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Asthma

Asthma. Presented by: Healthy Start in Child Care Lexington-Fayette County Health Department. What is Asthma. A condition which affects the “breathing tubes” (the airways for bronchi) of lungs

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Asthma

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  1. Asthma Presented by: Healthy Start in Child Care Lexington-Fayette County Health Department

  2. What 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

  3. Mild intermittent - On/off symptoms less than 2x wk Mild persistent -Symptoms more than 2x wk Moderate persistent - Symptoms daily Severe persistent - Continuous symptoms Types of Asthma

  4. Asthma 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

  5. Asthma Statistics • Affects more than 20 million Americans • Over 35% (5 million) are children • Incidence increasing • Medical bills $600 higher a year for asthmatic children

  6. Why some children get Asthma • 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

  7. Symptoms • Coughing • Shortness of breath • Chest tightness • Wheezing • Irritable/fussy • Fatigue

  8. Recognizing a severe asthma 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

  9. What to do for a severe 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

  10. Triggers • Infections • Exercise • Weather • Strong Emotions • Allergens • Aspirin • Irritants

  11. 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 Illness

  12. Exercise • Overexertion • Running upstairs • Carrying heavy loads • Jogging • Playing team sports • Reducing Risk • Premedicate (if prescribed by MD) • Encourage exercise

  13. Weather • 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

  14. Strong Emotions • Examples • Laughing • Crying • Yelling • Fear • Reducing Risk • Comforting child • Know what helps child gain control

  15. Allergens • Cockroaches • Dust mites • Pollen • Mold spores • Pet dander • Cigarettes

  16. Cockroaches • Droppings • Cockroaches love: • Warmth • Food • Water • Newspapers • Paper/Grocery bags • Garbage What would you do to reduce the incidence in your center?

  17. Dust 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?

  18. Pollen • Early Spring: Trees • Late Spring & Early Summer: Grasses • Late Summer & Fall: Weeds What would you do to reduce the incidence in your center?

  19. Mold • Dark damp places • Basements, attics, bathrooms, insulation, and refrigerators What would you do to reduce the incidence in your center?

  20. Pet Dander • Avoid furry/feathered pets • MUST: • Keep pet out of bedroom • Brush and bathe pet weekly • Launder pet beds weekly • Dust and vacuum weekly

  21. Cigarette Smoke • Don’t smoke while pregnant • Don’t smoke around children What would you do to reduce the incidence in your center?

  22. NSAID’s: Aspirin, Motrin, Tylenol cause attacks in 1/3 of asthmatic children

  23. Irritants • Tobacco smoke • Fireplace smoke • Cleaning agents • Chemical fumes • Perfumes What would you do to reduce the incidence in your center?

  24. Treatments • Pills • Inhalers and spacers • Nebulizers

  25. Goals 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

  26. Rule of 2’s • Awakened by wheezing/coughing 2 x’s a night • Use inhaled rescue med 2 x’s a week • Use up 2 rescue inhalers a month • Seek urgent care 2 x’s a year = Poor Asthma Control

  27. Long-Term Medicines • 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)

  28. Quick Relief Medicines • Relieve asthma attack • Use only as needed or before exercise • Bronchodilators • Open airways

  29. Asthma Meds • Anti-inflammatory drugs - Corticosteroids - Mast cell stabilizers - Leukotriene Modifiers • Bronchodilators -Long-acting - Short-acting

  30. Meds Contd. • Monoclonal antibody Xolair – new drug approved in 2003 for adults and teens. Given by injection 1-2 times a month

  31. Corticosteroids • Inhaled or pill (Flovent or Prednisone) • Most effective • Prevent symptoms • Take every day • Are steroids that are anti-inflammatory • Reduce mucus and swelling • Lead to better asthma control

  32. Mast Cell Stabilizers • Decrease inflammation caused by allergies • Help prevent wheezing and EIA • More effective in children • Are not appropriate for acute asthma symptoms

  33. Leukotriene Modifiers • Are fairly new, in pill form • Prevent inflammation caused by allergies • Prevent wheezing & EIA • May use as adjunct therapy for chronic asthma • Decrease need for short acting bronchodilators

  34. Bronchodilators • Relax muscle bands that tighten around the airways • Clear mucus from lungs • MD will add if Sx aren’t completely controlled by inhaled corticosteroids • Short acting – relieve acute Sx & prevent exercise induced bronchospasm • Long acting – help control asthma Sx & prevent attacks. Provide control, not quick relief

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

  36. Meter Dose Inhalers • Must use correctly!!! • 1st exhale completely then press inhaler and inhale. • DEMO

  37. WrongWay Do Not Put Inhaler In Mouth!

  38. Right Way Place 3 fingers in front of mouth and place inhaler at that point

  39. Holding Chambers & Spacers Spacers, allow medicine to be released through valve Holding chamber just hold med

  40. Cleaning 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

  41. Dry Powder Inhalers

  42. Nebulizers • 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.

  43. Possible side effects of treatments • 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)

  44. Possible side effects of treatments (cont.) • Bronchodilators • Increase in heart rate • Tremors of hands and finger that last a few minutes • HA, insomnia, nervousness • Ex… Theophylline may cause headaches, irritability, hyperactivity, stomach aches & vomiting.

  45. Peak Flow Meters • Detect early stages of airway narrowing so you can begin therapy before it becomes more serious • Decide whether you need more medicaton • Determine when ER care is needed • See whether specific allergens or irritants make your asthma worse

  46. Peak 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)

  47. Green Zone (80-100% of personal best.) Yellow Zone (50-79% of personal best) Add quick relief measures. Red Zone (below 50% of personal best) Call M.D. NOW! Peak Flow Zones

  48. School Days • Always document • Keep records • Talk with parents daily • ER visits

  49. Helping 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

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