Understanding Asthma

Charles S. Williams RRT, AE-C

What Is Asthma?

Asthma

is a chronic lung disease that affects a person's airways and makes it difficult to breathe.

The airways are the breathing tubes that are inside of your lungs. These are also called bronchial tubes.

What Is Asthma?
When a person has asthma: The inside of the airways become red and swollen. This is known as airway inflammation. The muscles around the airways tighten. This is called airway constriction or bronchospasms. Plus, the mucous cells along the airways also produce extra mucous.
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What Is Asthma?

What Is Asthma?
During an asthma flare-up, you may have:
Coughing Wheezing

Shortness

of Breath Chest Pain Chest Tightness

It may feel as if you are breathing through a straw or as if someone were sitting on your chest!
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What Is Asthma?
Questions:
When a person has asthma: The inside of the bronchial tubes become red and swollen. This is called airway inflammation

The muscles around the bronchial tubes tighten. This is known as bronchospasms or airway constriction
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What Is Asthma?
Remember:
Your

asthma is always there, even when you feel fine and dont have any symptoms.
Asthma

cannot be cured, but it can be controlled.

You should expect nothing less!

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What Is Asthma?
Question:

Can you catch asthma from someone else, like a cold?

Answer: No, you cant. Asthma is not contagious.You can't catch it from someone like you can catch a cold.

Who Gets Asthma?

Asthma is more common than you might think.

Fast Facts: Asthma is one of the most common chronic diseases in children. Asthma affects 20 million people in the United States and about 300 million worldwide.

Children miss about 14 million school days, each year due to asthma.

Source: Asthma and Allergy Foundation of America

Who Gets Asthma?

Asthma is more common than you might think.

Fast Facts: Every day in America: 40,000 people miss school or work due to asthma. 30,000 people have an asthma attack. 5,000 people visit the emergency room due to asthma. 1,000 people are admitted to the hospital due to asthma. 11 people die from asthma.

Source: Asthma and Allergy Foundation of America

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Who Gets Asthma?

Risk Factors For Development of Asthma:
Family Atopic

history of asthma

dermatitis (eczema) 40% to 50% of children with eczema develop asthma

Frequent Exposure Living Low

respiratory infections as a child

to secondhand smoke

in an urban area, especially with a lot of air pollution.

birth weight
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Who Gets Asthma?

No

one knows for sure why some people develop asthma and allergies and why some dont.
We

do know that asthma does run in families, along with other atopic (allergic) diseases such as hives, eczema, allergic conjunctivitis (hay fever), and allergic rhinitis.
That

means you may also have a parent, brother or sister, or other relative who has asthma or probably had it as a child.

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Who Gets Asthma?

True or False? A child with atopic dermatitis (eczema) is at high risk for developing asthma.

True

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Who Gets Asthma?

Question:
does / does not Asthma does run in families.

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What Causes an Asthma Flare-up?

The

things that cause asthma flare-ups and symptoms are known as asthma triggers.
Triggers

can be many different things. vary from person to person.

(Pets, cigarette smoke, stress, etc.)

Triggers You

should learn what your triggers are and avoid them whenever possible.
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What Causes an Asthma Flare-up?

Basically, asthma can be classified into two types: Allergic and Non-allergic asthma.
Allergic

asthma: This type of asthma is triggered by allergens. Allergens are things that cause an allergic reaction in the airway.
Non-allergic

asthma: Asthma symptoms are caused by irritants like cigarette smoke, or from something else such as exercise or temperature changes.
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What Causes an Asthma Flare-up?

Common allergen triggers include:
Dust

mites (tiny bugs that live in dust) Cockroaches (small indoor pests) Mold (a type of fungus. The funny smell in a damp
basement was probably mold)
Pollen (from flowers, trees, grass, and weeds)

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What Causes an Asthma Flare-up?

Common animal triggers include:
Cats, dogs, and

horses People with asthma can be

guinea pigs can also be the

sensitive to their dander, urine, and saliva.

Rabbits, hamsters, and

cause of asthma symptoms because of their urine.

