What You Should Know About Asthma

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

2 or more children are likely to have asthma

In a classroom of 30 children,

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

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)

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

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)

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

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

Is There A Cure For Asthma?

Asthma cannot be cured,but it can be controlled.

You should expect nothing less.

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

How Is Asthma Controlled? (cont.)

• Monitor response to treatment– Symptoms– Peak flow

• Get regular follow-up care

Classification of Asthma Severity: Clinical Features Before Treatment

Days with Nights with PEF % of personalsymptoms symptoms best peak flow

Step 4

Severe persistent Continual Frequent <= 60%

Step 3

Moderate Daily >= 5 times per month >60% - < 80% persistent

Step 2

Mild persistent 3-6 times per 3-4 times per month >= 80% week

Step 1

Mild intermittent <= 2 times per <= 2 times per month >= 80%

week

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

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.

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

Asthma MedicationsLong-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

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

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®.

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

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

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

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

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.

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

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.

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

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

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

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