1. ASTHMA

2. Asthma Identify asthma population in Ohio Define asthma
Identify causes of asthma
Explain control of asthma symptoms
Control asthma triggers
Medical management

3. Asthma in Ohio

4. Ohio Population with Asthma
2012 data
Ohio adults with less educational attainment and lower household income had a higher prevalence of current asthma than their peers with more education and higher household income.

5. Ohio Population with Asthma
2012 data
The prevalence of asthma decreases with increasing household income.
Ohioans with a household income less than $15,000 per year were three times more likely to currently have asthma compared with those earning $75,000 or more per year.
Ohioans who had not completed high school were 2.4 times more likely to report having asthma compared with those who earned a college degree.
Ohio Department of Health, 2013

6. Children with Asthma In Ohio
417,000 children have been told they have asthma
African American children
Living at or below the federal poverty level
The prevalence of asthma decreases with increasing household income.
Ohioans with a household income less than $15,000 per year were three times more likely to currently have asthma compared with those earning $75,000 or more per year.
Ohioans who had not completed high school were 2.4 times more likely to report having asthma compared with those who earned a college degree.

7. Ohio Asthma Morbidity
1,200,825 Ohio adults have been told they have asthma
847,000 Ohio adults report they currently have asthma
Relevant:
1,200,825 adults have been told they have asthma,
847, 641 report currently having asthma,
417,567 children have asthma in Ohio.
Ohio Stadium has an official capacity of 104, 851 people.
You fill the stadium
11.5 times for people who have been told they have asthma,
8 times for people who currently have asthma and
4 times for children.

8. Ohio Asthma Mortality Ohio experiences in one year: 155 asthma deaths
1 child a month
Little has changed since 1990
Very few people die from asthma 155 deaths a year in Ohio 1 death every 2-3 days.
Approx. one child a month

9. What is Asthma?
Asthma is a chronic, treatable disease of the lungs where there is inflammation (or swelling) of the airways making the airways sensitive.
GINA, 2015

10. What is Asthma? A history of respiratory symptoms AND
Asthma is a disease with many variations (heterogeneous). It is characterized by chronic airway inflammation and has two key defining features:
A history of respiratory symptoms
AND
variable expiratory airflow limitation.
Asthma is a chronic, treatable disease of the lungs where there is inflammation (or swelling) of the airways making the airways sensitive.
GINA, 2015

11. Asthma Symptoms Symptoms range from mild to severe. They are:
Frequent Cough – more common at night, waking you up.
Wheezing – a whistling sound when you breathe
Short of Breath – the feeling of not being able to get enough air
Tight Chest – the feeling like something heavy on your chest
These symptoms vary over time and in intensity.

12. Asthma Airway Asthma Airway: Muscles tighten Airway lining swells
Mucus increases

13. Asthma Airway
A closer look

14. What causes asthma? Asthma Triggers
The first and most important step in controlling allergen-induced asthma is to advise
patients to reduce exposure to indoor and outdoor allergens to which they are
sensitive
Asthma Triggers

15. And How To Control Symptoms Environmental Control
Cover it
Clean it
Clear it
Treat it
Environment
Cover it
Clear it
Clean it
Educate and treat smoking cessation
Environmental Control

16. Healthy Homes & Asthma
U.S. Department of Housing and Urban Development Office of Healthy Homes and Lead Hazard Control

17. Asthma and the Environment Animal Allergens - Pets
Clear the pet out of the bedroom
Keep the bedroom door closed
Clear upholstered furniture from the bedroom
Clear carpets from the home or bedroom when possible
Animal allergens –
If removal of the animal is not acceptable:
— Keep the pet out of the patient’s bedroom.
— Keep the patient’s bedroom door closed.
— Remove upholstered furniture and carpets from the home, or isolate the pet from
these items to the extent possible.
— In children’s beds, minimize the number of stuffed toys, and wash them weekly.

18. Asthma and the Environment House-dust mite allergen
Cover mattress and pillow in an allergen-impermeable cover
Wash (clean) sheets weekly in hot water
Treat indoor humidity by Reducing it to 30 – 50%
Clear stuffed animals & clutter
House-dust mite allergen.
Encase the mattress in an allergen-impermeable cover.
— Encase the pillow in an allergen-impermeable cover or wash it weekly.
— Wash the sheets and blankets on the patient’s bed weekly in hot water.
Reduce indoor humidity to or below 60 percent, ideally between 30 and
50 percent.
— Remove carpets from the bedroom.

19. Asthma and the Environment Mouse allergen exposure can be reduced by:
Cover or block entry
Treat with low-toxicity pesticides, traps
Clean or vacuum regularly
All warm-blooded animals, including pets and rodents, produce dander, urine, feces, and saliva that can cause allergic reactions
Rodents
— Mouse allergen exposure can be reduced by a combination of blocking access,
traps, and vacuuming and cleaning.
low-toxicity pesticides should be used sparingly, as they can be an allergen, themselves.

20. Asthma and the Environment
Cockroach allergen
Clear food or garbage from home
Cover food in containers with lids
Treat with poison baits, boric acid, & traps
Cockroach allergen.
Patients should not leave food or garbage exposed. Poison
baits, boric acid, and traps are preferred to other chemical agents, because the latter can be
irritating when inhaled by persons who have asthma. If volatile chemical agents are used, the
home should be well ventilated, and the person who has asthma should not return to the home
until the odor has dissipated.

