Asthma in Schools A MacRobbie January 2008

What is Asthma ? Asthma is a problem with breathing - it affects the airways which are the small tubes which carry air in and out of the lungs

What is Asthma? When a person with asthma comes into contact with something that irritates their airways (a trigger), the muscles around the walls of the airways tighten so that the airways become narrower (bronchospasm), the lining of the airways start to swell (inflammation) and sometimes sticky mucus or phlegm builds up. These cause the symptoms of asthma

Common asthma symptoms Cough Shortness of breath Wheeze Tight chest/chest pain

Goals of treatment No cough or wheeze during the day or night - no missed school physically active able to take part in sport Sleep through the night Prevent asthma flare-ups Use asthma medicines with few side-effects Avoid visits to A&E departments and hospital stays

How common is asthma? 390, ,000 children (1in 9) 290,000 adults (1 in 15) 19,700 people severe asthma

What does this mean for you?

Prevention is better than cure Avoid Triggers Ensure medicines are carried by pupil or there is easy access to medicines Anticipate medicine needs before planned exercise

Triggers Cold air or hot humid weather – wear a scarf for cold – transitions from hot to cold environments or vice versa – air conditioning for hot environments

Triggers Exercise –with good asthma management you can and should exercise regularly – anticipate need and pre-medicate – use warm-up and cool-down exercises – monitor air quality

Triggers Infections –keep hands from face –separate towels/disposable towels –wash hands

Triggers Molds & pollens – fix water leaks – close windows/exhaust fans – bin raked leaves/grass in grounds – minimise time outside

Triggers Strong smells - avoid or limit use e.g. perfumes, cleaning materials, chemicals in science or technical sessions Aerosols - avoid Candles - avoid

Triggers Dust Mites/Pets - more of a problem in the home HEPA filter vacuums minimise soft furnishings dehumidifiers avoid animals

Asthma Management in schools Joint approach GP & primary care School nurse &/or Community Paediatrician Hospital/clinic Pupil & parent School Etc.

Asthma Management Assessing asthma - peak flow meter Measure the pupils maximum ability to expel air from the lungs Readings are higher when pupils are well

Asthma Medicines Usually medicines are inhaled Two types of medicines used Preventers and Relievers

Asthma Medicines - Preventers Take every day even when pupil feels well Decrease swelling in airways and mucus production these inhalers are many colours often brown or dark red Examples - Becotide, QVAR, Flixotide, Pulmicort

Asthma Medicines - Relievers Relax the airway muscles and open up the airway Take these inhalers when asthma symptoms occur May be used before activity (e.g. PE) to prevent asthma which is triggered by exercise occurring Often inhalers are blue in colour - examples are ventolin (salbutamol), terbutaline

Asthma Medicines Occasionally for severe asthma or flare ups, pupils may be prescribed steroid tablets to reduce swelling in the lungs. An example is prednisolone.

Inhaler Devices Pressurised meter dose inhalers (MDIs) Breath activated MDIs Dry Powder inhalers Nebulisers

Spacer Devices

Asthma Management Green zone - no symptoms: breathing is good, no cough or wheeze, can work and play, sleeps at night. Peak flow > 80% of best action - avoid triggers, pre-treat before exercise if needed

Asthma Management Yellow zone - getting worse: some problems with breathing, cough, wheeze or tight chest, problems working or playing, awake at night. Peak flow % of best Action - take quick relief inhaled medicines, repeat if necessary, call for help if no better

Asthma Management Red zone - Get help, call 999 Lots of problems breathing, cannot work or play, getting worse instead of better, medicine is not helping, peak flow <50% of best Action - take quick relief medicine, if lip or fingernails blue or cannot talk in complete sentences call 999 immediately

Summary Stop activity - do not lie down, sit and rest,”Do you have asthma?” Stay calm - “relax shoulders, breathe out slowly through puckered lips, do you have a quick acting inhaler/reliever” Give treatment, repeat if doesn’t work, contact parent or get help if no treatment available Call ambulance if breathing gets harder, trouble talking, or lips or fingertips blue

Action Plan Knowing who the pupils are Having an individual healthcare plan for the pupils Being familiar with the contents of the plan Knowing and being confident in what to do Have good communication systems which work

Questions?