Managing Asthma Effectively in Older Adults

8/6/2019 Managing Asthma Effectively in Older Adults

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Maagg AhmaEecvely Olde Adl

A Edcaoal Gde o Pomog Bee Ahma Cool

Amog Olde Adl Lvg he Dc o Colmba

D i s t r i C t O C O L u M B i A D E P A r t M E n t O H E A L t H


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PREFACE Acknowledgements i

Letter to Instructors ii

Introduction iii

SECTION 1 INSTRuCTORS GuIdE

Background Q and A 1

How to Use the Curriculum 4

Health Education for Older Adults 6

Working with Older Adults in Health Promotion Programs 7

Cultural Competence 8

Asthma Learning Tool: Questionnaire 10

Instructor Questionnaire:

How Much Do You Know About Asthma in Older Adults? 18

SECTION 2 CuRRICulum REvIEw

Part I: Introction 21

A. Introduction and Icebreaker 22

B. Goal and Objectives 23

C. Pre-Program Questionnaire 24

D. DVD:Asthma and the Elderly 25

Part II: Astha Basics 26

A. Normal Lung Function 27

B. Asthma Causes and Symptoms 28

C. Asthma Episodes and Warning Signs 29

D. Asthma Emergencies 30

E. Asthma Triggers 31

F. Asthma Diagnosis and Management 32

table of contents


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Part III: daiy Sef manageent: Astha Sef-Care Skis 33

A. How Do You Achieve Good Asthma Control? 34

B. Identify Asthma Triggers 35

C. Recognize Early Warning Signs 40

D. Take Medicines Correctly 41

E. Partner on a Plan 43

Asthma Action Plan 44

F. Maintain Good Communication 45

Part Iv: Specia Consierations for Oer Ats ith Astha 47

A. Choosing An Asthma Healthcare Provider 48

B. When To See A Specialist 49

C. Medication Management and Multiple Health Conditions 50

D. Problems That Can Complicate Asthma Diagnosis 51

E. Understanding Case Management 52

Part v: liing Yor Best life 53

A. Smoking Cessation 54

B. Nutrition 55

C. Exercise 56

D. Tips for Feeling Great 57

E. Group Activities 58

F. Post-Program Questionnaire 59

SECTION 3 CuRRICulum PRESENTATION 61

SECTION 4 lESSONS lEARNEd 101

SECTION 5 RESOuRCES & GlOSSARY 105

Resources 105

Glossary 107

Toolkit Materials 110

Handouts 111


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Managing asthMa EEctivEly in OldEr adults

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e kowee M v. Bk-seez, Ms,

chEs, w B Eo aee toeeo he (B.E.a.t. o he), e oow

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expee o epo Managing Asthma Effectively

in Older Adults: An Educational Guide for Promoting

Better Asthma Control.

Pamela M. Banks, RN

Nurse Consultant

Joshua Holloway, MD, FAAP

Medical Advisor

ravonia Brown-Hughes, PhD

Gerontological Consultant

Edwina Davis-Robinson, MS, CHES

Asthma Program Manager

Community Health Administration

District o Columbia Department o Health

Jossolyn Edwards, EdD

Educational Research Consultant

Yvonne Esipila

Asthma Program and Community Partners

Liaison Intern

Community Health Administration

District o Columbia Department o Health

Sharland Reed, MSW

Adult Education Consultant

Patricia L. Surratt, BA

Principal Editor

Lori aylor, BS, RR

Asthma Education Consultant

C. Olivia Williams

Senior Lie Advisor Consultant

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Angela Diggs

Congress Heights Seniors Wellness Center

Stacie Tweatt

Model Cities Senior Wellness Center

Teresa Moore

Hattie Holmes Senior Wellness Center

Brenda urner

Greater Washington Urban League Aging Program

Alyce Murrell

Emmaus Services or the Aging

Elise Nicholls

United Planning Organization

Washington Seniors Wellness Center

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Dear Instructor,

Te prevalence o current asthma in the District o

Columbia has been consistently higher than the national

rate or the past seven years. Older residents (45-50

years o age) and elderly (65 years o age and older)

suering rom the eects o this serious but manageable

chronic condition is inordinately high. We appreciate the

commitment you have made to empower these individuals

with inormation about asthma and asthma management.

By using this toolkit and teaching theManaging

Asthma Eectively in Older Adults program, you make

a substantial dierence in the well-being and daily lives

o older adults with asthma. Your eorts will ensure

they have the tools necessary to become proactive in the

management o their asthma.

TeManaging Asthma Eectively in Older Adults program

is an eective, undamental asthma education program

specically designed or older adults living in the District

o Columbia. Te 90-minute session is easy to teach and

older adults respond well to it. Older adults gain helpul

asthma management skills and become more condent

about taking control o their disease.

You do not need to be an asthma expert to teach the

Managing Asthma Eectively in Older Adults program.

However, the program is intended to be used by health

educators, social workers, nurses, case managers and other

individuals who have knowledge and experience with

asthma and asthma care and work with the older adult

population.

I you are new to the subject o asthma or to teaching older

adults, these guidelines will provide you with the necessary

tools to actively engage older adults in the learning

process (through discussion, reection, role-playing, and

storytelling) that will lay the oundation or them to be

empowered participants in their own health care.

Te toolkit contains instructors guidelines, a curriculum,

Asthma and the Elderly DVD, a CD containing the

Managing Asthma Eectively in Older Adults power-pointpresentation and related handouts, as well as a copy o

Dr. om Plauts One Minute Asthma book. o prepare or

teaching the program:

1. View theAsthma and the Elderly DVD. Te DVD

provides a wealth o inormation about asthma and

asthma management and documents viewpoints

o older adults with asthma living in the District

o Columbia.

2. Review the One Minute Asthma book andamiliarize yoursel with theManaging Asthma

Eectively in Older Adults Curriculum and

Presentation.

3. Complete the Asthma Learning ool Questionnaire

and the Instructor Questionnaire: How Much Do

You Know About Asthma in Older Adults? Check

your answers and review any questions you answered

incorrectly.

4. Review the Instructors Guide and the remainder

o the toolkit or urther inormation about

implementing the program and working interactively

with older adults.

Tank you again or your dedication to programs and

services that benet older adults with asthma.

Te District o Columbia Department o Health

Community Health Administration,

Asthma Control ProgramDC Control Asthma Now (DC CAN)

Lee o ico


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iodco

Source: DC Department of Health Burden of Asthma in the

District of Columbia 2009.

Ovevew

Te District o Columbia Department o Health (DOH)

Asthma Control Program launched the DC Control

Asthma Now (DC CAN) Program to address national

Healthy People 2010 asthma objectives, and to improve

the quality o lie or District residents who suer rom

asthma.Managing Asthma Eectively in Older Adults: An

Educational Guide or Promoting Better Asthma Control

is one component o a multi-pronged approach to reduce

asthma morbidity and mortality among older adults in the

District o Columbia.

Wha Ahma?

Asthma is a chronic disease o long-lasting sensitivity and

swelling (inammation) o the lining o the airways in the

lungs characterized by respiratory symptoms including:

diculty breathing or shortness o breath, wheezing,

coughing, and chest tightness. Symptoms can vary in

sensitivity rom mild intermittent to severe or persistent.

Asthma can be controlled with a comprehensive asthma

management plan, which includes proper medication and

trigger reduction.

Ahma ad Olde Adl

he Dc o Colmba

According to the 2007 Behavioral Risk Factor Surveillance

System (BRFSS) survey data, approximately 9 percent o

adult residents (40,000 adults) and 11 percent o children

(13,000 children) currently have asthma, and about 15

percent o adults have been diagnosed with asthma at

some point in their lie. Overall, the prevalence o current

asthma in the District o Columbia has been consistently

higher than the national rate or the past seven years.

Asthma is ofen thought o as a childhood disease, but it

aects all age groups. In the District o Columbia certainsubgroups are disproportionately aected and they include

the non-Hispanic black population; very young children

0-4 years o age, adolescent emales, and adults (45-50

years o age) and the elderly (65 years o age and older),

tobacco smokers, overweight and obese populations,

residents with less than or some high school education,

and households with an income less than $15,000 appear

to be the most aected by asthma.

Te District o Columbias middle aged and elderly

populations have the highest hospitalization rate among

the adult population. Tis is also consistent with the

increased proportion o hospital admissions rom

emergency departments (ED) among these groups. In

addition the District o Columbias older adult population

had the highest asthma deaths among all age groups.


