Let’s
Talk about
Asthma! starring
the
AirBuds Name:___________ Hi there! We’re the AirBuds. We’re part of your lungs.
We want to tell you about ASTHMA and what you can do to " TAKE CONTROL!" " Are you ready?
An Asthma Self-Management Guide for Teens " Developed BY people with asthma FOR people with asthma
Jennifer Mammen, MSN FNP & Hyekyun Rhee, PNP PhD University of Rochester School of Nursing, University of Rochester Medical Center
"
Illustrated by Jennifer Mammen & T. Mark Bartley
______________
CONTENTS Round 1 So what’s it to me?
page 1
Pathology and Prevention of Asthma
Round 2 Better watch it!
page 8
Monitoring of Asthma Symptoms
Round 3 Hey, stop it!
page 16
Management of Asthma Symptoms
Round 4 Let’s Talk about Asthma! Communication and Social Issues
page 25
"
Round 1: So what’s it to me? Pathophysiology and Prevention of Asthma In this section we’re going to talk about what asthma is, what causes it, and how to prevent it!
!
first, let’s talk about NORMAL
BREATHING.
During normal breathing, AIR: moves into your nose and mouth, down into the airways, through the bronchi (the big tubes), into the bronchioles (the smaller tubes) then into the tiny alveoli (the little air sacs at the end). Your blood collects the oxygen from the alveoli, then moves it around to the rest of your body in red blood cells (kind of like a taxi ride).
!
ASTHMA.
People who have asthma have sensitive lungs. Something irritates your lungs (we don’t always know what). That causes SWELLING (inflammation) in your lungs.
!
swollen alveoli and clogged airways
cross section of airway NORMAL
⟿! INFLAMMED ⟿
AWFUL!!
!
THIS is what happens during asthma. The airway tubes get swollen (inflammation) and make more mucus. That makes it harder to get air in and out. You start out breathing through a nice big SNORKEL and end up trying to breath through a tiny STRAW! page 1
The swelling makes your lungs go crazy. Think about it—when you get irritated, what do you want to do?
FREAK OUT!
Gasp!
That’s what your lungs do. Irritation makes the muscles surrounding the lungs crazy and “hyper-responsive.” The muscles SQUEEZE tight around your airways so it’s harder to get air in and out (Broncho-SPASMS). This causes you to cough and make wheezing noises. NEXT, your lungs turn into mucus making factories, and block up what’s left of your airway with goo. So not only is your airway smaller, it also get OBSTRUCTED with mucus!
Hack!
The tale of doom continues….the more you cough, the more you irritate your lungs, the more they swell, the more they spasm, and the more mucus they make. ARGH!!! This weakens your lungs. When your lungs are weak, you get sick more.
Let’s STOP and SUMMARIZE:! Uncontrolled Asthma causes:!
Swelling (airways swell up)! Obstruction (more mucus, smaller spaces)! Spasms (constriction/ bronchospasm)! SOS!
page 2
! ! ! !
uncontrolled asthma makes your lungs weaker
ASTHMA TRIGGERS Triggers are ANYTHING that causes asthma symptoms. People with asthma have sensitive lungs, and some things bother us that don’t bother other people—they can cause asthma symptoms!
What are signs that something is triggering your asthma? PRE-ASTHMA SYMPTOMS itchy eyes sneezing tickle in throat getting sick
! !
ASTHMA SYMPTOMS coughing chest tightness wheezing short of breath
!
YEAH! Look at this.
chemicals
! !
Chemicals
pests + pets Pests: Roaches, Rats, Mice
Personal Care Products
Home Cleaners
!
exposures ! Cold weather
!
Fumes, Exhaust
Pets: fur / feathers
consumables Food Medicine
WHAT’S YOUR TRIGGER?
events Exercising/ Sports
Cigarette smoke
! !
ALOT of things can trigger asthma symptoms!
Mold
Laughing Stress
Pollens
Did you know cockroach poop is a HUGE problem for people with asthma? Cockroaches poop a lot, and when the poop gets stirred up, it floats around in the air. THEN, you breath it into your lungs. YUCK! Next thing you have symptoms!!
Catching a cold
Dust
The best way to treat asthma is to prevent it! THAT means knowing what your triggers are, so you can avoid them.
page 3
A lot of people with cat allergies think they’re allergic to dog What can you do about it? and cat hair--actually it’s the dead flaky cells pets (fur and feathers):__________________________ from the skin (called dander) that cause Avoid pets that trigger your asthma Keep pets out of your bedroom and keep your bedroom door closed. the real problem.
CAREFUL with the asthma TRIGGERS!!!
