What You Need to Know for schools Welcome:

What You Need to Know for schools Welcome:
Take this time to introduce yourself and talk about your involvement with the American Lung Association and your local agency. If a representative introduces you, provide them with a brief bio Asthma 101—the importance of educating our community: Asthma education is not only important for the person diagnosed, but also for everyone involved in the patient’s life. When education is spread to our community, we are helping to save lives. Over the next hour, we are going to review some key components to help each of you have a better understanding of what asthma is and how to manage it. What You Need to Know for schools

Megan Becker, RRT,NPS,AE-C Respiratory Therapist
North Country Hospital

Learning Objectives The scope of asthma Common asthma symptoms
Asthma 101 What You Need to Know was designed to provide basic information about asthma and its management. Upon completion of the course, the learner should be able to identify: The scope of asthma Common asthma symptoms Potential asthma triggers The difference between quick relief and controller medications used in asthma management How to manage an asthma episode How to respond to an asthma emergency The importance and components of an Asthma Action Plan Asthma 101™ What You Need to Know was designed to provide basic information about asthma and its management targeted to (list target audience you are presenting to) School Personnel Child Care Providers Coaches

We will breathe easier when the air in every American community is clean and healthy. We will breathe easier when people are free from the addictive grip of cigarettes and the debilitating effects of lung disease. We will breathe easier when the air in our public spaces and workplaces is clear of secondhand smoke. We will breathe easier when children no longer battle airborne poisons or fear an asthma attack. Until then, we are fighting for air. This is ALA credo. We read it at every presentation. Thanks for doing the same 

Asthma in the U.S. An estimated 25 million people currently have asthma (8% of population) 7 million children have asthma Asthma is one of the leading causes of school absenteeism Asthma accounts for 14.5 million lost work days Asthma is the third leading cause of hospitalizations among children under 15 In 2007, 185 children and 3,262 adults died from asthma. 3,262 adults died from asthma. 3 Emphasize that approximately 15 people die every day in the U.S. because of asthma. May wish to add personalized story about a person who has asthma and some of the challenges they have encountered because of it. Ask the participants if they have asthma or have a family member or friend with asthma. Deaths attributed based on an age-adjusted rate of 1.3 per 100,000 Reference: page 4 of handbook

Asthma in Vermont 10 % or approximately of Vermont youth (under 18) have current asthma. Approximately 1 in 10 students currently have asthma. Twice as many middle school students with asthma smoke compared to those without asthma (9% compared to 4%). A total of 19.5% of all middle school students and 24.3% of all high school students have ever been diagnosed with asthma. Asthma rates were 44% higher among those children living in New England households in which there was reported to be a smoker. Between Vermonters have died due to asthma. Bullet 1- 2: Asthma Data 2005, Vermont Department of Health Epidemiology Report Bullet 4 -This was taken during the school, and according to the School Nurses Survey Bullet 5- Asthma Regional Council

Asthma is… A chronic inflammatory disorder of the airways
Inflammation (swelling) of the lining of the airways Bronchoconstriction (tightening of the bands of smooth muscles surrounding the airways) which reduces the width of the airways Excess mucus production that further narrows the airways Asthma is a chronic inflammatory disorder that causes three primary changes in the lungs: Inflammation (swelling) of the lining of the airways Bronchoconstriction (tightening of the bands of smooth muscles surrounding the airways) which reduces the width of the airways Excess mucus production that further narrows the airways Asthma is an obstructive disease that may cause permanent changes (remodeling) (presenter may need to explain further) if not properly treated. While asthma cannot be cured, it can be controlled with a plan that includes a person’s parents, health care providers, child care providers, teachers, school nurses or coaches. Reference: page 6 of handbook

Normal Lung Tissue Asthma
Optional simulation/straw activity: (NOTE: Use same activity explanation as in participant guide) (2 OPTIONS) (pages 6 and 7 in handbook): Key messages for Participants: Imagine what it must be like to feel like this for prolonged periods during an actual asthma episode. Think how hard it must be to concentrate when you can’t breathe. Imagine how difficult it would be to climb a flight of stairs or walk down a long hallway to reach the school nurse or school office to obtain prescribed medications when each breath is an effort. Instructions for Speaker: If you use the straw exercise, ask the participants to describe what it felt like to breathe through a narrowed passage? Let participants know that anxiousness is a very common feeling felt during an asthma episode. Emphasize that the participants only breathed through the straw for about 15 seconds. Imagine being a person with asthma experiencing these symptoms for 15 or 20 minutes. Before asking for help. When speaking about children with asthma, be sure to mention to participants that children have smaller airways and that it does not take a great amount of swelling before they are in serious respiratory distress. Reference: pages 6 and 7 of handbook Color plates used with permission from Desjardins and Burton. Clinical Manifestations and Assessment of Respiratory Disease, 3E, Mosby, 1995