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Asthma in older adults is complicated because the normal

eects o aging can make asthma a diagnosis that is

dicult to identiy and treat.

Someasthmasymptomsaresimilartosignsofother

possible health conditions (congestive heart ailure,

chronic obstructive pulmonary disease).

eremaybeotherongoinghealthconcernsthat

make diagnosis and/or treatment more dicult.

Takingdierentmediationsand/ormonitoring

asthma properly can be challenging.

Olderadultsmaybemorelikelytohavesideeects

rom asthma and non-asthma medications.

Patienteducationmayneedtobemodiedto

account or possible memory problems, loss o

coordination and muscle strength, hearing and

visual diculties, and depression.

Te DC CAN, in collaboration with its community

partners, developedManaging Asthma Eectively in

Older Adults: An Educational Guide or Promoting BetterAsthma Control in response to the ollowing:

disparitiesinasthmaprevalenceamongolderadults;

uniqueasthmaeducationandmanagement

considerations; and

feedbackfromolderadultswithasthmalivinginthe

District o Columbia.


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y using this toolkit and

teaching the Managing

Asthma Effectively in

Older Adults program, you make

a substantial difference in the

well-being and daily lives of older

adults with asthma. Your efforts

will ensure they have the tools

necessary to become proactive in

the management of their condition.

B

section 1

Instructors Guide


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s 1

Creating Asthma-Friendly Schools

Background Q and A 1

How to Use the Curriculum 4

Health Education for Older Adults 6

Working with Older Adults in Health Promotion Programs 7

Cultural Competence 8

Asthma Learning Tool Questionnaire 10

Instructor Questionnaire:

How Much Do You Know About Asthma in Older Adults? 18

s 1

Instructors Guide


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sEctiOn 1 / instructOrs guidE 1

Why wa he oolk developed?

Te purpose o this toolkit is to provide health educators,

clinicians, social workers, case managers, and other

proessionals serving older adults with culturally appropriate

inormation on asthma management. In return, these

health proessionals can better educate their patients as

well their patients caregivers.

Tis toolkit is designed to:

Oerafundamentalasthmaeducationcurriculum

specically designed or older adults.

Provideabroadrangeofresourcestoassurethe

success o the educational process, both or health

proessionals and their patients and amilies.

Highlightasthmaeducationinitiativesimplemented

in the District o Columbia and provide lessons

learned rom each.

Te toolkit is intended or educational purposes only; it is

not intended to replace the medical advice or services o a

licensed healthcare provider.

Why wa Managing Asthma Effectively in

Older Adults Program developed?

Te Asthma Control Program, DC Control Asthma Now

(DC CAN), District o Columbia Department o Health

(DOH), recognized the necessity o a multi-pronged

approach that included community-driven health

education initiatives to reduce asthma morbidity and

mortality among older adults in the District o Columbia.

In 2004, it launched the rst o several initiatives targeting

those seniors residing in wards 6, 7, and 8 o the District.

Te decision to select this audience was based on ndings

rom the 2002 Behavioral Risk Factor Surveillance System

(BRFSS) report that indicated these wards had the highest

asthma prevalence rates in the District o Columbia.

While educating older adults on asthma management was

the primary goal, a secondary goal was engaging older

adults in developing asthma education tools and creating

opportunities or them to share their perceptions o

asthma sel-management.

In 2005, DC CAN developed Sharing the Keys to Asthma

Managementand launched the Senior Asthma Education

Project to address this need. It provided community-based educational outreach on asthma management to

residents in wards 7 and 8, ages 55 years and over, who

have been diagnosed with asthma. Pre-and post-program

survey results indicated success in meeting educational

objectives. However, survey responses also indicated the

need or continued asthma education with this population,

particularly as it relates to the use o asthma medications,

and an asthma action plan. Te current programManaging

Asthma Eectively in Older Adults places an even greater

emphasis on these topics.

Backgod Q & A


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2 Managing asthMa EEctivEly in OldEr adults

Below we have summarized major education and ocus

group ndings that led to the content and design o this

toolkit (or a more detailed description o DC CAN asthmaeducation initiatives or older adults, please see Section 4).

Older Adults with Asthma

Asthmaisoenmisdiagnosedamongolderadults.

Olderadultsoendistrustedtheirasthmahealthcare

provider unless there was a long-term relationship.

Misdiagnosis or a perceived delay in the diagnosis o

asthma also caused eelings o distrust.

Someolderadultssaidtheyreliedontheirhigherpower to cure their illness. Many seniors said they

did not claim the diagnosis o asthma or rebuked

the diagnosis o asthma.

Olderadultsingeneralarenotmanagingtheir

asthma adequately.

Manyolderadultsdidnothaveasthmaactionplans.

Manyolderadultswerenotusingtheirprescription

medications properly.

Olderadultsneededtodevelopstrongpartnerships

with their providers

Asthma Healthcare Providers

Providersneededtobeeducatedonasthma

management or older patients.

Providerswerenotawareofproblemsuniqueto

older adults with asthma.

Additionally, we ound:

Educationalmaterialsneedtobeage-andculture-

appropriate.

Olderadultswantedtobeinvolvedincreationof

materials and program design.

Olderadultspreferredtohaveafacilitatorthat

reects their age group and culture.

Wha he goal o Managing Asthma Effectively

in Older Adults Pogam?

Te program empowers older adults with asthma to better

manage their condition through an interactive teaching

curriculum. It teaches older adults how to:

Identifyasthmatriggersandreduceorremovethem.

Detectasthmawarningsignsandtakeappropriate

action.

Takemedicinesaccordingtotheirhealthcare

providers instructions.

Communicateeectivelywiththeirhealthcare

providers.

Assisttheirhealthcareproviderwithcompleting(or

updating) an Asthma Action Plan.

Consequently, older adults learn to lead healthier, more

active lives.


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Wha he phloophy o Managing Asthma

Effectively in Older Adults Pogam?

Te core element o the program is empowerment.

Trough the program, older adults learn to manage theirasthma and to become advocates in their own health

care. Te program addresses the physical, social and

psychological eects o asthma. For older adults, having

control over their asthma means having more control over

their lives. Tis program enables older adults to control

their asthma symptoms and empowers them to better

manage their asthma with the aid o their health care team,

amily and riends.

Wha he edcaoal heoy behd Managing

Asthma Effectively in Older Adults?

Te program is based on Hochbaum, Rosenstock and

Kegels Health Belie Model (HBM), a psychological model

that attempts to explain and predict health behaviors based

on the attitudes and belies o individuals, and current

research involving learning styles and older adults. Te

HBM is based on the theory that an individual will engage

in a health-related action i that individual:

Believesthatanegativehealthconditioncanbe

avoided.

Believesthatbytakingthesuggestedaction,he/shewill avoid a negative health condition.

Believesthathe/shecansuccessfullytakethe

suggested health action.

Learning style represents the manner in which individuals

consistently respond to and process inormation in a

learning environment. Research in this area suggests that

not all older adults are active, hand-on learners; but rather,

with aging, there is a tendency to become more reective

and observational in the learning environment. Teactivities inManaging Asthma Eectively in Older Adults

that enhance older adults learning experience include:

Useofreectiontosharefeelingsabutasthma.

Useofrole-playtorehearsenewskills.

Useofstorytellingtostimulateproblem-solving.

Useofobservationtoencourageretention.

As an instructor, you help to create a respectul,

supportive learning environment and build trust among

your audience. I respect, support and trust are present,

older adults become more interested in the inormation

presented. As a result, they are more likely to apply

knowledge they have learned in theManaging Asthma

Eectively in Older Adults program and experience better

asthma control.


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i. Maeal ad Eqpme

What materials and equipment are needed to teach

the program?

o teach the program, you need the ollowing:

Managing Asthma Eectively in Older Adults

Curriculum CD it contains your power point

presentation and related handouts.

LaptopwithLCDprojector.

Asthma and the Elderly DVD.

TelevisionwithDVDplayer.

Apenorpencilforeachattendee.

Afoldertocollectpre-andpost-program

questionnaires.

Handoutsforeachattendee:

Presentation Packet a copy o the power point

presentation

Pre-Program Questionnaire:

What Do You Know About Asthma?

What triggers Your Asthma?

Recognize Your Warning Signs

Asthma Action Plan

HowtoUseaMetered-DoseInhaler(MDI)

Post-Program Questionnaire:

What Do You Know About Asthma?

ii. seg

What is considered a good location to hold the session?

