbidity and Mortality Report, National Center for Health Statistics (NCHS), U.S. CDC, 20033 Surveillance for Asthma - United States, , MMWR Surveillance Summaries, CDC, March 29, 2002
6 Minnesota ChildrenIn a 2003 MDH survey of more than 5,0007th & 8th graders at 15 junior highs outside the metro area-1 in 12 reported they currently have asthmaIn a 2001 MDH survey of 13,000, 9th - 11th graders in rural MN-1 in 11 reported they currently have asthmaInformation provided due to surveys with information evaluated and compiled by MDH Epidemiologists Wendy Brunner and Marian Marbury (consultant to MDH)Questions were answered by students only. Survey results available on MDH asthma website: Data & Research section.
7 This Means.. In a class of 30 children, you can expect 2 to 3 students WILL have asthma!Information per the CDC
8 The Goal Of Asthma Management “Children should live happy, healthy, physically active lives, without asthma symptoms slowing them down “The General goals of proper asthma therapy/management according to NAEPP 1. Prevent Chronic asthma symptoms and asthma episodes during the day and night2. No sleep disruption by asthma,3. No missed school or work due asthma4.No or minimal need for ER (or UC) visits or hospitalizations5.Maintain normal activity levels- including exercise and other physical activities6.Have normal or near-normal lung function7. Be satisfied with the asthma care received.8. Have no or minimal side effects while receiving optimal medications(taken from p. 7 NAEPP/ NHLBI/NIH “Practical Guide for the Diagnosis and Management of Asthma- 10/97”
9 Impact Of Asthma On Students School Performance:Poorly controlled asthma has a negative impact on school performance in both academic achievement and physical education
10 Impact Of Asthma On Students cont... Psychosocial:Poor self-esteemAnxiety about asthmaFear of becoming ill at schoolAnxiety about exercise at schoolFear of being different
11 What Is Asthma? Asthma is a chronic disease that causes: Tightening of the muscles surrounding the airways (Bronchoconstriction/spasm)Swelling of the small airways (bronchioles)Over production of sticky mucus in the airwaysAsthma is a chronic disease that causes broncho-constriction and spasm (tightening of the muscles around the airways)Inflammation of the bronchioles/airways.Excessive mucus production in the bronchiolesThere may be periods when there are no symptoms but the airways are swollen and sensitive to some degree all of the time.For children with persistent asthma, Long-term anti-inflammatory medications are the proven treatment to control airway inflammation and eliminate or reduce symptoms.
12 Normal Bronchiole Inflamed Bronchiole with Mucus During an “asthma episode,” muscles around the airways tighten, linings of the airways (bronchioles) become inflamed, and mucus clogs the tiny airways, making breathing difficult.The airways become overly responsive (twitchy) to environmental changes, sometimes resulting in wheezing, coughing, breathlessness, or tightness in the chest.During an asthma episode a child may feel he/she can't inhale enough air, but actually, the child’s lungs are having trouble exhaling. Continued exposure and/or lack of treating the inflammation results in preventing O2/CO2 exchange.Untreated, the inflammation can cause recurrent episodes of wheezing, coughing, breathlessness, and chest tightness, especially at night / early morningPotentially, airway remodeling (a type of lung scarring which is permanent) can occur when asthma goes untreated.Asthma is a multi component chronic disease. It is not curable but is very treatable.Components are: Bronchial spasm (bronchoconstriction) or narrowing of the airways due to the muscles surrounding the bronchioles (small airways) tightening and closing the lumen off.Inflammation of bronchial tissue: Allergen exposure causes irritation w/redness' and swelling which in turn causes the mucus production. Continued exposure and/or lack of treating the inflammation can (and has) resulted in the child/asthma sufferer from being able to push out used oxygen (Co2). Inhaled corticosteroids is the gold standard for treating (on a daily basis) persistent severity levels of asthma (levels 2-4) per NHI/NHLBI guidelines. See web page for more info
13 Common Symptoms Of Asthma Frequent cough, especially at nightShortness of breath or rapid breathingChest TightnessChest painWheezingFatigueBehavior changesThese symptoms vary greatly in severity and not ALL children have the same symptomsSymptoms are often worse at night and in the early morning hours.The severity of asthma varies from child to child and the severity may worsen or improve depending on the child’s symptom control and amount of exposure to triggers or allergens.
