A PLAN TO IMPROVE ASTHMA CARE

1. A PLAN TO IMPROVEASTHMA CARE Barbara Mc Donagh RN BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

2. OBJECTIVES • ASTHMA OVERVIEW • ASTHMA STATISTICS • PURPOSE OF PEAK FLOW MONITORING • SIGNS & SYMPTOMS OF EXACERBATION • ASTHMA ACTION PLAN • ASTHMA MEDICATIONS BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

3. PURPOSE • IMPROVE ASTHMA CARE • PROMOTE SELF-MANAGEMENT • FOSTER TEAM-BASED PARTNERSHIP • EMERGENCY ROOM VISITS • FRAGMENTED CARE BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

4. ASTHMA • CHRONIC DISEASE • AIRWAY INFLAMMATION • INTERMITTENT AIRFLOW OBSTRUCTION • BRONCHIAL HYPERRESPONSIVENESS BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

5. ASTHMA STATISTICS (CDC,2012) • 24 MILLION PEOPLE • MOST COMMON CHRONIC DISEASE IN CHILDHOOD • 1.9 MILLION EMERGENCY VISITS • 475,000 HOSPITALIZATIONS • $56 BILLION BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

6. PATIENT POPULATION AFFECTED (CDC, 2012) • MORE BOYS THAN GIRLS • MORE WOMEN THAN MEN • WOMEN ACCOUNT FOR 2/3 OF ALL DEATHS DUE TO ASTHMA • AFRICAN AMERICAN & HISPANIC • LOWER SOCIO-ECONOMIC BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

7. PATIENT POPULATION AFFECTED (CDC,2012) • AFRICAN AMERICAN WOMEN HAVE HIGHEST MORTALITY RATE • 3,388 PEOPLE DIED FROM ASTHMA • AFRICAN AMERICANS ARE 2-3 TIMES MORE LIKELY TO DIE FROM ASTHMA BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

8. BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

9. ETHIOLOGY & RISK FACTORS • FAMILY HISTORY • ENVIRONMENTAL ALLERGENS • VIRAL EXPOSURE • ECZEMA/ ATOPIC DERMATITIS • OBESITY BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

10. SIGNS & SYMPTOMSEXACERBATION • WHEEZING • COUGHING • SHORTNESS OF BREATH • CHEST TIGHTNESS/PAIN BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

11. ASTHMA TRIGGERS BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

12. ASTHMA EXACERBATIONTRIGGERS • ALLERGENS/IRRITANTS • TOBACCO SMOKE • URI’s • AIR POLLUTION • EXERCISE • OCCUPATIONAL HAZARDS • SINUSITIS • DRUG USE BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

13. ASTHMACLASSIFICATION (NHLBI,2007) INTERMITTENT • 2 DAYS/WEEK 2NIGHTS/MONTH MILD PERSISTENT • >2 DAYS/WEEK 3-4NIGHTS/MONTH MODERATE PERSISTENT • DAILY/> 1NIGHT/WEEK SEVERE PERSISTENT • SEVERAL TIMES/DAY & 7 NIGHTS/WEEK BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

14. GOAL OF ASTHMA CARE CONTROL • Symptoms ≤ 2Days/Week • Nighttime ≤ 2 x/Month • Albuterol Use ≤ 2 Days/Week • Peak Flow ≥ 80% Personal Best • Perform Daily Activities BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

15. PEAK EXPIRATORY FLOW (PEF) • DECREASE IN NUMBER BEFORE WORSENING SYMPTOMS • OBJECTIVE DATA ON ASTHMA CONTROL • POOR PERCEPTION OF SYMPTOMS • DETERMINE EFFECTIVENESS OF ASTHMA • MANAGEMENT/TREATMENT PLAN BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

16. Peak Expiratory Flow (PEF) • MONITOR PEAK FLOW OVER 2 WEEKS TO DETERMINE ‘PERSONAL BEST’ • PERFORM STANDING • RECORD HIGHEST OF 3 READINGS • NORMAL PEAK FLOW CAN VARY UP TO 20% BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

17. PEAK EXPIRATORY FLOWPersonal Best = 300 Green Zone 80%-100% No Symptoms Yellow Zone 51%-79% Symptoms 2-3 days Red Zone < 50% NO IMPROVEMENT = 240 - 300 = 150 – 240 Rescue Inhaler 4-6hrs Start Prednisone Tabs ED if no Improvement <150 Continue Above Worse go to ED/9-1-1 LIFE THREATENING BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

18. ASTHMA ACTION PLANProvider & Patient WRITTEN PLAN THAT ADDRESSES: • Daily Inhalers & Medications • Avoid Triggers – Molds/Animals • What to do When Asthma Symptoms • Get Worse / Peak Flow Decreases • Increase ICS • Start Prednisone Burst • Seek Emergency Care BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

19. BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

20. MEDICATIONS RESCUE/RELIEF • Albuterol • Proventil • Ventolin • ProAir CONTROLLER • Qvar • Symbicort • Spiriva • Serevent • Pulmicort • Xolair Inj BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

21. CONTROLLER MEDICATIONS QVAR • Inhaled Corticosteroid (ICS) SEREVENT DISKUS • Long- Acting Beta Bronchodilator SYMBICORT • Combination Inhaler SPIRIVA • Long-Acting AntiChol Brochodilator BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

22. ASTHMA PATIENTSELF-MANAGEMENT • Barriers Cultural/Language/Literacy • Rescue V Controller • Taking Inhalers as Prescribed Bid • Using Aerochamber • Peak Flow Monitoring • Asthma Action Plan • Avoid/Minimize Allergen Triggers BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

23. ASTHMA PATIENT CLINIC VISIT • Recent ED Visits • Prednisone Use • Increased Asthma Symptoms • Increased Proventil Use • Smoking / Asthma Triggers • Influenza & Pneumonia Vaccines BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

24. CARE MANAGEMENT BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

25. REFERRAL TO ASTHMA SPECIALTY • AEROALLERGEN SKIN TEST • SPIROMETRY • ADMINISTER XOLAIR INJECTIONS • >2 ED VISITS/YEAR / INTUBATIONS • ADDITIONAL TEACHING BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

26. ED VISITS OVER PAST YEAR • ANY ADMISSIONS • ANY INTUBATIONS • PREDNISONE USE BURST/DAILY USE • CURRENT SYMPTOMS –COUGHING- DAYTIME OR NIGHTIME/WHEEZING/ SOB/CHEST TIGHTNESS/PAIN • MEDICATIONS - CONTROLLER/ RESCUE • KNOWS DIFFERENCE • USES INHALERS AS PRESCRIBED • MONITORS PEAK FLOW • KNOWS ASTHMA TRIGGERS • USES SPACER BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

27. ADDITIONAL ASTHMARESOURCES Asthma Action Plans www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.htm Asthma Care Evidence-Based Guidelines www.nhlbi.nih.gov/guidelines/archives/epr-2/athmafullrpt_archive.pdf BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

28. ADDITIONAL ASTHMARESOURCES Peak Flow Monitoring & Self-Management www.lung.org/lung-disease/asthma/taking -control-of-asthma/create-an-asthma-management-plan.html Free Asthma Educational Handouts www.cdc.gov/asthma/faqs.html BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS

29. REFERENCES CDC. (2012). Asthma's Impact on the Nation. Retrieved from http://www.cdc.gov/asthma/impacts_nation/default.htm NHLBI. (2007). Guidelines for the Diagnosis and Management of Asthma (EPR-3). Retrieved from https://www.nhlbi.nih.gov/guidelines/asthma/ BARBARA MC DONAGH RN ASTHMA CLINIC FANTUS CCHHS