Go where your audience is. Te best places to hold the

session are senior wellness centers and other locations

that provide services or seniors. Look or sites that can

help identiy older adults with asthma and market the

program. Ofen sites can provide someone to assist with

acilitating the session. Te site should have a large room

(i.e., conerence room) with good acoustics, an adequate

number o desks or tables, a television with DVD player,

a laptop computer and a LCD projector.

How should the room be arranged?

Create a supportive learning environment. Organize the

room according to the needs o your audience. I possible,

make arrangements or the acility to position tables or

desks in a semi-circle i you are using a podium or circle

i you will be seated among your audience. Provide each

empty seat with a copy o the power point presentation

and handouts; place additional materials within easy reach

o your seat or podium.

What potential barriers should be considered?

Keep in mind that barriers or other obstacles may hinder

learning; declining hearing and vision are two potential

barriers.

Bepreparedtohelpindividualsmovecloserto

sound sources.

Useextravoiceandmediaamplication.

Allowadequatetimeforadjustmentswhengoingrom light to dark area or vice versa, such as showing

theAsthma and the Elderly DVD.

Reduceglareanddirectsunlight.

Usehighcontrastonvisualsandhandoutmaterial.

Readmaterialaloudwherepossible,suchasthepre-

and post-tests, and other handouts.


How o ue he Cclm


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iii. aclag he seo

Te program can be modied to meet the needs o the

audience, however it should be carried out in the general

order in which it is presented. Te curriculum has been

planned to make the 90-minute session as easy as possible

to implement through:

1. Power-point slides

2. Instructions and a script to generate discussion

3. Related handouts

Interactive group activities are included at the end o the

program to encourage older adults to work together to

address barriers to asthma sel-management.

Te curriculum is divided into ve topics:

1. Introduction 35 minutes

2. Asthma basics 10 minutes

2. Sel-care practices 15 minutes

3. Special considerations or older adults with asthma

10 minutes

4. Living your best lie 20 minutes

opics and activities in the lesson that are used to meet

the learning objectives, materials required, and the

time necessary to complete the section are indicated at

the beginning o each lesson topic. Te curriculum is

ormatted or group implementation but can be easily

adapted or one-on-one instruction as well.

Summary o How to Use the Curriculum

1. Gather materials needed or the session. I possible,

make arrangements or the acility to store them

or you.

2. When you are in the education room, arrange tables

or desks in a circle or semi-circle. I possible, make

arrangements or the acility to position them or you.

3. Provide each empty seat with a pencil or pen and

copies o handouts; place additional materials within

easy reach o your seat or podium.

4. Set up the laptop/LCD projector. Load theManaging

Asthma Eectively in Older Adults Curriculum CD.

5. Load theAsthma and the Elderly DVD.

6. Open the oolkit to SECION 3: Curriculum

Presentation and Suggested Lesson Script.

7. Begin the presentation. Discuss the topic or carry

out the activity indicated or each power point slide

using the script to generate discussion.

How to Respond to Dicult Situations

What i a participant shares inormation that is incorrect?

I a participant shares inaccurate health inormation

during a discussion, respectully thank him/her or the

comment or answer but ask the participant to speak

urther with their doctor about the inormation, ollow-

up with Doctors tell us that or Experts say and

then give the correct answer. Re-direct the class by

asking questions like What can you do instead? or

What would you do in this situation? Make sure that

the correct inormation is given to the audience without

embarrassment to the participant and without shedding a

negative light on the original source o the inormation.

What i I do not know an answer to a question?

Be honest. Reer them to their healthcare provider.

What i I cant complete the entire curriculum within thetimerame allotted?

Base learning activities and instructional approaches on

the needs and interests o your audience.


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Te astest growing segment o the older population are

elders, specically those who are 85 years o age and older.

Tis population is expected to double rom 5 million in2003 to 10 million in 2030, and to double again in 2050 to

20million.Additionally,theU.S.populationisbecoming

more culturally diverse as it ages. By 2050, older adults o

color will make up 35 percent (30 million) o the 65 and

older population.

Older Americans comprise a diverse population and are

not all the same. Tere is an increasing range o ages,

unctional and cognitive abilities, and health status.

Dierences among older adults are attributed to actors

such as culture, race, ethnicity, religion, language, sexual

identity, gender, income and education. Te growth and

diversity o the aging population presents challenges as

well as opportunities to providers in the elds o aging

and health.

o create health programs that change behavior, create

supportive environments and encourage good health

practices, theAmerican Journal o Health Promotion

suggests a ramework o our essential elements: awareness,

motivation, skill-building and opportunity (ODonnell,2005). Tis ramework is based on the idea that people

need to:

Knowwhat to do (awareness).

Bereadyto do it (motivation).

Learnhowto do it (skill-building).

Haveaccess to do it (opportunity).

Framework author Michael ODonnell suggests that

Successul eorts at health behavior change will have

a much greater chance o occurring i all our o these

components are ormally addressed in the programs

design (ODonnell, 2005).

Tese elements were considered in developing this toolkit

to assure that elderly patients had the hands-on knowledge

to manage their asthma and the skills necessary to partner

with their healthcare providers in sustaining an eectiveasthma management plan. Te next section is a reminder

to health proessionals that older adults comprise a

unique group with characteristics that requires specialized

attention in educational programs.


Healh Edcao o Olde Adl

Reprinted from American Society on Agings Live Well, Live Long Issue Briefs

Series. Copyright 2006 American Society on Aging. San Francisco, CA.

www.asaging.org/CDC.


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1. Be awae ha olde adl ae o a homogeeo

gop.

A room ull o older adults may include a wide range oages and unctional and cognitive capacities. Tere may

also be big dierences between individuals based on

culture, race, religion, language, sexual identity, gender,

income, education, physical ability or other actors. Each

elder is a unique individual with distinct lie experiences.

Make sure to nd out about your audience beorehand.

2. Be awae o age ade.

Watch out or ageist attitudes that you may be expressing

inadvertently. Aging is sometimes negatively representedas a time characterized chiey by loss loss o physical

ability, loss o loved ones, and loss o social status. While it

is important to acknowledge loss, use this opportunity to

promote the positive side o aging.

Address elders ormally (using Mrs./Miss/Ms./Mr.)

unless they invite you to call them by their rst names.

Elder and older adult seem neutral and respectul, but

remember that people o varying cultural backgrounds

may not be comortable with the same descriptors. An

underlying respect or the elders youre working with willspeak volumes.

3. Be clve ad ojdgmeal.

Useeyecontactandothertechniquestoengageand

include everyone in a group or class. ry to acknowledge

and validate the needs o each individual while mainly

ocusing attention on the entire group. Base your

expectations o an individual on ability, not age. Establish a

positive, nonjudgmental tone that supports everyone.

4. Be awae o commcao dcle de o vo

o heag mpame o low leacy.

Makesureeveryoneinthegroupcanseeandhearyou.Use

a microphone i possible. Print materials or older adults

should be in a ont thats at least 14-point size, should not

use italics or script, and should have high contrast and

a clear, simple layout. Large-size visual aids can be very

helpul because they dont require that someone knows how

to read (a problem that aects one-third o older adults) orunderstand health terminology.

5. Be awae o ea ad coce ha olde adl

may have.

Elders may have many ears and concerns, such as losing

independence, being isolated, alling, getting injured,

having mixed eelings about participating, not being

accustomed to doing the activity, or eeling that the activity

is inappropriate. Acknowledge that societal attitudes toward

aging have changed over time. Listen to their concerns,validate their reality, and appreciate that you are in a

position to help them make positive changes in their lives.

6. Pay aeo o leag ad eachg yle.

Older adults can learn new skills (physical, mental

and social), but they may learn more slowly or need

dierent instructional techniques than younger adults. Be

prepared or a wide range o abilities among participants.

Break down components into small parts and give clear

explanations, both verbally and visually. Give participants

a lot o positive reinorcement and positive eedback. And

remember, every elder can improve his or her abilities. Be

sure to celebrate progress with the participants!

7. Ecoage ocal eaco amog pacpa.

For elders, one o the benets o participating in a group

setting is the opportunity to engage in social interaction.

Encourage peer education, sharing and interaction among

participants both in and out o class (or example, use

partner activities during a class).

8. Lea om elde theye he epe!

Appreciate that you are contributing to the empowerment

and quality o lie o elders in your program, and embrace

and value the lie experience they bring.


Wokg wh Olde Adl Healh Pomoo Pogam

Reprinted from American Society on Agings Live Well, Live Long Issue Briefs

Series. Copyright 2006 American Society on Aging. San Francisco, CA.

www.asaging.org/CDC.