Don’t use feather pillows or feather comforters. Use polyester pillows instead and cover them with allergy (dust-mite proof) covers. Ask friends if they have pets you are allergic to BEFORE visiting them.
!
Not pets (Roaches, Bugs, Rats, Mice):__________________________
Keep food and garbage in closed containers. Empty the trash every day. Keep food out of your bedroom. Seal cracks in walls and cabinets. Tell your parents if you notice bugs or rats/mice so they can arrange to exterminate them. Use mouse traps or cockroach gels to kill pests. Pesticide sprays can bother your asthma—try using other options for extermination.
!
Medicine:__________________________
Avoid medicine you are allergic to. Ask your parents or healthcare provider if you are not sure.
!
Food:__________________________
Avoid foods you are allergic to — these can cause you to have asthma symptoms. People with asthma may be sensitive to foods/medicines that contain sulfites (ex. dried fruit, shrimp). Avoid strong odors and smoke from cooking foods.
!
Exercising and Sports:__________________________
Always warm up 5-10 minutes before exercising. Use a quick relief inhaler 15 minutes before exercising, as directed by your provider. Tell coaches and teachers that you have asthma, and when you are having symptoms. If you have asthma symptoms during exercising stop the activity and rest. Use your inhaler as prescribed.
!
Dust:__________________________
Keep your bedroom dust-free. Use washable curtains or window shades. Wash curtains monthly and damp wipe shades weekly. Cover pillows and mattress/bedsprings with allergy (dust-mite proof) covers. Don’t use a bed cover or comforter as a blanket—remove it before you sleep. Wash pillowcases, sheets, and blankets on your bed in hot water weekly. Keep humidity less than 60% in your home. Keep stuffed animals off your bed and out of the bedroom. Vacuum once or twice a week throughout your home. HEPA filtered vacuums are best. Forced air furnace filters should be changed at least every 3 months. Keep clutter to a minimum—especially in your bedroom. Keep dust collecting items in closed containers or in drawers. Avoid sweeping floors. Use a vacuum instead or damp mop. Dust with a damp clean cloth. Avoid construction areas and remodeling areas due to dust exposure.
page 4
Getting a COLD can make your asthma worse. AND, it takes a lot longer for all the symptoms (like coughing) to go away
Personal Care Products:__________________________
Avoid perfume, cologne, and scented personal care products. Use unscented options. Alert family, teachers, and friends if you are sensitive to the perfume/cologne they are using. Avoid talcum powders, aerosol hair spray, and spray deodorants. Avoid using jewelry cleaner and nail polish remover due to strong odors.
!
Home Cleaners and Products:__________________________
Avoid using room fresheners/deodorizers, room sprays, or incense. Avoid using strong smelling cleaners like ammonia and chlorine bleach. Use unscented laundry detergents and avoid using dryer sheets. Use a damp clean cloth to dust - avoid using dusting sprays.
!
Chemicals:__________________________
Avoid chemicals with strong odors, like those found in new clothes, cleaning products, fertilizers, paints, glues, varnishes, and new carpets. Wash new clothing before wearing because many are chemically treated. Avoid exposure to lawn fertilizers/chemicals, pesticides, and household chemicals. Be aware of chemicals used in school science rooms especially in dissection classes.
!
Things at School:__________________________
Tell your teachers that you have asthma so you can work together to avoid things that trigger your symptoms at school. Also talk to your school nurses, science teachers, gym teachers, coaches, bus drivers, and cafeteria staff. It may be helpful to write a letter describing your asthma triggers and symptoms to give to school staff at the beginning of the school year.
!
Mold:__________________________
Avoid raking leaves. Avoid moldy books and damp areas. Fix leaky faucets, plumbing, and leaking roof areas. A dehumidifier can dry out damp basements. Throw out spoiled foods and keep refrigerator clean. Frequently clean the drip pan under the refrigerator to remove mold. Dry tub and shower areas after using them to decrease mold. Remove carpets from damp areas like the bathroom and basement. Use a fan in your bathroom if available to prevent mold from growing.
!
Don’t let people smoke around you.
Second hand smoke is one of the biggest asthma triggers.
Pollens:__________________________
Shower and wash hair at night before bed to remove pollens. Pollen counts may be highest during the middle of the day and the afternoon. If you are allergic to pollens your healthcare provider may recommend allergy shots.
!!
Weather:__________________________
Cover your mouth and nose with a scarf in cold weather to help warm up the air you are breathing. Cold air can trigger asthma symptoms. Limit outside activities when the weather is extremely cold, hot, windy, humid, or polluted.
!
