Asthma With a Slight Chance of Anaphylaxis

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1 Asthma With a Slight Chance of Anaphylaxis An Update for Alberta Oral Health Professionals Sept 25/13 Presented by Val Olson CRE Community Pediatric Asthma Service

2 Air passes through the: Nose or mouth Windpipe or trachea. Breathing Right lung left lung Smaller airways Tiny air sacs - alveoli. 2

3 What is Asthma? A chronic, variable and reversible narrowing of the airways of the lungs which causes inflammation and muscle tightening during asthma attacks 3

4 Asthma Facts The most common chronic illness in children and adults Uncontrolled asthma leads to absences from school, work and leisure activities Affects up to 20% of the population Half the people affected have symptoms, but have not been diagnosed In children, more boys than girls have asthma In adults, more women than men have asthma I feel sick! 4

5 Asthma Myths Myth Fact People with asthma should not exercise. Children outgrow asthma. Taking controller medication is riskier than allowing the asthma to be in poor control. Exercise keeps the heart, lungs and muscles strong so everyone, including people with asthma, should exercise. About 1/2 to 1/3 of children appear to outgrow asthma by puberty, however, their symptoms may come back later in life. Use of inhaled corticosteroids by children could have a minimal effect on expected adult height, poorly controlled asthma has many side effects. 5

6 Common Symptoms of Asthma Asthma symptoms are variable and may occur: Day or night During exercise With exposure to a trigger May include one or more of the following: Cough Wheeze Chest tightness Difficulty breathing 6

7 Symptoms History Cough Wheeze Short of Breath Tight Chest Diagnosis Story Allergies Eczema Family History Response to Medication 2-3 days with Inhaled Corticosteroid Significant difference in 2 weeks Response to Ventolin Breathing Test (Spirometry) 6 years and older Test of time Maybe Probably Yes

8 Asthma and Age Young children can have asthma triggered by colds, allergies, or both (pre-school wheezers) Older children who still have asthma are more likely to have allergic triggers

9 Asthma Triggers Triggers are substances that a person with asthma reacts to which causes them to have asthma symptoms Each person s triggers are unique Identify and avoid triggers Trigger avoidance is the #1 step toward control of asthma 9

10 Two Types of Triggers Triggers are classified and treated by the reaction they cause Inflammatory triggers - treated with inhaled corticosteroid Constricting triggers - treated with bronchodilators

11 Medications Except for very mild asthma, most people need two kinds of asthma medication: 1. Preventer/controller (anti-inflammatory) - safe inhaled steroids - used daily to prevent inflammation episodes 2. Rescue/reliever (temporary symptom relief) - used to quickly treat symptoms only - used by some before exercise 11

12 Possible Medication Side Effects Controller, medications Sore throat or infection in mouth, hoarse voice, systemic absorption. Minimized with proper use and rinsing mouth Reliever medications Shaking, rapid heart beat, hyper (dose related) 12

13 Inflammatory and Constricting Triggers Infections (viral) Animal Dander Exercise Cold Air Pollen and Mold Change in Temperature Second hand smoke Emotions/Stress Dust (mites) Strong Odours 13

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15 Asthma is in good control* when you have: No daytime symptoms No nighttime symptoms No limits to normal physical activity No missed school or work No need for reliever medication except for exercise *Global Initiative for Asthma (GINA), Asthma Management and Prevention in Children, December

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17 What to do if the child has signs and symptoms of asthma Remove the child from any obvious triggers (such as cold air, animals etc.) and stop activity. Remain with the child; stay calm and reassure. Have the child sit comfortable, leaning forward supporting arms on a table or on knees. DO NOT have the child lie down. Give reliever medication as directed by parent/doctor (ie. Ventolin in the dose that the parent has indicated). Repeat the reliever medication in 5-10 minutes if symptoms continue. Call parents for further directions. Observe the child for changes in asthma symptoms. Watch for DANGER SIGNS and call 911 if necessary.

18 Don t Forget the Nose! Many children with asthma also have nasal congestion Consider post-nasal drip as a trigger for coughing

19 Asthma Emergency Signs and Symptoms Signs to watch for: Child is unable to speak in more than one or two word sentences Child uses neck and shoulder muscles when breathing Notch at base of throat is sucked in Child stops wheezing noise (as the asthma symptoms progress the airways will become so inflamed and congested, air will no longer pass through). No response or improvement after receiving medication. Call 911!

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21 How to Use Your MDI with a Spacer (optichamber,aerochamber) 1. Remove the cap from mouthpiece. 2. Shake the MDI well. Place in spacer. 3. A child under 5 years may use a mask with a spacer. By age 6, a child can use the spacer without a mask. 4. When using a mask, make sure there is a good seal around the nose and mouth. 5. Depress the MDI into the spacer. A child should take 5-6 normal breaths with each puff. 6. Wait 30 seconds between puffs. Re-shake before the second the second puff.

22 A Helpful Asthma Website

23 What is Anaphylaxis? A serious allergic reaction, possibly life threatening Common triggers include peanuts, tree nuts, shellfish, fish, milk, eggs, soy, sesame seeds, wheat, insect stings, drugs and latex, sulphite additives

24 Anaphylaxis and Asthma "People with asthma who are also diagnosed with lifethreatening allergies are more susceptible to severe breathing problems when experiencing an anaphylaxis reaction. It is extremely important for asthmatic patients to keep their asthma well controlled * *Anaphylaxis in Schools and Other Settings, 2 nd edition, Canadian Society of Allergy and Clinical Immunology, September 2009, pp. 10, 4. 24

25 Think F.A.S.T Face: itchiness, redness, swelling of face and tongue Airway: trouble breathing, swallowing or speaking Stomach: pain, vomiting, diarrhea Total: hives, rash, itchiness, swelling, weakness, paleness, sense of doom, loss of consciousness

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27 Ephinephrine Auto Injectors Adult and Pediatric dosage Available without a prescription Allerject, Epi-pen, Twinject? Free placebo available from manufacturer If used, call 911.

28 A Helpful Website for Anaphylaxis

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33 Time for Device Demos and Questions To contact a Certified Respiratory Educator with Community Pediatric Asthma Service