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How Ca i Commcae Moe Eecvely?

When a person has an inherent caring, appreciation and

respect or others they can display warmth, empathy

and genuineness. Te most important ways to enhance

communication is to:

Beopen.

Behonest.

Berespectful.

Benonjudgmental.

Bewillingtolistenandlearn.

Listening and observational skills are essential. Letting

people know that you are interested in what they have

to say is vital to building trust. Older adults have a rich

variety o lie experiences and will likely want to share

some o them, especially asthma experiences, during the

class. Recognize individuality and the diversity o your

audienceandembracethem.Usethesediscussionsto

enhance the learning process.


Clal Compeece

Wha Clal Compeece?

Clal compeece beg wh a awaee o yo ow peoal bele ad pacce,

ad ecogo ha people om ohe cle may o hae hem. th mea moe ha

peakg aohe lagage o ecogzg he clal co o people. i mea chagg

pejdgme o bae yo may have o a people clal bele ad com.

Administration on Aging

coe me Bee:

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c coe

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Wha Clally Appopae sevce Delvey?

Moving toward culturally appropriate service delivery

means being:

Knowledgeableaboutculturaldierencesandtheir

impact on attitudes and behaviors.

Sensitive,understanding,non-judgmental,and

respectul in dealings with people whose culture is

dierent rom your own.

Flexibleandskillfulinrespondingandadaptingto

dierent cultural contexts and circumstances.

According to the Oce o Minority Health, cultural

competency is one o the main ingredients in closing

the health disparities gap because culture and language

may inuence:

Health,healing,andwellnessbeliefsystems.

Howillness,disease,andtheircausesareperceived,

both by the patient/consumer.

ebehaviorsofpatients/consumerswhoareseeking

health care and their attitudes toward health care

providers.

edeliveryofservicesbytheproviderwholooks

at the world through his or her own limited set o

values, which can compromise access or patients

rom other cultures.

Adapted from U.S. Department of Health and Human Services.

(2008, August 10). Administration on Aging cultural competency guidebook.

Retrieved from http://www.aoa.gov/pro/adddiv/cultural/cc-guidebook.pd.


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Copyright 2008, Pedipress, Inc. All rights reserved FromAsthma Charts & Forms or the Physicians Ofce and Managed Care,

Thomas F. Plaut, MD. Used with permission.

Ahma Leag tool: Qeoae


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Ahma Leag tool: Awe

Copyright 2008, Pedipress, Inc. All rights reserved FromAsthma Charts & Forms or the Physicians Ofce and Managed Care,

Thomas F. Plaut, MD. Used with permission.


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shortness of breath.


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3. soe o be o e oe.

4. Oe w m o exee.

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6. a pek fow mee e o moo ow e o.

7. a oe o m epoe e e/e

weez.

8. co f e m epoe.

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e ee we peope ee oo

10. Mo m epoe be peee.

11. i oe , m epoe o e wo

w.

12. tobo moke mke m mpom woe.

2007 Gdele o Dagog ad Maagg Ahma:

Chlde Age 5-11 Yea

ico Qeoae: Awe Key

How Mch Do Yo Kow Abo Ahma Olde Adl?

Pee ompee beoe e Managing Asthma Effectively in Older Adults: An Educational Guide for

Promoting Better Asthma Control. (cek o we e e e ook).

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here were so any

other things going on in

y boy, I int think

I neee to bring that [astha

syptos] up. I int think it was

anything serious...I just thought it

was a itte co in y throat an

y chest.

Carrie Leary, age 78

Asthma in older adults is complicated

because the normal eects o aging

can make asthma a diagnosis that

is difcult to identiy and treat.

The Managing Asthma Eectively

in Older Adults program empowers

older adults with asthma to better

manage their condition through an

interactive teaching curriculum.

T

section 2

Introuction & Astha Basics


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s 1

Creating Astha-Frieny Schooss 2

Introuction & Astha Basics

Part I: Introuction 21

A. Introduction and Icebreaker 22

B. Goal and Objectives 23

C. Pre-Program Questionnaire 24

D. DVD:Asthma and the Elderly 25

Part II: Astha Basics 26

A. Normal Lung Function 27

B. Asthma Causes and Symptoms 28

C. Asthma Episodes and Warning Signs 29

D. Asthma Emergencies 30

E. Asthma Triggers 31

F. Asthma Diagnosis and Management 32

Part III: daiy Sef manageent: Astha Sef-Care Practices 33

A. How Do You Achieve Good Asthma Control? 34

B. Identiy Asthma Triggers 35

C. Recognize Early Warning Signs 40

D. Take Medicines Correctly 41

E. Partner on a Plan 43

Asthma Action Plan 44

F. Maintain Good Communication 45

Part Iv: Specia Consierations for Oer Auts with Astha 47

A. Choosing An Asthma Healthcare Provider 48

B. When To See A Specialist 49

C. Medication Management and Multiple Health Conditions 50

D. Problems That Can Complicate Asthma Diagnosis 51

E. Understanding Case Management 52

Part v: liing Your Best life 53A. Smoking Cessation 54

B. Nutrition 55

C. Exercise 56

D. Tips or Feeling Great 57

E. Group Activities 58

F. Post-Program Questionnaire 59


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sEctiOn 2 / curriculuM rEviEW 21

TeManaging Asthma Eectively in Older Adults program

aims to empower older adults to become more condent

in managing asthma so that they can lead healthier, moreactive lives. As a result o the program, participants will

be able to 1) detect their asthma warning signs, 2) identiy

their asthma triggers, 3) limit their exposure to asthma

triggers, and 4) prevent or reduce their asthma symptoms.

Educational objEctivEs

th eco wll cove:

Icebreakeractivity.

Overviewoftheprogram.

Leag Objecve:

Te purpose o this section is to help establish a

comortable learning environment and identiy baseline

knowledge about asthma. o do this, your audience will:

Describeafavoriteactivity/pastimeanddiscuss

whether asthma symptoms have ever made the

activity less enjoyable.

Reviewthegoalandobjectivesoftheprogram.

CompleteHandout#2Pre-ProgramQuestionnaire.

DiscussandviewtheDVDAsthma and the Elderly.

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and the Elderly20 me


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Introductions may seem easy, however i done incorrectly

it can mean the dierence between a successul program

and an unsuccessul one. Keep your introduction brie andavoid acronyms and jargon, say My name is Busy Bee and

I am a nurse instead o My name is Busy Bee and I am

an R.N. with CHES certication and I work or NIH

Always thank your host, and let your audience know that

you are excited to lead the discussion. Be sure to address

elders ormally (using Mrs./Miss/Ms./Mr.) unless they

invite you to call them by their rst names. An underlying

respect or the older adults youre working with will speak

volumes. Although asthma is a serious disease, try to

maintain an environment o inormality and levity. Displayenthusiasm, warmth, empathy and genuineness.

Create a comortable learning environment that is

non-threatening, supportive and inviting. Group

icebreakers are tools you can use to help create thistype o environment. Icebreakers are activities or modes

o discussion used to help individuals ease into a group

setting. Te icebreaker used in this program is intended

to help your audience identiy commonalities, recognize

that asthma aects people dierently, prompt them to

begin thinking about what better asthma control can

mean or them, and emphasize the overall goal o the

program to learn how to become as ree rom asthma

symptoms as possible. Icebreaker activities are usually

met with enthusiasm, however it is important to recognizethat some audience members may not want to participate.

Always begin the icebreaker by allowing them to exempt

themselves rom the activity.

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iodcg he Managing Asthma Effectively

in Older Adults Pogam

TeManaging Asthma Eectively in Older Adults

curriculum is written to promote condence and success

by moving rom easy material to more dicult. Providing

the program description is no exception. Discuss the goal

o the program and the learning objectives then encourage

sel-directed determination o learning goals. o do

this, begin by introducing the program goal in general

terms we are here to talk about asthma and ways to stay

healthy. Next, oer a more concrete rationale or gathering

together to become more condent in managing asthma

so that we can lead more active lives. Lastly, describe the

anticipated outcomes (objectives) o the program at

the end o the program, you will be able to 1) detect your

asthma warning signs, 2) identiy your asthma triggers, 3)

limit your exposure to asthma triggers, and 4) prevent or

reduce your asthma symptoms. Next, ask your audience

to share personal goals or the program, inorm them that

you value their eedback and want to meet their learning

needs. Again, the curriculum can be modied to meet the

needs o the audience, however it should be carried out in

the general order in which it is presented.