Smoke/Fumes/Exhaust:__________________________
If you smoke cigarettes talk to your healthcare provider about how to quit. Ask smokers that live in your home to smoke outside, never inside the house, in the car, or around you. Avoid smoke and fumes from heaters (wood-burning, kerosene, gas); fireplaces; campfires; bonfires; and exhaust from cars, trucks, buses, and trains. 
page 5
page 6
symptoms. What do you think could be causing the problem?
Lazair notices that every time he goes over to his cousin Miguel’s house he gets asthma
Dr. Detective case #1
Circle the ones you see!
How many asthma triggers can you find?
So‌What about EXERCISE? Intense exercise may be a trigger for asthma. BUT, that doesn’t mean you should limit your exercise. In fact, exercising helps to make your lungs STRONGER and decreases inflammation, so that you get fewer symptoms over time. Exercise is an important part of being healthy and controlling asthma. People with asthma should exercise and be active just like everyone else The only DIFFERENCE is you may need to take your albuterol inhaler 15 minutes BEFORE exercising, and again (during or after) if you get symptoms.
! How!many asthma TRIGGERs can you find ? cigarette smoke animals laughing dust mites cockroaches exercise medicine stress food allergy mold cold air perfume influenza virus pollen chemical cleaners paint sinusitis latex pneumonia bronchitis strep throat excitement
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if you smoke...kick the habit! page 7
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Round 2: Better watch it!! Monitoring symptoms of Asthma
So, last chapter we learned what asthma is, what triggers are, and how to prevent symptoms. Now we’ll talk about how to keep things under control!
To control symptoms you need to: Watch how things are going (monitoring) Do something about it (managing) Let’s start with monitoring. Monitoring asthma is kind of like playing basketball. You don’t just stand around until the other team shoots a hoop-you try to stop them. You think ahead. You watch the way the game is going. You’re smart, and you stay on top of things. Well in asthma, you have to watch the way the game is going. You have to be smart enough to spot the little signs. And you have to know how to stop problems before they actually happen. Ignoring your asthma is like standing around on the court and waiting for someone to hit you in the head with a basketball. Monitoring is for smart people. It means you keep an eye on how things are going, and if something starts to go wrong, you do something about it.
There are two ways you can keep an eye on your asthma everyday: I don’t know why my nurse 1. Keeping track of your symptoms
!
thinks I’m coughing badly-I’ve been practicing all night!
2. Peak flow meters
page 8
Sometimes people ask me if it’s hard having asthma...
Let’s talk about
I tell them, No, it’s
wheezy!
symptoms
What are the symptoms of asthma? YES
cough
YES
mucus / sputum
YES
wheezing
YES
a frequent cough that is triggered easily or lasts too long irritated cells in the lungs make more mucus/sputum sound made by air as it tries to pass through a narrow airway
short of breath/ can’t get as much air in and out, so you have to breath faster to trouble breathing make up for it. lying down means you work harder to breath, and that makes the symptoms worse.
YES
cough at night
NO!
fever
YES
chest pain/ tightness
YES
symptoms with exercise
asthma symptoms slow you down when you are being active
YES
clearing throat
from too much sputum
YES
tiredness
YES
OTHER:
Fever is not a symptom of asthma--that means something else is wrong. working harder to breath--like a band around the chest
• struggling to breathe
______________________________________________________ • worsening symptoms
• trouble talking or walking • using chest muscles to breath • Nostrils open wide • lips or fingernails are blue
! Based on YOUR symptoms, how do ! you think your asthma is TODAY? ! Circle the box that you think fits you the best. Zero (0) means that you have NO symptoms, and 8 means you’re way out of control! ! !! 0 Great!
1
2
Red Flags
feeling more tired than you should
3
4
Borderline
get immediate medical attention !!
5
6
Out of control
page 9
7
8 Way out of control
Answer these questions to find out how your asthma control is today. Circle the answer that fits you best.
Try to do question 1 in the morning, and the rest at bedtime.
1. Did you wake up last night because of asthma? 0 - No, not once 1 - Once 2 - A few times 3 - A lot
2. Did you have any asthma symptoms today? 0 – No, not once 1 – Once 2 – A few times 3 - A lot
ADD all the scores.
! The TOTAL number tells you how good your control is.!
3. Did asthma limit your physical activity today?
0 is Great!!
0 - No, not once 1 - Once 2 - A few times 3 - A lot
1 to 2 is Borderline! 3 to 7 is Out of control! 9 or more is Way out of control!!
4. Did you use your rescue inhaler today? 0 – No, not once 1- Once 2- A few times 3 - A lot
Three strikes, !
