Keeping Kids with Keeping Kids with Asthma in ClassAsthma in Class
Michael Corjulo APRN, CPNP, AE-CMichael Corjulo APRN, CPNP, AE-CACES School SystemACES School [email protected]@aces.org
c.2010c.2010
Objectives• Demonstrate an understanding of
common barriers to successful asthma management for students in school
• Identify collaborative strategies that support academic achievement by improving asthma control for students
• Discuss initiatives to improve asthma management and control.
Pre-Test
Survey Question• On a scale of 1 to 10
– 1 being not at all– 10 being totally satisfied
• How satisfied are you with the overall asthma management of the students in your school?
• Write down your biggest issue or barrier
Pediatric AsthmaPediatric AsthmaBased on the National Based on the National
Institutes of Health Institutes of Health 2007 Expert Panel Report 32007 Expert Panel Report 3National Asthma Education National Asthma Education
and Prevention Program and Prevention Program (NAEPP(NAEPP))
Raise the Bar!
Asthma is the #1 cause of avoidable hospitalization
• Children hospitalized with asthma very often represent a failure of ambulatory care management
NAEPP: Components of Asthma Management
Corjulo, M (2005). Telephone triage for asthma medication refills, Pediatric Nursing, 1(2), 116-120.
ASSESSMENT & MONITORING
SymptomsMedication Use
TRIGGERS & ALLERGENS
ExposureAvoidance Interventions
PHARMACOLOGIC THERAPY
Request for Medication Refill
EDUCATION EDUCATION FORFOR
PARTNERSHIP WITH PARTNERSHIP WITH FAMILIES FAMILIES
Based onThe Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma (NHLBI, 1997)
Asthma Management 2010
The Big The Big PicturePicture
• How many times would a student needing asthma treatment be seen by the nurse in one day?
1. Assess the problem and treat2. Re-assess3. If not completely resolved – re-assess again4. If having to treat again5. Re-assess again
» Can’t send a student with acute symptoms home on a bus!
The Big The Big PicturePicture
• If this happened everyday– How many visits would this student
make to the nurse’s office in one week?
• Or if symptoms occur 3x/week• How many in a month?• a quarter?• a year?
The Big The Big PicturePicture
• How much time is that out of the classroom, not learning???– What else is the student not doing
because of their asthma?
• How much of this is avoidable?
» So what are we going to do about it?
Overcoming Asthma Overcoming Asthma Management BarriersManagement Barriers
… … in schoolin school……..and beyond..and beyond
The Asthma Action Plan Bridge
CT DPH AAP
TheACES AAP
3/09
Asthma Action Plan: Home, Play, School, & Travel Name: Date: Birth Date: Provider Phone #: Fax #: Parent/Guardian Phone #s:
Important! Things that make your asthma worse (Triggers): X smoke □ pets □mold
□ dust □pollen □colds/viruses □exercise □seasons: other: Severity: □ Severe Persistent □ Moderate Persistent □ Mild Persistent □Intermittent
Provider Signature ______________________________________________________ Date______________________ I give permission to the school nurse and my child’s health care provider to exchange information to assist in my child’s asthma management.