Myths and Truths About Asthma
Truth Airways swelling is real, even if triggered by strong emotions Myth Asthma is only an acute disease, and you can outgrow it Myth Asthma is a psychological or emotional illness Truth Asthma is a chronic disease, and you do not outgrow it Medical myths are all too common—including a lot of myths about asthma. Sometimes, what people think they know about a disease or its treatments can have a big impact on how they manage it. And when medical myths begin to interfere with proper management, it’s time for a dose of reality. Truth Asthma cannot be cured, but can be controlled Myth Asthma is curable

Truth Daily asthma controller/ pre-exercise medications allow individuals to be active Myth Asthma limits a person’s ability to fully participate in sports Myth Asthma always limits normal activities Truth Well- controlled asthma should not limit exercise and individuals can fully participate in sports Clearly state each myth and truth. Myth Asthma medications and inhalers are addictive Truth Asthma medications and inhalers are not addictive

Myth People cannot die from asthma Myth Asthma medications become ineffective if used regularly Truth Children and adults die from asthma each year Truth Controller medications work best when used daily. Use of daily quick relief (Albuterol) inhalers is an indicator of poor asthma control. Clearly state each myth and truth.

Asthma Diagnosis Assessment of Symptoms Medical history Physical exam
Spirometry test Diagnosis of asthma can be made by a health care provider through assessment of symptoms, medical history, physical examination and spirometry—a simple breathing test. Reference: page 7 of handbook

Symptoms of Asthma Wheeze Difficulty breathing /shortness of breath
Cough Tight chest/ chest pain Asthma symptoms may differ between individuals and possibly from episode to episode. Coughing may be the only symptom. Some people with asthma may never wheeze. Remember, it is important to take all asthma symptoms seriously. When asthma symptoms are first identified, action must be taken in order to provide relief. Children especially need to know they can feel confident that an adult is going to know what to do when they are experiencing an asthma episode. Reference: page 7 of handbook Retractions (neck area and/or muscles in ribs move inward with breathing), more noticeably in children

Asthma Classification
There are several different levels of asthma severity Severity assessment forms the basis of the asthma treatment plan Severity level determines the type, dose, and frequency of medications Classifications of asthma may be made using different methods. Diagnosing asthma is a fairly straightforward process. However, there are a number of approaches to classifying asthma. Asthma classification may be made according to one or more of the following methods: by underlying cause or disease process by severity by degree of control The goal of asthma control is to ensure that asthma does not impede a person’s daily activity. Reference: page 7 of handbook

Asthma Triggers Infections Allergens Irritants Behaviors
Triggers cause asthma symptoms to begin or get worse. Infections Allergens Irritants Behaviors Asthma episodes can be triggered by many substances or conditions, and triggers differ from person to person. Some of the most common asthma triggers include infections, allergens, irritants and behaviors. To complicate matters, many people with asthma have more than one trigger. So, they will need a health care provider’s help to isolate them. This may include blood or skin testing or keeping a detailed diary. When symptoms occur, the diary can help the health care provider find patterns in their behavior or exposures that point to a specific trigger. Asthma episodes may start suddenly or take many days to develop. So it may take some time, along with trial and error to identify known triggers. But the payoff is worth the wait. After one knows what triggers their symptoms they can take active steps to lessen the impact of asthma on their life. Reference: pages 9-12 of handbook and trigger poster If you avoid asthma triggers, you may prevent asthma episodes and may require less medication to keep your asthma under control.

Keep hands away from face
Infections Respiratory Infections Are the #1 Trigger for Asthma What Can You Do? Wash hands Viral infections such as colds or viral pneumonia can trigger or aggravate asthma, especially in young children. These infections can irritate the airways (nose, throat, lungs, and sinuses) and this added irritation often triggers asthma flare-ups. Hand washing is the single most effective way to prevent the spread of communicable diseases. Some of the best ways to prevent getting an infection include: Washing hands often Using paper towels during cold and influenza season Not sharing cups, toothbrushes, towels, or tissues Keeping hands away from face Getting an influenza shot yearly Reference: page 9 of handbook and trigger poster Keep hands away from face Get an influenza shot Use separate towels

Allergens Animals Cockroaches Dust mites Mold Pollens Food/additives
Cats, Dogs, etc. Birds, mice Cockroaches Dust mites Carpets/upholstery Mold Pollens Weeds, grass, trees Food/additives Peanuts, shrimp, tree nuts, wheat, milk, soy, fish Medical conditions Latex Gloves, balloons Generally, asthma episodes are “triggered” by something. Allergens are typically defined as something that causes an allergic reaction in some people, but not others. Reference: pages 9-11 of handbook and trigger poster

