Asthma Presented by: Child Care Health Consultation.
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Transcript of Asthma Presented by: Child Care Health Consultation.
AsthmaAsthma
Presented by:
Child Care Health Consultation
What is AsthmaWhat 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
Types of AsthmaTypes of Asthma• Mild intermittent - On/off symptoms less
than 2x wk
• Mild persistent - Symptoms more than 2x wk
• Moderate persistent - Symptoms daily
• Severe persistent - Continuous symptoms
Asthma FactsAsthma 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
Asthma StatisticsAsthma Statistics
• Affects more than 20 million Americans
• Over 35% (5 million) are children
• Incidence increasing
• Medical bills $600 higher a year for asthmatic children
Why Why somesome children get children get AsthmaAsthma
• 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
SymptomsSymptoms
• Coughing
• Shortness of breath
• Chest tightness
• Wheezing
• Irritable/fussy
• Fatigue
Recognizing a severe Recognizing a severe asthma attackasthma 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
What to do for a What to do for a severe attacksevere 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
TriggersTriggers• Infections• Exercise• Weather• Strong Emotions• Allergens• Aspirin• Irritants
IllnessIllness
• 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
ExerciseExercise
• Overexertion– Running upstairs– Carrying heavy loads– Jogging– Playing team sports
• Reducing Risk– Premedicate (if prescribed by MD)
– Encourage exercise
WeatherWeather• 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
Strong EmotionsStrong Emotions
• Examples– Laughing– Crying– Yelling– Fear
• Reducing Risk– Comforting child– Know what helps
child gain control
AllergensAllergens
• Cockroaches • Dust mites• Pollen• Mold spores• Pet dander• Cigarettes
CockroachesCockroaches• Droppings• Cockroaches love:
– Warmth– Food– Water– Newspapers– Paper/Grocery bags– Garbage
What would you do to reduce the incidence in your center?
Dust MitesDust 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?
PollenPollen
• Early Spring: Trees
• Late Spring & Early Summer: Grasses
• Late Summer & Fall: Weeds
What would you do to reduce the incidence in your center?
MoldMold• Dark damp places• Basements, attics, bathrooms, insulation,
and refrigerators
What would you do to reduce the incidence in your center?
Pet DanderPet Dander
• Avoid furry/feathered pets
• MUST: – Keep pet out of
bedroom– Brush and bathe pet
weekly– Launder pet beds
weekly– Dust and vacuum
weekly
Cigarette SmokeCigarette Smoke
• Don’t smoke while pregnant
• Don’t smoke around children
What would you do to reduce the incidence in your center?
NSAID’s: Aspirin, NSAID’s: Aspirin, Motrin, TylenolMotrin, Tylenol
cause attacks in 1/3 of asthmatic children
IrritantsIrritants
• Tobacco smoke
• Fireplace smoke
• Cleaning agents
• Chemical fumes
• Perfumes
What would you do to reduce the incidence in your center?
TreatmentsTreatments
• Pills
• Inhalers and spacers
• Nebulizers
Goals of TreatmentGoals 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
Rule of 2’sRule of 2’s
• Awakened by wheezing/coughing 2 x’s a night Awakened by wheezing/coughing 2 x’s a night
• Use inhaled rescue med 2 x’s a week Use inhaled rescue med 2 x’s a week
• Use up 2 rescue inhalers a month Use up 2 rescue inhalers a month
• Seek urgent care 2 x’s a yearSeek urgent care 2 x’s a year
= Poor Asthma Control= Poor Asthma Control
Long-Term Long-Term MedicinesMedicines
• 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)
Quick Relief Quick Relief MedicinesMedicines
• Relieve asthma attack
• Use only as needed or before exercise
• Bronchodilators– Open airways
Asthma MedsAsthma Meds
• Anti-inflammatory drugsAnti-inflammatory drugs
- Corticosteroids- Corticosteroids
- Mast cell stabilizers- Mast cell stabilizers
- Leukotriene Modifiers- Leukotriene Modifiers
• BronchodilatorsBronchodilators
-- Long-actingLong-acting
- Short-acting- Short-acting
Meds Contd.Meds Contd.
• Monoclonal antibodyMonoclonal antibody
Xolair – new drug approved in Xolair – new drug approved in
2003 for adults and teens.2003 for adults and teens.
