Health Services Training Module Washington County School District ASTHMA ASTHMA Welcome to the Washington County School District - Health Services Training Module This information is being made available to school personnel who may be called on to assist students with asthma. Let’s get started! Health Services Training Module

Recognizing early warning signs and WHAT IS ASTHMA? Leading public health problem for children in Utah Affects nearly 8 % under the age of 18 Number 1 reason for school absenteeism Symptoms can turn deadly at any time WHAT IS ASTHMA? Asthma is the leading public health problem for children in Utah. It affects nearly 8% under the age of 18. It is the NUMBER ONE REASON for school absenteeism. Despite being fairly common, asthma symptoms CAN TURN DEADLY at any time IF: Life-threatening symptoms are not recognized AND Medications are not readily available. Recognizing early warning signs and following the steps to control Asthma are imperative! Recognizing early warning signs and following the steps to control Asthma are imperative!

INFLAMMATORY DISEASE OF THE LUNGS ASTHMA IS A CHRONIC INFLAMMATORY DISEASE OF THE LUNGS Asthma is a chronic inflammatory disease of the lungs. People with asthma have airways that are hyper-reactive to Cold - Smoke - Exercise & other trigger factors that we will discuss later. Notice the difference between a normal airway and the airways during an asthma episode. The airway linings become: Inflamed Swollen - Red & Produce more mucous The muscles around the airways tighten Making the airway openings smaller - decreasing the oxygen supply to the lungs. It’s easy to understand a child’s panic and fear when they suddenly CANNOT take a deep breath OR get enough air.

CONTROLLING AN ASTHMA ATTACK EARLY RECOGNITION QUICK-RELIEF MEDICATION PROMPT MEDICAL ATTENTION People who have asthma - experience periods of Breathlessness, Wheezing, Coughing and Chest tightness KNOWN AS “Asthma Attacks or Episodes”. Early recognition of asthma symptoms, Use of Quick-Relief Medication, and Prompt medical attention as warranted WILL PROVIDE the care needed to control an asthma episode or attack. A student should NEVER BE ENCOURAGED to “tough it out” rather than take the QUICK RELIEF MEDICATIION prescribed by the student’s health care provider.. A student should never be encouraged to “tough it out” rather than to take the Quick-Relief Medication prescribed by the student’s Health Care Provider.

SYMPTOMS OF RESPIRATORY DISTRESS Chest Retractions Nasal Flaring Shortness of breath Complains of Chest tightness Inability to speak or lie down Anxious Coughs Wheezes loudly Blue or grey face, lips, and nail beds Stooped body posture Symptoms of respiratory distress may include Chest Retractions: This is when the skin around the bones of the chest get sucked in as the child is inhaling. For mild cases the skin retractions may be seen in the abdominal and mid-chest areas - While in severe distress the skin retractions can also be seen in the neck. Nasal flaring, Shortness of breath, Complaints of chest tightness, and The inability to speak or lie down are additional symptoms easily observed. The child may become very anxious, Cough or wheeze loudly when attempting to breathe, Display a blue or gray coloring in the face, lips and nail beds, AND May assume a stooped body posture as they attempt to catch their breath.

Students should avoid known triggers when possible ASTHMA TRIGGERS Allergens Animal Dander, Pollen, Molds, Dust Mites, Cockroach Droppings, Foods & Additives Irritants Smoke, Pollution, Odors, Fumes, and Sprays Exercise Excessive Exercise(Moderate is Okay) Weather Cold air, Excess heat, Humidity, Dry Climate Emotional Stressors Family problems, school, etc. Emotional Reactions Laughing or crying hard Respiratory Infections Such as colds, flu, sinus infections, etc Medications Some medications can cause an asthma episode, such as aspirin. Many common factors in our daily routine make asthma symptoms worsen. These factors are known as ASTHMA TRIGGERS. ALLERGENS such as animal dander, pollen, molds, dust mites, cockroach droppings, foods and additives, OR IRRITANTS such as smoke, pollution, odors, fumes and sprays , EXERCISE such as running & playing hard, OR WEATHER changes can such as cold or excess heat, EMOTIONAL STRESSORS such as family or school problems, and even EMOTIONAL REACTIONS such as laughing or crying hard can trigger an episode. RESPIRATORY INFECTIONS such as colds, flu or sinus infections AND MEDICATIONS such as aspirin can trigger asthma. Once the triggers to asthma are identified it is important to encourage students to be responsible and avoid the known triggers when possible. Students should avoid known triggers when possible

