AsthmaAsthma

Presented by:

Child Care Health Consultation

What is AsthmaWhat is Asthma

• A condition which affects the “breathing tubes” (the airways for bronchi) of lungs

• Asthmatic children are more likely to have inflammation of the airways than non-asthmatic children

Types of AsthmaTypes of Asthma• Mild intermittent - On/off symptoms less

than 2x wk

• Mild persistent - Symptoms more than 2x wk

• Moderate persistent - Symptoms daily

• Severe persistent - Continuous symptoms

Asthma FactsAsthma Facts

• Chronic, lasts a lifetime• Usually diagnosed by age of 3• May improve • NO cure, treatment is available• People who have allergies / symptoms

of disease may not have asthma• More common among lower

socioeconomic groups

Asthma StatisticsAsthma Statistics

• Affects more than 20 million Americans

• Over 35% (5 million) are children

• Incidence increasing

• Medical bills $600 higher a year for asthmatic children

Why Why somesome children get children get AsthmaAsthma

• Heredity• Allergies, hay fever, food allergies or

eczema at a very young age• Obesity• Premature babies & lung damage• Smoking during pregnancy

• Most cases, cause unknown

SymptomsSymptoms

• Coughing

• Shortness of breath

• Chest tightness

• Wheezing

• Irritable/fussy

• Fatigue

Recognizing a severe Recognizing a severe asthma attackasthma attack

• Blue or gray lips with flared nostrils• Tendency to lean forward with shoulders

high• Depressed rib spaces with over- inflated

chest• Pulse rate over 100• Difficulty speaking between breaths• Peak flow reading less than 50% of

child’s best

What to do for a What to do for a severe attacksevere attack

• Follow child’s action plan

• Bronchodilator treatments per prescription

• If no improvement within 5 minutes or if attack lasts more than 1 hour, get immediate medical advice from doctor or emergency room

• Remain calm, do not frighten the child

TriggersTriggers• Infections• Exercise• Weather• Strong Emotions• Allergens• Aspirin• Irritants

IllnessIllness

• Respiratory illnesses– Colds, flu, pneumonia– Viral infections last longer and can’t be

treated with antibiotics

• Reducing Risk– Handwashing– Encourage breastfeeding– Flu and pneumonia vaccines recommended

ExerciseExercise

• Overexertion– Running upstairs– Carrying heavy loads– Jogging– Playing team sports

• Reducing Risk– Premedicate (if prescribed by MD)

– Encourage exercise

WeatherWeather• Cold air or summer heat

• Seasonal pollens

• Reducing Risk– Cover mouth and nose in

winter– Seek shade in summer– Drink plenty of water– Keep windows closed

Strong EmotionsStrong Emotions

• Examples– Laughing– Crying– Yelling– Fear

• Reducing Risk– Comforting child– Know what helps

child gain control

AllergensAllergens

• Cockroaches • Dust mites• Pollen• Mold spores• Pet dander• Cigarettes

CockroachesCockroaches• Droppings• Cockroaches love:

– Warmth– Food– Water– Newspapers– Paper/Grocery bags– Garbage

What would you do to reduce the incidence in your center?

Dust MitesDust Mites• 80% of asthmatic children

are allergic to dust mites• Droppings• Hatch every 3 weeks• Mites love:

– Humidity– Pillows/comforters/ mattresses– Carpet

What would you do to reduce the incidence in your center?

PollenPollen

• Early Spring: Trees

• Late Spring & Early Summer: Grasses

• Late Summer & Fall: Weeds

What would you do to reduce the incidence in your center?

MoldMold• Dark damp places• Basements, attics, bathrooms, insulation,

and refrigerators

What would you do to reduce the incidence in your center?

Pet DanderPet Dander

• Avoid furry/feathered pets

• MUST: – Keep pet out of

bedroom– Brush and bathe pet

weekly– Launder pet beds

weekly– Dust and vacuum

weekly

Cigarette SmokeCigarette Smoke

• Don’t smoke while pregnant

• Don’t smoke around children

What would you do to reduce the incidence in your center?

NSAID’s: Aspirin, NSAID’s: Aspirin, Motrin, TylenolMotrin, Tylenol

cause attacks in 1/3 of asthmatic children

IrritantsIrritants

• Tobacco smoke

• Fireplace smoke

• Cleaning agents

• Chemical fumes

• Perfumes

What would you do to reduce the incidence in your center?

TreatmentsTreatments

• Pills

• Inhalers and spacers

• Nebulizers

Goals of TreatmentGoals of Treatment

• Prevent symptoms & attacks during day & night

• Maintain normal activity levels

• Have normal/near-normal lung function

• Be satisfied with Asthma care received

• Have no or minimal side effects

Rule of 2’sRule of 2’s

• Awakened by wheezing/coughing 2 x’s a night Awakened by wheezing/coughing 2 x’s a night

• Use inhaled rescue med 2 x’s a week Use inhaled rescue med 2 x’s a week

• Use up 2 rescue inhalers a month Use up 2 rescue inhalers a month

• Seek urgent care 2 x’s a yearSeek urgent care 2 x’s a year

= Poor Asthma Control= Poor Asthma Control

Long-Term Long-Term MedicinesMedicines

• Prevents Attacks– Decrease inflammation– Decrease mucus production

• Steroids (inhaled are most effective for long-term control. Oral steroids are best short-term for severe attack)

• Take daily(for rest of life)

Quick Relief Quick Relief MedicinesMedicines

• Relieve asthma attack

• Use only as needed or before exercise

• Bronchodilators– Open airways

Asthma MedsAsthma Meds

• Anti-inflammatory drugsAnti-inflammatory drugs

- Corticosteroids- Corticosteroids

- Mast cell stabilizers- Mast cell stabilizers

- Leukotriene Modifiers- Leukotriene Modifiers

• BronchodilatorsBronchodilators

-- Long-actingLong-acting

- Short-acting- Short-acting

Meds Contd.Meds Contd.