Parent/guardian signature __________________________________________________ Date____________________
Make an appointment with your primary care provider within two days of an ED visit, hospitalization, or for ANY problem or question with asthma * Bring asthma meds and spacer to all visits
You have any of these: First signs of a
cold Exposure to
known trigger Cough Wheeze Tight chest Coughing at night Coughing at night
Your Asthma is getting worse fast if you have any of these: Medicine is not helping Breathing is hard and
fast Nose opens wide Can’t talk well Getting nervous
GO – You’re Doing Well! USE THESE MEDICINES EVERYDAY TO PREVENT SYMPTOMS
CAUTION – Slow Down! Continue with Green Zone Medicine and ADD: CAUTION – Slow Down! CONTINUE WITH GREEN ZONE MEDICINE AND ADD:
You have any of these: First signs of a cold Exposure to known
trigger Cough Mild wheeze Tight Chest
Your asthma is getting worse fast: Medicine is not
helping Breathing is hard and
fast Nose opens wide
DANGER – Get Help! TAKE THESE MEDICINES AND CALL YOUR PROVIDER NOW
You have all of these: Breathing is good No cough or
wheeze Sleep through the night Can work and play
MEDICINE HOW MUCH HOW OFTEN/WHEN
Inhalers work better with Spacers
MEDICINE HOW MUCH HOW OFTEN/WHEN 1. Albuterol / Xopenex 2 puffs or 1 vial Every _____ Hours
□ Before Exercise as needed CALL our Office if: You need your ALBUTEROL or XOPENEX SOONER than EVERY 4 HOURS or EVERY 4 HOURS for MORE than 2 days or any questions or concerns CALL YOUR HEALTH CARE PROVIDER FOR HELP, ESPECIALLY IF YOU NEED YOUR ALBUTEROL OR XOPENEX SOONER THAN 4 HOURS OR EVERY 4 HOURS FOR MORE THAN 2 DAYS
MEDICINE HOW MUCH HOW OFTEN/WHEN Albuterol / Xopenex NOW! Get help from a doctor now! Do not be afraid of causing a fuss. It’s important! If you cannot contact your doctor, go directly to the emergency room or call 911 and bring this form with you. DO NOT WAIT.
The CMG AAP
Asthma Action Plan: Home, Play, Travel, and School Name:
Date:
Children’s Medical Group Phone #: 288- 4288 Fax #: 288- 1566 299 Washington Avenue Hamden, CT 06518 Provider: Your Asthma Triggers / Allergies: X smoke □ pets □mold □ dust □pollen □ grass □colds/viruses □exercise □seasons: other:
Severity: □ Severe Persistent □ Moderate Persistent □ Mild Persistent □Intermittent Inhalers work better with Spacers
Provider Signature _______________________________________________ Date_____________________
I give permission to the school nurse and my child’s health care provider to exchange information to assist in my child’s asthma management.
Parent/guardian signature __________________________________________________ Date____________________
Make an appointment with your primary care provider within two days of an ED visit, hospitalization, or for ANY problem
or question with asthma Next Visit:____________________ (At least every 6 months if doing well)
* Bring asthma meds and spacer to all visits
You have any of these: First signs of a cold Exposure to known
trigger Cough Wheeze Tight chest Coughing at night Coughing at night Your Asthma is getting worse fast: Medicine is not
helping Breathing is hard
and fast Nose opens wide Can’t talk well Getting nervous
GO – You’re Doing Well! USE THESE MEDICINES EVERYDAY TO PREVENT SYMPTOMS
CAUTION – Slow Down! CONTINUE WITH GREEN ZONE MEDICINE AND ADD: CAUTION – Slow Down! CONTINUE WITH GREEN ZONE MEDICINE AND ADD:
You have any of these: First signs of a cold Exposure to known
trigger Cough Mild wheeze Tight Chest
Your asthma is getting worse fast: Medicine is not
helping Breathing is hard and
fast Nose opens wide
DANGER – Get Help! TAKE THESE MEDICINES AND CALL YOUR PROVIDER NOW
You have all of these: Breathing is good No cough or wheeze Sleep through the night Can work and play
MEDICINE HOW MUCH HOW OFTEN/WHEN
1. _____ puffs AM / PM
2. _____ squirt(s) each nostril AM / PM
3. AM / PM
4. AM / PM
Inhalers work better with Spacers
MEDICINE HOW MUCH HOW OFTEN/WHEN 1. Albuterol / Xopenex 2 puffs or 1 vial Every _____ Hours
□ Before Exercise as needed 2. CALL our Office if: You need your ALBUTEROL or XOPENEX SOONER than EVERY 4 HOURS or EVERY 4 HOURS for MORE than 2 days or any questions or concerns
MEDICINE HOW MUCH HOW OFTEN/WHEN Albuterol / Xopenex 4 puffs or 1 vial NOW! & Call the office
OR Get help from a doctor now! Do not be afraid of causing a fuss. It’s important! If you cannot contact your doctor, go directly to the emergency room or call 911 and bring this form with you. DO NOT WAIT.