Goal ad ObjecveB


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Admeg he Pe-Pogam Qeoae

Be aware that older adults may not be amiliar with

tools or tests such as Likert scales that others may take

or granted. TeManaging Asthma Eectively in Older

Adults curriculum uses a multiple-choice questionnaire

to determine change in the participants knowledge,

attitudes and skills related to asthma management. Read

the questionnaire directions to the group and ask i there

are any questions. Read each question number ollowed

by the question. Allow or appropriate periods o time or

responding to questions. Inorm your audience that they

may stop you at any time. I you are ortunate enough to

have a co-acilitator or helper, encourage him/her to move

around the room to oer assistance. Afer administering

the pre-program questionnaire, explain the rationale

or completing the same questionnaire at the end o

the program.

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ee o e moe

i w k o o ompee e me qeoe

e e o e pom. B o we

oe beoe e pom, oe e e

pom, i w be be o e ow m o

ee w i o o mke e pom

bee.

Pe-Pogam Qeoaec


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iodcg he Senior Citizen Asthma Education

and In-Home Environmental AssessmentPlo

pojec (sCAEiEAP) adAsthma and theElderlyDVD

In 2004, the DC Department o Health Asthma Control

Program (DC CAN) partnered with the Greater

WashingtonUrbanLeagueandlaunchedaneducational

program called the Senior Citizen Asthma Education

and In-Home Environmental Assessment Pilot project

(SCAEIEAP). Inormation gained rom this program

was the impetus or developing theManaging Asthma

Eectively in Older Adults oolkit.

Begin the discussion by posing a question to your

audience did you know that the District o Columbia

has one o the nations highest asthma rates? Inorm

them that asthma aects District residents o all ages,

races and ethnic groups and older residents (45-50

years o age) and elderly (65 years o age and older) are

severely impacted by this serious but manageable chronic

condition. Discuss the background o the SCAEIEAP

program, as well as the goals, ndings and results o the

program per the related curriculum slides (slide numbers

6-10) and suggested lesson script. Next, introduce the

Asthma and the Elderly DVD.

Te DVD is an integral part o the curriculum. It provides

a wealth o inormation about asthma and asthma

management and documents viewpoints o older adultswith asthma living in the District. Group activities that

enhance the older adults learning experience are based on

scenarios rom the DVD. Afer viewing the DVD, provide

a brie opportunity or your audience to give their initial

reaction to the DVD. Pose a ew questions such as:

WhatdidyouthinkabouttheDVD?

What,ifanything,didyoulearn?

Whatdidyoundmostinteresting?

Couldyouidentifywith(relateto)anyoftheseniors

in the DVD who/why/why not?

Responses to these questions will give you better insight

aboutthelearningneedsofyouraudience.Usethis

inormation to identiy curriculum topics that may require

greater attention.

DVD:Asthma and the Elderlyd


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Pa ii: Ahma Bac

TeAsthma and the Elderly DVD provides an

introduction to asthma basics. In this section, you will

build on that inormation by discussing the physiologyand unction o the respiratory system and answering key

questions about asthma.


th eco wll cove:

Basicphysiologyoftherespiratorysystem.

Basicfactsaboutasthma.

Leag Objecve:

Te purpose o this section is to help ensure that all

participants have the same basic inormation about

asthma. o do this, your audience will:

Deneasthma.

Answerbasicquestionsaboutthedisease:

What happens when we breathe?

What is asthma?

What causes asthma?

What are asthma symptoms?

What is an asthma episode?

What are asthma triggers?

What are asthma warning signs?

When is asthma an emergency?

How is asthma diagnosed and treated?

topc / Acve Maeal needed Emaed tme

a. nom l ocm cd o

Peeo Pke

tOtAL:

10 me

B. am ce smpomcm cd o

Peeo Pke

c. am Epoe W scm cd o

Peeo Pke

d. am Emeeecm cd o

Peeo Pke

E. am tecm cd o

Peeo Pke

. am do Memecm cd o

Peeo Pke

This section is adapted from the National Heart, Lung, and Blood Institute. (2008, September 5).

Guidelines for diagnosis and management of asthma. Retrieved fromhttp://www.nhlbi.nih.gov/guidelines/asthma.


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Wha happe whe we beahe?

Your respiratory system makes breathing possible. With

each breath, you take in air through your nose and mouth,

and your lungs ll up and empty out. A normal respiratory

system includes your:

Nose

Mouth

roat

Larynx(voicebox)

Trachea(windpipe)

Lungs

Diaphragm

When you breathe in (inhale), your respiratory system

allows oxygen in the air to get into your lungs so that the

oxygen can travel to your blood. Your blood delivers the

oxygen to all parts o your body. Oxygen is important

because your cells need it or energy and growth. Without

oxygen, the bodys cells would die. Your lungs remove

carbon dioxide (a waste product o breathing) when air is

breathed out (exhaled).

Wha Ahma?

Asthma is a chronic (ongoing) disease that makes it more

dicult or you to get air in and out o the lungs. It is ofen

thought o as a childhood disease, but requently asthma

is diagnosed as a new condition in older adults. For some

people, it may be a continuing problem rom younger years.

When you have asthma, your airways (breathing tubes)

are sensitive. Tey may react to things that usually

dont bother people without asthma that are called

triggers. When airways react, they may tighten and

become inamed and swollen making it dicult or

you to breathe. Your diculty in breathing may change.Sometimes you will eel ne. Other times you may have

breathing problems. Although asthma cannot be cured,

most people with asthma can control it.

Appomaely 22.9 mllo Ameca had

ahma 2006, cldg almo 2.5 mllo

people ove he age o 65. Moe ha oe

mllo people ove he age o 65 had a

ahma aack o epode. the Dc o

Colmba ha oe o he ao hghe

ahma ae. Olde ede, 45 yea ad

olde, ae eveely mpaced by h choc

deae.

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Wha Cae Ahma?

Te exact cause o asthma isnt known. Many health

experts believe that several actors come together to cause

asthma, such as:

Afamilytendencytodevelopallergies(atopy).

Parentswithasthma.

Respiratoryinfectionsduringchildhood.

Exposuretocertainvirusesatanearlyage.

Other risk actors include, but are not limited to the

ollowing:

Gender-Childhoodasthmaoccursmorefrequently

in boys than in girls; but by age 40, more emales

than males have adult asthma.

AirwayHyperactivity-Asthmaismorelikelyto

develop in people with a very reactive (sensitive)

airway.

Allergies-Allergiesandasthmaoengotogether.

Many people with asthma also have allergies. Sources

o indoor allergens include pet dander, dust mites,

cockroaches, and mold. Sources o outdoor allergies

include pollen, grass and mold.

CigaretteSmoke-Severalstudiesconrmthat

cigarette smoking is linked with an increased risk or

developing asthma. Numerous ndings link second-

hand smoke exposure to the development o asthma

in early lie.

Obesity-Asthmaismorecommoninoverweight

adults and nearly twice as common among obese

adults.

Health experts have been ocusing attention, over the past

ew years, on the disproportionate burden o asthma on

minorities, particularly Arican-American and Hispanicchildren residing in inner cities (NIAID). Research on

the causes, treatments, and prevention o asthma is being

conducted to help reduce disparities in the incidence and

prevalence o this disease. Minorities experience higher

rates o emergency department (ED) visits, hospitalization,

and deaths due to asthma. Arican-American women,

or example have the highest death rate due to asthma

among all races. Tese dierences in rates, diagnosis, and

treatment may be linked to poverty, urban air quality,

indoor allergens, lack o education about asthma, andinadequate medical care.

Tere is still a lot unknown about causes o asthma,

and more research is being done to understand better

the causes o this chronic condition, including genetics

dierences between races and their responses to allergens.

Studies have shown, however, that education programs

are needed or low-income Arican American patients to

improve asthma healthcare.

Wha ae Ahma sympom?

Symptoms may include, but are not limited to the ollowing:

Coughing.

Breathinghardandfast.

Shortnessofbreathatrestorwithexercise.

Troubleexhaling.

Wheezing(awhistlingnoiseinthechest

while breathing).

Chestpainortightness.

Coughingupphlegm.

Nighttimeawakeningwithshortnessofbreath.

Headaches.

Fatigue,tiredness,orlethargy.

Ahma Cae ad sympomB


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Wha a Ahma Epode?

When your asthma symptoms are worse than usual, you

may experience an asthma episode. Te words asthma

attack, asthma problem, asthma episode, and asthma

are-up all mean the same thing. Not all asthma episodes

are the same. Sometimes symptoms can get worse, and

additional symptoms may appear to cause an asthma

episode. Some are worse than others. During an asthma

episode, it gets harder or you to breathe and to keep

your airways clear. One or more signs o asthma trouble

characterize an asthma episode:

Coughing.