YOU’RE OUT!! (A score of 3 on any one question means you’re WAY out of control)
0 Great!
1
2
Borderline
3
4
5
6
Out of control
page 10
7
8
9+ Way out of control
!
Baby, you’re like asthm a... you take my breat h away !
Great! (0) Medication
Keep taking prescribed medications. Use rescue inhaler if needed.
Peak Flow
Check peak flow 1-2 times a day (morning and/or night).
Activity
Keep it up! No limitations (don’t forget to take your inhaler first, if you’re supposed to).
Action Plan
Follow your asthma action plan. If you don’t have one--GET ONE!
Reminders
Avoid triggers, practice good hand-washing to prevent infection.
Borderline (1 to 2) Medication
You may need to ADJUST medications. Use the action plan, or check with your provider. Use rescue inhaler if needed. If you are borderline more than twice in a week, you need to FOLLOW UP with your provider.
Peak Flow
CHECK peak flow 1-2 times a day (morning and night).
Activity
Stop activities that cause asthma symptoms--TELL your provider.
Action Plan
Follow your asthma action plan. If you don’t have one--GET ONE!
Reminders
AVOID triggers, practice good handwashing to prevent infection, ! WATCH FOR WORSENING SYMPTOMS.
Out of Control (3 to 9+) Medication
Time to ADJUST medications—use your action plan and the ASTHMA ATTACK guide (next page). Use rescue inhaler as directed. If you are out of control more than twice in a week, you need to FOLLOW UP with your provider. If you score 3 in any category or 9+ total, you need to CALL NOW!
Peak Flow
CHECK peak flow 1-2 times a day (morning and night).
Activity
Stop activities that cause asthma symptoms. Stay sitting up.
Action Plan
Follow your asthma action plan. If you don’t have one--GET ONE!
Reminders
AVOID triggers, practice good handwashing to prevent infection, ! WATCH FOR WORSENING SYMPTOMS. page 11
page 12
immediately!!
YES
!
START oral steroid.
URGENT! CALL ! your doctor.!
Follow up with your Doc for further instructions.
Not urgent today.!
Adapted from Figure 5-4, National Asthma Guidelines (2007)
Is peak flow! less than 50% of best?
NO, it’s less
NO, it’s less
YES
! ! What should you do when you have an asthma attack? Follow the steps in this flow sheet to help you decide.
1.
! Do you have SYMPTOMS of LIFE THREATENING ASTHMA? ! ! can’t catch breath " can’t speak in full sentences "! ! use of stomach or chest muscles to breathe " exhausted ! !YES NO ! ! Do you have ANY symptoms of asthma? ! ! wheezing " short of breath " coughing "! ! chest tightness or discomfort ! ! YES ! ! TAKE! ! NO Is peak flow! Albuterol inhaler 2 or more puffs! ! more than 80% of best? as directed (wait 20 minutes)! ! Are you still having symptoms? ! ! YES ! REPEAT ! NO Albuterol inhaler 2 or more puffs! ! as directed (wait 20 minutes)! ! Are you still having symptoms? ! ! YES ! ! NO Is peak flow! REPEAT ! ! more than 50% of best? Albuterol inhaler 2 or more puffs! ! as directed (wait 20 minutes)! ! Are you still having symptoms? ! CALL 911 ! YES ! go to ER
ASTHMA ATTACK!!
Dr. Detective case #2 You’re the provider Darth Vader comes to see you because his asthma is really bad. He’s supposed to be taking a daily control medication, but ran out about 2 weeks ago because his underlings never got it refilled. He’s been using his albuterol instead. Now he has a cold, and he feels terrible. He tells you that he has taken 12 puffs of his albuterol in the last hour and is still uncomfortable. He looks (and sounds) out of breath and can’t talk in full sentences. What should you do?
!
1. What do you think is wrong with Darth? How do you know?
2. What do you want to do for him?
! Weird Word Scramble What do you call a pony with a bad cough? (ASHOER)
A Little page 13
_ _ _ R _ E!
0
1
1
1
3
PM
G Y R 385 G Y R G Y R G Y R G Y R G Y R G Y R G Y R G Y R G Y R G Y R G Y R G Y R G Y R G Y R G Y R G Y R G Y R G Y R G Y R G Y R G Y R G Y R GwhatYhappened R It’s hard to remember last week. G Y R DIARIES are great way G Y R to record symptoms soGyouYdon’t forget. R Be sure to bring itGto your Y next R check up! 1/1
TOTAL SCORE
AM
Did you need your rescue inhaler
PEAK FLOW
Did asthma limit your activity today?!