14 What Causes Asthma?Asthma may be caused by genetic, immune and/or environmental factors, and is often associated with eczema (scaly skin patches) and allergiesResearchers do not understand all of the causes of asthma or its increasing prevalenceIt boils down to “We just don’t really know for sure”
15 What Causes Asthma cont.. Of the 17 million asthma sufferers in the US, 10 Million (approx. 60%) have allergic asthma. 3 million of those are children1Exposure to certain allergens trigger asthma symptoms to beginExposure to certain irritants can also set an asthma episode in motion1National Institute of Environmental Health Sciences
16 Triggers And Irritants Copyright 2004, 3M Pharmaceuticals
17 Common Allergens (Triggers) Seasonal pollensAnimal dander /saliva/urineDust mitesCockroaches/mice/rat droppings and urineMoldSome medicationsSome foodsStrong emotional feelingsSeasonal pollens can mean some children suffer from asthma only during their “allergy” season. Ie tree pollen in the spring, grass in the summer etc.Aspirin is an example of a medication that some asthmatics can react to as a trigger.Only 6-8% of asthmatics have food as their asthma trigger, even though they may also have allergies that don’t cause an asthma reaction.
18 Common Irritants (Triggers) ExerciseCold airChalk dustViral/upper respiratory infectionsAir pollutionTobacco smoke or secondhand smokeChemical irritants and strong smellsStrong emotional feelingsDiesel fumesCleaning suppliesStrong emotional feelings such as crying, laughing, or even fear and agitation can set off an asthma episode in some children. One thing to keep in mind is just because the trigger is a psychological factor does NOT mean the asthma episode is not a physical reaction. These children need the same treatment and care any other child who has asthma receives.
19 Every Child Is Unique!Wheezing and coughing are the most common symptoms -but-No two children will have the exact same symptoms or the same triggerEvery child who has a diagnosis of asthma should have access to a rescue inhaler!Every child who has asthma should have an asthma action plan at school (AAP)
21 What’s An “Episode”?An asthma episode occurs when a child is exposed to a trigger or irritant and their asthma symptoms start to appearThis can occur suddenly without a lot of warning, or brew for days before the symptoms emergeEpisodes are preventable by avoiding exposure to triggers and taking daily controller medications (if prescribed)
22 How Do I Handle An Asthma Episode At School? Remain calm and reassure the childIf you know what triggered their episode, move the child away from itHave the child sit up and breathe slowly- in through the nose, out through pursed lipsContact the school nurse for assistance or whomever is responsible for providing medications in the nurses absence
23 Handling An Episode cont.. If you are responsible for medications, check the child's asthma action plan, emergency care plan or medication card for actionsGive “rescue or reliever” medications if ordered and available (some students carry their own asthma inhalers with them)Have the child sip room temperature water/ fluidsContact the parent or guardian as necessary AND-
24 Do NOT Leave The Child Alone! Every asthmatic reacts differently to their asthma- what you perceive as “okay” may in fact be a child is severe distress. Do NOT send a child to the health office by his/herself, either accompany the child, call the school nurse to come to him/her or find another adult (immediately) to assist the child.
25 Call 911 if.. Lips or nail beds are bluish Child has difficulty talking, walking or drinkingQuick relief or “rescue” meds (albuterol) is ineffective or not availableNeck, throat, or chest muscles are pulling in (retracting)Nasal flaring occurs when inhalingObvious distressAltered level of consciousness/confusionRapidly deteriorating conditionANY of these symptoms require a call to 911 after you have given the child their rescue inhaler (if available and ordered or the child is carrying their inhaler). Do not hesitate to call 911- it’s better to be safe.
27 What Is Exercise Induced Asthma (EIA)? Tightening of the muscles around the airways (bronchospasm)Distinct from “chronic” asthma in that it does NOT cause swelling and mucus production in the airwaysCan be avoided by taking pre-exercise medications and by warming up/cooling downExercise Induced AsthmaExercise-induced asthma is distinct from allergic asthma in that it does not produce long-term increase in airway activity. I.e.- bronchial inflammation w/mucus and these children wouldn’t necessarily require ICS’s (Inhaled Corticosteroids).Exercise induced SYMPTOMS are different because those children most likely either already have asthma and their asthma is triggered by exercise- yet they always have some inflammation going on in the lungs. These children should most likely be on ICS’s in addition to using reliever/rescue inhalers such as albuteral.Information from NHI/NHLBI guidelines: see webpage for more info.
