Asthma Basics ForAsthma Basics For Para Professionals Para Professionals

Minnesota Department of Health Minnesota Department of Health

Asthma ProgramAsthma Program

PresenterPresenter

Susan Ross RN, AE-CSusan Ross RN, AE-C

MDH Asthma Program StaffMDH Asthma Program Staff

612-676-5629 612-676-5629

Susan.Ross@health.state.mn.usSusan.Ross@health.state.mn.us

Minnesota Department Of HealthMinnesota Department Of HealthAsthma Website:Asthma Website:

www.health.state.mn.us/divs/hpcd/cdee/asthmawww.health.state.mn.us/divs/hpcd/cdee/asthma

As You View This Program..As You View This Program..

Consider how many people you know who Consider how many people you know who have asthma?have asthma?

How will you use the information you How will you use the information you receive here today?receive here today?

How can you help students prevent their How can you help students prevent their asthma symptoms from appearing?asthma symptoms from appearing?

How can you help improve asthma How can you help improve asthma management at your school?management at your school?

Asthma:Asthma:Accounts for 14 million lost school days Accounts for 14 million lost school days

annuallyannually33

Is the most common chronic disease Is the most common chronic disease causing absence from schoolcausing absence from school22

Is the leading cause of hospitalizations Is the leading cause of hospitalizations among children under 15among children under 1522

1 in 13 school children have asthma1 in 13 school children have asthma11

6.3 million children under 18 have asthma6.3 million children under 18 have asthma11

1 Asthma Prevalence, Health Care Use, and Mortality, 2000-01, National Center for Health Statistics, CDC1 Asthma Prevalence, Health Care Use, and Mortality, 2000-01, National Center for Health Statistics, CDC2 2 Morbidity and Mortality Report, National Center for Health Statistics (NCHS), U.S. CDC, 2003Morbidity and Mortality Report, National Center for Health Statistics (NCHS), U.S. CDC, 2003

3 Surveillance for Asthma - United States, 1980-99, MMWR Surveillance Summaries, CDC, March 29, 20023 Surveillance for Asthma - United States, 1980-99, MMWR Surveillance Summaries, CDC, March 29, 2002

Minnesota ChildrenMinnesota Children

In a 2003 MDH survey of more than 5,000 In a 2003 MDH survey of more than 5,000 7th & 8th graders at 15 junior highs outside 7th & 8th graders at 15 junior highs outside

the metro area- the metro area- 1 in 121 in 12 reported they currently have asthmareported they currently have asthma

In a 2001 MDH survey of 13,000, 9th - 11th In a 2001 MDH survey of 13,000, 9th - 11th graders in rural MN- graders in rural MN- 1 in 111 in 11 reported they currently have asthmareported they currently have asthma

This MeansThis Means....

In a class of 30 children, you can expect In a class of 30 children, you can expect

2 to 3 students WILL have asthma! 2 to 3 students WILL have asthma!

The Goal Of Asthma ManagementThe Goal Of Asthma Management

“ “Children should live happy, healthy, physically Children should live happy, healthy, physically active lives, without asthma symptoms slowing active lives, without asthma symptoms slowing them downthem down “ “

Impact Of Asthma On StudentsImpact Of Asthma On Students

School PerformanceSchool Performance:: Poorly controlled asthma has a negative Poorly controlled asthma has a negative

impact on school performance in both impact on school performance in both academic achievement and physical academic achievement and physical education education

Impact Of Asthma On Students cont...Impact Of Asthma On Students cont...

Psychosocial:Psychosocial: Poor self-esteemPoor self-esteem Anxiety about asthmaAnxiety about asthma Fear of becoming ill at schoolFear of becoming ill at school Anxiety about exercise at schoolAnxiety about exercise at school Fear of being differentFear of being different

What Is Asthma?What Is Asthma?