DAY TIME
Did you have asthma symptoms today?!
Give each question a score➤ 0 = No, not once 1 = Once 2 = A few 3 = A lot
Did you wake up last night from asthma?
Symptom Diary
8am
Three strikes, !
YOU’RE OUT!
0
1
2
3
4
5 page 14
6
7
8
9+
peak flow meters Peak flow meters measure how FAST you can blow air out of your lungs. A peak flow meter tells you what’s going on with your lungs before you even feel it. I think of it as kind of like spying on what your asthma is doing.
Remember what happens with asthma? SOS!
Swelling (from inflammation) ! Obstruction (more mucus/smaller spaces) ! Spasms (muscles around lungs spasm and squeeze tight)
!
SOS makes your airways smaller. A peak flow meter can measure small changes in your SOS before you have symptoms. That way you can prevent things from getting worse and stop symptoms before they happen!! WOW!
How to use a Peak Flow Meter (PFM) 1. 2. 3. 4. 5.
Set the slider on the PFM to 0. Stand up straight.! BREATH IN. Put the PFM in your mouth. Hold it straight out like a trumpet. ! BLOW OUT. Take the biggest breath you can, and then blow HARD and FAST. ! WRITE IT DOWN. Write down the number the slider stopped at. ! RESET the slider to 0 and try it 2 times more. ! The best (highest) number is your PEAK FLOW!
Most peak flow meters have a Green-Yellow-Red slider. When you know your personal best, you set the slider to that. GREEN is GOOD because it’s 80-100% of your best, YELLOW is for caution (50-79%), and RED (<50%) is the danger zone! Red means your lungs are constricted and swollen. If you’re RED—call your doctor.
GREEN 80-100% ➔! YELLOW 50-79% ➔! RED <50% !! ➔ page 15
Round 3: Hey, STOP it!! Managing symptoms of Asthma To treat asthma symptoms, you need the right: ✦ Timing
It’s easy to take asthma medications WRONG.…!
✦ Amount ✦ Kind of medicine
but they work better if you
✦ Method of taking it
TAK-M-RIGHT!
There are really only 2 kinds of ASTHMA MEDICATION: 1. Fast acting “RESCUE” medications 2. Slow acting (long-term) “CONTROL” medications Rescue and Control medications work differently to stop asthma. Fast Acting “rescue” medications
!
Control symptoms
RIGHT AWAY
and they won’t get so bad
(like albuterol)
Rescue medications treat SPASMS and OBSTRUCTION caused by spasms. Rescue medicine provides relief from symptoms like wheezing and coughing in 5 to 15 minutes. They don’t treat the underlying problem. Use them if you have a problem NOW, or before exercise to prevent symptoms.
!
Slower “control” medications
Control medications stop SWELLING and OBSTRUCTION caused by inflammation and mucus production. Control medications treat the underlying problem—not just the symptoms. They work by preventing symptoms from happening. They take days to weeks to take effect, and you have to take them every day to work. They are NOT for emergencies. Always take the prescribed amount. Taking more can give you side effects. Taking less means it may not work right. page 16
page 17
NO!
Singulair Accolate Zyflo Serevent
Advair Symbicort
Prednisone
Leukotriene modifier
Long acting bronchodialator
Combination Drugs
Oral Steroids
YES
NO!
NO!
NO!
!
FAST “rescue” meds
Inhaled Corticosteroid
Proventil Ventolin AccuNeb Xopenex Maxair Combivent
Albuterol
Common drug names
Flovent Pulmicort Azmacort Aerobid Qvar Asmanex
Short acting bronchodialator
Type
!
!
!
!
YES
NO!
“control” meds
SLOW
!
Works same day, but not fast acting. Helps to prevent bronchospasm, but doesn’t stop allergy or inflammation. Takes days to weeks to work. These drugs are combinations of two drugs, usually an inhaled steroid, and a bronchodialator. Starts working within hours to days. Prednisone is used during bad exacerbations, when other medications aren’t working. For short term use.
Prevents SWELLING, OBSTRUCTION SPASMS Stops SWELLING & OBSTRUCTION
Takes days to weeks to work. stops the allergic reaction that causes inflammation
Takes days to weeks to work. stops the allergic reaction that causes inflammation
Albuterol relaxes the muscles that squeeze tight around the lungs, and lets the air back in
Starts working within 5-15 minutes.
How does it work?
Prevents SPASMS
Prevents SWELLING & OBSTRUCTION
Prevents
SWELLING & OBSTRUCTION
Stops SPASMS FAST
!
QUICK FIX NOW
What’s it for?