Asthma/Allergy Connection
Strong link between asthma and allergies Important to keep them under control Some allergies affect the upper airway but can trigger an asthma episode in the lower airway All asthma is not allergy-related, and not all allergies will cause an asthma episode Allergens are identified and exposure is minimized to improve quality of life As scientists learn more about allergies and asthma, they are beginning to understand that these two diseases have a lot in common. Allergic rhinitis (hay fever) and asthma are both known as allergic conditions. Both can be triggered by many of the same allergens. And, in both conditions, increased amounts of leukotrienes play an important role in causing symptoms—in our nose in allergic rhinitis and in our lungs in asthma. Some individuals have both allergies and asthma and one wonders what they have in common besides a maddening ability to make individuals miserable. A lot, as it turns out. Allergy-induced asthma is the most common type of asthma in the United States; 60% of people with asthma have the allergic type. Many people with asthma will also take allergy medications, but know that all asthma is not allergy-related, and not all allergies will cause an asthma episode. Allergy shots may be beneficial. Identifying and minimizing exposure to known allergens can improve quality of life. Reference: page of handbook

Irritants Smoke Dust and chalk dust (when gloves are removed, and it is airborne) Strong odors (perfume, markers that smell, air fresheners, cleaning chemicals, paint, etc.) Cold (or very humid) air Sometimes it seems like the air we breathe can cause asthma or allergy symptoms to flare. The fact is that it is not the air itself, but the irritants in the air, that causes the problem. Aerosol sprays, perfume, cleansers, and other strong odorous products can irritate the airways and cause a reaction. Tobacco and air pollution are the most common irritants. Reference: page of handbook and trigger poster

Behaviors Emotions (crying, laughing, shouting)
What can one do to reduce or eliminate exposure to behavior types of triggers? Exercise—with good asthma management, you should exercise regularly. Use quick reliever medication before exercise, if directed by health care provider. Warming-up before and cooling down after exercise may be beneficial. Monitor air quality and only exercise outside when air quality is good. Quit smoking. Talk with healthcare provider or call the American Lung Association’s Lung HelpLine at 800-LUNG-USA ( ). Do not allow anyone to smoke in the house, garage, car, or near open windows. If someone smokes, recommend wearing the same jacket (smoking jacket) each time they smoke, and leave it outside (or in garage); it reduces the amount of smoke on clothes. Reference: page 12 of handbook and trigger poster Emotions (crying, laughing, shouting) Exercise may be a trigger for asthma, but asthma should not limit physical activity Smoking

Common Triggers Found at School
Dust and chalk Strong odors (perfume, markers that smell, air fresheners, cleaning chemicals, paint, etc.) Animals Mold Dust mites Foods/additives Latex (gloves, balloons) Americans spend up to 90% of their time indoors. Therefore, indoor allergens and irritants can play a significant role in triggering asthma episodes. It is important to recognize potential asthma triggers in the indoor environment and reduce exposure to those triggers (refer to those listed on slide). Reference: pages 9-12 in handbook Review slide.

Avoiding Asthma Trigger
Ask a person with asthma (or parents) to identify: his/her triggers in order of severity and 2. steps the health care provider suggests to avoid possible triggers Identifying asthma triggers and removing or eliminating them from the environment can drastically reduce asthma symptoms and severity of an asthma episode. In the case of children, continue to keep parents updated on actions you are taking to eliminate triggers.

Simple, Low-cost Modifications for Schools
Institute tobacco-free laws for schools and school property Institute a fragrance-free environment policy for the school building Maintain good indoor air quality Use odor-free cleaning chemicals Reduce or eliminate exposure to classroom pets Use fragrance-free markers Reduce or eliminate chalk dust Use vinyl gloves (non-latex products); allow only mylar balloons Use HEPA-filtered vacuum cleaners if your school has carpet Call the Vermont Department of Health Envision Program to learn more about programs to improve indoor air quality in your school. Refer to Environmental Checklist on pg in booklet.

Getting Help From the Professionals
It is important to see his/her health care provider regularly. He/she can help track triggers and work to find the right medicines to control asthma symptoms. Someone with asthma should see their health care provider once every 3 to 6 months, even when they are feeling well, and more often when experiencing breathing problems. The health care provider's role in asthma care begins with your diagnosis. Once he/she decides that you have asthma, then you and the health care provider can work together to control it. Review slide. Reference: page 14 in handbook

Goals of Therapy Control chronic and nighttime symptoms
Maintain normal activity levels, including exercise Maintain near-normal pulmonary function Prevent acute episode of asthma Minimize emergency department visits and hospitalizations Avoid adverse effects of asthma medications People with asthma can and should lead normal lives, including exercise and few, to no, missed school or work days Review slide. Reference: page 14 in handbook

For Students/Athletes with Asthma
Talk with your health care provider Explore the benefits of pre-medication Athletes should talk with their health care provider about exercising with asthma. Find out if they would benefit from using prescribed medication prior to physical activity. Play it safe, and remember to always have a quick relief medications on hand. Choosing the right activity will help one enjoy exercising. Jogging, biking, or playing tennis, for example, may be too strenuous for some individuals who might do better with walking or swimming. Whatever one chooses, be sure to monitor activity and watch for warning signs such as coughing, wheezing, difficulty breathing, and tightness of the chest. And don’t forget to talk to a health care provider to make sure the exercise one chooses will provide the desired health benefits. Reference: page 36 in handbook. Have your rescue medication with you at all times

