Asthma BasicsAsthma Basics

Developed and Provided by: Developed and Provided by:

Minnesota Department of Health Asthma ProgramMinnesota Department of Health Asthma Program

Minnesota Department Of HealthMinnesota Department Of Healthwww.health.state.mn.us/divs/hpcd/cdee/asthmawww.health.state.mn.us/divs/hpcd/cdee/asthma

As You View This Program..As You View This Program..

Consider how many people you know who Consider how many people you know who have asthma?have asthma?

How will you use the information you How will you use the information you receive here today?receive here today?

How can you help students prevent their How can you help students prevent their asthma symptoms from appearing?asthma symptoms from appearing?

How can you help your schools health How can you help your schools health office staff reduce asthma triggers at office staff reduce asthma triggers at school?school?

Goal SettingGoal Setting

Think about what you would like to achieve Think about what you would like to achieve here today here today

Pick one goal to work toward when you go Pick one goal to work toward when you go back to your classroom or work place back to your classroom or work place

Asthma:Asthma:Accounts for 14 million lost school days Accounts for 14 million lost school days

annuallyannually33

Is the most common chronic disease Is the most common chronic disease causing absence from schoolcausing absence from school22

Is the leading cause of hospitalizations Is the leading cause of hospitalizations (chronic) among children under 15(chronic) among children under 1522

1 in 13 school children have asthma1 in 13 school children have asthma11

6.3 million children under 18 have asthma6.3 million children under 18 have asthma11

1 Asthma Prevalence, Health Care Use, and Mortality, 2000-01, National Center for Health Statistics, CDC1 Asthma Prevalence, Health Care Use, and Mortality, 2000-01, National Center for Health Statistics, CDC2 Asthma in Children Fact Sheet, American Lung Association, June 17, 20032 Asthma in Children Fact Sheet, American Lung Association, June 17, 20033 Surveillance for Asthma - United States, 1980-99, MMWR Surveillance Summaries, CDC, March 29, 20023 Surveillance for Asthma - United States, 1980-99, MMWR Surveillance Summaries, CDC, March 29, 2002

Minnesota ChildrenMinnesota Children

In a 2003 MDH survey of more than 5,000 In a 2003 MDH survey of more than 5,000 7th & 8th graders at 15 junior highs outside 7th & 8th graders at 15 junior highs outside

the metro area- the metro area- 1 in 121 in 12 reported they currently have asthmareported they currently have asthma

In a 2001 MDH survey of 13,000, 9th - 11th In a 2001 MDH survey of 13,000, 9th - 11th graders in rural MN- graders in rural MN- 1 in 111 in 11 reported they currently have asthmareported they currently have asthma

This MeansThis Means....

In a class of 30 children, you can expect In a class of 30 children, you can expect

2 to 3 students WILL have asthma! 2 to 3 students WILL have asthma!

This number varies depending on age and This number varies depending on age and geographical location.geographical location.

““Healthy Children Learn Better”Healthy Children Learn Better”

The Goal Of Asthma ManagementThe Goal Of Asthma Management

“ “Children should live happy, healthy, physically Children should live happy, healthy, physically active lives, without asthma symptoms slowing active lives, without asthma symptoms slowing them downthem down “ “

Impact Of Asthma On StudentsImpact Of Asthma On Students

School PerformanceSchool Performance Poorly controlled asthma has a negative Poorly controlled asthma has a negative

impact on school performance in both impact on school performance in both academic achievement and physical academic achievement and physical education education

Impact Of Asthma On StudentsImpact Of Asthma On Students cont...cont...

PsychosocialPsychosocialPoor self-esteemPoor self-esteemAnxiety about asthmaAnxiety about asthmaFear of becoming ill at schoolFear of becoming ill at schoolAnxiety about exercise at schoolAnxiety about exercise at schoolFear of being differentFear of being different

What Is Asthma?What Is Asthma?