ASTHMA MEDICATIONS
Let’s STOP and SUMMARIZE medication treatment:! Remember uncontrolled Asthma causes:! ! ! Swelling (airways swell up)! CONTROL ! CONTROL Obstruction (more mucus, smaller spaces)! ! ! RESCUE Spasms (constriction/ bronchospasm)! ! ! ! SOS? ➔ RESCUE + CONTROL
EVERYONE with asthma needs a rescue inhaler. Rescue inhalers are good for emergencies. You should always have one with you. It’s like a cell phone. If you woke up in the middle of the night and realized someone was trying to break into your house, you would use your cell phone and call the police. Unless of course you didn’t have a cell phone⎯then you would be out of luck.
Remember your inhaler…IT COULD SAVE YOUR LIFE.
! ! ! !
Q: what did the corpse say to the doctor? A: this coffin’ is driving me crazy!
Hey!! Wait a sec!!! Does this mean I need to be on CONTROL medication too???
!
Maybe! But not everyone with asthma needs control medication. It all depends on your LEVEL of asthma SEVERITY and CONTROL.
How do you tell your asthma severity and control? (turn the page to find out) page 18
ASTHMA CONTROL
Well controlled asthma means you have symptoms 2 times a week or LESS.
!
3 x a week, and YOU’RE OUT of control.
Here’s how providers figure out how well controlled your asthma is. 1.
Start with the blue boxes. Next go sideways until you find the level that matches your symptoms. Circle one box for each row. control
2. Find the highest column that has a circle in it. This is your asthma control ➔ OVER THE PAST 4 WEEKS
WELL CONTROLLED
NOT WELL CONTROLLED
VERY POORLY CONTROLLED
symptoms
≤ 2 days per week, not more than once a day
> 2 days per week OR multiple times in one day
throughout the day
night time wake up for symptoms
≤ 1 days per month
3-4 time a month
>2 times /week
using rescue inhaler
≤ 2 days per week
>2 days per week
several times a day
activity limitations
none
some limitation
extremely limited
Peak Flow
> 80 % of best
60-80% of best
<60% of best
start
adapted from the National Guidelines (2007) Figure 3-4c
Now you try it. What kind of symptoms have you had over the last 4 weeks? Circle the answers to the blue boxes that fit you best. Is your asthma well controlled or not? OVER THE PAST 4 WEEKS
WELL CONTROLLED
NOT WELL CONTROLLED
VERY POORLY CONTROLLED
symptoms
≤ 2 days per week, not more than once a day
> 2 days per week OR multiple times in one day
throughout the day
night time wake up for symptoms
≤ 1 days per month
3-4 time a month
>2 times /week
using rescue inhaler
≤ 2 days per week
>2 days per week
several times a day
activity limitations
none
some limitation
extremely limited
Peak Flow
> 80 % of best
60-80% of best
<60% of best
adapted from the National Guidelines (2007) Figure 3-4c
page 19
Dr. Detective case #3
Instructions: Can you figure it out? Ask the instructor for more information if you need it.
Ok, you’re the provider. Shawn is 17. He comes to see you because he’s been coughing every day for about 6 months. It keeps waking him up at night. He hasn’t been able to play sports because he gets too out of breath. He wants to know why his cold won’t go away. What kinds of questions do you want to ask him so that you can fix his problem? Use the symptoms, severity and medication charts to help you figure out what to do for him. 1. Does it sound like asthma to you? Why? What other information do you need?
! 2. How bad is it?
! • How is his asthma control?
! controlled asthma doesn’t slow you down
page 20
REMODELING The real reason for CONTROL medicine is to prevent DAMAGE to your lungs, not just stop the symptoms. Asthma causes inflammation. Inflammation causes injuries to the lung. When injury heals up, it leaves a small stiff SCAR behind it. Over time, you get more
Try putting one rubber-band around your fingers. It’s still pretty easy to open and close them. Now add 2, then 3, 4, 5, and so on. After a while, you can’t open and close your fingers anymore. That’s what scarring from uncontrolled asthma does to your lungs.
and more of these scars, which reduces the ability of your lungs to move air in and out. The scars act like rubber bands around the lungs, so that it gets harder and harder to breathe.
Rescue inhalers make your symptoms go away, but don’t stop the SCARRING This process is called REMODELING — it permanently scars your lungs. SO…Treating asthma isn’t just about making you feel good now. It’s about the future. Everyday you don’t treat your asthma puts you one step closer to a really serious breathing problem. Let’s face it. Treating asthma is a pain in the butt…..But then so is walking around with an oxygen tank. That’s why we use control medications—because they stop REMODELING, make your asthma easier to control, AND prevent symptoms. Control medications prevent asthma from getting in the way of what you want to do. You don’t want asthma to slow you down—so STOP it!! SEVERITY:
MILD INTERMITTENT
MILD PERSISTENT
CONTROL:
WELL CONTROLLED
NOT WELL CONTROLLED & POORLY CONTROLLED
What kind of Rescue medicine (ex. Albuterol) medicine?
