ASTHMA Presented by your School Nurse Presented by your School Nurse.

ASTHMAASTHMA

Presented by your School NursePresented by your School Nurse

AsthmaAsthma

What is Asthma?What is Asthma?

Asthma is a chronic respiratory disease. Asthma is a chronic respiratory disease. Inflammation plays a large role.Inflammation plays a large role.

Inflammation contributes to airflow problems. Inflammation contributes to airflow problems. When an asthma attack occurs, the muscles of When an asthma attack occurs, the muscles of

the bronchial tree become tight and the lining of the bronchial tree become tight and the lining of the air passages swell, reducing airflow and the air passages swell, reducing airflow and

producing the characteristic wheezing sound. producing the characteristic wheezing sound. Mucous production is increased. Mucous production is increased.

Three levels of asthmaThree levels of asthma

Mild asthma: symptoms occur no more than twice a Mild asthma: symptoms occur no more than twice a week. The attacks don’t last long, and they are week. The attacks don’t last long, and they are alleviated quickly with medication. There are no alleviated quickly with medication. There are no symptoms between attacks.symptoms between attacks.

Moderate asthma: symptoms occur almost every Moderate asthma: symptoms occur almost every day and require an inhaler almost every time an day and require an inhaler almost every time an attack occurs for symptom relief.attack occurs for symptom relief.

Severe: symptoms are present most of the day Severe: symptoms are present most of the day every day. They restrict activity and they have every day. They restrict activity and they have often necessitated a hospital stay.often necessitated a hospital stay.

Several types of asthmaSeveral types of asthma

Adult-onset asthma develops after the age of Adult-onset asthma develops after the age of twenty. It is less common than asthma in twenty. It is less common than asthma in children, and it affects women more than men.children, and it affects women more than men.

Exercise-induced asthma involves symptoms Exercise-induced asthma involves symptoms that occur about 5-20 minutes after beginning that occur about 5-20 minutes after beginning an exercise that involves breathing through the an exercise that involves breathing through the mouth. Activities that require continuous mouth. Activities that require continuous activity that are played in cold weather are the activity that are played in cold weather are the most likely trigger for an asthma attack.most likely trigger for an asthma attack.

Nocturnal asthma occurs between midnight and 8 am. It is triggered by allergens in the home such as dust Nocturnal asthma occurs between midnight and 8 am. It is triggered by allergens in the home such as dust and pet dander or is caused by sinus conditions.and pet dander or is caused by sinus conditions.

Occupational asthma occurs in response to a trigger in the workplace. These triggers include contaminants Occupational asthma occurs in response to a trigger in the workplace. These triggers include contaminants and allergens in the air and extremes of temperature or humidityand allergens in the air and extremes of temperature or humidity

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What are factors that can What are factors that can cause an attack?cause an attack?

Respiratory infectionRespiratory infection ExerciseExercise Cold airCold air Tobacco smokeTobacco smoke PollutionPollution

StressStress FoodFood Drug allergies Drug allergies AspirinAspirin Non-steroidal inflammatoryNon-steroidal inflammatory

In sensitive individuals, asthma symptoms can be triggered by inhaledIn sensitive individuals, asthma symptoms can be triggered by inhaled allergens such as:allergens such as:

Pet danderPet danderDust mitesDust mitesCockroachCockroachMoldsMoldsPollen. Pollen.

Medicines can provoke an asthma attack in some patients.Medicines can provoke an asthma attack in some patients.

Asthma symptoms can also be triggered by:Asthma symptoms can also be triggered by:

Asthma affects 17.3 Asthma affects 17.3 million people in the million people in the United States. Asthma is United States. Asthma is found in 3-5% of adults found in 3-5% of adults and 7-10% of children. and 7-10% of children. Half the people with Half the people with asthma develop it before asthma develop it before age 10, and most age 10, and most develop it before age 30. develop it before age 30. Asthma symptoms can Asthma symptoms can decrease over time decrease over time especially in children.especially in children.

Who gets asthma?Who gets asthma?

More than twice as More than twice as many boys than many boys than girls, although boys girls, although boys are more likely to are more likely to experience a experience a decrease in decrease in symptoms as they symptoms as they reach adolescence.reach adolescence.

In adult onset In adult onset asthma, however, asthma, however, twice as many twice as many women than men women than men visit the ER and are visit the ER and are admitted with asthmaadmitted with asthma

Asthma affects all Asthma affects all races worldwide, but races worldwide, but it is more common in it is more common in blacks and Hispanicsblacks and Hispanics

Occupational asthma Occupational asthma is most common in is most common in those who work with those who work with animals or animal-animals or animal-derived products and derived products and in industries such as in industries such as plastics, rubber, plastics, rubber, chemical, textile, chemical, textile, electronics, paintingelectronics, painting

Printing, Printing, metalworking, metalworking, baking and baking and gardeninggardening

Risk Factors for AsthmaRisk Factors for Asthma

Smoking or living Smoking or living with a smoker is a with a smoker is a major risk factormajor risk factor

About 25% of About 25% of children who have children who have asthma have at least asthma have at least one parent who one parent who smokessmokes

A family history of A family history of asthma. If one parent asthma. If one parent has asthma a person has asthma a person has a 25% chance of has a 25% chance of developing it. If developing it. If both parents have both parents have asthma, a person has asthma, a person has a 50% chance of a 50% chance of manifesting it.manifesting it.