Asthma is a chronic disease that causes: Asthma is a chronic disease that causes: Tightening of the muscles surrounding Tightening of the muscles surrounding

the airways (Bronchoconstriction/spasm) the airways (Bronchoconstriction/spasm) Swelling of the small airways Swelling of the small airways

(bronchioles)(bronchioles) Over production of sticky mucus in the Over production of sticky mucus in the

airwaysairways

Normal Bronchiole Inflamed BronchioleNormal Bronchiole Inflamed Bronchiole with Mucus with Mucus

Common Symptoms Of AsthmaCommon Symptoms Of Asthma

Frequent cough, especially at nightFrequent cough, especially at nightShortness of breath or rapid breathing Shortness of breath or rapid breathing Chest Tightness Chest Tightness Chest pain Chest pain WheezingWheezingFatigueFatigueBehavior changesBehavior changes

What Causes Asthma?What Causes Asthma? Asthma may be caused by genetic, immune and/or Asthma may be caused by genetic, immune and/or

environmental factors, and is often associated with environmental factors, and is often associated with eczema (scaly skin patches) and allergieseczema (scaly skin patches) and allergies

Researchers do not understand all of the causes of Researchers do not understand all of the causes of asthma or its increasing prevalenceasthma or its increasing prevalence

It boils down to “We just don’t really know for It boils down to “We just don’t really know for sure”sure”

What Causes Asthma cont..What Causes Asthma cont..

Of the 17 million asthma sufferers in the Of the 17 million asthma sufferers in the US, 10 Million (approx. 60%) have allergic US, 10 Million (approx. 60%) have allergic asthma. 3 million of those are childrenasthma. 3 million of those are children11

Exposure to certain allergens trigger asthma Exposure to certain allergens trigger asthma symptoms to beginsymptoms to begin

Exposure to certain irritants can also set an Exposure to certain irritants can also set an asthma episode in motionasthma episode in motion

1National Institute of Environmental Health Sciences

Triggers And IrritantsTriggers And Irritants

Copyright 2004, 3M Pharmaceuticals

Common Allergens (Triggers) Common Allergens (Triggers)

Seasonal pollensSeasonal pollens Animal dander Animal dander

/saliva/urine/saliva/urine Dust mitesDust mites Cockroaches/mice/rat Cockroaches/mice/rat

droppings and urinedroppings and urine MoldMold Some medicationsSome medications Some foods Some foods Strong emotional feelingsStrong emotional feelings

Common Irritants (Triggers)Common Irritants (Triggers)Exercise Exercise Cold airCold airChalk dustChalk dustViral/upper Viral/upper

respiratory respiratory infectionsinfections

Air pollutionAir pollutionTobacco smoke or Tobacco smoke or

secondhand smokesecondhand smoke

Chemical irritants Chemical irritants and strong smellsand strong smells

Strong emotional Strong emotional feelingsfeelings

Diesel fumesDiesel fumesCleaning suppliesCleaning supplies

Every Child Is Unique!Every Child Is Unique!

Wheezing and coughing are the most Wheezing and coughing are the most common symptoms common symptoms -but--but-

No two children will have the exact same No two children will have the exact same symptoms or the same triggersymptoms or the same trigger

Every child who has a diagnosis of asthma Every child who has a diagnosis of asthma should have access to a rescue inhaler!should have access to a rescue inhaler!

Every child who has asthma should have an Every child who has asthma should have an asthma action plan at school (AAP)asthma action plan at school (AAP)

Handling Asthma EpisodesHandling Asthma Episodes

What’s An “Episode”?What’s An “Episode”?

An asthma episode occurs when a child is An asthma episode occurs when a child is exposed to a trigger or irritant and their exposed to a trigger or irritant and their asthma symptoms start to appearasthma symptoms start to appear

This can occur suddenly without a lot of This can occur suddenly without a lot of warning, or brew for days before the warning, or brew for days before the symptoms emergesymptoms emerge

Episodes are preventable by avoiding Episodes are preventable by avoiding exposure to triggers and taking daily exposure to triggers and taking daily controller medications (if prescribed)controller medications (if prescribed)

How Do I Handle An Asthma Episode At How Do I Handle An Asthma Episode At School?School?

1.1. Remain calm and reassure the childRemain calm and reassure the child

2.2. If you know what triggered their episode, If you know what triggered their episode, move the child away from it move the child away from it

3.3. Have the child sit up and breathe slowly- in Have the child sit up and breathe slowly- in through the nose, out through pursed lipsthrough the nose, out through pursed lips

4.4. Contact the school nurse for assistance or Contact the school nurse for assistance or whomever is responsible for providing whomever is responsible for providing medications in the nurses absence medications in the nurses absence

Handling An Episode cont..Handling An Episode cont..

