1. What You Should Know About Asthma

2. Asthma is a Major Public Health Problem Nearly 5 million children have asthma It is one of the most common chronic childhood illnesses It is a leading cause of school absences

3. 2 or more children are likely to have asthma In a classroom of 30 children,

4. What is Asthma? A disease that: Is chronic Produces recurring episodes of breathing problems –Coughing –Wheezing –Chest tightness –Shortness of breath Cannot be cured, but can be controlled

5. What are the Symptoms of Asthma? Shortness of breath Wheezing Tightness in the chest Coughing at night or after physical activity; cough that lasts more than a week Waking at night with asthma symptoms (a key marker of uncontrolled asthma)

6. What’s Happening in the Lungs with Asthma? The lining of the airways becomes swollen (inflamed) The airways produce a thick mucus The muscles around the airways tighten and make airways narrower

7. What Makes Asthma Worse? Allergens –Warm-blooded pets (including dogs, cats, birds, and small rodents) –House dust mites –Cockroaches –Pollens from grass and trees –Molds (indoors and outdoors)

8. What Makes Asthma Worse? (cont.) Irritants –Cigarette smoke and wood smoke –Scented products such as hair spray, cosmetics, and cleaning products –Strong odors from fresh paint or cooking –Automobile fumes and air pollution –Chemicals such as pesticides and lawn treatments

9. What Makes Asthma Worse? (cont.) Infections in the upper airways, such as colds (a common trigger for both children and adults) Exercise Strong expressions of feelings (crying, laughing) Changes in weather and temperature

10. Is There A Cure For Asthma? Asthma cannot be cured, but it can be controlled. You should expect nothing less.

11. How Is Asthma Controlled? Follow an individualized asthma management plan Avoid or control exposure to things that make asthma worse Use medication appropriately –Long-term-control medicine –Quick-relief medicine

12. How Is Asthma Controlled? (cont.) Monitor response to treatment –Symptoms –Peak flow Get regular follow-up care

13. Classification of Asthma Severity: Clinical Features Before Treatment Days with Nights with PEF % of personal symptomssymptoms best peak flow Step 4 Severe persistentContinualFrequent<= 60% Step 3 Moderate Daily>= 5 times per month>60% - < 80% persistent Step 2 Mild persistent3-6 times per 3-4 times per month>= 80% week Step 1 Mild intermittent = 80% week

14. Using a Peak Flow Meter A peak flow meter is a useful tool for objectively measuring the severity of asthma The value obtained is called a peak expiratory flow rate (PEFR) The PEFR shows the degree of airway obstruction or narrowing

15. Determining a “Personal Best” Value Each person has a normal PEFR based on height and gender. This is a predicted value. Many physicians prefer to use the person’s “personal best” value The “personal best” represents the highest rate obtained over a specific period of time.

16. Correct Technique for Using a Peak Flow Meter Place indicator at the base of the numbered scale Stand up Take a deep breath Place the meter in the mouth and close lips around the mouthpiece Blow out as hard and fast as possible Write down the achieved value Repeat the process two more times Record the highest of the 3 numbers achieved

17. Asthma Medications Long-term Controllers Used to control and prevent asthma symptoms Must be taken daily Quick-Relief Provides quick relief of an acute asthma episode by opening up the bronchioles Used as needed for symptoms and before exercise

18. Long Term Controller Medications Control and prevent asthma symptoms Make airways less sensitive to triggers and prevent inflammation that leads to an acute asthma episode Taken on a daily basis

19. Types of Long Term Controller Medications Brand names are listed as examples only, and are not inclusive. Inhaled corticosteroids - Flovent ®, Pulmicort ®, QVAR ®, Azmacort ®, Aerobid ®, Pulmicort Respules ® (only nebulized form), Vanceril ®, Beclovent ®. Preferred therapy for persistent asthma. Long acting bronchodilators - Serevent ®, Foradil ®.

20. Types of Long Term Controller Medications ( cont.) Brand names listed as examples only, and are not inclusive. Combination inhaled corticosteroids/long-acting brochodilator - Advair ® Leukotriene modifiers - Singulair ®, Accolate ®. A pill, not an inhaler, not a steroid Inhaled nonsteroid anti-inflammatory medications - Intal ®, Tilade ® Oral steroids

21. Quick Relief Medications Provide relief of an acute asthma episode Short acting inhaled bronchodilators - albuterol, pirbuterol (Maxair ® ) Oral prednisone burst, when albuterol alone is not effective

22. Using a Metered Dose Inhaler(MDI) MDIs deliver asthma medication directly to the lungs. To use: Remove the cap and hold inhaler upright Shake the inhaler Keep the head and neck in a neutral position and breathe out Position the inhaler in one of the following ways: –Open mouth and hold inhaler 1-2 inches away –Use holding chamber (recommended for young children) –Put in the mouth

23. Using a MDI (cont) Press down on inhaler to release medication as you start to breathe in Breathe in slowly (3 to 5 seconds) Hold breath for 10 seconds to allow medicine to reach deeply into lungs Repeat puffs as directed

24. Rules of 2™ When do you need more than a rescue bronchodilator? –Do you take your quick relief inhaler more than 2 times per week? –Do you awaken at night with asthma more than 2 times per month? –Do you refill your quick relief inhaler more than 2 times per year? If the answer to these questions is yes, a long term controller anti-inflammatory medication may be needed.

25. How are Asthma Episodes Controlled? Know the signs that asthma is worsening Treat symptoms or drop in peak flow at first signs of worsening Monitor response to therapy Seek a doctor’s help when it is needed

26. Exercise-induced Asthma (EIA) Symptoms include coughing, wheezing, chest tightness, or shortness of breath Usually begins during exercise and peaks 5-10 minutes after stopping exercise May occur more easily on cold, dry days than on hot, humid days Children may need treatment before exercise, even when asthma is well- controlled.

27. EIA (cont.) Asthma should not be an excuse to not participate in physical education, sports, or exercise Develop an asthma management plan that will allow the child to participate in any activity they wish Appropriate long-term control therapy can reduce the frequency and severity of exercise-induced symptoms Make it easy to take medications before exercise If full activity is not possible, modify A warm up period before exercise may help

28. What Should People with Asthma Be Able To Do? Be active without having asthma symptoms; this includes participating in exercise and sports Sleep through the night without having asthma symptoms Prevent asthma episodes (attacks) Have the best possible lung function (e.g., good peak flow number) Avoid side effects from asthma medicines

29. Additional Resources Allergy & Asthma Network/Mothers of Asthmatics, Inc. -- http://www.aanma.org American Academy of Allergy, Asthma, and Immunology -- http://www.aaaai.org American Academy of Pediatrics -- http://www.aap.org American College of Allergy, Asthma, and Immunology -- http://www.allergy.mcg.edu American Association of Respiratory Care -- http://www.aarc.org

30. Additional Resources American Lung Association -- http://www.lungusa.org Asthma & Allergy Foundation of America -- http://www.aafa.org/home National Asthma Education and Prevention Program -- http://www.nhlbi.nih.gov US Environmental Protection Agency -- http://www.epa.gov/iaq Centers for Disease Control and Prevention -- http://www.cdc.gov/nceh/airpollution/asthma Asthma and Schools -- http://www.asthmaandschools.org