NHLBI AAP
Don’t Have an Action Plan• Rely on the student’s recollection of his/her asthma plan– May not know the names
of meds or when they should be used
– Have to call the parent, who also may not be sure
– Makes having a creditable collaboration with the provider very difficult
– Seldom results in improved asthma
management
Have an Action Plan• Can review written plan with student– Discuss control
medication use• Consistency• Issues
– Identify knowledge gaps
– Review plan written by Provider with parent
– Can result in an office visit, prescription refill, or other positive action
The Big The Big PicturePicture
• Not having an Asthma Action Plan can be like trying to meet IEP goals that are not written
OR• Determining if immunizations
are up to date without an immunization record
Case Example• 13 y.o. who has had 22 doses of
albuterol in his first 37 days of school– Including 1 known ED visit
• Can you call his PCP without a HIPAA compliant release of information?
HIPPA, FERPA, & ASTHMA• Yes. The Privacy Rule allows those doctors, nurses,
hospitals, laboratory technicians, and other health care providers that are covered entities to use or disclose protected health information, such as X-rays, laboratory and pathology reports, diagnoses, and other medical information for treatment purposes without the patient’s authorization. This includes sharing the information to consult with other providers, including providers who are not covered entities, to treat a different patient, or to refer the patient. See 45 CFR 164.506.
Case Study F/U• His PCP contacts the family,
schedules an appointment for an asthma assessment:– Started on a daily control med– An Asthma Action Plan copy is sent to
school (as requested)• How will that have a positive impact?
» BTW, that was approximately 89 visits to the nurse’s office in that 37 days of school
The Action Plan Request Letter
Dear Fellow Health Care Provider,Enclosed / attached is a blank Asthma Action Plan for your patient. Please return or fax a copy back to the attention of the school nurse. This or any 3 zone action plan will be very helpful, so if you already have an updated action plan for this student, a copy of that would be appreciated…
• Thank you for making the effort to strengthen our collaborative relationship and improve the asthma care of children and adolescents in our community.
• Results?
TEMS (800 students)• 12/09
– 74 students with asthma medication orders– 9 AAP (12%)
• Letter mailed to each student’s provider• 3/10
– 48 AAP (65%)
The “Buy In”The “Buy In”Who’s buying in to what?Who’s buying in to what?
The Elephant inThe Elephant in the Roomthe Room
Compliance
EPR 3 Component 2• Education for a Partnership in
Asthma Care• Concepts found in:
– Chronic Care Models– Family-Centered Care– Medical Home
The Chronic Care Model• Use of explicit plans and protocols• Practice Redesign (sick model doesn’t
work)• Patient Education (self-management
behavior change, on-going support for patients who participate)
• An “expert system” (decision support, provider education, consultation)
• Supportive information systems (registries, outcomes, feedback, care planning)
• Which of the following concepts is NOT found within a Family-Centered Care framework?– Professional as expert model– Screening for non-compliance– Create opportunities to make informed choices– Social work consult for all difficult patients and
families
Family/Professional Collaboration
• Seek mutually-acceptable plans & goals vs.
Getting hung-up on
COMPLIANCE !
Assess & Negotiate: Why is this plan not working?
Medication History
• What do assessing for medication “compliance” and 3rd grade math have in common?
• 7 x 2 = 14• Or does it?
EPR 3 Component 2• Asthma self-management is essential• Self-management education should be
integrated into all aspects of care• Involve all members of the health care team• Occur at all points of care:
» Primary Care» Specialty Care» Home» School» Acute Care / ED» Where Else?