Asthma is a chronic disease that causes:Asthma is a chronic disease that causes:

Tightening of the muscles surrounding Tightening of the muscles surrounding the airways (Bronchoconstriction/spasm) the airways (Bronchoconstriction/spasm)

Swelling of the small airways Swelling of the small airways (bronchioles)(bronchioles)

Over production of sticky mucus in the Over production of sticky mucus in the airwaysairways

Group ExerciseGroup Exercise

Straw ExerciseStraw Exercise Stand upStand up Place the straw in your mouthPlace the straw in your mouth Try to breathe!Try to breathe! This is what is may feel like when a child This is what is may feel like when a child

is having a severe asthma episodeis having a severe asthma episode

Airway ObstructionAirway Obstruction

Copyright 3M Pharmaceuticals 2004

Common Symptoms Of AsthmaCommon Symptoms Of Asthma

Frequent cough, especially at nightFrequent cough, especially at nightShortness of breath or rapid breathing Shortness of breath or rapid breathing Chest Tightness Chest Tightness Chest pain Chest pain WheezingWheezingFatigueFatigueBehavior changesBehavior changes

Every Child Is Unique!Every Child Is Unique!

Wheezing and coughing are the most Wheezing and coughing are the most common symptoms common symptoms -but--but-

No two children will have the exact same No two children will have the exact same symptoms or the same triggersymptoms or the same trigger

Every child who has a diagnosis of asthma Every child who has a diagnosis of asthma should have access to a rescue inhaler!should have access to a rescue inhaler!

Every child who has asthma should have an Every child who has asthma should have an asthma action plan at school (AAP)asthma action plan at school (AAP)

Handling Asthma EpisodesHandling Asthma Episodes

What’s An “Episode”?What’s An “Episode”?

An asthma episode occurs when a child is An asthma episode occurs when a child is exposed to a trigger or irritant and their exposed to a trigger or irritant and their asthma symptoms start to appearasthma symptoms start to appear

This can occur suddenly without a lot of This can occur suddenly without a lot of warning, or brew for days before the warning, or brew for days before the symptoms emergesymptoms emerge

Episodes are preventable by avoiding Episodes are preventable by avoiding exposure to triggers and taking daily exposure to triggers and taking daily controller medications (if prescribed)controller medications (if prescribed)

How Do I Handle An Asthma Episode How Do I Handle An Asthma Episode At School?At School?

1.1. Remain calm and reassure the childRemain calm and reassure the child2.2. Contact the school health office for Contact the school health office for

assistanceassistance3.3. Check the child's asthma action plan or Check the child's asthma action plan or

individualized health plan for actionsindividualized health plan for actions4.4. Give “rescue or reliever” medications if Give “rescue or reliever” medications if

ordered and available ordered and available ((some students carry their some students carry their own asthma inhalers with them)own asthma inhalers with them)

Handling An Episode cont..Handling An Episode cont..

5. 5. If identified, get the child away from the If identified, get the child away from the triggertrigger

6.6. Have the child sit up and breathe slowly- Have the child sit up and breathe slowly- in through the nose, out through pursed in through the nose, out through pursed lips slowlylips slowly

77. . Have the child sip room temperature Have the child sip room temperature water/ fluidswater/ fluids

88. Contact the parent or guardian as . Contact the parent or guardian as necessary - AND-necessary - AND-

Do NOT Leave The Child AloneDo NOT Leave The Child Alone!!

Call 911 if..Call 911 if.. Lips or nail beds are bluishLips or nail beds are bluish Child has difficulty talking, walking or drinkingChild has difficulty talking, walking or drinking Quick relief or “rescue” meds (albuterol) is Quick relief or “rescue” meds (albuterol) is

ineffective or not availableineffective or not available Neck, throat, or chest muscles are pulling in Neck, throat, or chest muscles are pulling in

(retracting) (retracting) Nasal flaring occurs when inhaling Nasal flaring occurs when inhaling Obvious distressObvious distress Altered level of consciousness/confusion Altered level of consciousness/confusion Rapidly deteriorating conditionRapidly deteriorating condition

There should not be any delay once a child There should not be any delay once a child tells you they are having trouble breathing tells you they are having trouble breathing

ORORYou notice something's happening! You notice something's happening!

