1 Caring for Kids with Asthma Some slides courtesy of Healthy Learners Asthma Initiative, Minneapolis Public Schools

2 Background  Over the past 20 years, asthma in children has risen 72%  Asthma is most common chronic disease for children under 18 yrs  Children < 6 years have highest hospitalization rate Source: Counting on You, ALAWI

3 What is Asthma?  Defining Features: 1. Airway swelling 2. Tightening of airway muscles 3. Mucus production  Increased irritability of the airways (hyper-responsiveness) CAACP, 2004

4 Lungs When Asthma is in Good Control Healthy airways: air can easily get in and out no mucus muscles do not tighten around airway no swelling of airway lining CAACP, 2004

5 Lungs When Asthma is NOT in Good Control Unhealthy airways: air can’t easily get in or out Mucus plugs airway Muscles tighten around airways Lining of airways is swollen and irritated CAACP, 2004

6 Symptoms of Asthma  Constant / frequent cough, especially at night  Difficulty breathing / short of breath  Tight chest / chest pain  Breathing faster than usual CAACP, 2004

7 Symptoms of Asthma  Wheezing  Coughing or out of breath with exercise  Long recovery time (~20-30 min. or more) after exercise  Complaint of stomachache or headache CAACP, 2004

8 Asthma Management Goals  Free of symptoms  Sleep through the night  Participate in normal, everyday activities  Near normal lung function CAACP, 2004

9 Asthma Severity  Severity assessment forms the basis of the asthma treatment plan  Severity level determines the type, dose, and frequency of medications  Depending on severity, the child could be considered disabled CAACP, 2004

10 Asthma Severity Levels Days with symptoms Nights with symptoms Medications Mild Intermittent  2/week  2/month - No daily meds - Reliever meds as needed Mild Persistent >2/week, but not daily >2/month Frequent - Controller meds daily - Reliever meds as needed Moderate Persistent Daily>1/week - Controller meds - Reliever meds as needed Severe Persistent ContinuousFrequent - Controller meds daily + long acting reliever - Reliever meds as needed CAACP, 2004

11 Myths and Truths About Asthma Asthma Myths  It is a psychological or emotional illness  It is only an acute disease and you can outgrow it  Asthma is curable Asthma Truths  Airway swelling is real even if triggered by strong emotions  Asthma is a chronic disease, swelling can be present without symptoms  No, but it is manageable CAACP, 2004

12 Myths and Truths About Asthma Asthma Myths  It always limits normal activities  It limits a child's ability to fully participate in sports  Asthma medication and inhalers are addictive Asthma Truths  Daily asthma controller / pre-exercise medications allow children to be active  Well-controlled asthma should not limit exercise and children can fully participate in sports  Asthma medications and inhalers are not addictive CAACP, 2004

13 Myths and Truths About Asthma Asthma Myths  Asthma medication becomes ineffective if used regularly  Children do not die from asthma Asthma Truths  “Controller” inhalers work best when used daily, “Reliever ” (albuterol) inhalers will not be as effective if asthma is not in good control  Children and adults die from asthma each year CAACP, 2004

14 Triggers: Things That Can Start Asthma Symptoms Irritants  Tobacco smoke  Dust and chalk dust  Strong odors (perfume, markers that smell, air fresheners, cleaning chemicals, paint, etc.)  Cold (or very hot) air CAACP, 2004

15 More Asthma Triggers Allergens  Animals  cats, dogs, etc.  cockroaches, mice  Mold  Dust mites  carpets / upholstery  Pollens / grass / trees  weeds, grass, tree pollen  Certain foods / drugs  peanuts, shrimp, tree nuts, wheat, milk, soy, fish, sulfites, aspirin CAACP, 2004

16 More Asthma Triggers Others  Viruses (colds)  Exercise  Strong emotions CAACP, 2004

17 Avoiding Triggers  Ask parents to identify their child’s triggers  Ask parents what steps the child’s health care provider suggests to avoid possible triggers  Have parents number the child's triggers in order of their importance  Continue to keep the parents updated on actions you are taking to eliminate triggers Source: Counting on You, ALAWI

18 Actions to Reduce Triggers at Childcare Sites  Minimize dust by reducing clutter  Do not allow animals with fur/feathers  Avoid carpeted classroom floors  Encourage children not to sit on carpeted floors  If your site has carpet, encourage custodians to use HEPA-vacuum cleaners CAACP, 2004

19 Actions to Reduce Triggers at Childcare Sites  Do not block ventilation ducts  Avoid mold growth:  Reduce the number of plants that need frequent watering  Report moisture problems or water leaks to the engineer immediately CAACP, 2004

20 Actions to Reduce Triggers at Childcare Sites  Do not use aerosol, strong-smelling cleaning supplies, or air fresheners  Do not ask children to clap chalk erasers  Do not use permanent / odorous markers  Do not smoke in your childcare setting CAACP, 2004

21 Early Warning Signs  Sudden mood changes and/or irritability  Trouble completing sentences without gasping for breath  Itchy chin or neck  Watery, itchy eyes  Dark circles under the eyes Source: Counting on You, ALAWI

22 What to Look for…  Anxious or scared look  Unusual facial paleness  Flared nostrils  Pursed-lip breathing  Fast breathing/shortness of breath  Hunched-over body position CAACP, 2004  Perspiring  Vomiting due to hyperventilation  Restlessness during sleep  Fatigue that is not related to activity

23 What to Listen for…  Coughing or persistent cough when the child has no cold  Frequent clearing of the throat  Irregular breathing  Noisy, difficult breathing  Wheezing during exhaling CAACP, 2004

