Asthma Education

RESPIRATORY CARE SERVICES

Goals of Presentation

• Review for RT’s on asthma

(pathophysiology)

• Understand Asthma

Management and Asthma

Education

• Understand how Respiratory

Therapists can provide Asthma

Education services.

• Review asthma medications

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What is Asthma?

• Asthma is a chronic lung disease that inflames and narrows the airways.

• Chronic Diseases need to be managed with education provided to the patients.

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The National Guidelines for Asthma

Diagnosis and Management is the EPR 3

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How do Physicians Diagnose Asthma?

Screenings

• Signs and Symptoms

• Questionnaires (Pediatric Asthma Control & Communication Instrument)

• Spirometry and PFT’s

• Triggers

• Comorbidities

• Allergy testing

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Treatment and Management of Asthma

after Diagnosis

•Patient Education

• Identify triggers

•Prescribe medications and teach proper administration of medications

•Manage comorbidities

•Asthma Action Plans

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Important Points from EPR 3 and Asthma

Management

Four Components of

Asthma Management

Severity And

Control

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Four Components of Asthma

Management from EPR 3

Measures of assessment and monitoring, obtained by objective

tests, physical examination, patient history and patient report, to diagnose

and assess the characteristics and severity of asthma and to monitor

whether asthma control is achieved and maintained (Screening)

Education for a partnership in asthma care

Control of environmental factors and comorbid conditions that affect

asthmaPharmacologic therapy

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Severity

The intrinsic intensity of the disease process. Severity is most easily and directly measured in a patient who is not

currently receiving long-term control treatment.

Control

The degree to which the manifestations of asthma (symptoms, functional impairments, and risks of untoward events) are minimized and the goals of

therapy are met.

Severity and Control

Asthma Severity and Control

Severity

• Intermittent

• Mild Persistent

• Moderate Persistent

• Severe Persistent

Control

• Well Controlled

• Not Well Controlled

• Very Poorly Controlled

Asthma Severity

Asthma Control

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Respiratory Therapy and Asthma

Emergency Room

ICU

Hospital floor therapy

Clinics

Health Fairs

Pulmonary Function Labs

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Respiratory Therapy and Asthma Education

NAECB certifies Asthma Educators (AE-C) AARC certifies Asthma Programs

Respiratory Therapy and

Asthma Education

• Organizations and Asthma Education

•EPR 3 and NAEPP

•AE-C and NAECB

•ASME Certifications and AARC

• Respiratory Therapy and Asthma Education

•Exacerbations

•Screenings and Asthma Management

•Discharge and Asthma Action Plans

Respiratory Therapy and Asthma

Preventative Care

• Asthma Screenings

• Asthma Education and Self-Management

• Asthma Action Plan

• Spirometry and Pulmonary Function Tests

• MDI and Equipment Teaching

Critical Care

• Exacerbation and ER Treatment

• Blood Gas Management

• Airway Management

• Ventilator Management

• Asthma Protocols/Order sets

• Discharge Education

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Asthma Screenings

Asthma Management

Asthma Exacerbations

Respiratory Therapy and Asthma

Recap of Asthma and Asthma Education

• Asthma is a chronic lung disease

that inflames and narrows the

airways.

• Four components of asthma

management

• Severity and Control

• RT’s can be involved with all

aspects of Asthma Management

• ER exacerbations

• Respiratory Failure

• Admission and Discharge from hospital

• Screenings in clinics

• Screenings

• Patients with signs and symptoms

should be screened

• Asthma management starts with a

screening

• Organizations associated with

Asthma

• NHLBI

• NAECB

• AARC

• CDPH

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Goals for Implementing Asthma Education with

UCLA Respiratory Care Services

• To have RT Department and Pediatric

Pulmonology Division provide continuous

education on asthma to RT staff.