5.5. If you are responsible for medications, check If you are responsible for medications, check the child's asthma action plan, emergency care the child's asthma action plan, emergency care plan or medication card for actionsplan or medication card for actions

6.6. Give “rescue or reliever” medications if ordered Give “rescue or reliever” medications if ordered and available and available (some students carry their own asthma (some students carry their own asthma inhalers with them) inhalers with them)

7.7. Have the child sip room temperature water/ Have the child sip room temperature water/ fluidsfluids

8.8. Contact the parent or guardian as necessary Contact the parent or guardian as necessary --ANDAND--

Do NOT Leave The Child AloneDo NOT Leave The Child Alone!!

Call 911 if..Call 911 if.. Lips or nail beds are bluishLips or nail beds are bluish Child has difficulty talking, walking or drinkingChild has difficulty talking, walking or drinking Quick relief or “rescue” meds (albuterol) is Quick relief or “rescue” meds (albuterol) is

ineffective or not availableineffective or not available Neck, throat, or chest muscles are pulling in Neck, throat, or chest muscles are pulling in

(retracting) (retracting) Nasal flaring occurs when inhaling Nasal flaring occurs when inhaling Obvious distressObvious distress Altered level of consciousness/confusion Altered level of consciousness/confusion Rapidly deteriorating conditionRapidly deteriorating condition

Exercise Induced AsthmaExercise Induced Asthma

What Is Exercise Induced What Is Exercise Induced Asthma (EIA)?Asthma (EIA)?

Tightening of the muscles around the airways Tightening of the muscles around the airways (bronchospasm)(bronchospasm)

Distinct from “chronic” asthma in that it does Distinct from “chronic” asthma in that it does NOT cause swelling and mucus production in NOT cause swelling and mucus production in the airwaysthe airways

Can be avoided by taking pre-exercise Can be avoided by taking pre-exercise medications and by warming up/cooling down medications and by warming up/cooling down

EIA - What Happens?EIA - What Happens?

Symptoms include coughing, wheezing, Symptoms include coughing, wheezing, chest tightness and shortness of breathchest tightness and shortness of breath

Symptoms may begin during exercise and Symptoms may begin during exercise and can be worse 5 to 10 minutes after exercisecan be worse 5 to 10 minutes after exercise

EIA can spontaneously resolve 20 to 30 EIA can spontaneously resolve 20 to 30 minutes after startingminutes after starting

Can be avoided by doing the following:Can be avoided by doing the following:

Preventing Exercise Induced Preventing Exercise Induced Asthma (EIA)Asthma (EIA)

Become familiar with Asthma Action Plans, pre-Become familiar with Asthma Action Plans, pre-exercise medication orders and or health care plan exercise medication orders and or health care plan

Student should use reliever (Albuterol) 15 -30 Student should use reliever (Albuterol) 15 -30 minutes before activityminutes before activity

Do warm-up/ cool-down exercises before and after Do warm-up/ cool-down exercises before and after activitiesactivities

Check outdoor ozone/air quality levelsCheck outdoor ozone/air quality levels www.aqi.pca.state.mn.us/hourlywww.aqi.pca.state.mn.us/hourly// Never encourage a child to “tough it out” when Never encourage a child to “tough it out” when

having asthma symptomshaving asthma symptoms

MedicationsMedications

Medication: Determined By Medication: Determined By Severity Level ClassificationSeverity Level Classification

1.1. Mild IntermittentMild Intermittent Reliever only prn Reliever only prn

2.2. Mild PersistentMild Persistent Controller and reliever Controller and reliever

3.3. Moderate PersistentModerate PersistentController plus long-acting bronchodilator and Controller plus long-acting bronchodilator and relieverreliever

4.4. Severe PersistentSevere PersistentController plus long-acting bronchodilator and Controller plus long-acting bronchodilator and relieverreliever

Two Categories Of MedicationsTwo Categories Of Medications

Controller Medications Controller Medications Taken every day to prevent swelling in Taken every day to prevent swelling in

the lungsthe lungs Reliever or Rescue MedicationsReliever or Rescue Medications

Taken only when needed to relieve Taken only when needed to relieve symptoms symptoms