TREATMENT OF ASTHMA 2 Basic Types of Medications LONG-TERM CONTROLLER (Daily) Prevent an attack from occurring Reduce inflammation of the airway and mucus production QUICK RELIEF MEDICATION (As Needed) Used during an asthma attack Relaxes muscle tightness around the airways Allows more air to pass through the airways into the lungs Is taken before starting an activity with known triggers Although there is no cure for asthma, there are ways to control it and maintain a healthy, active lifestyle. There are 2 Basic Types of medications used to treat asthma on a daily basis. The LONG-TERM CONTROLLER MEDICATIONS Prevent asthma attacks from occurring by Reducing inflammation of the airway and Mucus production Since controller medications can PREVENT attack, they need to be taken daily even when asthma symptoms are not present. These are NOT TO BE USED as emergency medications.. QUICK RELIEF MEDICATIONS Provide immediate relief during asthma attacks by relaxing the muscle tightness around the airways. This allows more air to pass through the airways into the lungs and breathing becomes easier. It should be taken before starting an activity with known triggers, such as exercise, playing with pets, or when around dust and mold. Quick Relief Medications are delivered in an inhaler as seen in this photo.

PRIMING AN INHALER Pro Air Proventil Ventolin Xopenex Priming Guide Before first time use: 4 sprays After 4 days non-use: 2 sprays Proventil Before first time use: 4 sprays Ventolin Xopenex After 3 days non-use: 4 sprays QUICK-RELIEF INHALERS Priming Guide Bronchodilators have 200 inhalations per canister. To ensure that the medication is being released, the inhaler must be primed. Place the canister of medication into the inhaler and then depress the canister multiple times. Here are the QUICK-RELIEF inhalers that contain albuterol. Note that before first time use all inhaler s should be primed with 4 sprays. After 3 to 4 days, depending on the brand, the inhaler should be primed with 2 to 4 sprays. No priming is required with use in between those times. If you drop an inhaler, prime with 4 sprays. If you drop an inhaler – prime as if first time use

PROPER USE OF AN INHALER 1. Insert canister 2. Prime the 3. Exhale 4. Place inhaler then shake inhaler comfortably in mouth Let’s review the instructions given to a student for proper use of an inhaler: Insert the canister into the mouthpiece then shake to mix the medicine Prime the inhaler. Exhale comfortably Place the mouthpiece in your mouth. Depress the canister then inhale deeply. Hold your breath for up to 10 seconds if possible. If 2 puffs are ordered, repeat this process in 1 minute. Wash the mouth piece weekly and then let it air dry. 5. Depress canister 6. Hold breath 7. If 2 puffs ordered 8. Wash mouth then Inhale deeply 10 seconds repeat in 1 minute piece weekly with warm water & air dry

USING A SPACER Insert L-shaped inhaler into one end of the spacer. For young children who are unable to coordinate the timing of their breathing with medication administration, a spacer is frequently used. It can also be used by adults as well because it is a sure way to get the medicine distributed in the lungs properly When using a spacer, the medication canister is inserted into the inhaler device as shown on the previous slide. Shake it and prime it the same way, then follow these steps Insert the L shaped part of the inhaler into the spacer on one end. Then the child’s lip are enclosed around the mouthpiece of the spacer. Depress the canister inside of the inhaler device the child will breath in the medication over the next several minutes at their own pace. Repeat again If the doctor has ordered 2 puffs and. 1 minute. Many students will experience side affects from this medication: They will feel jittery, Nervous, and An increased activity level following their treatment. Insert L-shaped inhaler into one end of the spacer. Instruct child to breathe through the mouthpiece on the other end. Depress the canister inside of the inhaler device, letting child breath in medication over the next minute. 4. Repeat again if 2 puffs are ordered.

Nebulizer Treatment NEBULIZER A device often used to administer medication for quicker relief then an inhaler. It can be used for the young, the elderly and for a child with special needs. AEROSOLIZED MEDICATION Comes in the form of a liquid which is poured into the nebulizer cup. The nebulizer turns it into a fine mist. INHALATION The child inhales the fine mist of medication Through a mouthpiece or through a mask.

Nebulizer Components With Mask Without Mask The components of a nebulizer consist of a case which houses the nebulizer, a mouthpiece and/or mask, tubing and power cord.

