2. Taking Control of Your Asthma Spring Summer Winter Fall

3. Purpose of this Presentation This presentation will teach you:  What is asthma and how it affects the lungs  How to figure out if asthma is under control  How to take control of asthma  By avoiding triggers  By using medicines correctly

4. Asthma Statistics  2.7 million Canadians have asthma  13% of Ontarians have asthma, 21% of Ontario children aged 0-14 have asthma  39% of people with asthma report limitation in physical activity  Asthma is the # 1 reason for children being hospitalized

5. 1 out of every 5 children has asthma

6. What is Asthma … inhale fresh air into your lungs exhale stale air out of your lungs lungs

7. Lungs are made up of airways (air tubes) and tiny air sacs (alveoli) at the end of the airways airways air sacs airways are surrounded by tiny bands of muscle

8. What happens to the airways? swelling mucus air

9. All of this can lead to … these symptoms/signs Cough a s t h m a Wheezing Tight Feeling in the Chest Trouble Breathing

10. 60% of Canadians with asthma do not have it under control Why do so many people let asthma affect them so much?

11.  Do not know what good asthma control is  Do not realize that you can get good control of asthma  May not think that their asthma is bad enough to need treatment (even mild asthma often needs daily medicines)  Worried about taking medicines every day, about side effects, and costs  It may be hard to avoid triggers (eg. pets, smoke, dust mites in the bed, carpets, moulds, pollen) Possible reasons …

12. Asthma Control Questions Let’s find out if the asthma is under control Ask the following questions…

13. Childhood Asthma Control Test for children 4-11 y/o 1. How is your asthma today? 2. How much of a problem is your asthma when you run, exercise or play sports? 3. Do you cough because of your asthma? 4. Do you wake up during the night because of your asthma?

14. Asthma Control Test for teens 12 years and older. 1. In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home? 2. During the past 4 weeks, how often have you had shortness of breath? 3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness, or pain) wake you up at night or earlier than usual in the morning? 4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication 5. How would you rate your asthma control during the past 4 weeks?

15. How did you do? If the answer is yes to any of these questions, then the asthma is probably not under control Anyone with asthma should be able to: Live without asthma attacks Be symptom-free most of the time Exercise well Sleep well Live a normal life If they can’t do all of these, then they should see their health care provider.

16. Uncontrolled Asthma … Poorly controlled asthma can lead to: 1.Lower quality of life - can’t exercise or sleep well or do regular daily activities 2.Higher chance of severe attacks, which can be dangerous 3.Permanent damage to your lungs due to long- term inflammation 4.Lost days at work and school 5.A decrease in child’s growth, since so much energy is being used for breathing

17. How can someone take control of their asthma?

18. Learn - it is important to understand asthma and how to manage it Avoid - learn how to stay away from things that make asthma worse Manage - make sure you understand your medicines and take them as prescribed Taking Control

19. There are so many things to learn after being diagnosed with asthma:  What is asthma?  What things should be avoid to help asthma?  How to use puffers and other devices?  Why are medicines often needed every day?  Are there side effects from the medicines?  How do you know if asthma is under control?  Where can you go for more help? Learn all about asthma

20.  Ask questions at every visit to your health care providers – your doctor, pharmacist, and asthma educator, health representative  Go to an asthma education centre to learn from a Certified Asthma Educator  Contact The Lung Association’s Helpline for information and booklets – 1-888-344-5864  Visit reputable websites such as www.on.lung.ca Ask questions …

21. Avoid your triggers  A trigger is anything that bothers your asthma  Different triggers for different people  Sometimes it is easy to figure out what bothers your asthma, but not always  Ask your doctor about an allergy test to see if allergens may be bothering your asthma

22. Allergen versus Irritants  An allergen is a substance that can trigger—or set off—an allergic reaction in the body. This reaction can cause symptoms in the nose, eyes, mouth, throat, skin, and airways.  Irritants are substances that trigger asthma symptoms when they are inhaled by sensitive people.

23. Allergens - Pets  If a pet is making your asthma worse, the best option by far is to find it a new home  If it is not possible to find it a new home: Keep pet out of bedroom always Wash pet twice a week Encase pillows and mattress in allergy-proof covers Remove carpeting if possible Use a large HEPA* filter air cleaner in bedroom Vacuum furniture regularly with vacuum equipped with a HEPA* filter, or central vacuum system with exhaust outside the house *HEPA = High Efficiency Particulate Air

24. Allergens - Dust Mites  Dust mites are tiny microscopic insects that live off our skin flakes in our beds and carpets  If you are allergic to dust mites, the following may help: Encase mattress and pillows in allergy-proof covers Limit humidity in your home to 35-45% Wash linens in hot (55ºC) water every week Remove carpeting if possible

25. Allergens - Pollen  Pollens are tiny particles that come off trees, grass and weeds  If you are allergic to pollens, the following may help: Keep windows and doors closed in home and car during pollen seasons (air conditioner is often needed when it’s hot outside) After being outside for a long time during pollen season, shower and change clothes Person with allergies should not mow the lawn

26. Allergens - Mould  Moulds can be indoors in damp basements and bathrooms, and outdoors in damp weather  The following can help: Clean mouldy areas well Keep humidity around 35-45% A de-humidifier can help, especially in damp basements Get rid of clutter in the basement, to allow air to move freely Ensure proper water drainage around your home Keep bathroom dry and use fan to remove humidity Seek professional help if indoor mould doesn’t go away or if there is a lot of mould Limit outdoor activity when outdoor mould levels are high