• Monoclonal antibodyMonoclonal antibody

Xolair – new drug approved in Xolair – new drug approved in

2003 for adults and teens.2003 for adults and teens.

Given by injection 1-2 times Given by injection 1-2 times

a montha month

CorticosteroidsCorticosteroids

• Inhaled or pill (Flovent or Prednisone)Inhaled or pill (Flovent or Prednisone)

• Most effectiveMost effective

• Prevent symptomsPrevent symptoms

• Take every dayTake every day

• Are steroids that are anti-inflammatoryAre steroids that are anti-inflammatory

• Reduce mucus and swellingReduce mucus and swelling

• Lead to better asthma controlLead to better asthma control

Mast Cell StabilizersMast Cell Stabilizers

• Decrease inflammation caused by Decrease inflammation caused by allergiesallergies

• Help prevent wheezing and EIAHelp prevent wheezing and EIA

• More effective in childrenMore effective in children

• Are not appropriate for acute asthma Are not appropriate for acute asthma symptomssymptoms

Leukotriene ModifiersLeukotriene Modifiers

• Are fairly new, in pill formAre fairly new, in pill form• Prevent inflammation caused by Prevent inflammation caused by

allergiesallergies• Prevent wheezing & EIAPrevent wheezing & EIA• May use as adjunct therapy for chronic May use as adjunct therapy for chronic

asthmaasthma• Decrease need for short acting Decrease need for short acting

bronchodilatorsbronchodilators

BronchodilatorsBronchodilators• Relax muscle bands that tighten around the Relax muscle bands that tighten around the

airwaysairways• Clear mucus from lungsClear mucus from lungs• MD will add if Sx aren’t completely controlled MD will add if Sx aren’t completely controlled

by inhaled corticosteroidsby inhaled corticosteroids• Short acting – relieve acute Sx & prevent Short acting – relieve acute Sx & prevent

exercise induced bronchospasmexercise induced bronchospasm• Long acting – help control asthma Sx & Long acting – help control asthma Sx &

prevent attacks. Provide control, not quick prevent attacks. Provide control, not quick reliefrelief

FYIFYI

• If a patient is on both a bronchodilator If a patient is on both a bronchodilator and inhaled corticosteroid, pt should and inhaled corticosteroid, pt should take bronchodilator first and then the take bronchodilator first and then the inhaled steroid. This will open the inhaled steroid. This will open the airways quickly and help deposit the airways quickly and help deposit the drug deeper into the airways.drug deeper into the airways.

Meter Dose Inhalers

• Must use correctly!!!

• 1st exhale completely then press inhaler and inhale.

• DEMO

WrongWrong WayWay

Do Not Put Inhaler In

Mouth!

RightRight Way Way

Place 3 fingers in front of mouth and place inhaler at that point

Holding Chambers & SpacersHolding Chambers & Spacers

Spacers, allow medicine to be

released through valve

Holding chamber just hold med

Cleaning and UseCleaning and Use• 1 x a week rinse

MDI’s plastic mouthpiece with mild soap and warm water. Rinse and AIR dry.

• Spacers and masks rinse 1x month and let air dry.

Never Float Device

Dry Powder Dry Powder InhalersInhalers

NebulizersNebulizers• Often used with young

children and for severe attacks

• All medicine must be received

• Mouth piece must be in mouth or use a mask for infants.

Possible side effects of Possible side effects of treatmentstreatments

• Anti-inflammatory

– Ex…Cromolyn may cause irritation of the throat immediately after use

– Prolonged use of oral steroids can stunt growth, produce swelling of face and trunk & alter body’s production of steroids

– Inhaled steroids-may predispose child to fungal infection (Thrush)

Possible side effects of Possible side effects of treatments (cont.)treatments (cont.)

• Bronchodilators

– Increase in heart rate– Tremors of hands and finger that last

a few minutes

– HA, insomnia, nervousnessHA, insomnia, nervousness– Ex… Theophylline may cause

headaches, irritability, hyperactivity, stomach aches & vomiting.

Peak Flow MetersPeak Flow Meters• Detect early stages of airway narrowing Detect early stages of airway narrowing

so you can begin therapy before it so you can begin therapy before it becomes more seriousbecomes more serious

• Decide whether you need more Decide whether you need more medicatonmedicaton

• Determine when ER care is neededDetermine when ER care is needed• See whether specific allergens or See whether specific allergens or

irritants make your asthma worseirritants make your asthma worse

Peak Flow MetersPeak Flow Meters• Stand up• Take a deep breath.• Place meter in mouth, close lips and

teeth around mouth piece• Blow out as hard and fast as you can.• Do three times, record best effort. (reset

indicator to 0 before each try)

Peak Flow ZonesPeak Flow Zones

• Green Zone (80-100% of personal best.)

• Yellow Zone (50-Yellow Zone (50-79% of personal 79% of personal best) best) – Add quick relief Add quick relief

measures.measures.

• Red Zone (below 50% of personal best) – Call M.D. NOW!

School DaysSchool Days• Always document

• Keep records

• Talk with parents daily

• ER visits

Helping Parents CopeHelping Parents Cope

• Prevent negative feelings by encouraging activities and independence

• Bolster child’s confidence, provide him/her with a sense of accomplishment by giving tasks that child enjoys

and can do well

• Discipline

QuestionsQuestions• Can asthmatic children play sports?

• Can asthma attacks be handled at school?

• Is asthma a lifelong problem?

• Will moving to a new climate help?

Child Care Health Child Care Health ConsultationConsultation

The End!Thanks to:

Shannon Dunn, RN Carol Daniel, RN