28 EIA - What Happens?Symptoms include coughing, wheezing, chest tightness and shortness of breathSymptoms may begin during exercise and can be worse 5 to 10 minutes after exerciseEIA can spontaneously resolve 20 to 30 minutes after startingCan be avoided by doing the following:The symptoms of EIA may begin during exercise and be worse 5 to 10 minutes after stopping exercise or during the normal cool down periodSymptoms range from mild to severe and often resolve in min. Occasionally, some children will experience “late phase” symptoms four to 12 hours after stopping exercise. These late phase symptoms are frequently less severe and can take up to 24 hours to go away.
29 Preventing Exercise Induced Asthma (EIA) Become familiar with Asthma Action Plans, pre-exercise medication orders and or health care planStudent should use reliever (Albuterol) minutes before activityDo warm-up/ cool-down exercises before and after activitiesCheck outdoor ozone/air quality levelsNever encourage a child to “tough it out” when having asthma symptomsChildren who only experience asthma when they exercise may be able to control their symptoms with preventive measures such as warm-up and cool-down exercises.To prevent EIA:become familiar w/the child’s AAP- school personnel who are w/children who’s asthma occurs w/exercise should also be familiar w/that child’s aap and what actions to take. This is outlined in each section of our manual.Check ozone/air quality levels for outdoor activity prior to exercise.In addition to warm ups. Most children who have EIA can prevent symptoms by using their inhaler minutes before they begin strenuous exercise.It’s important for school nurses to assess each child’s need for their inhaler because each child has a different exercise tolerance level before their asthma kicks in.One child may need their inhaler at lower levels of physical activity- another may need it only when they are running or participating in very aggressive physical activityWorking collaboratively with the PE teacher or coach can help reduce unneeded treatment with albuteral.
31 Medication: Determined By Severity Level Classification Mild IntermittentReliever only prnMild PersistentController and relieverModerate PersistentController plus long-acting bronchodilator and relieverSevere PersistentLevel 1:Mild IntermittentNeeds only a reliever only prn (e.g. albuterol or pirbuterol)Level 2:Mild PersistentRequires both a Controller and reliever (low dose inhaled cortico-steroid, sometimes other medicaitons)Level 3:Moderate PersistentNeeds controllers (usuallly a medium dose inhaled cortico-steroid and a long-acting bronchodilator, sometimes other medications) and a reliever.Level 4Severe PersistentNeeds controllers (usually high dose inhaled corticosteriods and long-acting bronchodilator, other medications) and a reliever.
32 Two Categories Of Medications Controller MedicationsTaken every day to prevent swelling in the lungsReliever or Rescue MedicationsTaken only when needed to relieve symptomsOr to prevent exercise induced asthma from developing (taken before strenuous exercise)
33 Controller Medications Keep swelling and mucus from developing in the lungsMust be taken EVERY day even when the child is not having symptomsInhaled corticosteroids (ICS’s) are the most common and effective way to control asthmaHelp prevent asthma exacerbations from developing!An example of typical “controller” medications may be Inhaled Corticosteroids such as Azmacort, Pulmicort, Flovent, AdvairThese medications must be taken every day, regardless if there are symptoms or not. Typically, it can take up to 3 weeks before the inflammation in the lungs is reduced- a asthmatic may or maynot even notice in the short term but long term- the frequency of their episodes is reduced greatly.
34 Rescue Or Reliever Medications Are taken when asthma symptoms are appearing (asthma episode)Are taken minutes before strenuous exercise/activity by children with EIADo NOT reduce or prevent swelling from developing in the lungsMay be carried in school by a student only IF approved by the doctor, school nurse and parent!Rescue medications- which school personnel most likely have already come in contact with are Albuterol, Proventil, Ventolin, Maxair. These medications should always be used WITH a spacer and used to prevent exercise induced asthma or to treat an emerging asthma episode (attack).A child may carry their own inhaler ONLY with the signed permission of their doctor or medical care provider, their parent or guardian and in most districts (depending on school board policy) with the evaluation and approval of the school nurse.Check your school board policy for specifics but Minnesota does have an inhaler law.