Having allergies, Having allergies, including any including any hayfever and hayfever and eczema. It is not eczema. It is not known why some known why some people have alleriges people have alleriges and some don’t, but and some don’t, but allergies can be allergies can be inheritedinherited

Having allergies or Having allergies or severe viral severe viral infections before the infections before the age of threeage of three

Living in the inner Living in the inner city or in a low city or in a low income group income group

Being exposed to Being exposed to mice and cockroach mice and cockroach waste productswaste products

Frequently being Frequently being exposed to triggersexposed to triggers

What are the symptoms of asthma?What are the symptoms of asthma?

Wheezing, usually begins suddenly, is Wheezing, usually begins suddenly, is episodic, may be worse at night or in episodic, may be worse at night or in the early morningthe early morning

Aggravated by exposure to cold airAggravated by exposure to cold air Aggravated by exercise Aggravated by exercise Aggravated by heartburnAggravated by heartburn Resolves spontaneouslyResolves spontaneously Relieved by bronchodilators (drugs Relieved by bronchodilators (drugs

that open the airways)that open the airways) Cough with or without sputum Cough with or without sputum

production production Shortness of breathShortness of breath Breathing that requires increased Breathing that requires increased

workwork Intercostals retractions (Pulling of the Intercostals retractions (Pulling of the

skin between the ribs when breathing)skin between the ribs when breathing)

Additional SymptomsAdditional Symptoms

Nasal flaringNasal flaring Chest painChest pain tightness in chest tightness in chest abnormal breathing abnormal breathing

pattern, breathing out pattern, breathing out takes twice as long as takes twice as long as breathing in.breathing in.

Asthma SymptomsAsthma Symptoms What to look for if a child is What to look for if a child is

having difficulty breathing?having difficulty breathing? Respiratory Rate >40 Respiratory Rate >40

worrisomeworrisome Are they having nasal Are they having nasal

flaring?flaring? Do you see neck muscles Do you see neck muscles

sinking in?sinking in? Are they pulling in their ribs?Are they pulling in their ribs? What can be done to help What can be done to help

control asthma?control asthma? If you cannot cure it there If you cannot cure it there

are steps to control it. are steps to control it.

Tools used to detect asthma Tools used to detect asthma One way is through peak One way is through peak

flow meters.flow meters. With this meter you can see With this meter you can see

when you are breathing when you are breathing well, which is you personal well, which is you personal best, and when you are not best, and when you are not at your personal best , steps at your personal best , steps you can take to prevent an you can take to prevent an attack.attack.

These readings are These readings are categorized into zones.categorized into zones.

Flow meter reading Flow meter reading Green Zone – 80% of Green Zone – 80% of

personal best denotes good personal best denotes good controlcontrol

Yellow zone- 50 – 80% of Yellow zone- 50 – 80% of personal best, caution need personal best, caution need to use an inhalerto use an inhaler

Red Zone - <50% of Red Zone - <50% of personal best denotes severe personal best denotes severe asthma exacerbation, need to asthma exacerbation, need to use medicines, call MD, or use medicines, call MD, or go to ER.go to ER.

PreventionPrevention Avoid known allergens, Avoid known allergens,

exposure to cigarette exposure to cigarette smoke, air pollution , dust, smoke, air pollution , dust, remove carpet from remove carpet from bedrooms, vacuum bedrooms, vacuum regularly. Remove pets regularly. Remove pets from patients bedroom. from patients bedroom. May need to be allergy May need to be allergy tested.tested.

There are two basic kinds of There are two basic kinds of medications for controlling asthma:medications for controlling asthma:

Long term control medications – Long term control medications – used on a regular basis to prevent used on a regular basis to prevent attacks, not for treatment during an attacks, not for treatment during an attackattack

1.1. Inhaled steroids – examples are Inhaled steroids – examples are Azmacort, Vanceril, Aerobid , Azmacort, Vanceril, Aerobid , Flovent prevent inflammation.Flovent prevent inflammation.

2.2. Quick relief or rescue medications Quick relief or rescue medications – used to relieve symptoms during – used to relieve symptoms during an attack short acting an attack short acting bronchodilators such as Proventil bronchodilators such as Proventil Ventolin, xopenex, and othersVentolin, xopenex, and others

PreventionPrevention

PreventionPrevention

Patients with mild asthma may Patients with mild asthma may use relief medication as needed. use relief medication as needed. Those with persistent asthma Those with persistent asthma should take control medications should take control medications on a regular basis to prevent an on a regular basis to prevent an attack from occurring. A severe attack from occurring. A severe asthma attack requires a medical asthma attack requires a medical eval., and may require eval., and may require hospitalization, oxygen and hospitalization, oxygen and intravenous medication.intravenous medication.

In conclusion, education needs to be In conclusion, education needs to be tailored to meet the patient’s individual tailored to meet the patient’s individual and family needs. Need to know factors and family needs. Need to know factors responsible for an attack. Environmental responsible for an attack. Environmental control of allergies. Medication use, when control of allergies. Medication use, when to take. How often? Home peak flow to take. How often? Home peak flow monitoring.monitoring.

What to do if symptoms worsen? What What to do if symptoms worsen? What medications to add or increase? Develop medications to add or increase? Develop a written action plan with child and family a written action plan with child and family to cover these issues.to cover these issues.

Have proper supply of medications at Have proper supply of medications at home, school, or setting where child home, school, or setting where child attends.attends.

Goal of therapy is to maintain normal Goal of therapy is to maintain normal activity. activity.