Nancy Davis, RRT, AE-C

Nancy Davis, RRT, AE-C

Asthma Statistics 25.6 million Americans diagnosed with asthma 6.8 million are children 10.5 million missed school days per year 14.2 lost work days for adults Approximately 10% of all students have asthma Source: American Lung Association

What is asthma? Asthma is a chronic respiratory disease characterized by episodes or attacks of inflammation and narrowing of small airways in response to asthma triggers. National Asthma Education and Prevention Program

Asthma Asthma can not be cured, but it can be controlled. Asthma may cause chest tightness, shortness of breath, wheezing, coughing or night-time awakening with breathing difficulties.

During an asthma attack: Airways become irritated and swollen. Muscles in the airways constrict. Mucus production increases. Normal Asthma Muscle Lining Tight Muscles Swelling Mucus

Common Triggers Pollens Molds Animal Dander Dust Mites Tobacco Smoke Cockroaches Changes in the Weather Exercise Respiratory infections, such as colds Strong emotions Cold air

Reduce Allergen Exposure Do not allow smoking in the home. If you have a pet and removal from the home is not possible, keep pet out of bedroom. Control dust mites by encasing mattresses in allergen protective covering and wash sheets weekly in hot water ( 130 degrees) Minimize stuffed toys and wash weekly. Cover food and garbage tightly. Stay indoors when pollen counts are high.

Asthma Medications Rescue Quick Relief Medications Controllers Maintenance Medications

Rescue Quick Relief Medications Work fast to open air passages Relax the muscles that surround the airways Relieve coughing, wheezing, chest tightness and shortness of breath Effect should be felt within 5 15 minutes after taking medication Are called bronchodilators

Rescue - Quick Relief Medications Short Acting Beta Agonists Albuterol ProAir, Proventil, Ventolin, Xopenex

Atrovent Anticholinergic

Holding Chamber or Spacer Makes taking MDI easier Cuts down on oral deposits from corticosteroids May be used with mouthpiece or mask Has device that makes a musical not to let user know if they are breathing in too fast

Combined Rescue Medication Combivent or Duoneb Albuterol and Atrovent Short acting beta agonist and anticholinergic

Controllers Maintenance Medications Inhaled Corticosteroids (ICS) Long Acting Beta Agonists (LABA) Combined Medications (ICS and LABA) Non-Steroidal Anti-Inflammatories Leukotriene Blockers Theophylline Monoclonal Anti-IgE Antibodies

Flovent, QVAR, Pulmicort, Asmanex, Alvesco, Aerospan

Inhaled Corticosteroids (ICS) Make the airways less swollen and less sensitive to irritants Have no immediate effect on asthma symptoms Must be used on a regular basis to be effective Normally are taken twice a day (AM & PM) Must be taken even when feeling well Always rinse your mouth with water and spit out after taking ICS

Long-acting Bronchodilator Serevent Should NOT be used as alone Should NOT be used for acute symptoms Relaxes airway muscles Works best when used in combination with ICS for long-term control and prevention of symptoms

Combined Maintenance Medications Advair Flovent & Serevent Symbicort Foradil & Pulmicort Dulera Foradil & Asmanex

New Asthma Medications Arnuity Ellipta ICS > 12 years old 1 inhalation per day DPI (100 or 200mcg) Breo Ellipta ICS & LABA > 18 years old 1 inhalation per day DPI should only be used if not well controlled with ICS Spiriva Anticholinergic > 12 years old - 2 inhalations every day Add on treatment if not well controlled with ICS

Goals of Asthma Management Prevent chronic symptoms Minimize use of rescue medications Maintain near normal breathability Maintain normal activity levels including exercise Prevent episodes & minimize hospitalizations Prevent progressive loss of lung function & prevent reduced lung growth

Asthma Action Plan Home management plan Step by step approach for managing asthma symptoms

Green Zone Breathing is fine No cough or wheeze Sleeping through the night Working, going to school Able to perform activities without any issues Take controller medications as prescribed Rinse mouth after ICS use

Yellow Zone Mild wheeze Cough Tight chest Trouble breathing at night Add rescue medication every 4 hours as needed Continue controller medication

Red Zone Symptoms are getting worse Medicine is not helping Stomach or neck retractions Nasal flaring Can only speak 1 or 2 words at a time before stopping to catch breath Call your doctor Go to the nearest emergency department

Warning Signs of an Emergency Stomach or neck retractions Nasal flaring Accessory muscle use Unable to speak in sentences

Call 911 Lips or fingernails are blue Breathing is getting worse really fast Trouble walking or talking because breathing is so hard Visibly struggling to breathe Pass out

Barriers to Asthma Control Inhaler confusion Non-adherence with medications Risk factors: smoking, beta blockers, NSAIDS, allergen exposure Comorbidities: rhinitis, obesity, GERD, depression, anxiety

Prepare for your medical appointments Write down any questions you may have Bring your medications with you Ask for demonstration if you are unsure of how to use any of your inhaled medication devices Review your action plan Update action plan if necessary If you have trouble remembering or hearing, bring a trusted person with you to your appointment There is no such thing as a stupid question!

Questions? Thank you for your attention!