Asthma Management Update
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Transcript of Asthma Management Update
Asthma Management Update
Lisa Musso, ARNP, MN, CPNP Division of Pediatric Pulmonary Medicine
Children’s Hospital and Regional Medical Center
Objectives:Upon completion of this session, participants
will be able to:Describe three changes that asthma causes in the airwayIdentify two types of medicine used to treat asthmaList three typical asthma triggers and ways of minimizing their effect
Asthma Management Update
Overview:
Airway Changes in Asthma
How is Asthma Managed - Medications, Trigger Management
Asthma Management Plan - Working with the Parent and Health Care Provider
Triggers
Trigger Management
Asthma Management Update
What is Asthma?
Definition of Asthma:
Lung disease characterized by; reversible airway obstructionairway inflammation increased airway responsiveness
Airway Changes:
Physiologic response inflammationbronchoconstrictionhypersecretion of mucusAll lead to airway plugging, hyperinflation
and atelectasis.
Pathophysiology
Airways in Untreated Asthma
Airways After Administration of a Bronchodilator
Airways After Addition of an Inhaled Corticosteroid
Mild Intermittentdays with symptoms: < 2/weeknights with symptoms: < 2/monthFEV1 or PEF: > 80%
Asthma Severity
Mild Persistentdays with symptoms: >2/weeknights with symptoms: 3 - 4/monthFEV1 or PEF: > 80%
Asthma Severity
Quick review of asthma severity
Moderate persistentdays with symptoms: dailynights with symptoms: > 5/monthFEV1 or PEF . 60% to <80%
Asthma Severity
Quick review of asthma severity
Severe persistentdays with symptoms: continualnights with symptoms: frequentFEV1 or PEF: < 60%
Asthma Severity
Severity Daytime Symptoms
Nighttime Symptoms
Lung Functions
Comparison of Asthma Severity Levels
Mild Intermittent
Less than or equal to 2 times per week
Less than 2 times per month
FEV1 or PEF of greater than or equal to 80% Variability < 20%
Mild Persistent 3-6 times per week
3-4 times per month
FEV1 or PEF of greater than or equal to 80% Variability of 20-30%
Moderate Persistent
Daily symptoms Greater than or equal to 5 times per month
FEV1 or PEF 60-80% Variability > 30%
Severe Persistent
Continual symptoms
Greater than 5 times per month
FEV1 or PEF less than 60%Variability > 30%
Triggers
Viral infections
Cigarette smoke
Pets
Exercise
Strong emotion
Strong odors
Heart burn
GE Reflux
Seasonal allergiesDust mitesMoldCold weatherChange in weatherAir pollutionWood burning stovesAspirin Sensitivity
Upper Respiratory infections
Viral or bacterial
“colds”
ear aches
sinus
“flu”
Infections
Smoke
Active smoking
Passive smoking
Inside/outside home
Inside/outside car
Animals
Furry, hairyShedding
CatsDogsBirdsRabbits, hamsters, guinea pigs,rats
To Run and Play
ExerciseHow much is too muchRecessGymTeam Sports
Laughing
Crying
Stress
Anger
Anxious
Scared
To laugh or cry
Things that Smell
Perfume/cologne
Incense
Wood burning stoves
Paint
Cleaning products
Hair products
Foods
dust mites
animal dander
molds, mildew, fungi
pollens—grass, trees, weeds
cockroaches
Allergens
Cold or Warm Air – Weather Changes
Cold air versus warm air
To exercise or not
Weather changes
Prevention Strategies
Infections
Prevention Good hand washing Use of tissues Cleaning of school areas Cleaning of toys Sharing of school supplies, equipment, toys Staying at home Completion of course of medication if given
Controlling environmental tobacco smoke:
smoke-free child care environment
smoke-free vehicle
quit smoking
smoke outside wearing “smoking jacket”
Tobacco Smoke
Controlling animal dander:
keep cats, dogs, and other furry animals out of children’s area
replace w/non furred or feathered animals
Animal Dander
Controlling molds, mildews and fungi:
locate and remove mold growth
check walls, floors, window molding, ceiling, under carpet
don’t lay carpet on cement
prevent growth w/ good ventilation
Molds
Controlling cockroaches:restrict where food is eatenclean up after food preparationdo not leave out pet food overnightcover trash binsdon’t store paper products/ bottles at floor levelrepair cracks, holes in foundation, plumbing, wallsfix leaky faucets
Roaches
Controlling pollen exposure:minimize outdoor activity on high pollen
daysclose windows and doors on high pollen daysrun air conditioningallergy medicine as directed by
parent/provider
Pollens
Controlling dust mites:
cover mattresses and pillows
minimize stuffed animals
remove upholstered furniture
vacuum frequently w/children absent
maintain humidity @ about 40%
filters over heating ducts
washable rugs instead of carpets
Allergy Control
Controlling exposure to air pollution/ozone:
Minimize outside activity on high pollution days
avoid ozone-generating air cleaners
Air Pollution
Controlling exposure to fumes/sprays/strong odors:avoid aerosol spraysavoid strong “clean” smelling spraysavoid perfumes, after shave, candles,
potpourri, incenseclean with weak bleach solution and let air dry (see handout)
Odors---the good and the bad
Dealing with exercise-induced asthma:
pre-treat as directed by parent/ provider
Cover mouth and nose
warm up before strenuous exercise
rest periods
minimize outdoor activity if high level of triggers are present