Asthma Medications Controller and Quick Relief
Asthma medications are essential to asthma management. They are important in both preventing an asthma episode from occurring and in treating an asthma episode already underway. Many asthma medications are in the form of sprays or powders that are breathed in through the mouth and work best when they can get deep down into the lungs. A variety of medications are prescribed in the management of asthma. Some medications reduce inflammation and prevent asthma episodes. These are controller medications. They are taken on a daily basis, even when feeling well. Quick relief medications are used to treat asthma. Many of these medications are inhaled and start to work within a few minutes. Reference: pages in handbook

Asthma Medications Controllers (anti-inflammatory)
Help prevent an asthma episode Are taken daily Does not eliminate the need for quick relief medications Quick relief medications (inhaled bronchodilators) Fast-acting Relieve symptoms during an asthma episode As needed basis It is important to take controller medications every day to keep asthma under control and to prevent an asthma episode. Controller medications work slowly—medicine taken today will help days from now. Reference: pages in handbook

Controller Medications
Can be inhaled or taken orally Decrease swelling and inflammation in the airways Control symptoms Prevent asthma episodes Will not help during an asthma episode or in emergencies Take controller medication(s) every day, even when feeling well! Many people with asthma need to take medication every day to control their asthma. But there’s a good reason for taking a medication, even when one feels OK and doesn’t notice asthma symptoms. Controller medications work by keeping the airways in the lung open and clear, making it easier to breathe. But these medicines work slowly over time. It may take days or weeks for them to start working and keeping the airways from becoming swollen and narrow. That’s why they’re called controller medications—a person with asthma needs to take them regularly to control the condition. Comes in many forms: metered dose inhaler, dry powder inhaler, pill, liquid or nebulizer. Controller medications will NOT help during an asthma episode. Reference: pages in handbook

Quick Relief Medication
Also called reliever or rescue medication Relieves asthma symptoms quickly Relaxes airways muscles Use when asthma symptoms first appear and/or before exercise, as indicated by health care provider Take quick relief medication as soon as asthma symptoms appear. Quick relief medications relieve wheezing, chest tightness, and coughing and can help keep an asthma episode from getting worse. Sometimes a health care provider will encourage a person with asthma to take quick relief medication before exercise if exercise is a trigger. Quick relief medication will quickly decrease the bronchoconstriction (muscle tightening) in the lungs. No matter the severity or frequency of a person’s asthma, quick relief medications should be carried with them at all times! Medication comes in metered dose inhaler, nebulizer, or pill form. Health care providers will prescribe an inhaler that is best suited for the patient’s needs. One may need to try a few different devices to find what is best for them. There are a variety of different medications and devices for delivering them. The next few slides will demonstrate proper techniques for several different medications. Reference: page in handbook

Small Children Can Get Their Medications By……
Children should take their bronchodilator medication at the earliest sign of an asthma episode. Watch for early signs and symptoms so asthma medications can be started right away to relieve them. Remember that major episodes start with small symptoms. An episode is easier to stop if medication is taken as soon as early warning signs or symptoms appear. Anti-inflammatory medications should be taken exactly the way a child’s health care provider recommends, even if the child is not feeling any asthma symptoms. This will reduce airway swelling and keep asthma episodes from starting. This medication must be taken on a regular basis for it to work well. Anti-inflammatory medications are preventative in nature and will not relieve symptoms of an asthma episode, even though they may be taken through an inhaler. Using a metered- dose inhaler with spacer and mask Using a nebulizer

Inhaler with Spacer/Holding Chamber and Mask
4. Press 5. Six breaths 6. Repeat, as prescribed Shake Put together Seal Review technique

Nebulizer 1. Sit upright 3. Place in mouth or seal face mask
2. Add medicine and turn on 3. Breathe normally Review technique briefly Continue until nebulizer cup begins to sputter. Shake or tap the cup and continue breathing through the mouthpiece/face mask until nearly all the liquid in the nebulizer cup is gone.