• To have RT’s provide education to all

asthmatic patients

• To have RT’s utilize:

• Pediatric Asthma Order set

• PAS

• Inhaler assessment score

• Admission and discharge checklist

• PACCI (Pediatric Asthma Control &Communication

Instrument)

• Asthma action plan

• Guide and incentivize RT’s to

become AE-C’s

• Have UCLA Respiratory Care

Services become ASME certified.

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Asthma Medications Introduction

RESPIRATORY CARE SERVICES

Pathophysiology of Asthma

• Airway inflammation

• Bronchospasm (airflow obstruction and hyper responsiveness)

• Airway Secretions

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Four Components of Asthma

Management

1. Measures of assessment and monitoring, obtained by objective tests, physical examination, patient history and patient report, to diagnose and assess the characteristics and severity of asthma and to monitor whether asthma control is achieved and maintained (Screening)

2. Education for a partnership in asthma care

3. Control of environmental factors and comorbid conditions that affect asthma

4. Pharmacologic therapy (Medications)

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Goals # 4 Medications

Prevent and reduce symptoms

Prevent inflammation

Reduce inflammation

Prevent bronchospasm

Relieve bronchospasm

Increase secretion mobilization

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Chronic Management and Exacerbation

Treatment

Asthma Management

(Controller Medications)

• Inhaled Corticosteroids

• LABA’s

• Combination inhalers

• Leukotriene Modifiers

• Theophylline

• Antihistamines

• Immunomodulators

• Reflux medications

Exacerbation Therapy

(Rescue Medications)

• Albuterol or Short Acting Beta Agonist

• Systemic steroids (Prednisone, Decadron)

• Anticholinergic (Atrovent)

• Anesthetic agents (halothane, Isoflurane,

sevoflurane)

• Magnesium Sulfate

• Ketamine

• Epinephrine

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Inhaled Asthma Medications

• Short-acting beta agonist

bronchodilators

• Albuterol

• Levalbuterol

• Long-acting beta agonist

bronchodilators

• Serevent

• Inhaled corticosteroids

• Flovent

• Asmanex

• Qvar

• Pulmicort

• Combination medications (inhaled

corticosteroid and long-acting beta

agonist)

• Advair

• Dulera

• Symbicort

• Anticholinergic bronchodilators

• Atrovent

• Spiriva

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Asthma Medications

• Oral/IV Corticosteroids

• Prednisone

• Decadron

• Leukotriene Modifiers

• Singular

• Immunomodulators

• Omalizumab (Xolair)

• Antihistamines

• Zyrtec

• Claritin

• Allegra

• Mast Cell Stabilizer

• Cromolyn

• Xanthines (Bronchodilators)

• Theophylline

• Aminophylline

• Nasal Sprays

• Flonase

• Nasacort

• Nasonex

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Signs and Symptoms of an Asthma

Exacerbation

Signs and Symptoms

• wheezing

• coughing

• chest tightness

• shortness of breath

• agitation

• an increased respiratory rate

• an increased pulse rate

• decreased lung function

• difficulty speaking

• difficulty breathing

When asthma is not managed or controlled it

can lead to:

• Asthma exacerbations

• ER admissions

• Missed days of work or schools

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Treatment and Therapy for Asthma

Exacerbation

Exacerbation

• Vitals

• IV access

• Labs

• Corticosteroids

• Albuterol

• Oxygen

• Chest X-Ray

Respiratory Failure

• Continuous Albuterol

• ABG

• Heliox

• BiPAP

• Intubation

• Sedation

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Corticosteroids

How do Corticosteroids Work?

• All corticosteroids reduce inflammation in the airways that carry air to the lungs.

Why are corticosteroids used?

• Get relief of asthma symptoms during a moderate or severe asthma attack

• Get control of symptoms when you start long-term treatment of asthma after your initial

diagnosis.

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Corticosteroids

Common side effects of long-term treatment with

corticosteroids given by mouth include:

• Slower growth or stunted growth in children.

• Problems with the body's ability to use glucose (diabetes).

• Bone weakening (osteoporosis)

• Hypertension

• Repeated infections, bruising, and skin thinning (atrophy). Corticosteroids also make it less likely

you will have a fever, so that an infection is not always recognized immediately.