Wheezing.

Chesttightness.

Shortnessofbreath.

Wha Happe Dg a Ahma Epode?

During an asthma episode, air has more trouble getting in

and out. It gets harder to get rid o the used air and bring

in new air. Tree things happen to the airways during anasthma episode:

1. Infammation Te airways become swollen and

irritated. Tis also makes the airways smaller and

makes breathing more dicult.

2. Bronchospasm (or bronchoconstriction) Te

muscles around the airways tighten up and make

the airways smaller.

3. Mucus Production Inamed airways produce

excess mucus, which clogs the already narrowed

openings. Mucus normally helps the airways stay

moist. But during an asthma episode, too much

mucus is produced. Airways are tubes through which

air passes on the way to and through the lungs.

Te ollowing illustration shows the dierence between a

normal airway and one in the midst o an asthma attack.

Wha Ae Ahma Ealy Wag sg?

Early warning signs are changes that happen just beore or

at the beginning o an asthma episode. I you have asthma,

you have to know your own body well enough to recognize

when these changes happen. By recognizing these signs,you can stop an asthma episode or prevent one rom

getting worse. Early warning signs may include, but are not

limited to the ollowing:

Signsofacold,orallergies(sneezing,cough,nasal

congestion, sore throat and headache).

Frequentcoughing,especiallyatnight.

Loosingyourbreatheasilyorshortnessofbreath.

Troublesleepingbecauseofduetodiculty

breathing, coughing or wheezing.

Feelingtired,upset,grouchy,ormoody.

Reducedpeakowreadings.

Wheezingorcoughingaerexercise.

Ahma Epode ad Wag sgc


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Whe ahma a emegecy?

An asthma episode can lead to a medical emergency i

asthma symptoms are not controlled. Go to the emergency

department (ED) or call 911 right away i you notice any o

these signs:

Youhunchoverwhenyoubreathe.

Yourlipsorthetipsofyourngerareblue.

Youhavetroublewalkingortalking.

Youaresuckingintheskinbetweenyourribs.

Youarebreathingveryslowly.

Youfeelworseaeryourmedicinehashadtimeto

start working (within 10-15 minutes).

Ahma Emegeced


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Wha ae Ahma tgge?

When people have asthma, the airways in their lungs

react to things that usually do not bother people without

asthma. Tese things are called asthma triggers. For many

people, triggers may be:

Allergic reactions to:

Pets.

Dustmites.

Cockroaches.

Mold.

Pollen.

Grass.

Food.

Irritants:

Dust.

Cigarettesmoke.

Cleaningproducts.

Perfumeorotherstrongodors.

Other actors:

Physicalresponsestochangingweather,orcoldair.

Stressorstrongemotions.

Viralinfections,especiallyupperrespiratorytract

inections like the common cold.

Somemedicinesmaytriggerasthmasymptomsand

others may make asthma medicines less eective.

Ahma tggeE


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How Ahma Dagoed?

A proper diagnosis o asthma is the rst step toward

reducing your symptoms and improving your health. Your

healthcare provider may base a diagnosis o asthma on:

Yourmedicalhistory.

Aphysicalexamination.

Anyfamilyhistoryofasthmaorallergyproblems.

ChestX-rays-toruleoutotherpotentialcauses.

Spirometry-tomeasurehowmuchairthelungscan

hold and how well the respiratory system is able to

move air into and out o the lungs.

Monitoringpeakexpiratoryow(PEF)-usinga

peak ow meter to monitor the amount o orce with

which air is blown out o your lungs.

Diagnosis and treatment in older adults may present some

special concerns, including:

Someasthmasymptomsaresimilartosignsofother

possible health problems (congestive heart ailure,

chronic obstructive pulmonary disease).

eremaybeotherongoinghealthconcernsthat

make diagnosis and/or treatment more dicult.

Takingmanydierentmediationsand/ormonitoring

asthma properly can sometimes be challenging.

Olderadultsmaybemorelikelytohavesideeects

rom asthma and non-asthma medications.

Wha ype o ahma do yo have?

o assess your long-term asthma status, your healthcare

provider will check how ofen you had asthma symptoms

when you were not taking any asthma medication. Tere

are two main types o asthma:

Intermittentasthma-whenasthmasymptomscome

and go. For example, you may have symptoms two

times a week or less, or you may wake up because oasthma two times per month or less. In addition, the

time between these symptoms may be a ew weeks or

a ew months.

Persistentasthma-whenyouexperienceasthma

symptoms all the time.

Persistent asthma is classied as mild, moderate, or severe.

Your healthcare provider decides which type you have

based on:

1. What you can and cant do because o your asthma.

2. How much and what type o medicine you need.

3. ests o your breathing ability.

Asthma can be controlled. For intermittent asthma, being

controlled may mean your asthma rarely bothers you.

For severe persistent asthma, control means having ewer

symptoms that keep you rom doing what you want to do.

In the ollowing sections we will discuss ways to keep your

asthma under control.

How ahma maaged?

Asthma can be controlled success depends largely on

sel-care skills.

Sel-care skills include:

Avoidingtriggers.

Recognizingsymptomsandtakingaction.

Takingmedicinesappropriately.

Monitoringyourresponsetotreatment.

Gettingregularfollow-upcare.

Gettingimmediatehelpwhenneeded.

Ahma Dago ad Maageme


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th eco wll cove:

IdentifyingAsthmaTriggers.

RecognizingEarlyWarningSigns.

PartneringonaPlan.

TakingMedicinesCorrectly.

MaintainingGoodCommunication.

Leag Objecve:

Te purpose o this section is to discuss asthma sel-

care practices. Te audience will use inormation gained

to better manage asthma symptoms and assist their

healthcare provider with completing a personalized

asthma action plan. o do this, your audience will:

Identifypersonalasthmatriggersanddiscusswaysto

remove or reduce them.

ReviewHandout#3WhatTriggersYourAsthma?

Recognizeearlywarningsignsandidentify

appropriate action to take when they occur.

ReviewHandout#4RecognizeEarlyWarningSigns.

Identifykeycomponentsofanasthmaactionplan.

ReviewHandout#5AsthmaActionPlan.

Distinguishbetweenrescueanddailycontroller

medicines and discuss medicine delivery devices.

ReviewHandout#6HowToUseAMetered-Dose

Inhaler (MDI).

Discusswaystoenhancecommunicationwith

healthcare providers.

Pa iii: Daly sel Maageme: Ahma sel-Cae skll

topc / Acve Maeal needed Emaed tme

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Peeo Pke

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47/137


Successul asthma control takes cooperation between the

person diagnosed with asthma, their healthcare provider,

and all members o their healthcare team (respiratorytherapists, pharmacists, asthma educators, dieticians and

nutritionists especially i ood allergies cause asthma

symptoms, and anyone else helping them to manage their

asthma). Family and close riends can help also.

Control o asthma depends on three things:

Beingabletogetgoodmedicalcare.

Workingwithyourdoctortodevelopanasthma

action plan.

Havingasthmaself-careskills.

Getting good medical care is essential. In the next section

we will talk more about medical care and what to look or

when choosing an asthma doctor. An asthma action planis a written plan you get rom your healthcare provider

and help to complete. Te action plan is important because

it gives you inormation on how to control your asthma

it is your personal guide to staying healthy. It includes

inormation about your asthma triggers, symptoms,

medicines, and more. Sel-care skills are things that you

do yoursel to help keep your asthma under control. Te

most important sel-care skills are:

Identifyingasthmatriggers,reducingorremoving

them when you can.

Recognizingearlywarningsigns,andtaking

appropriate action.

Workingwithyourhealthcareprovidertodevelop

an asthma action plan and ollowing it.

Takingyourmedicineaccordingtoyourhealthcare

providers instructions.

Maintaininggoodcommunicationwithyour

healthcare provider, other members o your care

team, and your amily and close riends.

How Do Yo Acheve Good Ahma Cool?a


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When you have asthma, certain things can irritate your

airways. Tese things are called triggers because they can

trigger asthma symptoms by causing:

eairwaysbecomeswollenandirritated

(inammation).

emusclesaroundtheairwaystightenupandmakethe airways smaller (bronchospasm).

Toomuchmucusproduction,whichclogsthe

already narrowed openings.