Nebulizer Cleaning Techniques
Disconnect nebulizer from tubing, disassemble, and briefly wash in warm soapy water. Rinse nebulizer parts and shake off excess water. Place nebulizer parts on a towel or dish rack, and allow to air dry. Keep parts out of the reach of children. Reassemble the clean nebulizer, and place in a cool dry place. Review slide. Reference: page 18 in handbook

Inhaler with Spacer/Holding Chamber
1. Shake 5. Breathe in slowly 2. Put together 6. Hold your breath 3. Breathe out 7. Wait and repeat, as prescribed Review technique Note: Using a holding chamber ensures that more medication will reach the airways, which, in turn, will provide more relief. If an inhaler is used without a holding chamber, only a small amount of medication reaches the lung. Most of the medication ends up being trapped in the mouth or throat and will never reach the lung. 4. Press

Autohaler 1. Hold upright 4. Breathe out 7. Hold your breath
Flip up lever 5. Put in mouth 8. Wait and repeat, as prescribed 3. Shake 6. Breathe in Review technique

Diskus 4. Breathe in steadily and deeply 1. Open 5. Close 2. Click
Review technique 6. Rinse 3. Breathe out

Flexhaler 1. Hold upright 5. Put in mouth 9. Breath out
2. Remove cover 6. Breathe in fast and deep 10. Repeat, as prescribed 3. Twist to the right and twist back to the left until it clicks 7. Remove from mouth 11. Rinse Review technique 4. Breathe out away from mouthpiece 8. Hold your breath 12. Replace

Twisthaler 1. Hold upright Breathe in fast and deep
9. Repeat, as prescribed 2. Twist cap to the right 6. Remove from mouth 10. Rinse 7. Hold your breath Breathe out away from mouthpi ece 11. Replace Review technique 8. Twist cap to the left and click closed 4. Put in mouth

More on Medications Know when the medication expires
Check the inhaler for the date Do not use once expired Know how many doses have been used Some inhalers have dose counters on them-Pay attention to those Some inhalers need to be manually counted Place a piece of tape on the inhaler Write the date you start using the MDI on the tape Place a hash mark on the tape for each dose Count the hash marks often to make sure you still have doses remaining Review slide. Reference: page 15 in handbook

Oral Steroids Treat Severe Swelling in Your Lungs
Take during or after severe flare-up Take only as prescribed by health care provider Oral steroid pills and syrups are often used to treat severe asthma. They reduce swelling and help other asthma medicines work better. Typically they are taken for short periods of time (3-10 days). The steroids used in asthma management are corticosteroids and are permissible for use in athletic competitions. Anabolic steroids have been used by athletes to build body mass and are banned from use in many athletic competitions. Reference: pages in handbook

What is a Peak Flow Meter?
Hand-held device Measures how much air flows from your lungs in one fast blast Used by patients with moderate to severe persistent asthma When airways are open and not clogged with mucus, a person can breathe out a lot of air. However, when the muscles wrapped around the airways tighten, or when mucus builds up, a person can’t breathe out as much air. Peak flow rates can show a person with asthma if their asthma is getting worse, even before they feel any symptoms. A peak flow meter is a simple, easy-to-use device that measures how well our lungs are working. By measuring how efficiently one can breathe air out of our lungs, peak flow reading can help one identify worsening asthma so that one can adjust their treatment. Asthma episodes sometimes occur gradually. A peak flow meter can show small changes before signs appear. Early detection of an asthma episode can lead to early treatment. Reference: page 26 in handbook.

Why Should Someone With Asthma Use a Peak Flow Meter?
To become aware of changes in breathing To catch breathing problems early To identify when to take quick relief medication To identify when to call health care provider or seek emergency care Health care providers may recommend using a peak flow meter at least once a day— typically before one takes their regular asthma medication in the morning. Use the peak flow meter at the same time every day, and record peak flow rates in an asthma diary. If one’s asthma is under control most of the time, their health care provider may say it’s OK to check their peak flow reading every few days instead of every day. In addition to regular monitoring, one may also need to check their peak flow when: Asthma symptoms wake one up at night Increased symptoms during the day Have a cold, influenza, or other illness that affects their breathing Need quick relief: Check peak flow before taking quick relief medication. Then check it again after 20 or 30 minutes. Reference: page 26 in handbook

When to Use a Peak Flow Meter
Every morning, if indicated by health care provider During an asthma episode As with any chronic condition, daily monitoring is critical to ensure positive outcomes. Successful asthma control relies upon daily peak flow monitoring to accurately adjust medications and activities. Peak flow meters are good (objective) monitoring devices; however, always listen to the person with asthma and always take their symptoms seriously.

How Do You Use a Peak Flow Meter?
1. Slide to the bottom of the scale 4. Note number 2. Breathe deeply while standing 5. Repeat two more times Review technique. To assist in managing a person’s asthma, they need to find their personal best peak flow rate. By determining a person’s “personal best”, the health care provider or asthma educator can help the person with asthma determine their green, yellow, and red zones. Using the personal best number as a baseline, they can then compare that number with other peak flow rates. This will help determine if someone with asthma is having trouble moving air in and out of their lungs. By logging one’s peak flow rates in a diary, it will allow the person with asthma to determine their personal best rate, determine the severity of an asthma episode, and correlate it with an Asthma Action Plan. Reference: page 27 in handbook. 3. Blow hard and fast 6. Record highest number

Basic Asthma Management
Remain calm and reassure the person while providing assistance Stop the person’s physical activity and make sure he/she remains calm Remove the person from exposure to known asthma triggers Although all asthma episodes should be taken seriously, identifying and responding to symptoms early is important to prevent further exacerbation. Remember to do the following during an asthma episode: Stay calm! If the person with asthma sees that you are upset, it could make him or her more anxious and symptoms may worsen Try to get the person with asthma to relax and calm down Remove the person from the trigger exposure, if that is causing the asthma episode Follow the instructions from the Asthma Action Plan and give the appropriate medication If the person with asthma is an older child, try to get them to take some slow, deep breaths Reference: page 29 in handbook.

