What You Should Know About Asthma

1. What You Should Know About Asthma

2. Asthma is a Major Public Health Problem • Nearly 5 million children have asthma • It is one of the most common chronic childhood illnesses • It is a leading cause of school absences

3. In a classroom of 30 children, 2 or more children are likely to have asthma

4. What is Asthma? A disease that: • Is chronic • Produces recurring episodes of breathing problems • Coughing • Wheezing • Chest tightness • Shortness of breath • Cannot be cured, but can be controlled

5. What are the Symptoms of Asthma? • Shortness of breath • Wheezing • Tightness in the chest • Coughing at night or after physical activity; cough that lasts more than a week • Waking at night with asthma symptoms (a key marker of uncontrolled asthma)

6. What’s Happening in the Lungs with Asthma? • The lining of the airways becomes swollen (inflamed) • The airways produce a thick mucus • The muscles around the airways tighten and make airways narrower

7. What Makes Asthma Worse? • Allergens • Warm-blooded pets (including dogs, cats, birds, and small rodents) • House dust mites • Cockroaches • Pollens from grass and trees • Molds (indoors and outdoors)

8. What Makes Asthma Worse? (cont.) • Irritants • Cigarette smoke and wood smoke • Scented products such as hair spray, cosmetics, and cleaning products • Strong odors from fresh paint or cooking • Automobile fumes and air pollution • Chemicals such as pesticides and lawn treatments

9. What Makes Asthma Worse? (cont.) • Infections in the upper airways, such as colds (a common trigger for both children and adults) • Exercise • Strong expressions of feelings (crying, laughing) • Changes in weather and temperature

10. Is There A Cure For Asthma? Asthma cannot be cured, but it can be controlled. You should expect nothing less.

11. How Is Asthma Controlled? • Follow an individualized asthma management plan • Avoid or control exposure to things that make asthma worse • Use medication appropriately • Long-term-control medicine • Quick-relief medicine

12. How Is Asthma Controlled? (cont.) • Monitor response to treatment • Symptoms • Peak flow • Get regular follow-up care

13. Classification of Asthma Severity: Clinical Features Before Treatment Days with Nights with PEF % of personal symptoms symptoms best peak flow Step 4 Severe persistent Continual Frequent <= 60% Step 3 Moderate Daily >= 5 times per month >60% - < 80% persistent Step 2 Mild persistent 3-6 times per 3-4 times per month >= 80% week Step 1 Mild intermittent <= 2 times per <= 2 times per month >= 80% week

14. Using a Peak Flow Meter • A peak flow meter is a useful tool for objectively measuring the severity of asthma • The value obtained is called a peak expiratory flow rate (PEFR) • The PEFR shows the degree of airway obstruction or narrowing

15. Determining a “Personal Best” Value • Each person has a normal PEFR based on height and gender. This is a predicted value. • Many physicians prefer to use the person’s “personal best” value • The “personal best” represents the highest rate obtained over a specific period of time.

16. Correct Technique for Using a Peak Flow Meter • Place indicator at the base of the numbered scale • Stand up • Take a deep breath • Place the meter in the mouth and close lips around the mouthpiece • Blow out as hard and fast as possible • Write down the achieved value • Repeat the process two more times • Record the highest of the 3 numbers achieved

17. Long-term Controllers Used to control and prevent asthma symptoms Must be taken daily Quick-Relief Provides quick relief of an acute asthma episode by opening up the bronchioles Used as needed for symptoms and before exercise Asthma Medications

18. Long Term Controller Medications • Control and prevent asthma symptoms • Make airways less sensitive to triggers and prevent inflammation that leads to an acute asthma episode • Taken on a daily basis

19. Types of Long Term Controller Medications Brand names are listed as examples only, and are not inclusive. • Inhaled corticosteroids - Flovent®, Pulmicort®, QVAR®, Azmacort®, Aerobid®, Pulmicort Respules® (only nebulized form), Vanceril ®, Beclovent ®. Preferred therapy for persistent asthma. • Long acting bronchodilators - Serevent®, Foradil®.

20. Types of Long Term Controller Medications (cont.) Brand names listed as examples only, and are not inclusive. • Combination inhaled corticosteroids/long-acting brochodilator - Advair® • Leukotriene modifiers - Singulair®, Accolate®. A pill, not an inhaler, not a steroid • Inhaled nonsteroid anti-inflammatory medications - Intal®, Tilade® • Oral steroids

21. Quick Relief Medications Provide relief of an acute asthma episode • Short acting inhaled bronchodilators - albuterol, pirbuterol (Maxair®) • Oral prednisone burst, when albuterol alone is not effective

22. Using a Metered Dose Inhaler(MDI) MDIs deliver asthma medication directly to the lungs. To use: • Remove the cap and hold inhaler upright • Shake the inhaler • Keep the head and neck in a neutral position and breathe out • Position the inhaler in one of the following ways: • Open mouth and hold inhaler 1-2 inches away • Use holding chamber (recommended for young children) • Put in the mouth

23. Using a MDI (cont) • Press down on inhaler to release medication as you start to breathe in • Breathe in slowly (3 to 5 seconds) • Hold breath for 10 seconds to allow medicine to reach deeply into lungs • Repeat puffs as directed

24. Rules of 2™ When do you need more than a rescue bronchodilator? • Do you take your quick relief inhaler more than 2 times per week? • Do you awaken at night with asthma more than 2 times per month? • Do you refill your quick relief inhaler more than 2 times per year? If the answer to these questions is yes, a long term controller anti-inflammatory medication may be needed.

25. How are Asthma Episodes Controlled? • Know the signs that asthma is worsening • Treat symptoms or drop in peak flow at first signs of worsening • Monitor response to therapy • Seek a doctor’s help when it is needed

26. Exercise-induced Asthma (EIA) • Symptoms include coughing, wheezing, chest tightness, or shortness of breath • Usually begins during exercise and peaks 5-10 minutes after stopping exercise • May occur more easily on cold, dry days than on hot, humid days • Children may need treatment before exercise, even when asthma is well-controlled.

27. EIA (cont.) Asthma should not be an excuse to not participate in physical education, sports, or exercise • Develop an asthma management plan that will allow the child to participate in any activity they wish • Appropriate long-term control therapy can reduce the frequency and severity of exercise-induced symptoms • Make it easy to take medications before exercise • If full activity is not possible, modify • A warm up period before exercise may help

28. What Should People with Asthma Be Able To Do? • Be active without having asthma symptoms; this includes participating in exercise and sports • Sleep through the night without having asthma symptoms • Prevent asthma episodes (attacks) • Have the best possible lung function (e.g., good peak flow number) • Avoid side effects from asthma medicines

29. Additional Resources • Allergy & Asthma Network/Mothers of Asthmatics, Inc. -- http://www.aanma.org • American Academy of Allergy, Asthma, and Immunology -- http://www.aaaai.org • American Academy of Pediatrics -- http://www.aap.org • American College of Allergy, Asthma, and Immunology -- http://www.allergy.mcg.edu • American Association of Respiratory Care -- http://www.aarc.org

30. Additional Resources • American Lung Association -- http://www.lungusa.org • Asthma & Allergy Foundation of America -- http://www.aafa.org/home • National Asthma Education and Prevention Program -- http://www.nhlbi.nih.gov • US Environmental Protection Agency -- http://www.epa.gov/iaq • Centers for Disease Control and Prevention -- http://www.cdc.gov/nceh/airpollution/asthma • Asthma and Schools -- http://www.asthmaandschools.org