ASTHMA IN THE PEDIATRIC POPULATION SEARCH Rotation 2 August 23, 2010
Objectives Define asthma as a chronic disease Discuss the morbidity of asthma in pediatrics Discuss a few things that a health center needs to affectively manage their asthma patients
ASTHMA http://rileychildrenshospital.com/parents-and-patients/programs-and-services/asthma.jsp
What is asthma? Chronic respiratory disorder Characteristics Airway inflammation Reversible airway obstruction Airway hyper-responsiveness Symptoms Wheezing Cough Chest tightness Shortness of breath
Causes of asthma Genetic component Allergic March 1 Asthma Allergic rhinitis Atopic dermatitis Food allergies Triggers 2 Viral infections Allergens (dust mites, pet dander, pollen, mold) Tobacco smoke Air pollution Exercise Extreme weather changes
Complications of asthma 3 Frequent hospitalizations and ER visits Repeated absences from school Limited physical activity if not controlled properly Psychologic impact of having a chronic disease Declining lung function over a long period of time Prognosis Excellent prognosis with proper therapy and patient compliance with the treatment regimen 3
Asthma Treatment4 Quick-Relievers Short-acting Beta Agonists Ipratropium Long-term Controllers ICS Long-acting Beta Agonists Combined ICS & LABA Leukotriene Modifiers Oral corticosteroids Cromolyn Sodium Anti-IgE therapy http://www.101healthsolution.com/category/asthma/
Preventing exacerbations 2 Having an asthma management plan is the best way to prevent symptoms. Components of an asthma management plan: Identify and minimize contact with your asthma triggers Take your medications as prescribed by your doctor Monitor your asthma and recognize early signs that your asthma may be worsening (which medicine to take, how much to take, when to take it, when to call your doctor, and when to seek emergency care) Know what to do when your asthma is worsening
SCOPE OF THE ISSUE http://www.uttyler.edu/faculty/jplacyk/placykteaching2.htm
Asthma Statistics Asthma is the most common chronic condition that children in the US suffer from 5 Childhood asthma prevalence has more than doubled from 1980 to the mid-1990s 5 Affects about 1 in every 20 children 5 Affects how children play, learn, and sleep 5
Asthma Statistics continued Morbidity and mortality of asthma are highly correlated with Poorer socioeconomic status Poverty status 6 17.4% of those who have ever had asthma are poor 14.6% of those who have ever had asthma are near poor 12.8% of those who have ever had asthma are not poor Health insurance 6 17% of those who have ever had asthma are on Medicaid or other public insurance 9.9% of those who have ever had asthma are uninsured 12.4% of those who have ever had asthma have private insurance Lack of proper patient education Inadequate medical care
http://www.cdc.gov/nchs/data/ad/ad381.pdf
HOW CAN I HELP?
Asthma Education! What are the benefits of effective asthma education 7? Quality of life improved Symptoms improved Decreased limitations in activities Medication adherence improved Decreased urgent care visits and hospitalizations Decreased asthma-related costs http://www.epa.gov/iaq/schools/managingasthma.html
What should be included 7? Definition of asthma Key points about signs and symptoms of asthma Asthma triggers Roles of medication How to manage an asthma attack How to prevent asthma attacks
Solutions! Tracking methods Asthma diary Clinical practice guidelines from the National Asthma Education and Prevention Program recommend that asthma patients have close monitoring of their symptoms and adjustment of therapy to be continued over time 7 Patient education Asthma action plan Asthma education brochure Asthma self-management education which consists of information, self-monitoring, regular medical reviews, and a written action plan is effective and leads to a reduction in hospitalization and ER visits for asthma, unscheduled doctor visits, days lost from work, episodes of nocturnal asthma, indirect costs and an improvement in quality of life 8 http://www.pslweb.org/site/news2?page=newsarticle&id=11691&news_iv_ctrl=1008
Asthma Diary Patient Name Date of Birth Appt Date Had breathing problems during the day? Had breathing problems at night? Had breathing problems during physical activity? Had unexpected visit to the Dr or ER for asthma? What inhalers are you using? Provider Notes
GREEN ZONE Doing Well Breathing is good No cough or wheeze Sleep through the night Can work and play Take these long-term control medications EVERY day Medication Name How much to take When to take it Pulmicort (Budesonide) 2 puffs Two times a day Flovent (Fluticasone) Azmacort (Triamcinolone) Aerobid (Flunisolide) Qvar (Beclomethasone) Singulair (Montelukast) 1 tablet Once a day Before exercise take puffs 5-60 minutes before exercise YELLOW ZONE Asthma is getting worse First signs of a cold Exposure to a known trigger Cough Tight chest Mild wheeze Coughing at night RED ZONE Medical Alert! Medicine is not helping Breathing is hard and fast Nose opens wide Ribs show Can t talk well Lips or fingernails are blue Prednisone Continue with your green zone medication and add Medication Name How much to take When to take it Proventil, Ventolin (Albuterol) 2 puffs every 20 min Xopenex (Levalbuterol) 4 puffs Maxair (Pirbuterol) Nebulizer once mg Call your doctor NOW! Go to the hospital or call an ambulance if you are still in the red zone after 15 minutes or if you have not reached your doctor
http://fromyourdoctor.com/
References 1. Liu, Andrew H. "The Allergic March of Childhood." Medical Scientific Update 22.1 (2006): 1-12. National Jewish Medicine and Research Center. Summer 2006. Web. 20 Aug. 2010. <http://www.nationaljewish.org/pdf/zzz_library/23n1msu_2006.pdf>. 2. "Asthma Overview." Asthma and Allergy Foundation of America - Information About Asthma, Allergies, Food Allergies and More! 2005. Web. 20 Aug. 2010. <http://aafa.org/display.cfm?id=8&sub=14>. 3. Schwartz, M. William. The 5-minute Pediatric Consult. Philadelphia: Lippincott Williams & Wilkins, 2005. Print. 4. Mayo Clinic Staff. "Asthma - MayoClinic.com." Mayo Clinic Medical Information and Tools for Healthy Living - MayoClinic.com. 27 May 2010. Web. 19 Aug. 2010. <http://www.mayoclinic.com/health/asthma/ds00021>. 5. Akinbami, Lara J. "The State of Childhood Asthma, United States, 1980-2005." Vital Health and Statistics (2006): 1-24. 26 Dec. 2006. Web. 08 Aug. 2010. <http://www.cdc.gov/nchs/data/ad/ad381.pdf>. 6. Bloom B, Cohen RA, Freeman G. Summary health statistics for U.S. children: National Health Interview Survey, 2008. National Center for Health Statistics. Vital Health Stat 10(244). 2009. <http://www.cdc.gov/nchs/data/series/sr_10/sr10_244.pdf >. 7. Mangan, Joan M., and William Bailey. "What Do Patients Need to Know about Their Asthma?" UpToDate Inc. 9 Mar. 2009. Web. 19 Aug. 2010.