What is the most common chronic illness in children?
asthma 155 deaths per year
What is the cause of asthma?
unknown
What is the asthma triad?
3 Common components in asthma that 12-15% of ppl with asthma have
- nasal polyps
- asthma
- sensitivity to aspirin&NSAIDs
What do 30% of asthmatics have?
chronic sinus problems
What are predisposing factors to asthma?
- genetics
- atony (greater tendency to have allergic reaction to environmental allergens)\
- Exposure to tobacco smoke
Define atony.
Allergic
What factors cause airway obstruction in asthma?
mucus
swollen mucosa
muscle spasm
What are common triggers of asthma?
Irritants: tobacco smoke, exercise, weather changes, outdoor pollutants, exposure to indoor chemicals
Allergens: dustmites, pet dander, pollen, moulds, cockroaches, food additives
What are common triggers of asthma?
Irritants: tobacco smoke, exercise, weather changes, outdoor pollutants, exposure to indoor chemicals
Allergens: dustmites, pet dander, pollen, moulds, cockroaches, food additives
Other factors: URT infection (90% of attacks in children triggered by a cold or flu), rhinitis/sinusitis, gastroesophageal reflux, sensitivity to aspirin and other NSAIDs, topical and systemic beta-blockers
What triggers asthma attacks in 90% of children?
URT infection
What are the characteristics of asthma?
sudden onset or persistent symptoms of:
- dyspnea
- chest tightness
- wheezing
- Sputum production
- Cough
What are the classifications of asthma
Mild- O2 sats >90%
Cough @ night, SOBOE
Moderate- O2 sats >90%
SOB @rest, talking, normal mental status
Severe- O2 sats >90%
Laboured resp, tachycardia
Can’t talk, altered mental status
What is mild asthma?
O2 sats >90%
Cough at night, SOBOE
What is moderate asthma?
O2 sats >90%
SOB at rest, talking, normal mental status
What is severe asthma?
O2 sats >90%
Labouted resp, tachycardia,
Can’t talk, altered mental status
What is the asthma severity scale?
4 classifications of severity of asthma
1: mild, intermittent
2: mild persistent
3: moderate persistant
4: severe, persistent
What are the components of asthma management?
education environmental control measures - appropriate meds - action plan, regular follow-up care adherence to treatment plan
What are the components of asthma management?
- education
- environmental control measures
- appropriate meds
- action plan
- regular follow-up care
- adherence to treatment plan
how do you gain optimal asthma control?
- education
- environmental control measures
- appropriate meds
- action plan
- regular follow-up care
- adherence to treatment plan
What is the most common cause or trigger for the increasing rates of asthma in children?
dust mites
What are environmental conrols for dust mite triggered?
Get rid of the carpets; non laminent has to be hard wood
Laundry more than once a week in hot water
How do we promote asthma control?
Collaborative goals
- relief & prophylaxis of attacks
- prevention of exacerbation
- provide quick relief of symptoms
How do we promote asthma control?
Collaborative goals
- relief & prophylaxis of attacks
- prevention of exacerbation
- provide quick relief of symptoms
- symtom control (cough, wheeze, chest tightness and breathlessness
- use of least amount of medication with the least side effects
How do we assess for asthma control?
5 Q asthma test to assess for asthma control; if you answer yes to any one of these questions asthma is not under good control
What are the 5 Qs to assess for asthma control?
- Do you use your blue inhaler 4x/wk?
- Do you cough, wheeze or have a tight chest 4x/wk?
- Do you cough, wheeze or have chest tightness wake you at night?
- Did you stop exercising because of asthma in the last 3 months?
- Do you miss school, work, social activities in the past 3 months?
What are 3 types of reliever medications
B2 agonists (salbumtamol-ventolin)- quick relief
Anticholinergics (ipatropium bromide- atrovent)- not first line, can be in conjunction with ventolin
Theophyllin, aminophyline (older, not routinely given)
Name a B2 agonist (reliever)?
salbumtamol (Ventolin)
Name an anticholinergic (reliever)
ipatropium bromide (atrovent)
Name 4 types of controller medications.
- corticosteroids (bdesonide, beclomethason, futicasone) Inhaled !st line
- Leukiotriene antagonist (singulair, acccolate)
- Prednisone 2nd line (status asthmatics only)
- Long acting beta2 agonist- 2nd line (salmeterol)
What is classified as the green zone?
Peak flow 80-100%
- no cough, wheeze, chest tightness, or shortness of breathing during the day or night
TAKE LABA EACH DAY
What is classified as the yellow zone?
Peak flow 50-80% Cough, wheeze, chest tightness or SOB - Waking due to asthma - can do some but not all usual activities TAKE LABA AND ADD SABA
What is classified as the red zone?
Peak flow less that 50%
- very SOB
- SABA not helping
- cannot do usual activities
- symptoms are same or worsen after 24 hours in the yellow zone
TAKE SABA & LABA AND GO TO EMERGENCY ROOM
What should be done in follow up?
PEFR (peak expiratory flow rate) L/min
Measure amount of air that can be forcefully exhaled in 1 second
ESTABLISH PERSONAL BEST
What should be done in follow up?
PEFR (peak expiratory flow rate) L/min
Measure amount of air that can be forcefully exhaled in 1 second
ESTABLISH PERSONAL BEST
(PEFR symptom diary)
What is status asthmatics?
Ongoing severe respiratory distress despite vigorous treatment
How do you manage status asthmatics?
Assess: accessory muscle use, dyspnea, neuro, O2 sats
Management by correction of dehydration, acid-base balance, electrolyte imbalance via IV, reduce hypoxia (O2 therapy, and sat monitoring, arterial blood gases, inhalation therapy, possible IV corticosteroids and high fowlers)
What is needed when developing a teaching plan?
Assessment Identify learning needs Plan Implement plan Evaluate
What is needed when developing a teaching plan?
Assessment (needs, development, readiness to lean, self-efficacy)
Identify learning needs (cognitive affective psychomotor)
Plan (objective, prioritize, collaborate, developmentally appropriate)
Implement plan
Evaluate
What are school based asthma programs?
developed to teach both children with or without the disease how to control it
Why school-based asthma programs?
- Asthma interfere with learning and limits physical activity at school
- Convenient location to access student for health teaching
- Provides knowledge about asthma to the school staff and students
- Raises awareness about asthma and increases the chances of getting help quicker
- Reduces bullying of children with asthma
What are 2 ontario based programs for asthma education?
Public Health School Asthma Project (Government of Ontario’s Ministry of Health and Long Term Care)
Roaring Adventures of Puff (The Ontario lung Association)