ASTHMA ACTION PLANS- What are they and how do they work? Tracy Marquette RRT, AE- C C. Michael Bowman M.D. AE- C

ASTHMA ACTION PLANS- What are they and how do they work? Tracy Marquette RRT, AE- C C. Michael Bowman M.D. AE- C

I HAVE NO DISCLOSURES.

What is an AAP?

What is an AAP? Written Plan or Instructions for the patient and/or caregiver Gives instruction on what medications to take when they have acute symptoms Symptoms drive responses

What are AAPs intended to do? Guide patient/caregiver in assessment and treatment of acute asthma symptoms

Importance of AAPs Following instructions on the plan can help treatment of an attack at home and help to avoid the need for the hospital emergency room or doctor s office Following instructions can relieve and/or control acute symptoms and their progression Treatments are made to short circuit the symptoms Caregiver must be aggressive and treat symptoms early

Organized into Three Zones Green Zone good no symptoms. Patient generally doing well Yellow Zone- caution symptoms/distress worsening in spite of initial treatment Red Zone- danger symptoms have progressed further to a medical emergency

Example of an AAP

What Symptoms drive the responses? Most important assessments are the presence of symptoms- wheeze, cough, shortness of breath, respiratory rate, inability to speak, and decreases in peak expiratory flow rate Caregiver/patient must be able to assess the dynamics of the attack and recognize how the patient is doing compared to their baseline status Must also assess deterioration Symptoms are usually new but have happened before, and usually last > 10-15 minutes

Peak Flow Meter Many physicians choose symptom based AAP versus Peak Flow Based Poor perceivers benefit from peak flow Obtain personal best by performing over two weeks Green Zone > 80% of the patient s normal Yellow Zone 50-80% of baseline Red Zone <50% of baseline

Keep Points to an AAP Must be available Readable Understandable Accurate as to when treatment increases with symptom increases Helpful as to the contact for care when the patient worsens (24/7)

What treatments are given? Rescue Inhaler medications albuterol, pro air, Ventolin, Xopenex Given by inhaler or treatment Nebulizers (if available) can provide a higher dose of drug per treatment (1 vial is similar to 10 puffs from an MDI) Green Zone- 2 puffs every 4 hours Yellow Zone- 4-6 puffs every 4-6 hours Red Zone- 6-10 puffs every 20 minutes If they don t rapidly improve from the yellow zone, or if they even get to the red zone, the caregiver/patient should call the provider listed on the AAP If they do not get called back right away, they should call an ambulance 2 puffs every 4 hours is NOT the correct treatment for all zones in an acute flare of asthma

When are AAPs used? Should be accessible wherever the patient is located They are an important part of asthma education and should be revised with every medication change Should be reviewed with every visit Extremely helpful to provide pictures of the asthma medication devices, specific to that patient.

Who should have them? Parents (both parents) Family members who are caregivers Coaches Teachers Daycare All caregivers should have a rescue medicine and inhaler with the AAP

How many patients have AAPs?

30% Children 40% Adults

QUESTIONS?

References Asthma - friendly schools see CDC.gov. Program for asthma teaching in the classroom NIH.gov. Toolkit for SAMPRO aaaai.org/sampro. National Guidelines for the Management of Asthma 2007 EPR3 www.nhlbi.nih.gov/guidelines/asthma/asth summ.htm.

Tracy Marquette 32426 Hwy. 943 South Donaldsonville, LA 70346 Home: (225) 473-1456 Cell: (225) 921-9504 Tracy.Marquette@ololrmc.com Professional Background Enthusiastic Registered Respiratory Therapist with 30 years experience. High Performing therapist ACLS, PALS, AE-C bringing knowledge and strong ability to establish rapport with patients, family and staff. Skill Highlights Patient assessor Floor therapist Asthma Educator Certified Emergency room experience Pediatric transport team Accomplishments Vice President of LSRC CHAPTER 6 (Louisiana Society of Respiratory Care) 1998-1999 and 1999-2000 LSRC Chapter 6 Most Outstanding Therapist 1999-2000 (Louisiana Society of Respiratory Care) Nicholls State University Most Outstanding Preceptor 2004 Nicholls State University Most Outstanding Preceptor 2006 Therapist of the Year 2013 Our Lady of the Lake Regional Medical Center Chairman of the Board East Baton Rouge Head Start 2014 Director of Asthma Camp OLOLRMC and BREC 2014, 2015, 2016 St. Francis Service Award November 2014 Health Hero s Award with Health Centers in Schools for working with the Asthma population 2015 Member of the Louisiana Healthy Homes Collaboration Friend of the Nurses Award 2017 Professional Experience Full time Registered Respiratory Therapist October 1986 to Current Our Lady of the Lake Regional Medical Center/ Children s Hospital Baton Rouge, Louisiana Current