21. Asthma and the Environment
Non-pharmacological strategies for people with asthma
Remediation of dampness or mold in homes reduces asthma symptoms and medication use in adults (Sauni et al, Cochrane 2015)
Dampness and Mold
For children at risk of asthma, dampness, visible mold and mold odor in the home are associated with increased risk of developing asthma (Quansah et al, PLoS ONE 2012)

22. Asthma and the Environment
Indoor Mold
Fix or treat leaks
Repair water problems
Clean all mold with warm soapy water

23. Asthma and the Environment
Indoor Irritants
Formaldehyde and Volatile Organic Compounds
Gas Stove
Sprays or strong scents
body sprays
plug-ins
essential oils
Formaldehyde and VOCs—can arise from sources such as new linoleum flooring,
synthetic carpeting, particleboard, wall coverings, furniture, and recent painting—have been
implicated as potential risk factors for the onset of asthma and wheezing.
We saw an increase in calls at ODH after the 60 Minutes“ reported Lumber Liquidators was selling laminate flooring made in China with levels of formaldehyde higher than those allowed under California law. The news program sent an undercover team to a factory in China to speak with factory managers who acknowledged that inventory being produced for Lumber Liquidators was labeled incorrectly being compliant.
Gas Stoves Use of unvented gas stoves and appliances results in increased indoor levels of NO2.
Sprays or strong scents are a source of irritation and can be difficult to diagnose. The girl’s body wash, sitting in the next seat during math, or the body spray after gym.

24. Asthma and Smoking Clear The Home and Car of Smoke
Eliminate smoking in home
Eliminate smoking in car
Other Sources of Smoke
Fireplace
Campfire
Trash fire
Tobacco smoke is the most common irritant
Heavy smokers are less likely to realize the impact of secondhand smoke.
Smoking out of doors to avoid exposing others may not adequately reduce exposure for children.
Exposure to maternal smoking has been shown to be a risk factor for the development of asthma in infancy and childhood.
Effects of ETS on a child’s asthma are greater when the mother smokes than when others in the household smoke.
Other Sources of Smoke
Fireplace wood-burning appliances or fireplaces,
Campfire
Trash fire which aren’t as common anymore, but are occasionally experienced out in the country.
Avoiding is the best line of defense, of sitting as far way and down wind as possible.

25. Asthma and Smoking

26. Asthma and Smoking

27. Asthma and Smoking
Nearly 9 out of 10 cigarette smokers first tried smoking by age 18.
*****
If smoking continues at the current rate among youth, 5.6 million of those younger than 18 today will die early from a smoking-related illness.
That is 1 of every 13 youth 17 years or younger alive today.

28. Medical Control Of Asthma
Asthma is a chronic, lifelong disease of the lungs.
It must be routinely managed
Asthma has no cure.
Asthma is a chronic, lifelong disease of the lungs. Asthma has no cure. It is possible to live an active, normal life with asthma. Asthma must be routinely managed
It is possible to live an active, normal life with asthma.

29. Medical Control Of Asthma Evaluating asthma control
Do you have an asthma action plan?
Do You take asthma medicine?
Do you have a Primary Care Provider (PCP) who manages your asthma?
Do you have health insurance?
Evaluating asthma control

30. Medical Control Of Asthma
Asthma Action Plan
Explain taking medicine
Identify triggers
Recognize worsening symptoms
Define actions at each level
Green
Yellow
Red
Everyone with asthma should have an asthma action plan, but only about 20% actually have one. Asthma emergency happen at home, school, work or away from medical help. This help people with asthma and their families know what to do.
If someone has asthma ask if they have an asthma action plan?
Do you have an asthma action plan?

31. Medical Control Of Asthma
Is the medicine expired?
Is it a metered dose inhaler (MDI)?
Do you use a spacer with it?
Have them locate their medication and check the expiration date. Medicine comes in different packaging but
Do you have asthma medicine?

32. Medical Control Of Asthma
Do you have a Primary Care Provider who manages your asthma?
Do you have health insurance?

33. Get Covered Connector

34. Asthma Medical Management Do you have an asthma action plan?
Review
People with asthma
Symptoms of asthma
Medical management
Environmental Triggers
Asthma is a chronic disease of the lungs
Once you have asthma you always have asthma
There is no cure but it can be controlled
You can life a normal healthy life with asthma when if is controlled
Although anyone can have asthma, it is most common along adults with less education and lower income
Medical Management
Do you have an asthma action plan?
Do You take asthma medicine?
Do you have a Primary Care Provider (PCP) who manages your asthma?
Do you have health insurance?
Frequent Cough – more common at night, waking you up.
Wheezing – a whistling sound when you breathe
Short of Breath – the feeling of not being able to get enough air
Tight Chest – the feeling like something heavy on your chest
Environmental Triggers
Identify it
Clean it
Clear it
Cover it
Treat it

35. References
U.S. Department of Housing and Urban Development Office of Healthy Homes and Lead Hazard Control
Center for Disease Control. (2016). Database and statistics. Smoking and tobacco use. Retrieved from:
Environment
Cover it
Clear it
Clean it
Educate and treat smoking cessation

36. Questions Environment Cover it Clear it Clean it
Educate and treat smoking cessation