What Causes Asthma?What Causes Asthma? Asthma may be caused by genetic, immune and/or Asthma may be caused by genetic, immune and/or

environmental factors, and is often associated with environmental factors, and is often associated with eczema (scaly skin patches) and allergieseczema (scaly skin patches) and allergies

Researchers do not understand all of the causes of Researchers do not understand all of the causes of asthma or its increasing prevalenceasthma or its increasing prevalence

It boils down to “We just don’t really know for It boils down to “We just don’t really know for sure”sure”

What Causes Asthma cont..What Causes Asthma cont..

Of the 17 million asthma sufferers in the Of the 17 million asthma sufferers in the US, 10 Million (approx. 60%) have allergic US, 10 Million (approx. 60%) have allergic asthma. 3 million of those are childrenasthma. 3 million of those are children11

Exposure to certain allergens trigger asthma Exposure to certain allergens trigger asthma symptoms to beginsymptoms to begin

Exposure to certain irritants can also set an Exposure to certain irritants can also set an asthma episode in motionasthma episode in motion

1National Institute of Environmental Health Sciences

Triggers And IrritantsTriggers And Irritants

Copyright 2004, 3M Pharmaceuticals

Common Allergens (Triggers) Common Allergens (Triggers)

Seasonal pollensSeasonal pollens Animal dander Animal dander

/saliva/urine/saliva/urine Dust mitesDust mites Cockroaches/mice/rat Cockroaches/mice/rat

droppings and urinedroppings and urine MoldMold Some medicationsSome medications Some foods Some foods Strong emotional feelingsStrong emotional feelings

Common Irritants (Triggers)Common Irritants (Triggers)Exercise Exercise Cold airCold airChalk dustChalk dustViral/upper Viral/upper

respiratory respiratory infectionsinfections

Air pollutionAir pollutionTobacco smoke or Tobacco smoke or

secondhand smokesecondhand smoke

Chemical irritants Chemical irritants and strong smellsand strong smells

Strong emotional Strong emotional feelingsfeelings

Diesel fumesDiesel fumesCleaning suppliesCleaning supplies

Dust MitesDust Mites Live in pillows, carpet, fabric-covered furniture, Live in pillows, carpet, fabric-covered furniture,

curtains curtains What to do:What to do:

Avoid bringing in fabric covered furniture from Avoid bringing in fabric covered furniture from homehome

Vacuum often when people with asthma/allergies Vacuum often when people with asthma/allergies are not in the area (HEPA filter vacuum cleaners)are not in the area (HEPA filter vacuum cleaners)

Dust book cases and furniture frequently Dust book cases and furniture frequently Keep room humidity < 50% if possibleKeep room humidity < 50% if possible

MoldMold Moisture control is keyMoisture control is key What to do:What to do:

Report leaks and wet/moist areas right away for Report leaks and wet/moist areas right away for school custodianschool custodian

Wash mold off surfaces using plain soap and waterWash mold off surfaces using plain soap and water Replace moldy porous items such as ceiling tiles & Replace moldy porous items such as ceiling tiles &

carpetcarpet Avoid installing carpet in areas exposed to regular Avoid installing carpet in areas exposed to regular

moisture such as drinking fountains & sinksmoisture such as drinking fountains & sinks

R7R7

Animals In The ClassroomAnimals In The Classroom Dander, urine & saliva are triggersDander, urine & saliva are triggers Triggers can remain after pet is removedTriggers can remain after pet is removed What to do:What to do:

Prohibit/remove animals from schoolsProhibit/remove animals from schools If removal is not possible:If removal is not possible:

• Keep animals in cages Keep animals in cages • Clean cages oftenClean cages often• Keep animals away from fabric furniture, carpet & Keep animals away from fabric furniture, carpet &

ventilation systemventilation system• Locate sensitive students away from animalsLocate sensitive students away from animals

Pre-notify parents if animals with fur/feathers visitPre-notify parents if animals with fur/feathers visitR1R1

PestsPests

Droppings or body parts can trigger asthmaDroppings or body parts can trigger asthma What to do:What to do:

Use integrated pest management (IPM) methodsUse integrated pest management (IPM) methods• Don’t leave food, water or garbage exposedDon’t leave food, water or garbage exposed• Don’t eat or drink in classroomDon’t eat or drink in classroom• Seal entry points for pestsSeal entry points for pests• Custodians should use pesticides only as Custodians should use pesticides only as

neededneededR7R7

Secondhand SmokeSecondhand Smoke

Is an irritant trigger causing asthma in children Is an irritant trigger causing asthma in children State law prohibits tobacco use in K-12 public State law prohibits tobacco use in K-12 public

schoolsschools What to do:What to do:

Enforce smoking bans (for students, parents Enforce smoking bans (for students, parents and teachers)and teachers)

Include anti-smoking message in curriculumInclude anti-smoking message in curriculum

Outdoor AirOutdoor Air

Ozone & fine particles are biggest concernOzone & fine particles are biggest concern Actions:Actions:

Sign up for Air Quality Index noticeSign up for Air Quality Index notice Pollution Control Agency sends e-mail alerts Pollution Control Agency sends e-mail alerts

when they expect poor air quality (regional)when they expect poor air quality (regional) Avoid being outside at high pollen count times, Avoid being outside at high pollen count times,

especially if students are allergic to particular especially if students are allergic to particular pollenspollens

School BusesSchool Buses Diesel fuel emissions are an irritant and can set off Diesel fuel emissions are an irritant and can set off

an asthma episode in many childrenan asthma episode in many children State law requires:State law requires:

Reduce unneeded idling in front of schoolsReduce unneeded idling in front of schools Reroute bus parking zones away from air intakes, if Reroute bus parking zones away from air intakes, if

possiblepossible What to do:What to do:

Post “no idling” signsPost “no idling” signs Maintain bus fleetMaintain bus fleet Invest in cleaner fuelsInvest in cleaner fuels Replace old buses with cleaner running onesReplace old buses with cleaner running ones

R3, R4R3, R4

Exercise Induced AsthmaExercise Induced Asthma

What Is Exercise Induced What Is Exercise Induced Asthma (EIA)?Asthma (EIA)?

Tightening of the muscles around the airways Tightening of the muscles around the airways (bronchospasm)(bronchospasm)

Distinct from allergic asthma in that it does Distinct from allergic asthma in that it does NOT cause swelling and mucus production in NOT cause swelling and mucus production in the airwaysthe airways

Can be avoided by taking pre-exercise Can be avoided by taking pre-exercise medications and by warming up/cooling down medications and by warming up/cooling down

EIA - What Happens?EIA - What Happens?

Symptoms include coughing, wheezing, Symptoms include coughing, wheezing, chest tightness and shortness of breathchest tightness and shortness of breath

Symptoms may begin during exercise and Symptoms may begin during exercise and can be worse 5 to 10 minutes after exercisecan be worse 5 to 10 minutes after exercise

EIA can spontaneously resolve 20 to 30 EIA can spontaneously resolve 20 to 30 minutes after startingminutes after starting

Can be avoided by doing the following:Can be avoided by doing the following:

Preventing Exercise Induced Preventing Exercise Induced Asthma (EIA)Asthma (EIA)

Become familiar with Asthma Action Plans Become familiar with Asthma Action Plans Student should use reliever (Albuterol) 15 -30 Student should use reliever (Albuterol) 15 -30

minutes before activityminutes before activity Do warm-up/ cool-down exercises before and after Do warm-up/ cool-down exercises before and after

activitiesactivities Check outdoor ozone/air quality levelsCheck outdoor ozone/air quality levels www.aqi.pca.state.mn.us/hourlywww.aqi.pca.state.mn.us/hourly// Never encourage a child to “tough it out” when Never encourage a child to “tough it out” when

having asthma symptomshaving asthma symptoms

MedicationsMedications

Two Categories Of MedicationsTwo Categories Of Medications

Controller Medications Controller Medications Taken every day to prevent swelling in Taken every day to prevent swelling in

the lungsthe lungs Reliever or Rescue MedicationsReliever or Rescue Medications

Taken only when needed to relieve Taken only when needed to relieve symptoms symptoms

