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BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
A PLAN TO IMPROVEASTHMA CARE
Barbara Mc Donagh RN
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
OBJECTIVESASTHMA OVERVIEWASTHMA STATISTICS
PURPOSE OF PEAK FLOW MONITORINGSIGNS & SYMPTOMS OF EXACERBATION
ASTHMA ACTION PLANASTHMA MEDICATIONS
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
PURPOSEIMPROVE ASTHMA CARE
PROMOTE SELF-MANAGEMENT
FOSTER TEAM-BASED PARTNERSHIP
EMERGENCY ROOM VISITS
FRAGMENTED CARE
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMACHRONIC DISEASE
AIRWAY INFLAMMATION
INTERMITTENT AIRFLOW OBSTRUCTION
BRONCHIAL HYPERRESPONSIVENESS
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMA STATISTICS (CDC,2012) 24 MILLION PEOPLE
MOST COMMON CHRONIC DISEASE IN CHILDHOOD
1.9 MILLION EMERGENCY VISITS
475,000 HOSPITALIZATIONS
$56 BILLION
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
PATIENT POPULATION AFFECTED (CDC, 2012)
MORE BOYS THAN GIRLS
MORE WOMEN THAN MEN
WOMEN ACCOUNT FOR 2/3 OF ALL DEATHS DUE TO ASTHMA
AFRICAN AMERICAN & HISPANIC
LOWER SOCIO-ECONOMIC
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
PATIENT POPULATION AFFECTED (CDC,2012)
AFRICAN AMERICAN WOMEN HAVE HIGHEST MORTALITY RATE
3,388 PEOPLE DIED FROM ASTHMA
AFRICAN AMERICANS ARE 2-3 TIMES MORE LIKELY TO DIE FROM ASTHMA
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ETHIOLOGY & RISK FACTORSFAMILY HISTORY
ENVIRONMENTAL ALLERGENS
VIRAL EXPOSURE
ECZEMA/ ATOPIC DERMATITIS
OBESITY
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
SIGNS & SYMPTOMSEXACERBATION
WHEEZING
COUGHING
SHORTNESS OF BREATH
CHEST TIGHTNESS/PAIN
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMA TRIGGERS
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMA EXACERBATIONTRIGGERS
ALLERGENS/IRRITANTS TOBACCO SMOKEURI’sAIR POLLUTIONEXERCISEOCCUPATIONAL HAZARDSSINUSITISDRUG USE
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMACLASSIFICATION (NHLBI,2007)
INTERMITTENT 2 DAYS/WEEK 2NIGHTS/MONTH
MILD PERSISTENT >2 DAYS/WEEK 3-4NIGHTS/MONTH
MODERATE PERSISTENT DAILY/> 1NIGHT/WEEK
SEVERE PERSISTENT SEVERAL TIMES/DAY & 7 NIGHTS/WEEK
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
GOAL OF ASTHMA CARECONTROL
Symptoms ≤ 2Days/Week
Nighttime ≤ 2 x/Month
Albuterol Use ≤ 2 Days/Week
Peak Flow ≥ 80% Personal Best
Perform Daily Activities
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
PEAK EXPIRATORY FLOW (PEF)DECREASE IN NUMBER BEFORE WORSENING
SYMPTOMSOBJECTIVE DATA ON ASTHMA CONTROL
POOR PERCEPTION OF SYMPTOMS
DETERMINE EFFECTIVENESS OF ASTHMA
MANAGEMENT/TREATMENT PLAN
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
Peak Expiratory Flow (PEF)MONITOR PEAK FLOW OVER 2 WEEKS TO DETERMINE ‘PERSONAL BEST’
PERFORM STANDING
RECORD HIGHEST OF 3 READINGS
NORMAL PEAK FLOW CAN VARY UP TO 20%
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
PEAK EXPIRATORY FLOWPersonal Best = 300
Green Zone80%-100%
No Symptoms
Yellow Zone51%-79%
Symptoms 2-3 days
Red Zone< 50%
NO IMPROVEMENT
= 240 - 300
= 150 – 240Rescue Inhaler 4-6hrsStart Prednisone TabsED if no Improvement
<150 Continue Above
Worse go to ED/9-1-1LIFE THREATENING
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMA ACTION PLANProvider & Patient
WRITTEN PLAN THAT ADDRESSES:Daily Inhalers & Medications Avoid Triggers – Molds/AnimalsWhat to do When Asthma Symptoms Get Worse / Peak Flow DecreasesIncrease ICSStart Prednisone BurstSeek Emergency Care
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
MEDICATIONSRESCUE/RELIEF
Albuterol ProventilVentolinProAir
CONTROLLERQvar
SymbicortSpiriva
SereventPulmicortXolair Inj
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
CONTROLLER MEDICATIONSQVAR
Inhaled Corticosteroid (ICS)SEREVENT DISKUS
Long- Acting Beta BronchodilatorSYMBICORT
Combination InhalerSPIRIVA
Long-Acting AntiChol Brochodilator
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMA PATIENTSELF-MANAGEMENT
Barriers Cultural/Language/LiteracyRescue V ControllerTaking Inhalers as Prescribed BidUsing Aerochamber Peak Flow MonitoringAsthma Action PlanAvoid/Minimize Allergen Triggers
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ASTHMA PATIENT CLINIC VISIT
Recent ED Visits
Prednisone Use
Increased Asthma SymptomsIncreased Proventil Use
Smoking / Asthma Triggers
Influenza & Pneumonia Vaccines
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
CARE MANAGEMENT
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
REFERRAL TO ASTHMA SPECIALTY
AEROALLERGEN SKIN TEST
SPIROMETRY
ADMINISTER XOLAIR INJECTIONS
>2 ED VISITS/YEAR / INTUBATIONS
ADDITIONAL TEACHING
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ED VISITS OVER PAST YEARANY ADMISSIONSANY INTUBATIONSPREDNISONE USE BURST/DAILY USECURRENT SYMPTOMS –COUGHING- DAYTIME OR
NIGHTIME/WHEEZING/ SOB/CHEST TIGHTNESS/PAINMEDICATIONS - CONTROLLER/ RESCUEKNOWS DIFFERENCEUSES INHALERS AS PRESCRIBEDMONITORS PEAK FLOWKNOWS ASTHMA TRIGGERS USES SPACER
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ADDITIONAL ASTHMARESOURCES
Asthma Action Planswww.nhlbi.nih.gov/health/public/lung/asthma/
asthma_actplan.htm
Asthma Care Evidence-Based Guidelineswww.nhlbi.nih.gov/guidelines/archives/epr-2/
athmafullrpt_archive.pdf
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
ADDITIONAL ASTHMARESOURCES
Peak Flow Monitoring & Self-Managementwww.lung.org/lung-disease/asthma/taking -
control-of-asthma/create-an-asthma-management-plan.html
Free Asthma Educational Handoutswww.cdc.gov/asthma/faqs.html
BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS
REFERENCESCDC. (2012). Asthma's Impact on the
Nation. Retrieved from http://www.cdc.gov/asthma/impacts_natio
n/default.htm
NHLBI. (2007). Guidelines for the Diagnosis and Management of Asthma (EPR-3).
Retrieved from https://www.nhlbi.nih.gov/guidelines/asth
ma/