35 Yep, this horse needed an inhaler treatment after a race-! Picture courtesy of American Lung Association of the Inland Counties CA 2004
37 Spacers Or Holding Chambers Most MDI’s (metered dose inhalers) must be used with a spacer or holding chamberThis device attaches to the MDI and allows the user to breathe in more medication effectivelyThe physician must write an order for it when prescribing your reliever medicationDry powder inhalers do NOT require spacers
40 How To Use: Metered Dose Inhalers w/Spacers 1. Stand up (or sit up straight)2. Shake the inhaler well to mix up the medicine3. Remove the cap and check the spacer/inhaler for foreign objects4. Insert the inhaler into the spacer5. Exhale all your air out fully6. Before inhaling, put the mouthpiece of the spacer into your mouth, over your tongue and between your teeth Close your lips around it while tilting your head and the inhaler back slightly
41 Using An MDI Cont..Press down on the inhaler canister and breathe in slowly and deeply through your mouthHold your breath for 10 seconds, exhale normallyIf using a “reliever”, wait 1-2 minutes between puffsRepeat starting with #5 if a 2nd puff is orderedRinse your mouth and spit after using a “controller” inhaler
43 MN Asthma Inhaler Law Summary (2001) Allows MN students to self-carry and administer inhalersIn order for a child to carry his/her inhaler at school, authorization and signatures from the following individuals are required:Child’s health care providerParent/guardianAssessment and approval of the school nurse (if present in district)Be sure to check and follow policies and procedures in local school districtR8 MN Medication Administration statutesR9 MN Inhaler use Statute
44 Para Professionals Role Identify students with asthmaDistribute & collect communication formsIn the health office the RN may delegate specific tasks such as:Documenting asthma visits by completing or initiating student asthma recordsAsking about symptoms & check PFM levelsProviding episodic care to students with asthma symptoms including medication administrationCommunicating with parents regarding asthma care/episodes
45 Communicate With The NURSE You are the eyes and ears for the nurseBe aware of students with asthma and their typical symptomsHelp remind students to pre-medicate before exerciseAlways document clearly and neatly what you see, hear and what the student tells youCall the nurse with questions or urgent situationsIf you don’t know- ask!Don’t be afraid to call 911 in emergencies
47 Peak Flow Meters (PFM)Peak flow rates can be evaluated by anyone - as long as you receive training and are confident you can do it properly..
48 Peak Flow MetersMeasures how well the student’s lungs are doing at that momentAssociated with the Green-Yellow-Red system of managing asthma symptomsCongruent with asthma action plansHelps students and families self-manage asthmaUse of a PFM (Peak Flow Meter) in conjunction with an AAP (Asthma Action Plan) can many times track the downward spiral of an individuals peak flow rate. For asthmatics who have persistent asthma (those on daily medications), taking a peak flow rate every morning when you wake up BEFORE you take medications- this should be a daily routine.Write down the peak flow rate in your ASTHMA DIARY.Take your PFR (Peak Flow rate) when you are having asthma symptoms or an episode and after taking medicine for the episode. This can tell you hw bad your asthma episdoe is and whether your medicine is working or not.Your PFR corresponds to the green/yellow/red zones on an asthma action plan.
49 How to use a Peak Flow Meter Review the stepsStand upPlace indicator at the base of the numbered scaleTake a deep breathPlace the meter in the mouth and close lips around the mouthpieceBlow out into the meter as hard and fast as possibleWrite down the achieved numberRepeat the process twice moreRecord the highest of the three numbers achievedRead slide- Exercise--PFM results can then be compared to the AAP for determination of whatZONE the child is in and guide you toward what action to take based on that information.*See MDH asthma website or CD Rom for “Peak Flow Instructions” step by step document
51 Asthma Action Plan Zones Green Zone: All Clear/Breathing Good/GoNo asthma symptoms and/orPeak flow % Predicted or Personal bestYellow Zone: Caution/Slow DownSome asthma symptoms and/orPeak flow 50-80% Predicted or Personal bestRed Zone: Medical Alert/StopSevere asthma symptoms and/orPeak flow < 50% Predicted or Personal best
52 Successful Asthma Management Requires Everyone's Cooperation TeachersParentsStudentsMedical ProvidersCoachesAll School PersonnelTalk with your school Nurse to find out what YOU can do to help manage asthma in your school