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Caring for Kids with Asthma

Some slides courtesy of Healthy Learners Asthma Initiative, Minneapolis Public Schools

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Background

Over the past 20 years, asthma in children has risen 72%

Asthma is most common chronic disease for children under 18 yrs

Children < 6 years have highest hospitalization rate

Source: Counting on You, ALAWI

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What is Asthma?

Defining Features:

1. Airway swelling

2. Tightening of airway muscles

3. Mucus production

Increased irritability of the airways (hyper-responsiveness)

CAACP, 2004

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Lungs When Asthma is in Good Control

Healthy airways: air can easily get in and out

no mucus

muscles do not tighten around airway

no swelling of airway lining

CAACP, 2004

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Lungs When Asthma is NOT in Good Control

Unhealthyairways:air can’t easily getin or out

Mucus plugs airway

Muscles tighten around airways

Lining of airways is swollen and irritated

CAACP, 2004

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Symptoms of Asthma

Constant / frequent cough, especially at

night

Difficulty breathing / short of breath

Tight chest / chest pain

Breathing faster than usual CAACP, 2004

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Symptoms of Asthma

Wheezing

Coughing or out of breath with exercise

Long recovery time (~20-30 min. or more) after exercise

Complaint of stomachache or headache

CAACP, 2004

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Asthma Management Goals

Free of symptoms

Sleep through the night

Participate in normal, everyday

activities

Near normal lung function

CAACP, 2004

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Asthma Severity

Severity assessment forms the basis of the asthma treatment plan

Severity level determines the type, dose, and frequency of medications

Depending on severity, the child could be considered disabled

CAACP, 2004

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Asthma Severity Levels

Days with symptoms

Nights with symptoms

Medications

Mild Intermittent

2/week 2/month - No daily meds- Reliever meds as needed

Mild Persistent

>2/week, but not daily

>2/monthFrequent

- Controller meds daily- Reliever meds as needed

Moderate Persistent

Daily >1/week - Controller meds- Reliever meds as needed

SeverePersistent

Continuous Frequent - Controller meds daily + long acting reliever- Reliever meds as neededCAACP, 2004

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Myths and Truths About Asthma

Asthma Myths

It is a psychological or emotional illness

It is only an acute disease and you can outgrow it

Asthma is curable

Asthma Truths

Airway swelling is real even if triggered by strong emotions

Asthma is a chronic disease, swelling can be present without symptoms

No, but it is manageable

CAACP, 2004

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Myths and Truths About Asthma Asthma Myths It always limits normal

activities

It limits a child's ability to fully participate in sports

Asthma medication and inhalers are addictive

Asthma Truths Daily asthma controller

/ pre-exercise medications allow children to be active

Well-controlled asthma should not limit exercise and children can fully participate in sports

Asthma medications and inhalers are not addictive

CAACP, 2004

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Myths and Truths About Asthma

Asthma Myths

Asthma medication becomes ineffective if used regularly

Children do not die from asthma

Asthma Truths

“Controller” inhalers work best when used daily, “Reliever ” (albuterol) inhalers will not be as effective if asthma is not in good control

Children and adults die from asthma each year

CAACP, 2004

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Triggers: Things That Can Start Asthma Symptoms

Irritants Tobacco smoke

Dust and chalk dust

Strong odors (perfume,

markers that smell, air fresheners, cleaning chemicals, paint, etc.)

Cold (or very hot) air

CAACP, 2004

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More Asthma TriggersAllergens

Animals cats, dogs, etc. cockroaches, mice

Mold Dust mites

carpets / upholstery Pollens / grass / trees

weeds, grass, tree pollen

Certain foods / drugs peanuts, shrimp, tree

nuts, wheat, milk, soy, fish, sulfites, aspirin

CAACP, 2004

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More Asthma Triggers

Others

Viruses (colds)

Exercise

Strong emotions

CAACP, 2004

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Avoiding Triggers

Ask parents to identify their child’s triggers

Ask parents what steps the child’s health care provider suggests to avoid possible triggers

Have parents number the child's triggers in order of their importance

Continue to keep the parents updated on actions you are taking to eliminate triggers

Source: Counting on You, ALAWI

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Actions to Reduce Triggers at Childcare Sites

Minimize dust by reducing clutter

Do not allow animals with fur/feathers

Avoid carpeted classroom floors

Encourage children not to sit on carpeted floors

If your site has carpet, encourage custodians to use HEPA-vacuum cleaners

CAACP, 2004

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Actions to Reduce Triggers at Childcare Sites

Do not block ventilation ducts

Avoid mold growth:

Reduce the number of plants that need

frequent watering

Report moisture problems or water

leaks to the engineer immediately

CAACP, 2004

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Actions to Reduce Triggers at Childcare Sites

Do not use aerosol, strong-smelling cleaning supplies, or air fresheners

Do not ask children to clap chalk erasers

Do not use permanent / odorous markers

Do not smoke in your childcare settingCAACP, 2004

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Early Warning Signs

Sudden mood changes and/or irritability

Trouble completing sentences without gasping for breath

Itchy chin or neck

Watery, itchy eyes

Dark circles under the eyes Source: Counting on You, ALAWI

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What to Look for…

Anxious or scared look Unusual facial paleness Flared nostrils Pursed-lip breathing Fast

breathing/shortness of breath

Hunched-over body position

CAACP, 2004

Perspiring

Vomiting due to hyperventilation

Restlessness during sleep

Fatigue that is not related to activity

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What to Listen for…

Coughing or persistent cough when the child has no cold

Frequent clearing of the throat

Irregular breathing

Noisy, difficult breathing

Wheezing during exhaling

CAACP, 2004

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What to do for Asthma Episodes (Attacks)