Exercise
Drop in peak flowcoughwheezecold symptomschest tightnessdifficulty breathing
Fast breathing
shortness of breath
restlessness
poor appetite
headache
dark circles
Triggers
Controller Cromolyn sodium Nedocromil sodium Inhaled Corticosteroids Leukotriene modifiers Long acting Beta 2 Sustained released
theophylline Nebulized steroids
Rescue Short acting Beta 2 Oral steroids (short
burst)
Medications
Nebulizersmetered dose inhaler (MDI)
spacer /spacer with maskdiskhaler
AerolizersTurbohaler
dry powder inhalertabletsliquids
Gadgets and Gizmos
Peak Flow Meters
What do they really tell you? If asthma is worsening If asthma is better or worse If medications is helpingAre you really having an asthma attack
Peak Flow Meters
Who should use one?Moderate to severe asthmaticsPoor perceivers of severity of symptomsNewly diagnosedHistory of severe exacerbationsExercised Induced Asthmatics
Peak Flow Zones
Green
80% of predicted
No asthma symptoms
No night time cough
Normal activities
No need for rescue medications
Take controller medications daily
Have rescue medications handy
Yellow
50 - 80% of predicted
Having some asthma symptoms
Drop in peak flow
Take controller medications
Use rescue medications
Monitor for improvementRed
Less than 50% of predicted
Increased asthma symptoms
Drop in peak flow
Poor or no response to rescue medications
Take controller medications daily
Have rescue medications handy
Zones Signs and Symptoms Plan
Definition:an written educational tool or plan which
describes daily management and how to handle asthma episodes/excerbations
Asthma Management Plans
Known Asthma
Symptoms
ASTHMA MANAGEMENT PLAN Name__________________________________________Drug Allergies__________________________ Weight________
Green Zone: Go No symptoms of an asthma episode (no
coughing, no wheezing, no shortness of breath, no nighttime awakenings)
Able to do usual activities, run, play, attend school. Usual medications control asthma
Peak Flow 80% of personal best PFM________to________
Plan A: Take these preventative medicines all the time:Controller/Preventative Medicine How delivered How much How often
15-20 minutes before sports/exercising take:
Yellow Zone: Caution Increased asthma symptoms,
increased coughing, wheezing, work of breathing, shortness of breath, retractions, awakening at night
Usual activities somewhat limited, unable to run, play, attend school as can normally
Increased need for asthma medication Peak Flow 50-80% of personal best PFM__________to__________
Plan B: Continue Plan A and add these quick relief medicines:Short-Acting 2 Medicine How delivered How much How often
If you feel better after taking this medication: Go back to your Green Zone medications and recheck every 4 hours for continued improvement or worsening of asthma symptoms. If you DO NOT feel better in 20 to 60 minutes or if you need Albuterol every 4 hours then Follow the RED ZONE Plan.
Red Zone: DANGER Very short of breath, coughing and
wheezing that won’t stop Usual activities severely limited, can’t walk,
run, play, sleep or need to sleep upright Asthma symptoms have not gone away or
return quickly (less than 4 hours) despite using asthma medications
Can’t talk in complete sentences, ribs show with each breath
Peak Flow less than 50% of personal best PFM less than ______________
Plan C: This is a Danger Zone! Take these medicines immediately!Short-Acting 2 Medicine How delivered How much How often
Oral steroid dose
Next, call your own physician for further instructions.BUT, see the doctor RIGHT AWAY or go to the hospital if ANY of these things are happening: • Lips or fingernails are blue or gray, or • You are struggling to breathe, or • You do not feel any better 20 to 30 minutes after taking the extra medicine.
FOR SCHOOL AND CHILD CARE MEDICATION PERMISSION: This patient has been instructed in the proper way to take his/her medications. He/she is capable of self-administering medications: ___Yes ___NoHe/she can reliably report asthma symptoms: ___Yes ___NoHealth Care Provider’s Signature___________________________________________Date_________________
PARENT SIGNATURE ________________________________________________
Date signed_________________________
Known Asthma Triggers
Asthma Management
Plan
ASTHMA DISEASE
MANAGEMENT PROGRAM
respiratory infection
animals (specify)_______
foods (specify) ________
cigarette smoke
pollens/mold
temperature changes
strong odors or fumes
exercise
wood smoke
dust/chalk dust
other ________________
coughing
wheezing
shortness of breath
tightness in chest
other______________
No coughing
No difficulty breathing
No waking at night
Normal activities
No acute episodes that require PCP visit, ER or hospitalizationNo absences from school or workNormal ( or near normal) lung function
What does this mean in real life?
Summary
Asthma is a chronic diseaseIt is controllable, some exacerbations sometimes can be preventedDifferent medications treat the different phases of asthmaAsthma Management Plans really do helpSchool Nurses do a great job!
Questions
References
Helpful Web Resourceshttp://www.ginasthma.comhttp://www.guidelines.govhttp://nhlbi.nih.govhttp://lungusa.org