Understanding Asthma

Understanding Asthma Charles S. Williams RRT, AE-C

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What is Asthma? ? ?

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Asthma is a chronic lung disease that affects a person's airways and makes it difficult for them to breathe.

Cartilage Muscle layer

Mucus Gland

Reduced airway opening

Extra Mucus

Swelling inside of airway

Tightened muscle

There are

3

Alveoli filled with trapped air

things that happen during an asthma flare-up:

 Inflammation  Bronchoconstriction  Extra Mucus

During an asthma flare-up, you may have:

cough

cough wheeze

•Coughing •Wheezing •Shortness of Breath •Chest Pain •Chest Tightness

wheeze

It may feel as if you are breathing through a straw or as if someone were sitting on top of your chest!

Remember: Your asthma is always there, even when you feel fine and don’t have any symptoms. Asthma cannot be cured, but it can be controlled. You should expect nothing less!

Asthma is one of the most common chronic diseases in children.

Asthma affects 20 million people in the United States and about 300 million worldwide.

Every year, children miss about 14 million school days due to asthma.

Source: Asthma and Allergy Foundation of America

Asthma is more common than you might think.

Asthma is more common than you might think.

Source: Asthma and Allergy Foundation of America

Risk Factors For Development of Asthma:

Family history of asthma Atopic dermatitis (eczema) 40% to 50% of children with eczema usually develop asthma

Frequent respiratory infections as a child Exposure to secondhand smoke Living in an area a lot of air pollution. Low birth weight

No one knows for sure why some people develop asthma and allergies and why some don’t. We do know that asthma does run in families, along with other allergic diseases such as hives, eczema, hay fever, etc.

Question:

What 3 things happen during an asthma flare-up?

Question:

What 3 things happen during an asthma flare-up? Answer:  Inflammation  Bronchoconstriction  Extra mucus

True or False: Children with eczema are at a higher risk for developing asthma.

True or False: Children with eczema are at a higher risk for developing asthma. Answer:  True 40% to 50% of children with eczema, also develop asthma.

Does asthma tend to run in families?

Does asthma tend to run in families? Answer:  Yes, it does. Along with other allergic diseases such as hives, eczema and hay fever.

Asthma Triggers

The things that cause asthma flare-ups and symptoms are known as asthma “triggers”. Triggers can be many different things such as pets, cigarette smoke, stress, or catching a cold.

Triggers vary from person to person

Dust mites

Cockroaches

Mold

Pollen

*Pollen can come from flowers, trees, grass or weeds.

Common Allergens

Animals

Cats & Dogs

Horses

Rabbits

*Cats are the most common cause of pet allergies. Approx. 10 million people in the United States are allergic to cats.

Hamsters & Guinea Pigs

Smoke

Strong Odors

Air Pollution

Chalk Dust

*Strong odors can include cleaning products, hairsprays, deodorants, and air fresheners.

Irritants

Other triggers

Cold Air

Catching a cold or the flu

Emotional Stress

*The most common cause of asthma flare-ups, in children under the age of 3, is catching a cold.

Exercise

Some people with asthma are sensitive to certain medications. Beta Blockers & Aspirin and NSAIDS (Nonsteroidal anti-inflammatory drugs)

NSAIDS include: Ibuprofen (Advil®, Motrin®, Nuprin®) Naproxen (Aleve®, Naprosyn®)

Sulfites are common preservatives used in various foods and medications. Including: fruit juices, ciders, dried fruits and vegetables, beer & wine.

Sulfites can increase symptoms in some people with asthma, particularly in adults with severe asthma.

Question: What do we call the things that cause asthma flare-ups and symptoms?

Question: What do we call the things that cause asthma flare-ups and symptoms?

Answer:  They are called “triggers”

Question: What is the most common cause of asthma flare-ups in children under the age of 3?

Question: What is the most common cause of asthma flare-ups in children under the age of 3? Answer:  Catching a cold

Question: Someone with asthma should be careful when using which medication? Antibiotics

Aspirin

Tylenol®

Question: Someone with asthma should be careful when using which medication? Antibiotics

Aspirin

Answer: Aspirin

Tylenol®

Asthma Medications

People with asthma can help manage and control their asthma by taking medication.

Asthma medications can be taken with a nebulizer or a metered dose inhaler. Some asthma medications are taken as pills or by injection.

There are

2

main types of asthma medications:

 Rescue

(Fast-acting or quick relief)

 Long-Term Controllers

Rescue medication (Short-acting bronchodilators)

 Works fast!  Used to relieve sudden symptoms  Not for long-term control

The most common rescue medication used to treat asthma is Albuterol® Also available as:

Proventil® Ventolin®

ProAir® Albuterol relaxes the muscles that cause bronchoconstriction.

Other rescue inhalers available: Xopenex® & Maxair®

Anticholerginics are another type of bronchodilator medication. Available as:

Atrovent®

Combivent®

Spiriva®

(Atrovent + Albuterol)

They work differently than Albuterol .