Actions to Take For an Asthma Episode
Have someone stay with person Follow the person’s Asthma Action Plan Make certain quick relief medicine is available and used properly Observe person to ensure he/she improves Communicate with emergency contacts if the person with asthma has experienced breathing difficulties while engaging in physical activity It is essential to take asthma symptoms seriously and immediate action taken.

Activity Can Continue When…
Wheezing has resolved There is no chest tightness There is not shortness of breath Person is able to speak in complete sentences Person is able to freely walk around Person’s peak flow rate is 80% predicted or better Review slide. Reference: page 29 in handbook.

Asthma Action Plan All people with asthma should have an Asthma Action Plan based on their peak flow rates or symptoms. The Asthma Action Plan provides a treatment guide for a person with asthma and/or their caregiver. The Asthma Action Plan should be determined by a healthcare provider or certified asthma educator. Every person with asthma will be given an asthma severity category based on the frequency of their symptoms and breathing tests. The Asthma Action Plan has three sections, one for each of the asthma zones— green, yellow, and red. The Asthma Action Plan provides instruction for managing asthma depending on what zone they are in, what medicines should be used, and how to manage an asthma episode. People with asthma should bring their Asthma Action Plan with them to every visit to their health care provider to make sure it is accurate and up-to-date. The Asthma Action Plan should be updated every year. Keep an Asthma Action Plan in a highly visible and accessible place (on outside of refrigerator) so others can easily find it as well as providing a copy to all needed personnel—i.e., work, school, daycare provider, etc. Reference: pages in handbook.

Use of an Asthma Action Plan
For children, have the parent/guardian and health care provider complete an Asthma Action Plan For children, send a copy of the Asthma Action Plan to the child’s care provider, school, and/or coach Keep on hand and in an accessible location in case of an emergency Peak flow recording and understanding what to do when a person with asthma is in a specific zone is crucial successful management. Studies have shown that people with written Asthma Action Plans had fewer asthma episodes, reduced emergency room visits, and hospitalizations and improved lung function. Reference: page 29 in handbook

Green Yellow Red Zones of Asthma There are three zones of asthma:
People often refer to asthma symptoms and their level of seriousness in three zones. Each zone is depicted by a color with instructions on what to do in each zone and represents a different level of asthma symptoms. The colors and instructions used are very similar to the ones used in a traffic light— i.e., green means “go”, yellow means “caution”, and red means “stop”. Reference: page 30 in handbook

Green Zone Go: No Asthma Symptoms
In the Green Zone, asthma is under control (no coughing, or wheezing, able to sleep through the night, and participate in all activities). Be sure to take controller medication daily, if prescribed. Reference: page 30 in handbook Go: No Asthma Symptoms

What to Do in the Green Zone
Take controller medication every day, if prescribed, even when feeling well Keep quick relief medications on hand Give Asthma Action Plan to other care providers, if necessary Eliminate asthma triggers in home See health care provider regularly for an asthma check-up Review slide. Reference: page 30 in handbook

Early Warning Signs and Asthma Symptoms Begin
Yellow Zone In the Yellow zone, early warning signs and asthma symptoms begin. Reference: page 30 in handbook Caution: Early Warning Signs and Asthma Symptoms Begin

Early Warning Signs May Include…
A drop in peak flow meter readings An itchy chin or neck (a child may rub his chin or neck in response to this feeling) “Clipped” speech (a child may speak in very short, choppy sentences in order to catch his/her breath) Itchy, watery eyes Dark circles under eyes Runny nose and/or sneezing Hunched shoulders Change in mood and/or irritability We all can become experts in spotting the early signals of asthma. Maybe we’re experts already! As one alert parent said to her child, "Asthma may not be a friend, but if it's an enemy, at least it isn't sneaky. It always gives a warning.” Every individual with asthma has a built-in early warning system that signals when symptoms are on the way. Those signals can be seen, heard, and felt. Every individual has his or her own pattern of signals. Follow the Asthma Action Plan prescribed by a person’s health care provider if any of these signs appear (review slide). Be prepared. Do not wait until the last minute to learn how to handle an emergency. The childcare provider/teacher/school nurse/coach, etc. should meet with the person who has asthma and his/her parents to put together an emergency care plan as part of a comprehensive Asthma Action Plan. The Asthma Action Plan should include a phone number where the emergency contacts can be reached, the health care provider’s name and phone number, and plans for getting the person with asthma to a health care provider or hospital as soon as possible. Reference: page 30 in handbook