*Cats are the most common cause of pet allergies. Approximately 10 million people in the United States are allergic to cats.
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What Causes an Asthma Flare-up?

Common irritant triggers include: Smoke (cigarettes, wood burning) Chemical fumes (from cleaning products) Perfumes Air pollution Chalk dust

*Smoking is always bad, especially around someone who has asthma!

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What Causes an Asthma Flare-up?

Some other triggers include: Cold air Changes in temperature Catching a cold or the flu Emotional stress Exercise
Some people have what's called exercise-induced asthma. This means they have breathing problems only when they exercise.
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What Causes an Asthma Flare-up?

There are some medications that you need to be careful using when you have asthma.
Beta-Blockers (non-cardioselective)
(Used for high blood pressure, heart failure, etc.)

Aspirin and NSAIDs (nonsteroidal anti-inflammatory drugs)

Aspirin and products containing aspirin
(Alka-Seltzer, Excedrin, Pepto-Bismol)

Ibuprofen
(Advil, Motrin, Nuprin)

Naproxen
(Aleve, Naprosyn)
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What Causes an Asthma Flare-up?

Some foods and beverages may contain sulfites as a preservative. Sulfites have been know to cause asthma flare-ups in some people with asthma.
Sulfite-containing foods: Baked goods, potato chips Dried fruits Maraschino cherries Condiments and Relishes Guacamole Jams Gravy Dehydrated, precut, or peeled fresh potatoes Molasses Shrimp Soup mixes Sulfite-containing beverages: Beer Wine Hard cider Fruit and vegetable juices Tea
Common food allergies include: milk, eggs, peanuts, soy, wheat, fish

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What Causes an Asthma Flare-up?

Question: An asthma flare-up from dust mites would be an example of allergic or non-allergic asthma?
Answer:

allergic asthma
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How is Asthma Treated?

People who have asthma should try to avoid the triggers that can cause asthma flare-ups.
They can also manage and control their asthma by taking medication.

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How is Asthma Treated?

There are two main types of asthma medications: Quick-relief and Long-term controllers Quick-relief (rescue) Works fast! Used to relieve sudden symptoms Not for long-term control

Long-term controllers Not used for quick-relief Used to prevent symptoms Must be taken every day!
*With Long-term controllers, you shouldnt need quick-relief medicine as much.
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How is Asthma Treated?

The most common quick-relief medications are short-acting bronchodilators. They include:
Albuterol
Proventil, Ventolin, ProAir

Xopenex

Maxair

They work by relaxing the muscles around the airways. (airway constriction or bronchospams)
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How is Asthma Treated?

Another type of bronchodilator are called anticholerginics.
They

work differently than Albuterol . Theyre usually not used for asthma, but your doctor may include them to help treat your asthma.
Atrovent

Combivent
(Atrovent + Albuterol)

Spiriva
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How is Asthma Treated?

There are many types of Long-term controller medicines used to prevent asthma flare-ups.
Corticosteroids

(steroids) Long-acting bronchodilators Leukotriene blockers and modifiers Mast cell stabilizers Methylxanthines IgE blocker injections

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How is Asthma Treated?

Corticosteroids (Anti-inflammatory steroids)
Not the same as steroids that are used by body builders (anabolic). Mimic the effects of natural steroids produced by the body (cortisol).

They work by reducing the swelling (inflammation), inside of the airways.

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How is Asthma Treated?

Corticosteroids (Anti-inflammatory steroids)
Corticosteroids are the most potent and effective long-term medications for asthma. Systemic corticosteroids (prednisone, pediapred, etc.) can have a lot of potential side-effects. Side-effects are dose related.

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How is Asthma Treated?

Potential Side Effects from Corticosteroids
Increased appetite Weight gain Deposits of fat in chest, face, upper back, and stomach Water and salt retention Swelling and edema High blood pressure Diabetes Black and blue marks Slowed healing of wounds Osteoporosis Cataracts Acne Muscle weakness Thinning of the skin Increased susceptibility to infection Stomach ulcers Increased sweating Mood swings Psychological problems

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How is Asthma Treated?