These are not normally prescribed for asthma, but your doctor may include them to help treat asthma symptoms.

Long-Term Controllers

 Not used for quick-relief

 Used to prevent symptoms and flare-ups  Must be taken every day!

There are lots of different long-term controller medications. The most common are:  Corticosteroids  Long-acting bronchodilators  Leukotriene modifiers

Corticosteroids Not the same kind of steroids used by body builders (anabolic) Mimics the effects of cortisol. (A steroid hormone produced by the body.)

They work by reducing the swelling (inflammation), inside of the airways.

Corticosteroids are the most potent and effective long-term controller medications for asthma.

Caution:

*Repeated use of high dosage corticosteroids (systemic), can have a lot of potential side effects.

Increased appetite Weight gain Deposits of fat in chest, face, upper back, and stomach Water and salt retention Swelling and edema High blood pressure Diabetes Black and blue marks Slowed healing of wounds Osteoporosis Cataracts Acne Muscle weakness Thinning of the skin Increased susceptibility to infection Stomach ulcers Increased sweating Mood swings Psychological problems

Potential side effects from repeated use of high dosage corticosteroids.

A major goal for someone with asthma should be to avoid the need for systemic steroids, such as Prednisone®, Pediapred®, and Solumedrol®, as much as possible.

A major goal for someone with asthma should be to avoid the need for systemic steroids, such as Prednisone®, Pediapred®, and Solumedrol®, as much as possible. That’s where inhaled steroids come in!

Inhaled steroids vs. Systemic steroids

Inhaled steroids vs. Systemic steroids  Inhaled steroids are given in micrograms (mcg), systemic steroids are given in milligrams (mg).

1000 mcg = 1 mg

Inhaled steroids vs. Systemic steroids  Inhaled steroids are given in micrograms (mcg), systemic steroids are given in

1000 mcg = 1 mg  Inhaled steroids are deposited directly to the airways. milligrams (mg).

(Systemic steroids affect your entire body)

Inhaled steroids vs. Systemic steroids  Inhaled steroids are given in micrograms (mcg), systemic steroids are given in

1000 mcg = 1 mg  Inhaled steroids are deposited directly to the airways. milligrams (mg).

(Systemic steroids affect your entire body)

 Inhaled steroids are safe and effective.

Inhaled steroids vs. Systemic steroids  Inhaled steroids are given in micrograms (mcg), systemic steroids are given in

1000 mcg = 1 mg  Inhaled steroids are deposited directly to the airways. milligrams (mg).

(Systemic steroids affect your entire body)

 Inhaled steroids are safe and effective.  Inhaled steroids are virtually free of side effects at normal doses.

Steroid inhalers that are available:

Aerobid®

Pulmicort® Flovent®

Asmanex®

Azmacort®

Alvesco®

QVAR®

*Pulmicort® is also available in respules for use in a nebulizer.

Remember: Always rinse your mouth after using steroid inhalers to help prevent sore throat and oral candidiasis (thrush). Using a spacer or holding chamber with your inhaler will help too.

Long-acting bronchodilators are another type of long-term controller medication. They last for 12 hours or more.

Serevent®

Foradil®

*These are no longer recommended to use by themselves for asthma.

Not for quick relief! May help inhaled steroids work better. Should only be taken twice a day.

Combination inhalers combine a long-acting bronchodilator & inhaled steroid together in one. Available as:

Advair®

Symbicort®

Not for quick relief! Should only be taken twice a day. Rinse mouth after using.

Some other long-term controllers include: Singulair® Treats symptoms of indoor and outdoor allergies

Xolair® Allergy shot for moderate to severe allergic asthma

Remember:

It can take about 14 days or 2 weeks for your long-term controller medications to start working. You’re controller medication must be taken every day as prescribed by your doctor.

Question:

What are the 2 main types of asthma medications?

Question:

What are the 2 main types of asthma medications? Answer:  Rescue &

 Long-term Controller

relaxes the muscles that cause bronchoconstriction.

reduces the swelling (inflammation) inside of the airways.

treats symptoms of indoor and outdoor allergies. Choose one: Singulair

Albuterol

Corticosteroids

Albuterol relaxes the muscles that cause bronchoconstriction.

reduces the swelling (inflammation) inside of the airways.

treats symptoms of indoor and outdoor allergies. Singulair

Albuterol

Corticosteroids

Albuterol relaxes the muscles that cause bronchoconstriction. Corticosteroids reduces the swelling (inflammation) inside of the airways.

treats symptoms of indoor and outdoor allergies. Singulair

Albuterol

Corticosteroids

Albuterol relaxes the muscles that cause bronchoconstriction. Corticosteroids reduces the swelling (inflammation) inside of the airways. Singulair treats symptoms of indoor and outdoor allergies. Singulair

Albuterol

Corticosteroids

Question: What should you always do after using a steroid inhaler to help prevent a sore throat and oral thrush?