Remain calm and reassure the childHave child sit up and breathe slowly,

in through the nose, out through pursed lips

Have child sip water/fluids

Have someone stay with the child

Follow the child’s asthma action plan

CAACP, 2004

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Asthma Medications

Asthma Controllers (Anti-inflammatories) Include Inhaled-corticosteroids

Controls asthma by reducing inflammation and prevents asthma episodes

Daily medication - usually taken in inhaled form

Examples – Advair, Flovent, Pulmicort, QVAR

CAACP, 2004

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Asthma MedicationsAsthma Relievers (Bronchodilators)

Provides quick relief temporarily Usually taken in inhaled form Taken on as needed basis Examples: Albuterol, Maxair, Proventil

Oral Steriods Treats severe asthma episode Taken for a few days

CAACP, 2004

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Small Children Can Get Their Medications by…

Using a nebulizer

Metered Dose Inhaler (MDI) with spacer and mask

CAACP, 2004

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Spacer Use with Inhalers

Important that children use a spacer with an aerosol inhaler Get more medication into the lungs

CAACP, 2004

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Without Spacers, Inhalers Are Difficult to Use Because…

It is hard to coordinate breathing and spraying at the same time

The user breathes in too fast

The user does not hold their breath

The medicine comes out of the inhaler too fast

CAACP, 2004

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How to Use a Metered Dose Inhaler1. Shake well (at least 10

seconds), remove cap2. Insert inhaler into

spacer 3. Breathe out fully with

chin up to empty lungs 4. Put mouthpiece

between the teeth and close lips around it - do not block opening with your tongue

5. Press down once on inhaler

6.Breathe in deeply and slowly through the mouth

7.Continue breathing in slowly for 3-5 seconds

8.Hold breath for 10 seconds to get medication deep into lungs

9.Wait 1 to 2 minutes before repeating if directed

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Delivering Nebulizer Treatments

Wash hands thoroughly

Make sure machine is dry and assemble equipment

Check to ensure written order for medication is available from health care provider

Connect one end of the tubing to compressor and other end to container with medication

Add child’s medication to the containerSource: Counting on You, ALAWI; CAACP, 2004

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Delivering Nebulizer TreatmentsPosition child upright in chair or hold

smaller child on lap

Turn on compressor and check that mist is coming out of the mask or mouthpiece

Administer medication to child (usually 5 to 15 minutes)

Rinse and dry mouthpiece/mask before putting away

Source: Counting on You, ALAWI: CAACP, 2004

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Asthma Action Plan

See handout for example

Written plan of care from health care provider includes zones and symptoms

Guidelines for managing asthma episodes

Includes medication information, special instructions

CAACP, 2004

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Using an Asthma Action Plan

Ask parents to have their health care provider complete one for the child

Keep handy for when symptoms occur

Source: Counting on You, ALAWI

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Zones of Asthma Episodes

Green zone

Yellow zone

Red zone

CAACP, 2004

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Green Zone

The child’s asthma is under control

Children often on daily controller medication when in this zone

The goal is to participate in all activities and not be limited in any way

CAACP, 2004

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Yellow Zone…What Asthma Can Feel Like

By Henry 5th grade

CAACP, 2004

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Yellow Zone

Starting to have early warning signs

Caution – slow down

Take reliever medications and daily controller medications

If child in yellow zone for 12-24 hrs or breathing symptoms are worse – contact parent and primary health care provider

CAACP, 2004

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Red Zone…Reasons to Call 911

“Quick relief” medicine is not effective, not available, or used too recently to repeatBluish lip area or blue nail bedsDifficulty talking, walking, or drinkingSkin areas of neck, throat, or chest suck inNasal flaring when inhalingObvious distress (gasping for air, fearful,

etc.)Altered level of consciousness/confusion

CAACP, 2004

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Red Zone

In a severe episode, wheezing is not

apparent, although the child is having

symptoms. This is a sign of little-to-no

air movement. Seek medical attention

immediately!

CAACP, 2004

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Scenarios

What seems to be the trigger?

What signs/symptoms indicated that this child is having an asthma episode?

What zone is this child in?

What should you do next?

CAACP, 2004

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Scenario 1

Children are outside on the

playground running, climbing on the

jungle gym, and jumping rope. It is a

windy, spring day with lots of pollen

in the air. Juan is sitting alone near

the building and breathing heavy.

CAACP, 2004

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Scenario 2

Joey is a new boy in your childcare.

On one of his first days of childcare in

January, he had an asthma episode

while playing outside. Now he never

joins the other children at active

games and stays to himself.

CAACP, 2004

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Scenario 3

During the weekend, Mia has an asthma episode and parents brought her to the emergency department. The following Monday, her parents bring Mia to childcare with antibiotics and asthma medications.

CAACP, 2004

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Scenario 4

After playing with the cat, Tasha has

an asthma episode. She is gasping

for air, has difficulty talking to you,

and looks scared. Tasha did not bring

her inhaler to childcare today.

CAACP, 2004

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Parents Need to Know…

If a child complains that they can’t participate in sports or activity due to asthma

If you notice a child coughing, wheezing, having trouble breathing, breathing rapidly, or complaining of chest pain or a tight chest

If you observe children using their inhaler incorrectly, using it frequently, or sharing it with another child

CAACP, 2004

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Key Points Good asthma control means children can

participate in school, exercise without restrictions, and have good attendance

Not participating or missing a lot of school due to asthma is a sign of poor asthma management

Parents should be informed if child has a chronic cough or difficulty breathing

Encourage use of reliever medication (pre-exercise) before gym class or recess, or if frequent coughing

CAACP, 2004

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Asthma Is Treatable

Good communication between parents, health care providers, and childcare providers is essential in providing effective asthma management within a childcare setting.

Source: Counting on You, ALAWI