Assessing Asthma Assessing Asthma ControlControl
Assessing Asthma Control and Adjusting Therapy in Children 5 to 11 Years of Age
Adapted from National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (EPR-3 2007). U.S. Department of Health and Human Services. Available at: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf. Accessed August 29, 2007.
ImpairmentImpairment
• Maintain current stepMaintain current step• Regular follow-up every Regular follow-up every
1 to 6 months1 to 6 months• Consider step down if Consider step down if
well controlled for at well controlled for at least 3 monthsleast 3 months
• Step up at least 1 step Step up at least 1 step andand
• Reevaluate in 2 to Reevaluate in 2 to 6 weeks6 weeks
• For side effects, consider For side effects, consider alternative treatment alternative treatment optionsoptions
• Consider short course of Consider short course of oral systemic corticosteroidsoral systemic corticosteroids
• Step up 1 or 2 steps, andStep up 1 or 2 steps, and• Reevaluate in 2 weeksReevaluate in 2 weeks• For side effects, consider For side effects, consider
alternative treatment optionsalternative treatment options
Very Poorly Very Poorly ControlledControlled
Not Well Not Well ControlledControlledWell ControlledWell Controlled
>80% predicted/>80% predicted/personal bestpersonal best>80%>80%
60%-80% predicted/60%-80% predicted/personal bestpersonal best75%-80%75%-80%
<60% predicted/<60% predicted/personal bestpersonal best<75%<75%
Several times per daySeveral times per day>2 days/week>2 days/week2 days/week2 days/weekSABA use for symptom control SABA use for symptom control (not prevention of EIB)(not prevention of EIB)
RiskRisk
Components of ControlComponents of Control
Medication side effects can vary in intensity from none to very troublesome and Medication side effects can vary in intensity from none to very troublesome and worrisome. The level of intensity does not correlate to specific levels of control but worrisome. The level of intensity does not correlate to specific levels of control but should be considered in the overall assessment of riskshould be considered in the overall assessment of risk
Treatment-related Treatment-related adverse effectsadverse effects
≥2/year
Extremely limitedExtremely limitedSome limitationSome limitationNoneNoneInterference with normal activityInterference with normal activity
≥≥2x/week2x/week≤≤1x/month1x/monthNighttime awakeningsNighttime awakenings
Throughout the dayThroughout the day>2 days/week or multiple >2 days/week or multiple times on ≤2 days/weektimes on ≤2 days/week
≤≤2 days/week but not more 2 days/week but not more than once on each daythan once on each day
SymptomsSymptoms
Evaluation requires long-term follow-upEvaluation requires long-term follow-upReduction in lung growthReduction in lung growth
0-1/year
Recommended ActionRecommended Actionfor Treatmentfor Treatment
Lung functionLung function• FEVFEV11 or peak flow or peak flow
• FEVFEV11/FVC/FVC
≥≥2x/month2x/month
Exacerbationsrequiring oral systemic corticosteroids Consider severity and interval since last exacerbation
Assessing Asthma Control and Adjusting Therapy in Youths ≥12 Years of Age and Adults
Adapted from National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (EPR-3 2007). U.S. Department of Health and Human Services. Available at: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf. Accessed August 29, 2007.