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 Perspiring Vomiting due to hyperventilation Restlessness during sleep Fatigue that is not related to activity Asthma episodes rarely occur without warning. Most people with asthma have warning signs (physical changes) that can occur hours before actual symptoms appear. Warning signs are not the same for everyone. A person may have different signs at different times. By knowing what the warning signs are and acting on them, we may be able to help avoid a serious asthma episode (review slide). Reference: page 30 in handbook

What to Listen for… Coughing or persistent cough with no other cold symptoms Frequent clearing of the throat Irregular breathing Noisy, difficult breathing Wheezing during exhaling A person with asthma may know what happens to them before an asthma episode actually happens. A person with asthma may tell someone that: His/her chest is tight or hurts He/she cannot catch a breath His/her mouth is dry His/her neck feels funny, or He/she “doesn’t feel well.” Review slide

What to Do in the Yellow Zone
Step up medications as prescribed and reduce activities as indicated Take quick relief medication Sit down, inhale slowly through the nose, and exhale through the mouth with lips partially open Keep taking daily controller medicines Stay calm Review slide. Reference: page 30 in handbook

Call Medical Services or 911
Red Zone GET HELP! Call Medical Services or 911 In the Red zone, get immediate help. Reference: page 30 in handbook

In the Red Zone Quick relief medication is not effective, not available, or has been used within the past 4 hours with no relief In obvious distress: blue/darkened fingernail beds or area around the lips, retractions, lots of effort needed to breathe, trouble walking and talking Wheezing and coughing may stop because breathing had reduced severely Call 911 if: Peak flow is less then 50% of predicted or personal best Blue or darkened fingernail beds or area around lips Marked wheezing and shortness of breath Review slide. Reference: page 30 in handbook

Get Emergency Help If any of the symptoms listed on a person’s Asthma Action Plan as emergency indicators are present If no improvement or relief from medications is noted after 15 to 20 minutes (or time period indicated by health care provider on Asthma Action Plan) OR If any of the following conditions are present: The person is hunched over with shoulders lifted, straining to breath The person has difficulty completing a sentence without pausing for breath The person’s lips or fingernails turn blue The person’s peak flow reading is below 50% below personal best Review slide. Reference: page 31 in handbook.

Emergency Action Plan Administer emergency medications specified in Asthma Action Plan Call 911 or emergency services Notify parent, guardian or emergency contact Review slide. Reference: page 31 in handbook.

Goals for Asthma Control
Sleep through the night Not cough or wheeze during the day or night Be physically active Not miss school or work due to asthma Not having asthma related visits to the emergency room to hospitalization If asthma is well controlled the chance of needing to respond to an emergency is reduced. The goals of controlling asthma include– (Review slide). Reference: page 33 in handbook.

Control of Asthma Depends on..
1. Being able to get medical care 2. Having good self-management skills 3. Having good communication between a person with asthma and those around them (parents, coaches, teachers, child care providers, friends and co-workers) Improving control over asthma will give a person with asthma more control in their life. Understanding how asthma affects the lungs is an important step toward good self- management. Reference: page 33 in handbook.

Preventing and Controlling Asthma Episodes
To prevent and control asthma episodes, work closely with parents/guardians and a child’s health care provider to devise and fallow a medical plan that: Prevents symptoms Reduces contact with triggers Prepares for any changes in symptoms Determines when a health care provider’s help is needed and when to seek immediate help Review slide. Reference: page 33 in handbook.

How Do You Know Your Asthma is Not in Control?
THE RULES OF TWO™ Do you take your rescue inhaler more than TWO times per week? Do you awaken at night with asthma more then TWO times per month? Do you refill your rescue inhaler more than TWO times per year? Rules of Two is a federally registered trademark of Baylor Health Care System. Used with Permission. Here are some tools one can use when talking with their health care provider about adjusting their Asthma Action Plan. An overuse of quick relief medications does not treat the underlying problem of inflammation. Inflammation needs to be addressed by a health care provider or asthma specialist (allergist or pulmonologist). Reference: page 34 in handbook.

Is Your Facility Asthma Friendly?
Does your facility require an Asthma Action Plan for each person with asthma? Does your facility have an emergency plan to handle severe asthma episodes and asthma episodes and asthma emergencies? Are emergency communication devices provided in each area of your facility’s buildings and grounds? Asthma Action Plans can serve as a quick resource guide that provides instructions for managing asthma. They are a useful tool for teachers, coaches, substitute teachers, or other worksite personnel. Asthma Action Plans should be available to all necessary personnel for special and emergency instructions for each person with asthma. For both a child and a parent, school can be a daunting place, especially when asthma is thrown into the mix. Many schools across the U.S. are old and play host to potential asthma triggers. Potential triggers such as old carpets, scented cleaning supplies, activities leading to excitability, require a confident understanding of asthma. Being prepared with a clear Asthma Action Plan can ensure that a child is comfortable at school. Reference: pages in handbook.

