Controlling Asthma in American Cities Project Minneapolis and St. Paul

1. Managing Your Child’s Asthma Controlling Asthma in American Cities Project Minneapolis and St. Paul

2. Overview of Presentation • What is asthma? • Asthma triggers • Asthma medicines • Zones of asthma • Asthma Action Plans

3. Trachea Air sacs Airway What is asthma? Asthma is a life-long lung disease 1. Inside of airway gets swollen (inflamed) 2. Muscles around airways squeeze airways partly shut 3. Airway makes thick mucus

4. Asthma MythsAsthma Facts • “My child will outgrow asthma” • “Asthma is curable” • “My child can’t play sports or run around because he has asthma” • Asthma is a chronic illness for life • Asthma cannot be cured, but it can be managed • When your child’s asthma is well controlled, it shouldn’t interfere with his normal activities

5. “My child will become addicted to asthma medicine” “Asthma is all in your head” “Children can’t die from asthma” Asthma medicines are NOT addictive Asthma is a physical lung disease. Crying, shouting, or laughing can trigger flare-ups Although rare, some children do die from asthma Asthma MythsAsthma Facts

6. Asthma Triggers Triggers are things that cause asthma symptoms to begin or get worse IRRITANTS ALLERGIES INFECTION BEHAVIORS

7. Avoiding Common Asthma Triggers Infection: Get flu shot & wash hands often Smoke: Don’t smoke in home or car Use smoking jacket when smoking outside Pets: Keep pets out of house and especially bedroom Dust mites: Wash bedding once a week in hot water Use mattress & pillow covers

8. Avoiding Common Asthma Triggers Strong Odors: Avoid using products with strong odor Reduce amount of products that you use Mold: Fix water leaks and keep humidity low Pests: Use traps to reduce mice and roaches Call exterminator

9. What would you do if… • Your child likes to play outside during the winter, but the cold air makes her asthma worse • Your relatives are coming to celebrate your child’s birthday, and some of them smoke • Your child often gets colds during the winter

10. Zones of Asthma There are three zones of asthma Green Yellow Red

11. COUGH The green zone • Your child’s asthma is under control • Child is free of symptoms: • Sleeps through night • Doesn’t cough or wheeze • Takes part in physical activity

12. What to do in the green zone • Take controller medicine every day, if prescribed, even when feeling well • Keep reliever medicines on hand • Give copies of asthma action plan to the school and other adults who take care of your child • Get rid of asthma triggers in the house • Take your child to the doctor for an asthma check-up every 6 months • This is a good time to schedule a well-child visit as well

13. Controller Medicine • Controls asthma • Decreases swelling and mucus • Prevents asthma episodes (flare-ups) before they happen • Take every day even when feeling well • Will not help during an asthma episode or in emergencies

14. The yellow zone • When symptoms first begin • Warning zone & time to take action • Most common symptoms include: • Cough • Wheezing • Shortness of breath • Trouble breathing • Tight chest/chest pain (Symptoms vary for all children. This list is not complete)

15. What to do in the yellow zone 1) Help your child: • Take his reliever medicine • Sit down, inhale slowly through the nose, and exhale through the mouth with his lips partially open • Keep taking daily controller medicines • Stay calm

16. What to do in the yellow zone 2) What you or caregiver should do: • Stay Calm • Monitor your child’s breathing and activity level • Follow your child’s Asthma Action Plan • Call the doctor if • Your child doesn’t get better in 12-24 hours • Your child’s asthma gets worse • Reliever medicine does not last for 4 hours

17. Reliever Medicine Also called Quick Relief or Rescue Medicine • Relieve asthma symptoms quickly • Relax airway muscles • Use when: • Asthma symptoms first appear • Before exercising • As indicated by your doctor

18. The red zone • Symptoms are severe • Your child’s nails or area around lips turn blue or darken • Has difficulty speaking, walking, or drinking • Works hard to breathe • Muscles or ribs show in the neck, throat, or chest • Nostrils open widely • Child is scared, confused, or not totally alert

19. What to do in the red zone • Have child take reliever medicine right away • Call your doctor or clinic now • If your child’s symptoms get worse or you can’t reach your doctor or clinic, go to the emergency room or call 911 right away!

20. Goals of asthma management With good management, your child should be able to: • Be symptom-free • Be physically active • Sleep through the night • Prevent asthma flare-ups (episodes) • Use asthma medicines with few side effects • Avoid hospital stays, emergency room visits

21. Asthma Action Plan

22. What would you do if… • You come home from work and your child is not feeling well and is having trouble breathing • The clinic where you bring your child is always very busy. You don’t have much time with the doctor • You had to take your child to the emergency room for an asthma flare-up - What would you do in the days after the visit? • Your child has a slumber party at a house with cats. She will be sleeping on the floor. She returns home the following morning feeling good and without symptoms. What did she do?

23. Video

24. When to Use a Peak Flow Meter For children over 5, a peak flow meter may be used: • During an asthma flare-up • When it’s hard to see or notice symptoms or changes in breathing • To catch breathing problems early • Every morning, if indicated by doctor Because every child is different, your child’s zones are based on his own best score

25. How to use a Peak Flow Meter 1. Slide 4. Note number 2. Deep breath 5. Repeat Twice More 3. Blow hard and fast 6. Take Highest

26. Using a Metered Dose Inhaler (MDI) with a spacer • More medicine gets to the lungs • May help reduce side effects from medicine • Works as well as nebulizer machine • May be easier to carry and use than nebulizer • Can easily keep one at home and one at daycare or school • Appropriate for all ages, but children under 5 should use a face mask • Valved holding chambers are the best type of spacers

27. How to use a MDI with a spacer 1. Shake 4. Press & Inhale medicine slowly 2. Put together 3. Breathe out 5. Hold breath for 10 seconds 6. Wait 1 minute & repeat

28. How to Use a MDI with Spacer and Mask 1. Shake3. Place mask over nose & mouth 2. Put together 4. Press down 5. Breathe six breaths with mask against face 6. Repeat if needed

29. Dry Powder Inhalers • Variety of medications in dry powder form Diskus – for children 4 years or older Turbuhaler – for children 6 years or older Twisthaler – for children 12 years or older • Easy to carry in bag or purse • Easy to put together and clean

30. How to Use DISKUS 1. Open 2. Breathe out away from mouthpiece 3. Place mouthpiece in mouth 4. Inhale steadily & deeply 5. Hold breath for 10 seconds 6. Close Inhaler 7. Rinse mouth

31. How to Use Turbuhaler & Twisthaler TurbuhalerTwisthaler Remove cap Twist cap off Twist right, then left until clicks Hold upright Breathe out away from mouthpiece Put in mouth Breathe in fast and deep Remove Hold breath for 10 seconds Breathe out Repeat if needed Rinse Replace cover

32. Nebulizer machine When to Use: • May be used with any age child • For anyone who cannot use an inhaler with spacer or spacer and mask Tips: • During treatment, take a deep breath every minute to get medication deeper into lungs • Don’t forget to replace the filter as often as instructions say • Clean the nebulizer cup with warm water and dish soap after every use – let air dry

33. Evaluations Please take a few moments to fill out the evaluation form in your packet.

34. Thank you! Thanks to the American Lung Association of Minnesota and Hennepin County Medical Center Thanks to Metropolitan Health Plan, especially Sheila Beecher and Joan Mailander, for the development and use of the video, Managing an Asthma Flare-up Supported with funds from the Centers for Disease Control and Prevention and GlaxoSmithKline Revised January 2006