Question: What should you always do after using a steroid inhaler to help prevent a sore throat and oral thrush?

Answer:  Rinse your mouth

Managing Asthma

For good asthma control, you should: • Learn: About asthma, allergies, and triggers • Use: Your medications and devices. (Nebulizer, inhalers, spacers, peak flow meters, etc.)

• Develop: An Asthma Action Plan

Physician and emergency contact information

Green, yellow, and red zones for assessing severity and what to do

“Personal Best” Peak Flow number

Medication list: Rescue and Long-term controllers

Asthma Action Plan

The Asthma

“Rules

of

2”

The Asthma

“Rules

of

2”

Do you use your rescue inhaler a week?

more than

2

times

The Asthma

“Rules

of

2”

Do you use your rescue inhaler a week?

more than

2

times

Do you wake up at night with asthma symptoms more than

2

times per month?

The Asthma

“Rules

of

2”

Do you use your rescue inhaler a week?

more than

2

times

Do you wake up at night with asthma symptoms more than

2

times per month?

Do you refill your rescue inhaler more than

2

times per year?

The Asthma

“Rules

of

2”

If you answered “yes” to any of these questions, your asthma may not be well controlled.

There are some conditions can worsen your asthma or make it difficult to manage. GERD (Acid Reflux Disease) Obesity OSA (Obstructive Sleep Apnea) Rhinitis Sinusitis Speak to your doctor about treating these conditions first in order to help better control your asthma.

To prevent exercise-induced asthma symptoms…

…use your rescue inhaler 15 to 20 minutes before starting a sport or physical activity.

Using an inhaler with a spacer

1. Shake the inhaler well

2. Insert the mouthpiece of the inhaler into the end of the spacer

Using an inhaler with a spacer

3. Breathe all of the air out of your lungs. 4. Place the inhaler into your mouth making a tight seal.

5. Press the inhaler down once to release the medicine. 6. Inhale slowly and deeply.

Be sure to hold your breath for at least 5-10 seconds. Wait 1 minute between puffs.

Practice Time

For children using a spacer with a mask

With each puff given: •Hold the mask in place •Have the child breathe in and out normally for about 15-20 seconds (about 6 breaths).

*Be sure to use a tight fitting mask.

People who have asthma can use a peak flow meter to get an idea of how well they are breathing that day.

Peak flow meters measure how fast air can move out of your lungs.

Using a Peak Flow Meter

1. Set the meter to zero

2. Stand in an upright position 3. Take a deep breath…and hold it in

Using a Peak Flow Meter

4. Place the meter in your mouth, close your lips around it. 5. Blow hard and fast!!!!

6. Record your meter reading.

80% of

*You should be able to blow at least your personal best or predicted value.

Practice Time

Signals all clear.

If no asthma symptoms are present… …your routine treatment plan can be followed.

Signals caution. An acute flare-up may be present and you may be having symptoms. A temporary increase in medication may be indicated.

Signals a medical alert. Rescue inhaler or nebulizer should be taken. If symptoms don’t improve call your doctor or seek medical help.

Call your doctor or get to the emergency room if:

Call your doctor or get to the emergency room if:  Symptoms get worse even after taking extra medication.

Call your doctor or get to the emergency room if:  Symptoms get worse even after taking extra medication.  You’re having a hard time breathing (or your peak flow has dropped below 50%).

Call your doctor or get to the emergency room if:  Symptoms get worse even after taking extra medication.  You’re having a hard time breathing (or your peak flow has dropped below 50%).

You’re struggling to walk or talk.

Call your doctor or get to the emergency room if:  Symptoms get worse even after taking extra medication.  You’re having a hard time breathing (or your peak flow has dropped below 50%).

You’re struggling to walk or talk.  Your lips and fingernails are turning blue-gray

Question: Should you use your rescue inhaler before or after a sport, to help prevent asthma symptoms?

Question: Should you use your rescue inhaler before or after a sport, to help prevent asthma symptoms? Answer:  Before a sport or activity

Question: What do peak flow meters measure?

Question: What do peak flow meters measure? Answer:  They measure how fast air moves out of your lungs.

Question: This form is called an Asthma ?

Question: This form is called an Asthma ?

Answer:  An Asthma Action Plan

Thank you!! Please feel free to ask any questions.

Sources:

The Asthma Educator’s Handbook Asthma and Allergy Foundation of America (website: www.aafa.org) Riley Hospital for Children (website: rileychildrenshospital.com/) The Children’s Asthma Education Center (website: www.asthma-education.com/content/ National Heart Lung and Blood Institute (website: www.nhlbi.nih.gov/guidelines/asthma/) Kid’s Health (website: www.kidshealth.org)

Sources:

Images and graphics:

Respiratory Care staff at St. Joseph’s Regional Medical Center, Inc. (Thanks Everyone!) Wikimedia Commons: website: https://secure.wikimedia.org/wikipedia/ commons/wiki/Main_Page Special thanks to my daughter, Cierra Williams (Thanks Honey!! )