A PLAN TO IMPROVE ASTHMA CARE
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Transcript of A PLAN TO IMPROVE ASTHMA CARE
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
A PLAN TO IMPROVEASTHMA CARE
Barbara Mc Donagh RN
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
OBJECTIVESASTHMA OVERVIEWASTHMA STATISTICS
PURPOSE OF PEAK FLOW MONITORINGSIGNS & SYMPTOMS OF EXACERBATION
ASTHMA ACTION PLANASTHMA MEDICATIONS
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
PURPOSEIMPROVE ASTHMA CARE
PROMOTE SELF-MANAGEMENT
FOSTER TEAM-BASED PARTNERSHIP
EMERGENCY ROOM VISITS
FRAGMENTED CARE
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMACHRONIC DISEASE
AIRWAY INFLAMMATION
INTERMITTENT AIRFLOW OBSTRUCTION
BRONCHIAL HYPERRESPONSIVENESS
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMA STATISTICS (CDC,2012) 24 MILLION PEOPLE
MOST COMMON CHRONIC DISEASE IN CHILDHOOD
1.9 MILLION EMERGENCY VISITS
475,000 HOSPITALIZATIONS
$56 BILLION
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
PATIENT POPULATION AFFECTED (CDC, 2012)
MORE BOYS THAN GIRLS
MORE WOMEN THAN MEN
WOMEN ACCOUNT FOR 2/3 OF ALL DEATHS DUE TO ASTHMA
AFRICAN AMERICAN & HISPANIC
LOWER SOCIO-ECONOMIC
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
PATIENT POPULATION AFFECTED (CDC,2012)
AFRICAN AMERICAN WOMEN HAVE HIGHEST MORTALITY RATE
3,388 PEOPLE DIED FROM ASTHMA
AFRICAN AMERICANS ARE 2-3 TIMES MORE LIKELY TO DIE FROM ASTHMA
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ETHIOLOGY & RISK FACTORSFAMILY HISTORY
ENVIRONMENTAL ALLERGENS
VIRAL EXPOSURE
ECZEMA/ ATOPIC DERMATITIS
OBESITY
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
SIGNS & SYMPTOMSEXACERBATION
WHEEZING
COUGHING
SHORTNESS OF BREATH
CHEST TIGHTNESS/PAIN
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMA TRIGGERS
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMA EXACERBATIONTRIGGERS
ALLERGENS/IRRITANTS TOBACCO SMOKEURI’sAIR POLLUTIONEXERCISEOCCUPATIONAL HAZARDSSINUSITISDRUG USE
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMACLASSIFICATION (NHLBI,2007)
INTERMITTENT 2 DAYS/WEEK 2NIGHTS/MONTH
MILD PERSISTENT >2 DAYS/WEEK 3-4NIGHTS/MONTH
MODERATE PERSISTENT DAILY/> 1NIGHT/WEEK
SEVERE PERSISTENT SEVERAL TIMES/DAY & 7 NIGHTS/WEEK
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
GOAL OF ASTHMA CARECONTROL
Symptoms ≤ 2Days/Week
Nighttime ≤ 2 x/Month
Albuterol Use ≤ 2 Days/Week
Peak Flow ≥ 80% Personal Best
Perform Daily Activities
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
PEAK EXPIRATORY FLOW (PEF)DECREASE IN NUMBER BEFORE WORSENING
SYMPTOMSOBJECTIVE DATA ON ASTHMA CONTROL
POOR PERCEPTION OF SYMPTOMS
DETERMINE EFFECTIVENESS OF ASTHMA
MANAGEMENT/TREATMENT PLAN
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
Peak Expiratory Flow (PEF)MONITOR PEAK FLOW OVER 2 WEEKS TO DETERMINE ‘PERSONAL BEST’
PERFORM STANDING
RECORD HIGHEST OF 3 READINGS
NORMAL PEAK FLOW CAN VARY UP TO 20%
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
PEAK EXPIRATORY FLOWPersonal Best = 300
Green Zone80%-100%
No Symptoms
Yellow Zone51%-79%
Symptoms 2-3 days
Red Zone< 50%
NO IMPROVEMENT
= 240 - 300
= 150 – 240Rescue Inhaler 4-6hrsStart Prednisone TabsED if no Improvement
<150 Continue Above
Worse go to ED/9-1-1LIFE THREATENING
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMA ACTION PLANProvider & Patient
WRITTEN PLAN THAT ADDRESSES:Daily Inhalers & Medications Avoid Triggers – Molds/AnimalsWhat to do When Asthma Symptoms Get Worse / Peak Flow DecreasesIncrease ICSStart Prednisone BurstSeek Emergency Care
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
MEDICATIONSRESCUE/RELIEF
Albuterol ProventilVentolinProAir
CONTROLLERQvar
SymbicortSpiriva
SereventPulmicortXolair Inj
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
CONTROLLER MEDICATIONSQVAR
Inhaled Corticosteroid (ICS)SEREVENT DISKUS
Long- Acting Beta BronchodilatorSYMBICORT
Combination InhalerSPIRIVA
Long-Acting AntiChol Brochodilator
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMA PATIENTSELF-MANAGEMENT
Barriers Cultural/Language/LiteracyRescue V ControllerTaking Inhalers as Prescribed BidUsing Aerochamber Peak Flow MonitoringAsthma Action PlanAvoid/Minimize Allergen Triggers
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMA PATIENT CLINIC VISIT
Recent ED Visits
Prednisone Use
Increased Asthma SymptomsIncreased Proventil Use
Smoking / Asthma Triggers
Influenza & Pneumonia Vaccines
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
CARE MANAGEMENT
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
REFERRAL TO ASTHMA SPECIALTY
AEROALLERGEN SKIN TEST
SPIROMETRY
ADMINISTER XOLAIR INJECTIONS
>2 ED VISITS/YEAR / INTUBATIONS
ADDITIONAL TEACHING
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ED VISITS OVER PAST YEARANY ADMISSIONSANY INTUBATIONSPREDNISONE USE BURST/DAILY USECURRENT SYMPTOMS –COUGHING- DAYTIME OR
NIGHTIME/WHEEZING/ SOB/CHEST TIGHTNESS/PAINMEDICATIONS - CONTROLLER/ RESCUEKNOWS DIFFERENCEUSES INHALERS AS PRESCRIBEDMONITORS PEAK FLOWKNOWS ASTHMA TRIGGERS USES SPACER
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ADDITIONAL ASTHMARESOURCES
Asthma Action Planswww.nhlbi.nih.gov/health/public/lung/asthma/
asthma_actplan.htm
Asthma Care Evidence-Based Guidelineswww.nhlbi.nih.gov/guidelines/archives/epr-2/
athmafullrpt_archive.pdf
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ADDITIONAL ASTHMARESOURCES
Peak Flow Monitoring & Self-Managementwww.lung.org/lung-disease/asthma/taking -
control-of-asthma/create-an-asthma-management-plan.html
Free Asthma Educational Handoutswww.cdc.gov/asthma/faqs.html
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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
REFERENCESCDC. (2012). Asthma's Impact on the Nation.
Retrieved from http://www.cdc.gov/asthma/impacts_nation
/default.htm
NHLBI. (2007). Guidelines for the Diagnosis and Management of Asthma (EPR-3).
Retrieved from https://www.nhlbi.nih.gov/guidelines/asthm
a/