USING A NEBULIZER AT SCHOOL GATHER SUPPLIES: Compressor, tube, cup, mouthpiece or mask, and prescribed medication 1. Set the compressor on a level surface near an electrical outlet. 2. Pour the medicine in the nebulizer cup & attach the cup to the mouthpiece or mask 3. Attach one end of tube to nebulizer cup & the other end to compressor. 4. Place the mask over the mouth & nose then secure elastic, or place the mouthpiece in the mouth. 5. Turn on the compressor & watch the vapors rise from the mask. 6. Keep the compressor on until the medicine in cup completely vaporizes in about 10 minutes. 7. Turn the compressor off. Remove the mask or mouthpiece, and detach the cup from the tubing. 8. Wash cup and the mask or mouthpiece or soak it in a solution of one part vinegar to 3 parts water. Rinse & air-dry.

WASHINGTON COUNTY SCHOOL DISTRICT POLICY 2320 Students can carry emergency medication for asthma if: Parental & Physician Authorization is on file Student knows how and when to use Quick-Relief Medication (inhaler) Student acts responsibly with medication & does not share with others Washington County School District’s Policy 2320 allows students with asthma to carry their own emergency medication If parental and physician authorization forms have been signed; If the student understands how and when to use their emergency medication, and If the student acts responsibly with the medication, keeping it in a back pack and does not share the medication with others. For students who cannot be responsible with their medication - personnel have been established within each school that can assist with medication administration according to the delegation procedures provided by district nurses.

Asthma Action Plan GO CAUTION STOP Breathing easily - No symptoms - Able to work and play easily ASTHMA UNDER CONTROL No action needed. CAUTION Coughing, wheezing, short of breath, feeling tightness in chest MILD TO MODERATE SYMPTOMS Asthma is getting worse. Student needs Quick Relief Med! Symptoms should resolve in 15 minutes. Call parent STOP Medicine isn’t helping, breathing is difficult, coughing, gasping for air, nose opens wide, chest & neck retract with each breath SEVERE SYMPTOMS Get help now – CALL 911! Lets review the ASTHMA ACTION PLAN that school personnel should initiate in the event of an asthma attack at school. Always reassure the student by supporting them through an asthma episode. Encourage them to take slow, deep breaths and remain calm. Turn to the Individualized Health Care Plan to determine specific treatment that is needed: THE GREEN LIGHT: signifies GO! In this phase breathing is regular, relaxed and no asthma symptoms are present. No treatment is needed at this time. THE YELLOW TRIANGLE : signifies CAUTIION! Asthma symptoms are not well controlled and the child is experiencing respiratory difficulties such as shortness of breath, chest tightness , coughing or wheezing. Does the student have a Quick Relief medication ,such as an inhaler at school? If so, give this medication immediately. Breathing should improve within 15 minutes. Also, notify the parents. They may wish to come to school and give their child a nebulizer treatment if ordered. These treatments provide greater relaxation of the airway muscles, making breathing easier. THE RED ZONE: signifies STOP! This student’s breathing has not improved, has become more labored, or the student is breathing more than 30 breaths per minute. Look at the child’s lips and nail beds - are they gray or blue? Is the student unable to speak without taking a breath? Are their severe chest, neck or abdominal retractions? Is nasal flaring present? If so, call 911! Contact the child’s parents immediately and be prepared to start CPR with rescue breaths if this child stops breathing.

BE SENSITIVE TO STUDENTS CONCERNS Student may become NON-COMPLIANT with Quick-Relief Medication due to fear of what peers might think of them. Provide privacy as needed Provide positive feedback for independence & responsible behavior in self-care Student may AVOID EXERCISE if they fear exercise -induced asthma. Provide adequate time for warm-up and cool-down. Make activity modifications as needed. Encourage quiet activities when recovering from an asthma episode. It is important that we are sensitive to the needs of students with asthma. Many of these students may become noncompliant with their treatment due to the fear of what others might think of them when they use an inhaler at school. They fear ridicule and Concern about being different from their peers. Provide privacy as needed. Also provide the student with positive feedback for good decisions made in becoming independent and responsible for their self-care. Students may also avoid exercise altogether if they fear EXERCISE-INDUCED Asthma. Provide adequate time for warm-up before exercise AND cool down thereafter . Make activity modifications as needed. If a student has an asthma episode encourage quiet activities during the recovery period. Remember, that early recognition, QUICK RELIEF MEDICATIONS and prompt emergency medical attention when needed are the control measures we must take in caring for students with asthma.

This concludes the Health Services Training Module Please follow the instructions below to complete a short quiz. Thank you for taking the time to learn how to care for students with Asthma Washington County School District Health Services Make a copy of the test for this module then answer the questions. You can also make a copy of this power point to assist you with the test. 3. Check the answers. 4. Send a copy of your answers to the school nurse.