24 What to do for Asthma Episodes (Attacks)  Remain calm and reassure the child  Have child sit up and breathe slowly, in through the nose, out through pursed lips  Have child sip water/fluids  Have someone stay with the child  Follow the child’s asthma action plan CAACP, 2004

25 Asthma Medications  Asthma Controllers (Anti-inflammatories)  Include Inhaled-corticosteroids  Controls asthma by reducing inflammation and prevents asthma episodes  Daily medication - usually taken in inhaled form  Examples – Advair, Flovent, Pulmicort, QVAR CAACP, 2004

26 Asthma Medications  Asthma Relievers (Bronchodilators)  Provides quick relief temporarily  Usually taken in inhaled form  Taken on as needed basis  Examples: Albuterol, Maxair, Proventil  Oral Steriods  Treats severe asthma episode  T aken for a few days CAACP, 2004

27 Small Children Can Get Their Medications by…  Using a nebulizer  Metered Dose Inhaler (MDI) with spacer and mask CAACP, 2004

28 Spacer Use with Inhalers  Important that children use a spacer with an aerosol inhaler  Get more medication into the lungs CAACP, 2004

29 Without Spacers, Inhalers Are Difficult to Use Because…  It is hard to coordinate breathing and spraying at the same time  The user breathes in too fast  The user does not hold their breath  The medicine comes out of the inhaler too fast CAACP, 2004

30 How to Use a Metered Dose Inhaler 1.Shake well (at least 10 seconds), remove cap 2.Insert inhaler into spacer 3.Breathe out fully with chin up to empty lungs 4.Put mouthpiece between the teeth and close lips around it - do not block opening with your tongue 5.Press down once on inhaler 6.Breathe in deeply and slowly through the mouth 7.Continue breathing in slowly for 3-5 seconds 8.Hold breath for 10 seconds to get medication deep into lungs 9.Wait 1 to 2 minutes before repeating if directed

31 Delivering Nebulizer Treatments  Wash hands thoroughly  Make sure machine is dry and assemble equipment  Check to ensure written order for medication is available from health care provider  Connect one end of the tubing to compressor and other end to container with medication  Add child’s medication to the container Source: Counting on You, ALAWI; CAACP, 2004

32 Delivering Nebulizer Treatments  Position child upright in chair or hold smaller child on lap  Turn on compressor and check that mist is coming out of the mask or mouthpiece  Administer medication to child (usually 5 to 15 minutes)  Rinse and dry mouthpiece/mask before putting away Source: Counting on You, ALAWI: CAACP, 2004

33 Asthma Action Plan  See handout for example  Written plan of care from health care provider includes zones and symptoms  Guidelines for managing asthma episodes  Includes medication information, special instructions CAACP, 2004

34 Using an Asthma Action Plan  Ask parents to have their health care provider complete one for the child  Keep handy for when symptoms occur Source: Counting on You, ALAWI

35 Zones of Asthma Episodes Green zone Yellow zone Red zone CAACP, 2004

36 Green Zone  The child’s asthma is under control  Children often on daily controller medication when in this zone  The goal is to participate in all activities and not be limited in any way CAACP, 2004

37 Yellow Zone… What Asthma Can Feel Like  By Henry 5th grade CAACP, 2004

38 Yellow Zone  Starting to have early warning signs  Caution – slow down  Take reliever medications and daily controller medications  If child in yellow zone for hrs or breathing symptoms are worse – contact parent and primary health care provider CAACP, 2004

39 Red Zone… Reasons to Call 911  “Quick relief” medicine is not effective, not available, or used too recently to repeat  Bluish lip area or blue nail beds  Difficulty talking, walking, or drinking  Skin areas of neck, throat, or chest suck in  Nasal flaring when inhaling  Obvious distress (gasping for air, fearful, etc.)  Altered level of consciousness/confusion CAACP, 2004

40 Red Zone In a severe episode, wheezing is not apparent, although the child is having symptoms. This is a sign of little-to-no air movement. Seek medical attention immediately! CAACP, 2004

41 Scenarios  What seems to be the trigger?  What signs/symptoms indicated that this child is having an asthma episode?  What zone is this child in?  What should you do next? CAACP, 2004

42 Scenario 1 Children are outside on the playground running, climbing on the jungle gym, and jumping rope. It is a windy, spring day with lots of pollen in the air. Juan is sitting alone near the building and breathing heavy. CAACP, 2004

43 Scenario 2 Joey is a new boy in your childcare. On one of his first days of childcare in January, he had an asthma episode while playing outside. Now he never joins the other children at active games and stays to himself. CAACP, 2004

44 Scenario 3 During the weekend, Mia has an asthma episode and parents brought her to the emergency department. The following Monday, her parents bring Mia to childcare with antibiotics and asthma medications. CAACP, 2004

45 Scenario 4 After playing with the cat, Tasha has an asthma episode. She is gasping for air, has difficulty talking to you, and looks scared. Tasha did not bring her inhaler to childcare today. CAACP, 2004

46 Parents Need to Know…  If a child complains that they can’t participate in sports or activity due to asthma  If you notice a child coughing, wheezing, having trouble breathing, breathing rapidly, or complaining of chest pain or a tight chest  If you observe children using their inhaler incorrectly, using it frequently, or sharing it with another child CAACP, 2004

47 Key Points  Good asthma control means children can participate in school, exercise without restrictions, and have good attendance  Not participating or missing a lot of school due to asthma is a sign of poor asthma management  Parents should be informed if child has a chronic cough or difficulty breathing  Encourage use of reliever medication (pre-exercise) before gym class or recess, or if frequent coughing CAACP, 2004

48 Asthma Is Treatable Good communication between parents, health care providers, and childcare providers is essential in providing effective asthma management within a childcare setting. Source: Counting on You, ALAWI