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Corticosteroids for Asthma (Inhaled and

IV/Oral)

Oral or IV Steroids

•Methylprednisolone(Medrol,Methylpred, Solu-Medrol)

•Prednisone (Deltasone)

•Prednisolone (Prelone, Pediapred, Opared)

•Dexamethasone (Decadron)

Inhaled Corticosteroids

• Beclamethasone dipropionate (Qvar)

• Budesonide (Pulmicort)

• Budesonide/Formoterol (Symbicort)

• Fluticasone (Flovent)

• Fluticasone/Salmeterol (Advair)

• Mometasone (Asmanex)

• Mometasone/formoterol (Dulera)

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Medications for Asthma Exacerbation in

the Emergency Room

• Oral or IV Steroids

•Prednisolone -1mg/kg PO/PGT daily (40-60 mg max)

•Methylprednisolone-1mg/kg IV q6 hours

• Bronchodilators

•Albuterol -2.5mg, 5 mg, 7.5 mg Q3.

•Continuous Albuterol 0.5mg/kg/hr up to 15 mg/hr.

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Asthma Education Goals

• Prevent ER admissions

• Decrease frequency of symptoms

• Improve quality of life

• Decrease work and school absences

• Use four components of Asthma Management for patients

• Screening

• Education

• Control of triggers and comorbidities

• Medications

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Medications Relationship with Triggers

and Comorbidities

• Long term medications help reduce or prevent comorbidities and triggers that cause asthma exacerbations.

• Patients are at higher risk for asthma exacerbations if comorbidities and triggers are not controlled.

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Asthma Management

Comorbidities and Triggers

• Comorbidities

A comorbid medical disease is a condition that occurs in addition to the primary illness.

For example, a person can have co-

existing asthma (primary illness) and

obesity (comorbid condition).

• Triggers

An asthma trigger is anything that brings on coughing, wheezing,

trouble breathing, and other symptoms in a person with asthma.

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Long term medications help reduce or prevent comorbidities and triggers that

cause asthma exacerbations.

Triggers and Asthma

• Allergens

• Irritants

• Colds/Respiratory Infection

• Exercise

• Stress

• Medication

• Weather

• Pollutants

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Comorbidities and Asthma

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AsthmaGERD

Sinusitis

Rhinitis

Obesity Sleep Apnea

Vocal Cord Dysfunction

Psychological, behavioral

Stress

Common Comorbidity Medications and

Treatment

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• Zantac

• Prilosec

• Prevacid

• Pepcid

GERD

• Antibiotics

• Inhaled Steroids (Nasal)

• Decongestants (Phenylephrine)

• Antihistamines (Zyrtec, Claritin)

• Cough Medicines

Sinusitis and Rhinitis

• Weight loss

• CPAP

• Surgery (tonsils, adenoids)

Obesity and Sleep Apnea

Asthma Medications Chronic

Management or Exacerbation Treatment?

Asthma

Management

• Inhaled Corticosteroids

• LABA’s

• Combination inhalers

• Leukotriene Modifiers

• Theophylline

• Antihistamines

• Immunomodulators

• Reflux medications

Exacerbation

Therapy

• Albuterol or Short Acting Beta Agonist

• Systemic steroids (Prednisone, Decadron)

• Anticholinergic (Atrovent)

• Anesthetic agents (halothane, Isoflurane,

sevoflurane)

• Magnesium Sulfate

• Ketamine

• Epinephrine

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References

• http://www.healthline.com/health/asthma/acute-asthma-exacerbation#symptoms2

• http://annals.org/aim/article/1136284/how-do-corticosteroids-work-asthma

• https://www.uptodate.com/contents/management-of-acute-exacerbations-of-asthma-in-adults

• https://www.webmd.com/asthma/systemic-corticosteroids-for-quick-relief-during-asthma-attacks

• https://www.nhlbi.nih.gov/files/docs/guidelines/04_sec3_comp.pdf

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