Given by injection 1-2 times Given by injection 1-2 times
a montha month
CorticosteroidsCorticosteroids
• Inhaled or pill (Flovent or Prednisone)Inhaled or pill (Flovent or Prednisone)
• Most effectiveMost effective
• Prevent symptomsPrevent symptoms
• Take every dayTake every day
• Are steroids that are anti-inflammatoryAre steroids that are anti-inflammatory
• Reduce mucus and swellingReduce mucus and swelling
• Lead to better asthma controlLead to better asthma control
Mast Cell StabilizersMast Cell Stabilizers
• Decrease inflammation caused by Decrease inflammation caused by allergiesallergies
• Help prevent wheezing and EIAHelp prevent wheezing and EIA
• More effective in childrenMore effective in children
• Are not appropriate for acute asthma Are not appropriate for acute asthma symptomssymptoms
Leukotriene ModifiersLeukotriene Modifiers
• Are fairly new, in pill formAre fairly new, in pill form• Prevent inflammation caused by Prevent inflammation caused by
allergiesallergies• Prevent wheezing & EIAPrevent wheezing & EIA• May use as adjunct therapy for chronic May use as adjunct therapy for chronic
asthmaasthma• Decrease need for short acting Decrease need for short acting
bronchodilatorsbronchodilators
BronchodilatorsBronchodilators• Relax muscle bands that tighten around the Relax muscle bands that tighten around the
airwaysairways• Clear mucus from lungsClear mucus from lungs• MD will add if Sx aren’t completely controlled MD will add if Sx aren’t completely controlled
by inhaled corticosteroidsby inhaled corticosteroids• Short acting – relieve acute Sx & prevent Short acting – relieve acute Sx & prevent
exercise induced bronchospasmexercise induced bronchospasm• Long acting – help control asthma Sx & Long acting – help control asthma Sx &
prevent attacks. Provide control, not quick prevent attacks. Provide control, not quick reliefrelief
FYIFYI
• If a patient is on both a bronchodilator If a patient is on both a bronchodilator and inhaled corticosteroid, pt should and inhaled corticosteroid, pt should take bronchodilator first and then the take bronchodilator first and then the inhaled steroid. This will open the inhaled steroid. This will open the airways quickly and help deposit the airways quickly and help deposit the drug deeper into the airways.drug deeper into the airways.
Meter Dose Inhalers
• Must use correctly!!!
• 1st exhale completely then press inhaler and inhale.
• DEMO
WrongWrong WayWay
Do Not Put Inhaler In
Mouth!
RightRight Way Way
Place 3 fingers in front of mouth and place inhaler at that point
Holding Chambers & SpacersHolding Chambers & Spacers
Spacers, allow medicine to be
released through valve
Holding chamber just hold med
Cleaning and UseCleaning 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
Dry Powder Dry Powder InhalersInhalers
NebulizersNebulizers• 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.
Possible side effects of Possible side effects of treatmentstreatments
• 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)
Possible side effects of Possible side effects of treatments (cont.)treatments (cont.)
• Bronchodilators
– Increase in heart rate– Tremors of hands and finger that last
a few minutes
– HA, insomnia, nervousnessHA, insomnia, nervousness– Ex… Theophylline may cause
headaches, irritability, hyperactivity, stomach aches & vomiting.
Peak Flow MetersPeak Flow Meters• Detect early stages of airway narrowing Detect early stages of airway narrowing
so you can begin therapy before it so you can begin therapy before it becomes more seriousbecomes more serious
• Decide whether you need more Decide whether you need more medicatonmedicaton
• Determine when ER care is neededDetermine when ER care is needed• See whether specific allergens or See whether specific allergens or
irritants make your asthma worseirritants make your asthma worse
Peak Flow MetersPeak 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)
Peak Flow ZonesPeak Flow Zones
• Green Zone (80-100% of personal best.)
• Yellow Zone (50-Yellow Zone (50-79% of personal 79% of personal best) best) – Add quick relief Add quick relief
measures.measures.
• Red Zone (below 50% of personal best) – Call M.D. NOW!
School DaysSchool Days• Always document
• Keep records
• Talk with parents daily
• ER visits
Helping Parents CopeHelping 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
QuestionsQuestions• Can asthmatic children play sports?
• Can asthma attacks be handled at school?
• Is asthma a lifelong problem?
• Will moving to a new climate help?
Child Care Health Child Care Health ConsultationConsultation
The End!Thanks to:
Shannon Dunn, RN Carol Daniel, RN