Coordinator of the Community Asthma Management Program Evaluates health education needs of patient and provides necessary instruction. Works with public school nurses and doctors personalizing plans for asthma patients Provides material and support to the public by supporting health fairs and Initiatives Collaborates with organizations on providing education and care for the pediatric asthma population Organizes a yearly asthma camp with the Baton Rouge Recreation and Our Lady of the Lake Children s Hospital Current Transport Team Our Lady of the Lake Children s Hospital Provides respiratory care and support during transport to and from out laying hospitals Current Patient Assessor Utilized strong assessment skills to determine necessary patient care. Evaluated health education needs of patients and provided necessary training and instruction. Educated on proper techniques for taking inhalation medicines. Current Clinical Instructor/Preceptor Mentored and Observed students in critical care, emergency room and floor therapy. Instructed on appropriate therapy. Educated on diseases such as asthma and emphysema. Current Children's Pastor Educates and teaches biblical knowledge at age appropriate level. Creates visual and interactive object lessons. Organizes yearly vacation bible school. Gathered workers and coordinates classes and times for 50 and more children. Plans and organizes summer children's camp to Texas. Taking over 500 kids to camp over 20 year period Current National Day of Prayer Coordinator Organizes events encouraging prayer at city level and parish level. Gathers organizations, businesses, and elected officials for sponsorship. City level has gathered 120 and more at each event for over 18 years. Parish level has gathered over 200 at each event for 4 years. Education and Training Nicholls State University 1986 Thibodeaux, Louisiana, United States Allied Health and Sciences Associate of Science and Allied Health

Certifications Registered Respiratory Therapist Licensed with State of La. BLS-Basic Life Support PALS-Pediatric Advanced Life Support ACLS-Advanced Cardiac Life Support AE-C National Asthma Educator Certification Board Affiliations American Association of Respiratory Care active member, current National Certified Asthma Educators Association active member, current

CURRICULUM VITAE A. PERSONAL INFORMATION Name: Business Address: Business Telephone /FAX: E - mail: Home Address: Charles Michael ("Mike") Bowman, Ph.D., M.D. Medical University of South Carolina Division of Pediatric Pulmonology 135 Rutledge Ave. Rm 281 Charleston, SC 29425 (843) 876-1555;; 876-1251 (v-mail);; 876-1583 (FAX) "bowmanm@musc.edu" 1400 Southern Magnolia Lane Mt. Pleasant, SC 29464 Home Telephone: (843) 216-3648 Date of Birth: November 30, 1946 Place of Birth: Citizenship: Marital Status: Wife's Maiden Name: Urbana, Illinois United States Married (still!) Mary Margaret Coughlin Children: Kenneth (7/3/82);; Mark (10/9/84) Social Security Number: Available on request if needed B. EDUCATION Undergraduate: University of Illinois, Urbana;; B.S., Chemistry (Honors), 1968 Postgraduate: Graduate School: University of Wisconsin, Madison;; Ph.D., Genetics, 1972 Medical School: University of Wisconsin, Madison;; M.D., 1975 Internship: Department of Pediatrics, Children's Hospital of Vanderbilt University, Nashville, Tennessee, 6/75-6/76 Residency: Department of Pediatrics, Children's Hospital of Vanderbilt University, Nashville, Tennessee, 7/76-6/78 1

Chief Residency: Fellowship: Medical licensure: Board Certification: Department of Pediatrics, Children's Hospital of Vanderbilt University, Nashville, Tennessee, 7/78-6/79 Fellow, Pediatric Pulmonology, University of Colorado Health Sciences Center, Denver, Colorado, 7/79-6/81 (sponsored by the National CF Foundation) Colorado (#22985) (inactive) California (#G53182) (inactive) South Carolina (#21884) *Diplomate of the American Board of Medical Examiners, #150219, July 1, 1976 *Diplomate of the American Board of Pediatrics, #23900, February 17, 1980 (voluntary recertification 1992) *Diplomate, Subspecialty Board of Pediatric Pulmonology, American Board of Pediatrics, #19, July 18, 1986 (recertification 1995, 2003, 2012;; MOC 12/2015) C. PROFESSIONAL BACKGROUND Academic Appointments: Professor of Pediatrics, Department of Pediatrics, Medical University of South Carolina (MUSC), Charleston, South Carolina (SC), 2000 - present Medical Staff Appointments: Attending Pediatric Pulmonologist, Department of Pediatrics, MUSC Childrens Hosp Charleston, SC 2000 - present Teaching Responsibilities: MUSC 3 rd year student lecture series Introduction to Pulmonary Disease in Children two lectures every two months, 2000-2002;; 1 case-based lecture Interesting and Illustrative Pulmonary Cases every 6 wks 2003 - present Specific Administrative Responsibilities (school, university or hosp committees, etc.): Current (at MUSC): Division Director, Pediatric Pulmonology, Dept of Pediatrics;; 2000 - present Member, MUSC Health Literacy Action Team, 2013 - present State Committee Memberships: Member, Executive Committee, American Academy of Pediatrics (SC);; 2010 present Secretary Treasurer, 2016 - present Member, Board of Directors, SC Asthma Alliance, 2010 present Originator of SCAA Summer Attack on Asthma Project 2011 present Originator and member of SCAA Speakers Bureau, 2011 present Chair, SCAA Education Committee, 2012 present Organizer, Regional Asthma Summit Education Conferences, June, 2013;; November, 2014 2