Te rst step toward asthma control is guring out what

triggers your asthma symptoms. Te most common

asthma triggers are:

Respiratory Inections colds, u, and sinus

inections. Respiratory inections are one o the most

common asthma triggers.

Allergens things that can trigger an allergic

reaction and irritate your airways.

Irritants irritants can bother anyones airways, but

i you have asthma they can cause asthma symptoms.

Exercise exercise can irritate airways.

Emotions strong emotions can cause asthma

symptoms.

Chemicals many people have asthma reactions

rom breathing in certain chemicals.

Seasonal Changes some people have more asthma

symptoms during a particular time o year, usually

the all and spring because there is more pollen in

the air.

Medicines some medicines may cause problems

or people with asthma, some may trigger asthma

symptoms and others may make your asthma

medicines less eective.

Foods - or some people milk, wheat, corn, soy, nuts,

sugar, or other oods may irritate or trigger asthma

symptoms.

GERD (acid refux disease) may be an underlying

cause or contributor o asthma. In such cases,

successul treatment o the digestive problem will

ofen clear up the asthma.

Dierent people may have dierent triggers. Once you know

your triggers, you can do more to keep yoursel healthy.

sElf-carE skill #1

idey yo ahma gge ad elmae

o edce yo epoe o hem.

idey Ahma tggeB


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Wha tgge Yo Ahma?

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ce e wee

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Mee

oo

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d me e

oe o oe

so emoo epoe -

, , e.

se

Peme, bo eoo, e.

so em me p, e

e

co, oe epo eo

Mo, mew

tobo moke

a poo moke, me, e.

cokoe-e we e bo p

am - e we, e

(fke om e k)

Oe

1. reew e o ommo m e.

2. cek e oe eem o mke o m woe.

3. i o e o e, keep e o w o e o ebe e me o

e m epoe o e. cek e o ee w e m e bee pee mke oe.

4. se omo w o oo, m oe e.

now o kow w e o m, o o ee .

1. remoe o o e e. s w o ome. i o ee ep k. yo m oe

e m be be o o.

2. lm be o e e. i o ompee o e e, o o ke

e oom omeoe mok o k e o o o ome e e

e, ke pe, e.

3. i e e obe, k o oo bo k o qk-ee mee beoe o e

o e.


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Way o remove o Avod tgge

Review the ollowing ways you can remove dierent

kinds o triggers. Check the ones that you will try. Afer

removing or reducing your asthma triggers, share any

results with your doctor.

Indoor Air Pollution

Change air lters once a month. Tis is a simple

and eective way to lter the air that is circulated

throughout your home. Buy special allergen lters

(available at most hardware and home stores) i

possible. Tey last up to three months and are designedto remove more allergens, irritants and other unwanted

things rom the air.

Outdoor Air Quality

Limit outdoor activities when news reports indicate

pollen counts are high or air quality is poor due to

high humidity or high heat-index (code yellow and

code red days).

Mold and Mildew

Reduce air humidity with a dehumidier.

Stay out o damp places, like basements, etc.

Useableachsolutiontopreventmoldandmildewin

sinks and tubs; wear a mask or have someone else do it

or you. White distilled vinegar may be an alternative.

It is excellent or killing mold and bacteria.

Have heating, ventilation and air conditioning systems

cleaned and serviced regularly.

Fix all water leaks.

Some orms o mold are toxic (very harmul to yourbody) and require immediate attention and removal

by a proessional.

Animals

Pets are great company. Research shows that older adults

who have pets can actually live longer than those who live

alone. However, pets shed hair and dander (akes rom

their skin), which can be triggers or people with asthma

or allergies.

Wash hands immediately afer contact with pets or

other animals.

Vacuum oors daily using a HEPA air lter.

Keep pets outdoors or in certain rooms keep them

out o your room and never let pets sleep in your bed.

In some cases your doctor may tell you that nding a

new home or your pet is best.


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Dust Mites

Dust mites are tiny insects that are too small to be seen

without a microscope. Tey live in bedding, pillows,

comorters, stued animals, quilts, and blankets.

Dust with a damp cloth and vacuum requently using

a HEPA air lter remove carpet i possible, especially

rom your bedroom.

Encase your mattress and pillows with vinyl covers.

Wash your sheets and blankets weekly in hot water.

Avoid eather pillows and down comorters.

Useadehumidier.Reduceindoorhumidityto

less than 50%, i you can. Dust mites thrive in high

humidity.

Remove stued toys and other dust-collecting objects

rom your bedroom. Any that are not removed should

be cleaned ofen.

Clean curtains and woodwork ofen.

Replace urnace lters each month during the winter

season, i possible.

Cockroaches

Cockroach waste, eggs and remains can be signicant

triggers or people with asthma and allergies.

Keep ood in tightly sealed containers.

Wash dishes daily and dry all dishes thoroughly.

Keep bathtubs and sinks dry when not in use.

Keep rooms as clutter-ree as possible.

Keep trash in enclosed bins and remove rom your

home daily.

Usepoisonbaitortraps;trytoavoidchemical

treatments unless absolutely necessary. Be out o your

home when used.

Cold Air

ry to breathe through your nose when outdoors.

Wear a scar that covers your nose and mouth.

Pollen

Useairconditioningtoavoidhavingtoopenwindows,

i possible.

Limit outdoor activities when the news reports indicate

pollen counts are high.

Foods

Eliminate polyunsaturated vegetable oils, margarine,

vegetable shortening, all partially hydrogenated oils

that might contain trans-atty acids, all oods that

might contain trans-atty acids (such as deep-ried

oods).

Experiment with eliminating (one at a time) wheat,

corn, soy and sugar or six to eight weeks to see i the

condition improves.


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Smoke and other Irritants

Smoking can trigger asthma and cause sudden symptoms.

So can smoke rom someone elses cigarette called

secondhand smoke.

I you smoke quitting now can help your lungs

work better.

Ask amily and riends not to smoke in your home or car.

Avoid places where people smoke indoors.

Limit the use o wood-burning stoves.

Avoid using strong-smelling cleaners and other

products.

Inections (Colds and Flu, etc.)

Wash hands requently with soap and warm running

water.

Stay away rom people who have colds or other viral

inections, i possible.

Get prompt medical treatment or cold symptoms and

respiratory inections.

Get a u shot each year and the pneumonia vaccine

i you are 65 years o age or older, or i your doctor

recommends it.

Medicine

Some medicines may cause problems or people with

asthma. ell your doctor i any medication triggers your

asthma or causes an irregular heartbeat. Do not stop

taking any prescriptions without your doctors approval.

Some common drugs that can aect asthma include:

Blood pressure medicine, heart medicine, and some

medicines used to treat glaucoma may trigger asthma

symptoms they include: Beta-blockers (propranolol,

nadolol, timolol, atenolol) and ACE inhibitors.

Aspirin, ibuproen, and naproxen may trigger asthma

symptoms these medicines may be ound in cold

medicines or pain remedies also.

Sleeping pills, tranquilizers, and other sedatives can

slow breathing this can be unsae or people with

asthma.


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a pek fow mee e o ow we o

e o. i mee ow o

bow o o o e eep be.te ke o pek fow mee

o peo be oe. yo peo be

oe e e o 3 pek fow oe ke

we o e o m mpom.

yo ee poe w ow o ow o:

Useapeakowmeter.

Findyourpersonalbestscore.

Usethepersonalbestscoretodene

o eme zoe.

u o pek fow mee ee ep

o e m mpom e

e em beoe e woe.

Te second sel-care skill is recognizing asthma early

warning signs. Early warning signs are changes that

happen just beore or at the beginning o an asthma

episode. Tey may appear hours or days beore your

asthma gets out o control. I you have asthma, you have to

know your own body well enough to recognize when these

changes happen. By recognizing these signs, you can stop

an asthma episode or prevent one rom getting worse.

Tink about the symptoms you have had beore an asthma

episode. Review the list below and check the symptoms

that you have experienced. alk to your doctor so that you

can take action to get your asthma under control.

Signs o a cold, or allergies (sneezing, cough,

nasal congestion, sore throat and headache).

A tight eeling in your chest.

Frequent coughing, especially at night.

Cant do normal activities.

A need to clear your throat ofen.

Loosing your breath easily or shortness o breath.

rouble sleeping due to diculty breathing,

coughing or wheezing.

Feeling tired, upset, grouchy, or moody.

Restlessness.

Reduced peak ow readings.

Fever.

Wheezing.

Wheezing or coughing afer exercise.