Or to prevent exercise induced asthma Or to prevent exercise induced asthma from developing (taken before strenuous from developing (taken before strenuous exercise)exercise)

Controller MedicationsController Medications

Keep swelling and mucus from developing Keep swelling and mucus from developing in the lungsin the lungs

Must be taken EVERY day even when the Must be taken EVERY day even when the child is not having symptomschild is not having symptoms

Inhaled corticosteroids (ICS’s) are the most Inhaled corticosteroids (ICS’s) are the most common and effective way to control common and effective way to control asthmaasthma

Help prevent asthma exacerbations from Help prevent asthma exacerbations from developing!developing!

Rescue Or Reliever MedicationsRescue Or Reliever Medications

Are taken when asthma symptoms are Are taken when asthma symptoms are appearing (asthma episode)appearing (asthma episode)

Are taken 15-30 minutes before strenuous Are taken 15-30 minutes before strenuous exercise/activity by children with EIA exercise/activity by children with EIA

Do NOT reduce or prevent swelling from Do NOT reduce or prevent swelling from developing in the lungsdeveloping in the lungs

May be carried in school by a student only May be carried in school by a student only IF approved by the doctor, school nurse and IF approved by the doctor, school nurse and parent!parent!

Picture courtesy of American Lung Association of the Inland Counties CA 2004Picture courtesy of American Lung Association of the Inland Counties CA 2004

Typical Spacers/Holding Typical Spacers/Holding ChambersChambers

Spacers Or Holding ChambersSpacers Or Holding Chambers Most MDI’s (metered dose inhalers) must be Most MDI’s (metered dose inhalers) must be

used with a spacer or holding chamberused with a spacer or holding chamber This device attaches to the MDI and allows the user This device attaches to the MDI and allows the user

to breathe in more medication effectivelyto breathe in more medication effectively The physician must write an order for it when The physician must write an order for it when

prescribing your reliever medicationprescribing your reliever medication Dry powder inhalers do NOT require spacersDry powder inhalers do NOT require spacers

How MDI Technology WorksHow MDI Technology Works

How To Use Your InhalerHow To Use Your Inhaler

How To Use:How To Use:Metered Dose Inhalers w/SpacersMetered Dose Inhalers w/Spacers

1. Stand up (or sit up straight)1. Stand up (or sit up straight)

2. Shake the inhaler well to mix up the medicine2. Shake the inhaler well to mix up the medicine

3. Remove the cap and check the spacer/inhaler for 3. Remove the cap and check the spacer/inhaler for foreign objectsforeign objects

4. Insert the inhaler into the spacer4. Insert the inhaler into the spacer

5. Exhale all your air out fully5. Exhale all your air out fully

6. Before inhaling, put the mouthpiece of the spacer into 6. Before inhaling, put the mouthpiece of the spacer into your mouth, over your tongue and between your teeth. your mouth, over your tongue and between your teeth. Close your lips around it while tilting your head and the Close your lips around it while tilting your head and the inhaler back slightlyinhaler back slightly

Using An MDI Cont..Using An MDI Cont..

7.7. Press down on the inhaler canister and breathe in Press down on the inhaler canister and breathe in slowly and deeply through your mouthslowly and deeply through your mouth

8.8. Hold your breath for 10 seconds, exhale Hold your breath for 10 seconds, exhale normallynormally

9.9. If using a “reliever”, wait 1-2 minutes between If using a “reliever”, wait 1-2 minutes between puffspuffs

10.10. Repeat starting with #5 if a 2Repeat starting with #5 if a 2ndnd puff is ordered puff is ordered

11.11. Rinse your mouth and spit after using a Rinse your mouth and spit after using a “controller” inhaler“controller” inhaler

Minnesota Inhaler LawMinnesota Inhaler Law

MN Asthma Inhaler Law MN Asthma Inhaler Law Summary (2001)Summary (2001)

Allows MN students to self-carry and administer Allows MN students to self-carry and administer inhalersinhalers

In order for a child to carry his/her inhaler at school, In order for a child to carry his/her inhaler at school, authorization and signatures from the following authorization and signatures from the following individuals are required:individuals are required:

Child’s health care providerChild’s health care providerParent/guardian Parent/guardian Assessment and approval of the school nurseAssessment and approval of the school nurse (if (if

present in district)present in district) Be sure to check and follow policies and procedures in Be sure to check and follow policies and procedures in

local school districtlocal school district

Para Professionals Role Para Professionals Role Identify students with asthma Identify students with asthma Distribute & collect communication formsDistribute & collect communication forms In the health office the RN may In the health office the RN may delegatedelegate specific tasks specific tasks

such as:such as: Documenting asthma visits by completing or initiating Documenting asthma visits by completing or initiating

student asthma recordsstudent asthma records Asking about symptoms & check PFM levelsAsking about symptoms & check PFM levels Providing episodic care to students with asthma Providing episodic care to students with asthma

symptoms including medication administrationsymptoms including medication administration Communicating with parents regarding asthma Communicating with parents regarding asthma

care/episodescare/episodes

Communicate With The NURSECommunicate With The NURSE

You are the eyes and ears for the nurseYou are the eyes and ears for the nurse Be aware of students with asthma and their typical Be aware of students with asthma and their typical

symptomssymptoms Help remind students to pre-medicate before exerciseHelp remind students to pre-medicate before exercise

Always document clearly and neatly what you see, Always document clearly and neatly what you see, hear and what the student tells youhear and what the student tells you

Call the nurse with questions or urgent situationsCall the nurse with questions or urgent situations If you don’t know- ask!If you don’t know- ask! Don’t be afraid to call 911 in emergenciesDon’t be afraid to call 911 in emergencies

Tools To Help Manage AsthmaTools To Help Manage Asthma

Peak Flow Meters (PFM)Peak Flow Meters (PFM)

Peak Flow MetersPeak Flow Meters

Measures how well the student’s lungs are Measures how well the student’s lungs are doing at that momentdoing at that moment

Associated with the Green-Yellow-Red Associated with the Green-Yellow-Red system of managing asthma symptomssystem of managing asthma symptoms

Congruent with asthma action plansCongruent with asthma action plansHelps students and families self-manage Helps students and families self-manage

asthma asthma

How to use a Peak Flow MeterHow to use a Peak Flow Meter

1.1. Review the stepsReview the steps

2.2. Stand upStand up

3.3. Place indicator at the Place indicator at the base of the numbered base of the numbered scalescale

4.4. Take a deep breathTake a deep breath

5.5. Place the meter in the Place the meter in the mouth and close lips mouth and close lips around the around the mouthpiecemouthpiece

6.6. Blow out into the Blow out into the meter as hard and meter as hard and fast as possiblefast as possible

7.7. Write down the Write down the achieved numberachieved number

8.8. Repeat the process Repeat the process twice moretwice more

9.9. Record the highest of Record the highest of the three numbers the three numbers achievedachieved

Asthma Action Plan (AAP)Asthma Action Plan (AAP)

Asthma Action Plan ZonesAsthma Action Plan Zones

Green ZoneGreen Zone: : All Clear/Breathing Good/Go All Clear/Breathing Good/Go – No asthma symptoms and/or No asthma symptoms and/or – Peak flow 80-100% Predicted or Personal bestPeak flow 80-100% Predicted or Personal best

Yellow ZoneYellow Zone:: Caution/Slow DownCaution/Slow Down– Some asthma symptoms and/orSome asthma symptoms and/or– Peak flow 50-80% Predicted or Personal bestPeak flow 50-80% Predicted or Personal best

Red ZoneRed Zone: : Medical Alert/StopMedical Alert/Stop– Severe asthma symptoms and/or Severe asthma symptoms and/or – Peak flow < 50% Predicted or Personal bestPeak flow < 50% Predicted or Personal best

Successful Asthma Management Successful Asthma Management Requires Everyone's CooperationRequires Everyone's Cooperation TeachersTeachers ParentsParents StudentsStudents Medical ProvidersMedical Providers CoachesCoaches All School PersonnelAll School Personnel

Talk with your school Nurse to find out what Talk with your school Nurse to find out what YOUYOU can do can do to help manage asthma in your schoolto help manage asthma in your school