• Maintain current stepMaintain current step• Regular follow-ups Regular follow-ups
every 1-6 months to every 1-6 months to maintain controlmaintain control
• Consider step down if Consider step down if well controlled for at well controlled for at least 3 monthsleast 3 months
• Step up 1 step andStep up 1 step and• Reevaluate in 2 to 6 Reevaluate in 2 to 6
weeksweeks• For side effects, consider For side effects, consider
alternative treatment alternative treatment optionsoptions
• Consider short course of Consider short course of oral systemic corticosteroidsoral systemic corticosteroids
• Step up 1-2 steps, andStep up 1-2 steps, and• Reevaluate in 2 weeksReevaluate in 2 weeks• For side effects, consider For side effects, consider
alternative treatment optionsalternative treatment options
Very Poorly Very Poorly ControlledControlled
Not Well Not Well ControlledControlledWell ControlledWell Controlled
00≤0.75≤0.75≥20≥20
Validated questionnairesValidated questionnairesATAQATAQACQACQACTACT
1-21-2≥1.5≥1.516-1916-19
3-43-4N/AN/A≤15≤15
Several times per daySeveral times per day>2 days/week>2 days/week≤≤2 days/week2 days/weekSABA use for symptom control SABA use for symptom control (not prevention of EIB)(not prevention of EIB)ImpairmentImpairment
RiskRisk
Components of ControlComponents of Control
Medication side effects can vary in intensity from none to very troublesome and Medication side effects can vary in intensity from none to very troublesome and worrisome. The level of intensity does not correlate to specific levels of control but worrisome. The level of intensity does not correlate to specific levels of control but should be considered in the overall assessment of riskshould be considered in the overall assessment of risk
Treatment-related Treatment-related adverse effectsadverse effects
Extremely limitedExtremely limitedSome limitationSome limitationNoneNoneInterference with normal activityInterference with normal activity
≥≥4x/week4x/week1-3x/week1-3x/week≤≤2x/month2x/monthNighttime awakeningsNighttime awakenings
Throughout the dayThroughout the day>2 days/week>2 days/week≤≤2 days/week2 days/weekSymptomsSymptoms
Evaluation requires long-term follow-upEvaluation requires long-term follow-upProgressive loss of lung functionProgressive loss of lung function
<60% predicted/<60% predicted/personal bestpersonal best
60%-80% predicted/60%-80% predicted/personal bestpersonal best
>80% predicted/>80% predicted/personal bestpersonal best
FEVFEV11 or peak flow or peak flow
Recommended ActionRecommended Actionfor Treatmentfor Treatment
Exacerbations requiring oral systemic corticosteroids
≥2/year0-1/yearConsider severity and interval since last exacerbation
#1•Appreciate the Chronic &
Inflammatory nature of the disease
A Key to Control
Inhaled Steroids have become the pharmacological key to long-term asthma control. Daily use can:Minimize the need for systemic steroids Decrease ED use and Hospitalization Decrease the potential for symptoms & acute
exacerbations Improve exercise and activity tolerance
Classifying Asthma Severity and Initiating Treatment in Youths ≥12 Years of Age and Adults
EIB = exercise-induced bronchospasm; FEV1 = forced expiratory volume in one second; FVC = forced vital capacity.Adapted from National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (EPR-3 2007). U.S. Department of Health and Human Services. Available at: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf. Accessed August 29, 2007.
Exacerbationsrequiring oral systemic corticosteroids
SevereSevereModerateModerateMildMild
Step 4 or 5Step 4 or 5Step 3Step 3
PersistentPersistent
Extremely limitedExtremely limitedSome limitationSome limitationMinor limitationMinor limitationNoneNoneInterference withInterference withnormal activitynormal activity
≥2/year0-1/year
Several timesSeveral timesper dayper dayDailyDaily
>2 days/week>2 days/weekbut not daily and not but not daily and not more than 1x on any daymore than 1x on any day
2 days/week2 days/weekSABA use for SABA use for symptom control (not symptom control (not prevention of EIB)prevention of EIB)
Often 7x/weekOften 7x/week>1x/week but>1x/week butnot nightlynot nightly3-4x/month3-4x/month2x/month2x/monthNighttime awakeningsNighttime awakenings