MODERATE PERSISTENT
SEVERE PERSISTENT
You need CONTROL medicine and RESCUE medicine page 21
Dr. Detective case #4
What’s up, doc? Can you figure out what’s going on? HINT: Use the information from pages 11, 18-19, 21-22, 24, to answer the questions.
Maca is 14. She has had asthma for 5 years. She says things are great and that she only has her normal symptoms. She treats it with an albuterol inhaler, which easily gets rid of the symptoms. She’s coming to see you because she needs a refill of her albuterol inhaler.
You’re the provider. 1. What are Maca’s asthma symptoms? What other information do you need?
2. What’s her asthma control?
3. Is she taking the right medications? Why or Why not?
if you have symptoms of asthma more than TWICE A WEEK, it’s NOT
4. What else does she need? Why?
!
NORMAL
!
KEY POINT: People with persistent asthma need CONTROL + RESCUE medication. page 22
Now that we know what medications to take, let’s make sure we’re taking them RIGHT!
How to take inhalers (correctly) because ANYONE can do it wrong.
1. 2. 3. 4. 5. 6. 7. 8.
Stand up.! Shake the inhaler.! Breath OUT. (Blow out all the air in your lungs.)! Hold the inhaler up right, start breathing in, puff the inhaler as you start.! Keep breathing in slowly, the biggest breath you can.! Hold it for 10 seconds, then breath out.! Wait 1 minute and repeat if needed.! Remember to rinse your inhaler at least once a week so it doesn’t get clogged up. MAKE SURE YOU RINSE YOUR MOUTH AFTER TAKING STEROID INHALERS.
(otherwise you can get a yeast infection in your mouth.)
Don’t forget to use a Spacer! 1. Shake the inhaler and attach it to the spacer! 2. Breath OUT ! 3. Put the spacer mouth piece in your mouth, squirt in one puff into the chamber, and then inhale slowly through your mouth! 4. Hold for 10 seconds! 5. Wait 1 minute and repeat as directed! 6. Clean your spacer as directed by the manufacturer
Spacers (chambers) are little plastic tubes that help more medicine get to your lungs. When you use your inhaler with out a spacer a lot of the medicine just stays in your mouth. Use a spacer whenever you can. page 23
Round 4: Let’s Talk about Asthma! Communication & Social Issues So now we know all sorts of stuff about asthma. But what about all those other people out there who don’t? Like friends, and teachers, and the people you live with? Sometimes they don’t know what causes asthma, or what the triggers are. What do we do about that?
Let’s
Talk about Asthma!
! us? !what do people need to know about I gotta remember to tell ! my doc how often I have symptoms! ! Sometimes I forget r e d i v o r p to talk about my e r a c h t l a e h! NORMAL symptoms. ! h c a o c ! s frie r e ! ch n
tea
sister
parents
ds
brother
I want the NURSE to know that just because she can’t SEE my asthma symptoms doesn’t mean I don’t have them. I want her to believe me!
grandparents If I use an inhaler, will people make fun of me?
school nurse page 24
What kind of problems do you have in dealing with other people? Check the boxes that fit you.
! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !
✓
✓
Problems with Friends My friends smoke.
No one fills my inhalers on time
My friends have pets I’m allergic to.
People smoke in my house.
People smoke or do drugs at parties and I don’t know how to handle it.
My house is dusty and dirty.
My friends don’t know I have asthma.
We have pets, and I’m allergic.
I’m embarrassed to carry an inhaler.
I have too much stress.
I’m allergic to things, and I’m embarrased to tell people about it.
My parents don’t seem to care.
I don’t like taking my inhaler where people can see me.
My parents are too protective.
My friends worry about my asthma too much.
My problem is...! ✓
I feel left out of things because of my asthma. I feel pressured to do things I don’t want to do.
Problems with Healthcare Providers I keep forgetting to say what my symptoms are
My problem is...! ✓
Problems at home
I don’t think I’m getting the right medicine.
Problems with other people
They treat me like a little kid.
People don’t seem to care that I have asthma.
They aren’t very friendly.
People worry too much that I have asthma
I don’t trust them.
My coach thinks I’m being a wimp if I ask to rest during practice.