Or to prevent exercise induced asthma Or to prevent exercise induced asthma from developing (taken before strenuous from developing (taken before strenuous exercise)exercise)

Controller MedicationsController Medications

Keep swelling and mucus from developing Keep swelling and mucus from developing in the lungsin the lungs

Must be taken EVERY day even when the Must be taken EVERY day even when the child is not having symptomschild is not having symptoms

Inhaled corticosteroids (ICS’s) are the most Inhaled corticosteroids (ICS’s) are the most common and effective way to control common and effective way to control asthmaasthma

Help prevent asthma exacerbations from Help prevent asthma exacerbations from developing!developing!

Rescue Or Reliever MedicationsRescue Or Reliever Medications

Are taken when asthma symptoms are Are taken when asthma symptoms are appearing (asthma episode)appearing (asthma episode)

Are taken 15-30 minutes before strenuous Are taken 15-30 minutes before strenuous exercise/activity by children with EIA exercise/activity by children with EIA

Do NOT reduce or prevent swelling from Do NOT reduce or prevent swelling from developing in the lungsdeveloping in the lungs

May be carried in school by a student only May be carried in school by a student only IF approved by the doctor, school nurse and IF approved by the doctor, school nurse and parent!parent!

Picture courtesy of American Lung Association of the Inland Counties CA 2004Picture courtesy of American Lung Association of the Inland Counties CA 2004

Spacers Or Holding ChambersSpacers Or Holding Chambers

Most MDI’s (Metered dose inhalers) must Most MDI’s (Metered dose inhalers) must be used with a spacer or holding chamberbe used with a spacer or holding chamber This device attaches to the MDI and allows the This device attaches to the MDI and allows the

user to breathe in more medication effectivelyuser to breathe in more medication effectively The physician must write an order for it when The physician must write an order for it when

prescribing your reliever medicationprescribing your reliever medication Dry powder inhalers do NOT require spacersDry powder inhalers do NOT require spacers

Typical Spacers/Holding Typical Spacers/Holding ChambersChambers

Tools To Help Manage AsthmaTools To Help Manage Asthma

Peak Flow Meters (PFM)Peak Flow Meters (PFM)

Peak Flow MetersPeak Flow Meters

Measures how well the student’s lungs are Measures how well the student’s lungs are doing at that momentdoing at that moment

Associated with the Green-Yellow-Red Associated with the Green-Yellow-Red system of managing asthma symptomssystem of managing asthma symptoms

Congruent with asthma action plansCongruent with asthma action plansHelps students and families self-manage Helps students and families self-manage

asthma asthma

Symptoms and PFM DiarySymptoms and PFM Diary

Asthma Action Plan (AAP)Asthma Action Plan (AAP)

Asthma Action Plan ZonesAsthma Action Plan Zones

Green ZoneGreen Zone: : All Clear/Breathing Good/Go All Clear/Breathing Good/Go – No asthma symptoms and/or No asthma symptoms and/or – Peak flow 80-100% Peak flow 80-100%

Yellow ZoneYellow Zone:: Caution/Slow DownCaution/Slow Down– Some asthma symptoms and/orSome asthma symptoms and/or– Peak flow 50-80% Peak flow 50-80%

Red ZoneRed Zone: : Medical Alert/StopMedical Alert/Stop– Severe asthma symptoms and/or Severe asthma symptoms and/or – Peak flow < 50%Peak flow < 50%

Working TogetherWorking Together

Successful Asthma Management Successful Asthma Management Requires Everyone's Requires Everyone's CooperationCooperation

TeachersTeachers ParentsParents StudentsStudents

Medical ProvidersMedical Providers CoachesCoaches All School PersonnelAll School Personnel

Talk with your school Nurse to find out Talk with your school Nurse to find out what what youyou can do to help manage asthma in can do to help manage asthma in your schoolyour school

YOU Can Make A Difference!YOU Can Make A Difference!