Asthma Friendly Facilities (Cont’d.)
Are people allowed to take prescribed asthma medications at your facility? Is a nurse in your building throughout the day? Are people allowed to carry their quick relief medications, if they have appropriate authorization? Review slide Reference: pages in handbook. Vermont Law: Students with life threatening allergies or asthma, whose parents or guardians comply with all of the requirements of Act 175 of 2008, shall be permitted to possess and self-administer emergency medication at school, on school grounds, at school sponsored activities, on school provided transportation, and during school-related programs. The school shall provide an opportunity for communication with the student, parent/guardian and physician regarding the efficacy of the medication administered during school hours. In the case of medication possessed by students with life threatening allergies or with asthma, the school shall provide forms for parents to submit authorizing possession of the medication and releasing the school from liability as a result of any injury arising from the student’s self administration of the emergency medication.

Asthma Friendly Facilities (cont’d.)
Does your facility enforce tobacco-free policies? Does your facility maintain good indoor air quality (IAQ) and take measures to reduce asthma triggers, such as allergens and common irritants? Does your facility have pets? Does your facility provide asthma education programs for faculty, full-time and part-time staff, bus drivers and support staff, extracurricular activities sponsors, and volunteers? Review slide. Reference: pages in handbook.

More on Asthma Friendly Facilities
How are replacement personnel informed of people with asthma? Does the facility offer modified or alternative activities for people with asthma when medically warranted? Does the facility utilize an Asthma Action Plan? Asthma Action Plans can serve as a quick resource guide that provides instructions for managing asthma. They are a useful tool for teachers, coaches, substitute teachers, or other worksite personnel. Asthma Action Plans should be available to all necessary personnel for special and emergency instructions for each person with asthma. Reference: pages in handbook.

Other Important Issues
Who is responsible for asthma medications during a field trip or an away sporting event? Who is responsible for administering medications if a nurse is not present? Does every teacher know the students in their classroom who have asthma? Asthma management is a team effort between school personnel, students, parents/guardians, and primary health care providers. Everyone has to participate in the management of asthma in order to be successful. School personnel should know where quick relief medications are kept and what to do when someone is experiencing an asthma episode. The school nurse or administrator should review the asthma friendly school questions and identify areas in the school that may need attention. Reference: pages in handbook.

Asthma Travel Pack Should be available for all outings…
Field trips, athletic competitions, extracurricular events Minimum contents… Student's quick relief medications A current copy of student’s Asthma Action Plan Cell phone with fully-charged batteries Should be carried by the adult responsible for the student during the outing/event Planning ahead is the key to enjoying a field trip, athletic competition, or office outings (review slide). Reference: page 39 in handbook.

For Coaches/Physical Education Teachers
Have Asthma Action Plan Listen to your athletes Make sure quick relief medications are part of standard equipment needed for each practice/game Take action during an asthma episode Get emergency help, when needed Understanding asthma, helping students or athletes to prevent symptoms, and knowing how to respond if an asthma episode occurs, can help both adults and children breathe easier. Keep the following in mind when working with students/athletes who have asthma: Know which students/athletes have asthma and where their quick relief medications are kept. Maintain high expectations for all students and athletes, but be flexible if conditions do not permit optimal activity levels. Treat students and athletes with asthma as part of the group, but discuss asthma concerns privately. Have a positive attitude when working with any chronic disease or health concern. Reference: page 36 in handbook.

Parents/Guardians Need to Know if Child…
Complains that he/she can’t participate in activities or sports due to asthma Is coughing, wheezing, having trouble breathing, or complaining of a tight chest Is using his/her inhaler incorrectly, using it frequently, or sharing it with another child Asthma management requires teamwork between the student, parents(s)/guardians(s), health care provider, and school personnel. See Page 54 of the participant guide for an example of a letter from the school.

Summary People with asthma should always have their quick relief medications with them. Quick relief medications should be used before exercise or with frequent coughing, if prescribed. Controller medications should be taken every day, even when feeling well. Encourage use of quick relief medication before exercise, or with frequent coughing, if prescribed. Good communication is essential for effective asthma management. With proper precautions, everyone with asthma can achieve optimal performance. Review slide.

Remember… Asthma episodes can be prevented.
When asthma symptoms go away, asthma is still there. Asthma is treatable-all episodes should receive immediate attention. A severe asthma episode is an emergency! A person with even mild asthma can suffer a fatal episode. Review slide.

American Lung Association Lung HelpLine
Call LUNGUSA or visit for immediate, clear, accurate lung health and disease information Review slide.

For More Information 1-800-LUNGUSA (1-800-586-4872) www.LUNGUSA.org
372 Hurricane Lane, Suite 101 Williston, VT 05495 Review slide.

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