27. Irritants - Cigarette Smoke Smoke from cigarettes and other tobacco products can be dangerous, especially for people with asthma Avoid tobacco smoke always Never allow smoking anywhere in your home or car, even if the person with asthma is not there at the time – smoke stays around for a long time If you smoke, try to quit for your health and for the health of those around you

28. Irritants - Air Pollution  Air pollution comes from many sources, including vehicles and industry  Highest pollution levels tend to be during the hot humid days of summer  To reduce exposure to air pollution, the following may help: Reduce outdoor activity when pollution levels are high Keep windows and doors closed when there are high pollution levels(air conditioning may be needed when it gets hot)

29. Colds and the Flu A “cold” or “the flu”, can make asthma worse during the infection and up to 6 weeks after Get a flu shot Wash your hands regularly, especially after being in public Do not touch your nose, eyes or mouth while in public Try to avoid people with colds (especially during the first few days of their cold) Have a balanced, healthy diet and exercise regularly

30. Aspirin and Similar Medicines  For some people, Aspirin and medicines which contain acetylsalicylic acid (ASA), ibuprofen (eg. Advil, Motrin), or other similar medicines, can make their asthma worse  These medicines affect about 20% of adults and 5% of kids with asthma and can sometimes be dangerous  If you are affected by these medicines, avoid them and avoid all medicines that contain them  Read the ingredients for all medicines to make sure they are not in them – ask your pharmacist for help  If you are going for a medical procedure, tell your doctor if you are sensitive to these types of medicines

31. Exercise Exercise can cause asthma symptoms … BUT Asthma should not usually prevent you from exercising if you:  Keep your asthma under control  Warm-up before and cool-down after exercise  Take a “reliever” medicine 5–10 minutes before exercising, if needed

32. Manage your asthma Medicines are usually needed to manage asthma properly, even with mild asthma There are two kinds of asthma medicines: 1.Controllers/Preventers  Medicines that are usually taken every day for long-term asthma control  Do not stop taking them unless directed by your doctor 2.Relievers/Emergency  Usually only taken when needed, for quick relief  If needed more than 3 times per week, see your doctor

33. Types of Controller/Preventer Medicines Inhaled corticosteroids = Steroids  Takes 4-7 days to work, and may need to take for a long period  Daily puffers that control/prevents  Swelling of the lining of the airway tubes  Lots of mucous production  Generally the most effective controller medicine  Examples: Pulmicort, Flovent (diskus, puffer)

34. Reliever (Emergency) Medicine  Since they work quickly – within minutes  They open up the airways by relaxing the tiny bands of muscles that surround the airways  To be used during an “asthma attack”  Often used before exercising to prevent exercise-induced symptoms  Not useful for long-term control of asthma – does not control inflammation  Examples: Ventolin, Bricanyl

35. Spacer/Holding Chamber  Device that is used with the pressurized puffers (MDIs) to better deliver medicine to your lungs  Easier to coordinate than with puffer alone  May reduce side effects like hoarse voice and thrush that sometimes happens with inhaled steroids

36. Monitoring Asthma

37. Asthma Action Plan - Sample Warning SignsWhat to Do Green Light  I feel Good!  I am not coughing!  I sleep well!  I have lots of energy!  Green Zone  Take my regular controller  Carry my blue reliever  Exercise /play everyday Yellow Light  I am coughing/wheezing  I use my reliever 3 or more times  I don’t feel good!  Yellow Zone  Follow my action plan  Use my controller  Get lots of rest  Go get help! Red Light  I am breathing fast  I have trouble walking/ talking  I am coughing lots  Red Zone  Asthma is dangerous!!!  Take my reliever!  Go Get Help from an adult or call 911!

38. Asthma Action Plan  A written set of instructions that helps guide you in changing your medicines depending on how well your asthma is under control  Everyone with asthma should have one  Bring a copy to your doctor to fill out with you  Available from www.on.lung.ca, by contacting The Lung Association, or from your doctor or pharmacist

39. Asthma Diary - Sample

40. Asthma Diary  An Asthma Diary helps you keep track of your asthma symptoms on a day-to-day basis  Your diary can help you and your doctor see if your asthma is under control and to figure out what may be making your asthma worse  Available from www.on.lung.ca, by contacting The Lung Association, or from your doctor or pharmacist

41. Breathing Tests  Objective measurements done at 6 years and older

42. Breathing Tests  Spirometry Testing: lung volumes in/out, lung flow of air in/out  Peak Flow Monitoring: lung flow of air in/out

43. Summary Learn  Ask questions at every visit to the health care providers – your doctor, pharmacist, asthma educator  The more you learn, the more likely you will be able to manage asthma properly  Contact The Lung Association’s Asthma Action Helpline for information and booklets – 1-888-344-5864  Visit reputable educational websites such as www.on.lung.ca  Avoid  Find out what asthma triggers are, and manage asthma by avoiding them as much as possible – always avoid smoke

44. Summary Manage  Take daily medicines as prescribed and don’t stop taking them before discussing it with the doctor  Daily anti-inflammatory puffers are usually the most important because asthma is a chronic (long-term) inflammation in the lungs (controllers/preventers)  Asthma medicines are generally safe – the doctor will prescribe the lowest amount that will control the asthma  Anyone with asthma should have a written Asthma Action Plan from their doctor

45. A Call To Action  If asthma is affecting daily life, sleep or exercise, need to see the doctor  If asthma is not under control based on the Asthma Control Questions, see the doctor  The healthier the lungs, the healthier people will feel  With well-managed asthma, anyone can lead a normal life

46. This presentation was made possible by an educational grant from the Ontario, Ministry of Health and Long-Term Care, MOHLTC Public Health Agency of Canada, PHAC