Organization Offices and Positions: Member, Board of Directors, SC Asthma Alliance (non-profit organization committed to the improvement of asthma care and understanding in SC) 2010 - present Medical Home Asthma Champion, SC Chapter, American Academy of Pediatrics, 2010 present Member, Executive Committee, SC Chapter, American Academy of Pediatrics, 2012 present Member, Executive Committee of Board of Directors, Association of Asthma Educators (AAE), 2016 - present Secretary, Association of Asthma Educators, 2016 - present Awards: Finalist, Morris and Mary Press Humanism Award, CHLA, 1993, 1999 Listing in The Best Doctors in America (1994-95), (2 nd edition) edited by Steven Naifeh and Gregory W. Smith, 1994;; The Best Doctors in America (1998), (3 rd edition, 1998), The Best Doctors (2002 - present) Distinguished Service Award, CHLA, 1995 Listing in The Best Doctors in America: Pacific Region (1996-97), edited by Steven Naifeh and Gregory W. Smith, 1996 Walt Ector, MD Award for Innovative Clinical Practice in Pediatrics, Dept. of Pediatrics, MUSC, 2003 Best Teacher Award, Pediatric Residency Program, MUSC, 2005 Educator Mentor Award, 2006, MUSC (selected from 34 nominees from throughout all MUSC colleges) Best Sub-specialist Teacher Award, Pediatric Residency Program, MUSC, 2006-07 Listing in Guide to America s Top Pediatricians, 2008 - present Best Inpatient Teacher Award, Pediatric Residency Program, MUSC, 2008 09 Best Mentor Award, Pediatric Residency Program, MUSC, 2010 11 High ratings by residents and students in annual evaluations of teaching (annually) Special Award of Merit, American Academy of Pediatrics, SC Chapter, 2012 and 2015 Listing in US News and World Report Best Doctors, 2012 - present D. SOCIETY MEMBERSHIPS Local Professional Societies: South Carolina Chapter, American Academy of Pediatrics American Lung Association, Southeast Region National Professional Societies: Member, American Thoracic Society Member, American College of Chest Physicians Fellow, American Academy of Pediatrics Associate Member, American Board of Pediatrics Member, Academic Pediatric Association / Pediatric Academic Societies Member, Association of Asthma Educators E. CONSULTANTSHIPS Local / state: Ad hoc consultant SC Dept Health Human Services Medicaid Managed Care organizations QI project to improve asthma outcomes 2010 - present 3

Asthma specialist and consultant;; SCORxE projects on Academic Detailing for Pediatric practices in SC state AAP Q-TIPP project, Department of Pharmacy, University of South Carolina and MUSC, 2011 - present F. RESEARCH ACTIVITIES Complete bibliography: Appended (see section I) Major areas of research interest: Improving outcomes for children with asthma Improving education in academic Pediatrics Palliative care in Pediatrics G. ADVOCACY ACTIVITIES Member, Wellness Committee, Mitchell Elementary School, Charleston, SC, 2008 2011 (team received award for outstanding activity from CHS schools, 2012) Founder and member, Asthma Action Team;; Mitchell and other schools;; Charleston County School District / MUSC Dept of Pediatrics / Div of Pulmonology;; Charleston, SC;; 2009 present Member, Pediatric Residency Advocacy Committee, MUSC, 2012 - present Member, Wellness Committee, Stono Park School, Charleston, SC 2012 2015 School Medical Liaison in Docs-Adopt Program;; Charleston County Medical Society;; Doctors adopting public schools Stono Park School 2012 2015;; Memminger Elementary School 2015 present Bibliography and teaching documentation available on request Updated 3/3/16 4