Throughout the dayThroughout the dayDailyDaily>2 days/week but not daily>2 days/week but not daily2 days/week2 days/weekSymptomsSymptoms
Components of SeverityComponents of Severity
• Normal FEVNormal FEV11 between between exacerbationsexacerbations
• FEVFEV11 >80% >80% predicted predicted
• FEVFEV11/FVC normal/FVC normal
• FEVFEV11 <60% <60% predicted predicted
• FEVFEV11/FVC /FVC reduced >5%reduced >5%
• FEVFEV11 >60% but >60% but <80% predicted <80% predicted
• FEVFEV11/FVC/FVCreduced 5%reduced 5%
• FEVFEV11 >80% predicted >80% predicted • FEVFEV11/FVC normal/FVC normal
Lung FunctionLung Function
IntermittentIntermittent
Normal FEVNormal FEV11/FVC:/FVC: 8-19 yr8-19 yr 85%85% 20-39 yr20-39 yr 80%80% 40-59 yr40-59 yr 75%75% 60-80 yr60-80 yr 70%70%
ImpairmentImpairment
Relative annual risk of exacerbations may be related to FEV1
RiskRisk
Step 2Step 2Step 1Step 1and consider short course of oral and consider short course of oral systemic corticosteroidssystemic corticosteroids
In 2 to 6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordinglyIn 2 to 6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly
Recommended StepRecommended Stepfor Initiating Treatmentfor Initiating Treatment
Consider severity and interval since last exacerbationFrequency and severity may fluctuate over time for patients in any severity category
Asthma Control Report: For Family and Health Care Provider Student/ Child’s
Name:
Age:
Grade:
Home Town/City:
School:
Date:
PART 1 School Nurse or asthma educator can assist the student or family in understanding the questions in a developmentally and culturally appropriate manner in order to obtain objective and accurate information. Circle the correct response
1. Does your asthma get in the way or stop you from doing an activity in school, at home, during play or a sport? YES
NO If YES: Rarely
(less than once a month) Sometimes
(less than once a week) Frequently
(at least once a week)
2. In the past 4 weeks, how many times did you wheeze, cough, feel tight in the chest, or have trouble breathing?
Rarely (2 or less times a month)
Sometimes (3 – 8 times a month)
Frequently ( at least 3 times a week)
3. In the past 4 weeks, how many times did your asthma wake you up at night or make it hard to sleep?
Rarely (2 or less times a month)
Sometimes (2 – 4 times a month)
Frequently ( at least 4 times a month)
4. In the past 4 weeks, how many times did you have to use your rescue inhaler or nebulizer (albuterol or xopenex)?
Rarely (2 or less times a month)
Sometimes (3 – 8 times a month)
Frequently ( at least 3 times a week)
5. How many days of school have you missed this year because of your asthma?
PART 2 On a scale of 1 – 10: “1 being your asthma never really bothers you; and 10 being your asthma is so bad you should be in the hospital” , What is your asthma number?
Do you have a spacer to use with your inhaler? Yes No
o If yes, how often do you use it? Never Sometimes Always
Is there an Asthma Action Plan for this student at the school or in the
home?
Yes
No:
(blank enclosed)
o If yes, most recent date:
PART 3 Known frequency of Albuterol or Xopenex use in: school or home (circle one). Can tally to keep track (IIII II = 7)
Sept Oct Nov Dec Jan Feb March April May June July August
Planned (Pre-Ex)
Acute Sx’s
Any additional information you think would be helpful for this student’s health care provider or family to know:
Nurse or Assessor’s Printed Name:
Phone Number:
ACES Student Asthma Control Report: For Family and Health Care Provider
Part B: Compare how the student’s asthma control rates according to the 2007 National Asthma Guidelines
In the past 4 weeks:
Well Controlled
Not Well Controlled
Very Poorly Controlled
1. How many times did your asthma get in the way or stop you from
doing an activity in school, at home, during play or a sport?
None
Sometimes
Frequently
2. How many times did you wheeze, cough, feel tight in the chest, or
have trouble breathing?
2 or less
3-8
Every day
3. How many times did your asthma wake you up at night or make it
hard to sleep?
2 or less
2-4
More than 4
4. How many times did you have to use your rescue inhaler or
nebulizer (albuterol or xopenex)?