I don’t understand what they’re saying
Sometimes people won’t let me take an inhaler when I need to.
They don’t explain things to me.
My problem is...!
So, what do we do?
Let’s TALK
!
I think they’re too busy to talk to me about asthma treatment.
My problem is...!
What do you do if dad says no?
about ways to solve the problems. page 25
You as-th-Ma!
Dr. Detective case #5
What are reasons why people don’t want to use inhalers?
Keisha is 16. She has had asthma for 1 year. She coughs off and on every day, and wheezes once in a while, but it doesn’t bother her very much. She doesn’t wake up at night. She has to be a little careful with sport and gym. She only uses her inhaler at home because she’s embarassed to take it to school. You told her she needs to start taking an inhaled steroid every day, AND carry her albuterol with her, but she doesn’t want to. She heard in health class that taking steroids is bad for you. What are you going to do? !
1. How is Keisha’s asthma control?
2. What are the reasons she should take a controller medication? (what do steroid inhalers do?)
controller medications make your lungs STRONGER because they STOP inflammation
3. What are her risks if she doesn’t take a controller medication?
4. Why should she carry her rescue inhaler?
5. How can you help her?
Some people worry about the side effects of taking medications. NOT treating asthma is far more dangerous than side effects. If the idea of side effects worries you, you should talk to your provider about it.
page 26
Fact or Fiction?
1. Asthma is something you grow out of. Fiction. You don’t grow out of asthma. However, the kinds of symptoms you have may change, depending on where you live and what your exposed to. Also, as kids get older, their airway gets bigger, so the swelling and inflammation that happens in the lungs may not be as noticeable as in smaller airways.
2. Taking my inhaled steroids will make me hairy with big muscles. Fiction. No way, Jose. There’s only a little bit of steroid, and most of that stays on the surface of your lungs—it’s just not enough to cause those kinds of side effects. That myth come from stories about people (like some athletes) using steroids to “bulk up.” Any one who wants big muscles is going to have to do it the old fashioned way—working out.
3. Taking steroids can give you osteoporosis. Fact. Taking prednisone for long periods of time can weaken your bones. That’s why it’s so important to take the inhaled corticosteroids regularly--so you won’t have to take the prednisone (pills). Most of the inhaled steroids stays on the surface of your lungs--only a tiny amount goes into your system. That’s why it doesn’t have the same problems that the prednisone pills do. The risks from taking steroid inhalors are really, really low--much lower than the risk of NOT taking them and permanently damaging your lungs from uncontrolled inflammation.
4. If you take inhalers too much, you can get addicted. Fiction. You don’t get hooked on inhalers. You don’t even get cravings for them. In fact, the people I know only take inhalers because they know it’s the SMART thing to do--not because they’re addicted. So don’t worry about turning into an inhaler junkie.
5. Having asthma means you can’t be as active as other people. Fiction. If your asthma is under control, there is no reason why you can’t be as active as everyone else. The only time asthma slows you down is when it is poorly controlled. So the take home message is--control your asthma, don’t let asthma control YOU!
page 27
ANSWER KEY CROSSWORD PUZZLE
C
I I N G F F O O D A L L P N R U N I E E M N U L A Z E M A L A X O D U S T M C N G O I I H L T A I D E N M G C H E E N L A T E T S T
page 9
C V I R U S O M I L E N E R G Y D R D U A T I S X E R C I S E C N I T R I E T T N L U E E L S I T E S O E M U F R E P C O C K R O A C H E S
B R O N C H I T P I M I C A L C L E A N E R S I X N R E P T H R O A T
REFERENCES:
Page 15 Weird word scramble: What do you call a pony with a bad cough?
! ! ! Answer: A little HOARSE! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !
!
American Lung Association. (2009) Kickinâ&#x20AC;&#x2122; Asthma Student Workbook. Retrieved from https://lungne.app.box.com/s/hnpwq6spultwhuto9waq7ucbvh5gyj6l Current Asthma Population Estimates. (2010). 2010 National Health Interview Survey Data, from http://www.cdc.gov/asthma/nhis/2010/table3-1.htm Mammen, J., Rhee, H., 2012. Adolescent asthma self-management: a concept analysis and operational definition. Pediatric Allergy, Immunology, and Pulmonology 25 (4), 180-189. National Asthma Education and Prevention Program (National Heart Lung and Blood Institute). (2007). Expert Panel report 3: guidelines for the diagnosis and management of asthma. Bethesda, Md.: National Institutes of Health. National Heart, Lung, and Blood Institute. a Broncho-spasm! What do you call a rodeo horse having a seizure?
page 28
oooooh! Bad pun!