Rapid heartbeat.

sElf-carE skill #2

recogze Ealy Wag sg.

recogze Ealy Wag sgc


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Medicines are a key part o controlling asthma. Tey are

prescribed or two main reasons: (1) to avoid asthma

symptoms beore they start, and (2) to stop symptoms

once they have started. You can keep your asthma under

control by knowing how and when to use medicines

your healthcare provider prescribes.

Tere are two main types o asthma medicines:

1. Quick-Relie (Rescue) Medicines

Tobetakenwhenyouneedthem.

Usedtorelaxmusclesthattightenaroundyour

airways.

Workfasttoprovideimmediatereliefofasthma

symptoms.

2. Long-erm (Daily) Controller Medicines

Tobetakendailyevenifyoufeelne.

Usedtocontrolinammationinyourairways.

Preventsymptomsandattacks.

Qck-rele Medce

Te names quick-relie , rescue, reliever, and

emergency medicines all mean the same thing. Everyone

with asthma needs a quick-relie medicine to stop asthma

symptoms beore they get worse. Tese medicines, alsoknown as ast-acting beta2-agonists, are taken at the rst

sign o asthma symptoms or when you are experiencing

an asthma episode or attack. Quick-relie medicines work

ast, usually within 10-15 minutes afer taking them. Your

healthcare provider may recommend that you take this

medicine at other times like beore exercise.

Quick-relie medicines taken by inhaler or nebulizer:

Common brand names or inhaled rescue medicines are:

Albuterol (Proventil, Ventolin, or generic albuterol),

Xopenex, Maxair, Combivent, and Alupent.

Quick-relie medicines taken by mouth:

Oral corticosteroids (such as prednisone) can be used

over a short (3- to 10-day) course to gain initial control o

asthma and to speed resolution o exacerbations. When

oral corticosteroids are used short-term, the risk o side

eects is low. Tere are serious side eects associated with

long-term use o oral corticosteroids.

Log-tem Cool Medce

How do you know when your quick-relie medicine is

not enough?

I you answered yes to any o these questions, your asthma

is not under control. alk to your healthcare providerabout adding a long-term controller medicine to your

treatment plan. Te names controller, preventive,

and long-term control medicines all mean the same

thing. Long-term controller medicine works to reduce

inammation o the airways. Controller medicines are

inhaled using a metered-dose-inhaler (MDI), discus

inhaler or taken by mouth.

sElf-carE skill #3

take Yo Medce he rgh Way.

ollow he rle o two

do o e o qk-ee e moe

wo me week?

do o e wke p w m moe

wo me mo?

do o e o m pepo moe

wo me e?

2001 Baylor Health Care System. All rights reserved. Rules of Two

is a federally registered service mark of Baylor Health Care System.

take Medce Coeclyd


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Taken by metered-dose inhaler (MDI) or discus inhaler:

Combination Terapywo-in-one medicines containing corticosteroids and

long acting beta2-agonists (includingAdvairand

SYMBICORT) reduce inammation o the airways and

relax muscles around the airways.

Inhaled corticosteroids

Tese medicines are the most eective anti-inammatory

medicines or most people. Tey are very dierent rom

the steroids taken by some athletes. Like many other

medicines, inhaled corticosteriods can have side eects.

But doctors agree that the benets ar outweigh the risks

o side eects. Brand names o inhaled corticosteroids

include:AeroBid, Asmanex, Azmacort, Beclovent,

Flovent, Pulmicort Turboinhaler, Pulmicort Respules,

QVAR, Vanceril.

Inhaled long-acting beta2-agonists

Tese medicines can help to prevent symptoms when

taken with inhaled corticosteroids. Tey should not beused alone. Tey also should not be used to treat serious

symptoms or an attack. Brand names o inhaled long-

acting beta2-agonists include: Sereventand Floradil.

aken by mouth

Leukotriene modiers, or anti-leukotriene medicines are

available in pill orm and used alone to treat persistent

asthma or with inhaled corticosteroids to treat moderate

asthma. Tey are not as eective as inhaled corticosteroids

or most patients. Brand names include: Singulair, Zyo,

and Accolate.

Ahma Medce Delvey Devce

Make sure the medicine gets to your lungs!

Inhalers

Many asthma medicines come as sprays and powders in

an inhaler. An inhaler is a hand-held device that delivers

the medication right to the airways in your lung where

it is needed. Tere are several kinds o inhalers; the most

common is a metered-dose inhaler (MDI).

Holding Chamber (commonly reerred to as a spacer)

Your doctor may instruct you to use a spacer with your

MDI. A spacer is a device that helps asthma medicine get

deep into your lungs. It ts together with your inhaler like

a puzzle.

Nebulizer

A nebulizer is a device that creates a mist out o your

asthma medicine, which makes it easy to breathe the

medicine into the lungs.

Many older adults have conditions such as arthritis that

limittheabilitytouseaMDI.Useofspacerswithinhalers

or nebulized medicines may improve drug delivery to

lower airways and reduce symptoms more eectively. Be

sure to review the best ways to use inhalers, spacers and

other medicine delivery devices with your healthcare

provider. ell your healthcare provider i you notice

changes in your ability to use medicine delivery devices.


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Individuals diagnosed with asthma must recognize that

they are the most important members o their healthcare

team. Tey must advocate or themselves one way

or them to do this is to communicate eectively with

everyone involved in helping to manage their asthma and

to expect the same in return. Encourage your audience

to use the ollowing strategies to maintain successul

communication with healthcare providers.

Writedownquestionsandthingsyouwanttotalk

with the healthcare provider about. Include any

new symptoms. ake the list with you to medical

appointments.

SharetheinformationfromtheWhat Triggers Your

Asthma?handout with your healthcare team, amily

and riends.

Keepacopyofyourmedicalrecordsandalistofall

o the medicines you are currently using, includingprescribed and over-the-counter medicines, herbs,

supplements, and home remedies. ake copies with

you to your medical appointments and share with

amily and riends.

Whenitcomestoyourhealth,dontbeshyask

questions i you dont understand something. Your

healthcare team is there to do everything they canto help you better manage your asthma they wont

mind repeating something, explaining something in

a dierent way, or using dierent words.

Re-evaluateyourasthmaactionplanwithyour

healthcare provider on a regular basis. I you have

diculty reading your asthma action plan, ask your

healthcare provider or a plan with a larger ont size.

Requestinstructionsifyourasthmasymptomsare

worsening.

Askforademonstrationonhowtoproperlyuse

your metered dose inhaler and/or spacer and other

asthma tools. ell your healthcare provider i it

is becoming more dicult to use your medicine

delivery devices.

sElf-carE skill #5

Maa Good Commcao

Maa Good Commcao

Adapted from American Academy of Allergy Asthma and Immunology.

(2008, November 7). Seniors and asthma. Asthma control for the mature

adult. Retrieved from http://www.aaaai.org.


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Commcao Poblem / solo

Poblem Poble solo

te ee poe o membe e

wo i o o e.

ak em o o oe wo o o o kow

o ee o, k em o o moe oeme ee wo.

te ee poe o membe k

oo .

ak em o ow ow e wo m

bee e w o o e. repe

w w , o ow wo, o mke e

o e.

i eem e ee poe e

e b o o e me o we o

o qeo.

i o epob o k

qeo. remembe, e me

wok o ep o mpoe o e. i

ee, mke moe ppome we

ow qeo beoe o o.

im embe o k qeo. hee poe e ke e o

qeo ee . Oe o e mo mpo

p o e job o e o e

omo, mo e o o .

i emembe ee e ee

poe .

tke pe p o o ppome. tke

oe o k e ee poe o we

ow w o o o. i eo,

ke pe eoe.

te ee poe me

o o e me eo bo m

eme meme opo.

ak o moe omo o oe pe

o e omo (webe, b, e.)

Source: American Lung Association. (2005). Breathe well, live well an asthma management program for adults. New York, NY: Author.


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th eco wll cove:

Howtochooseanasthmahealthcareprovider.

Whentoseeaspecialist.

Medicationmanagementandmultiplehealth

conditions.

Problemsthatcancomplicateanasthmadiagnosis.

Understandingcasemanagement.

Leag Objecve:

Te purpose o this section is to review the characteristics o

a good asthma healthcare provider, recognize when the need

to see a specialist arises, discuss management o multiple

health conditions, including the role and benet o case

management, and discuss potential social and psychological

eects o asthma. o do this, your audience will:

Describecharacteristicsofagoodasthmahealthcare

provider.

Discusswhentoseeaspecialist.

Describeapproachestoasthmamanagementwhen

other health conditions are present

Managing Asthma Effectively in Older Adults

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