8 or less
More than 8
Usually
every day Answers in these
boxes should indicate good asthma control
Any answers in these sections could indicate the need for an asthma visit
Any answers in these boxes indicates the need to call for an asthma visit
Your Quality Asthma Management Checklist:
I s your asthma well controlled?
Have you had a planned asthma visit (not for an acute attack or exacerbation) in the past 6 months?
Are you sure that you know what your asthma allergies are?
Do you know how to avoid your asthma triggers and allergies?
Do you have a copy of an Asthma Action Plan that you understand and know how to use?
I f you are able to check off the whole list – Great! I f not, or if you have any questions about asthma or medications, call your provider f or an asthma visit
This project is in accordance with the CT Department of Public Health Collaborative Effort for Addressing Asthma in Connecticut: 2009-2014; The Yale New Haven Community Medical Group Pediatric Asthma Sub-Committee; and the ACES Students with Asthma Quality Improvement Program
Any questions, please contact:
The Missing LinksThe Missing Links
Broad Categories of Why Asthma Management Fails
• MDI’s work better with Spacers!
• You should request a spacer to use with all MDI orders
» Stop Laughing (again)
Teaching Moment: Why a Spacer
Demonstrate what a puff of an MDI looks like in the air and point out how hard it is to make sure it is not squirted on the tongue or back of throat and how hard it is to breathe in at exactly the right second
So Jimmy, do you have a spacer to use with that inhaler?
Why a Spacer: Sample Dialogue
• When discussing the use of an inhaler without a spacer ask:
“Did you ever puff it so it felt like you got it down in your lungs…. (yes)….
“Well did you ever miss a little and get it on your tongue or the back of your throat”
…(yes)…. “that’s medicine that doesn’t do any good, it doesn’t help your asthma”
Useful Analogies: Inhaled Asthma Meds only work if
you get them in your lungs
• Like taking 2 Tylenol for your headache and throwing one over your shoulder
You’re still going to have a headache
• Like eating pizza or ice cream and spitting it out or like throwing popcorn up in the air and missing it
You’re still going to be hungry
• Identifying and avoiding allergens & triggers is at least as important as medication
• How much of the $12 billion that asthma costs can we save if we stop throwing fuel on the fire?
MedicationAllergy / Trigger
The Chronic Inflammation of Asthma
Medication Allergy / Trigger
The Chronic Inflammation of Asthma
Keys to Successful Asthma Management for Students
• Just call it ASTHMA!– Need a diagnosis
• Assess Control• Obtain an Asthma Action Plan
– Use it to communicate and educate• Focus on inhaled medication technique• Improve environmental interventions
»Including your school’s IAQ
Your IAQ Program• Does your school/district have one• How active is it?• How involved are you in it?
• Do you want to learn more about it?
IAQ ContactsCThttp://[email protected] [email protected]
Everywhere Elsehttp://www.epa.gov/iaq/whereyoulive.html
Sample Summary of Successful Asthma Programs and Initiatives in CT
• In 2008 the ACES school system increased the number of Asthma Action Plans from 12 to 164 in one SY
• The Yale Community Medical Group is standardizing asthma management with all Yale-affiliated PCPs
• The CCMC based Easy Breathing Program has significantly improved the number of children diagnosed with asthma and decreased hospitalization
• The DPH has regional programs that will do in-home asthma trigger evaluations and teaching– And they accept school nurse referrals
Sample Summary of Successful Asthma Programs and Initiatives in CT
• CT DPH has a lot of information about statewide initiatives and resources
http://www.ct.gov/dph/cwp/view.asp?a=3137&q=387872
The Primary Care Medical Home
Model
Home
Community Educators Home
Care and VNA
Pulmonologists and Allergists
Local Health Departments
Schools and SBHC
ED & Hospitals
Community Health Centers
Coordination
Communication
Technology
Funding
Post-Test