Corticosteroids (Anti-inflammatory steroids)
You shouldnt experience any harmful sideeffects with an occasional short-term course of systemic steroids.

A major goal for someone with asthma should be to avoid the need for systemic steroids, as much as possible. Thats where inhaled steroids come in!!
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How is Asthma Treated?

Inhaled steroids vs. Systemic steroids
Inhaled Inhaled

steroids are safe and effective.

steroids are given in micrograms (mcg), Systemic steroids are given in milligrams (mg). (1000 mcg = 1mg)
Inhaled

steroids are deposited directly to the airways. Systemic steroids affect your entire body. Inhaled steroids are virtually free of side effects at normal doses.
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How is Asthma Treated?

Corticosteroid inhalers:

Pulmicort
*Also comes in respules for nebulizing

Aerobid

Flovent

Asmanex

Azmacort

Qvar
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How is Asthma Treated?

Remember:
Always

rinse your mouth after using inhaled steroid inhalers to help prevent sore throat and oral candidiasis (thrush).
Using

a spacer or holding chamber with your inhaler will help too.

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How is Asthma Treated?

Long-acting bronchodilators are another type of long-term controller medication. They last for 12 hours or more.
Serevent
Foradil
Not

for quick relief! May help inhaled steroids work better Should only be taken twice a day.
(*Foradil begins working in 5 minutes, Serevent in 30 minutes) 36

How is Asthma Treated?

Combination inhalers combine a long-acting bronchodilator and inhaled steroid together in one.
Advair
Symbicort
Not

for quick relief! Should only be taken twice a day. Rinse mouth after using.

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How is Asthma Treated?

Your doctor may also prescribe other types of longterm controller medications.
Leukotriene

blockers and modifiers

Singulair, Accolate, Zyflo

Mast

cell stabilizers

Intal, Tilade

Methylxanthines (Theophylline)
Theo-dur, Slo-Bid,Theo-24

IgE

Blocker (allergy shot)

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Omalizumab (Xolair)

How is Asthma Treated?

Remember:
It

can take about 14 days (2 weeks) or so for you long-term controller medication to start working).
Youre controller

medicine must be taken every day as prescribed by your doctor.

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How is Asthma Treated?

Remember:
Dont

stop taking your controller medication just because you are feeling better and dont have any symptoms.
You

wouldnt stop brushing your teeth just because you dont have any cavities, would you?

Its all about prevention!!

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How is Asthma Treated?

Question: Which type of medication should be take every day to help prevent flare-ups and control asthma symptoms?
Quick-relief or Long-term controller? Answer: Long-term controller
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How is Asthma Treated?

Asthma

medicine often is taken through a device called an inhaler.

The

inhaler may have a spacer, or holding chamber attached to it. This will help the medicine get into your lungs better.
The

medicine can also be taken with a nebulizer using a mouthpiece or a mask.

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How is Asthma Treated?

Using an Inhaler:

1 2 3

Put the spacer on the inhaler. Then shake the inhaler well.
Breathe out normally. Then put the mouthpiece in your mouth. Close your lips around it. Stand up straight with your chin up. Press down 1 time on the top of the inhaler. This gives you 1 puff of medicine. Breathe in slowly and deeply through your mouth. Hold your breath while (count slowly to 10 in your head) Take the mouthpiece out of your mouth. Pucker your lips. (as if you were going to blow out a candle) Breath out slowly through your lips.
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How is Asthma Treated?

Using an Inhaler:
Children using an inhaler and spacer w/mask:

Be sure to use a tight fitting mask With each puff delivered, hold the mask in place and have the child breathe in and out normally for about 15-20 seconds (about 6 breaths).

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How is Asthma Treated?

Using a Nebulizer:
With a Mask
Put the correct dose of medicine in the cup. Connect one end of the tubing to the cup and the other end to the machine. Place the mask over your nose and mouth. Make sure it fits securely and comfortably.
Turn on the machine. Take slow, deep breaths until all of the medicine is gone. This usually takes 10 to 15 minutes.
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How is Asthma Treated?

Using a Nebulizer:
With a Mouthpiece
Put the correct dose of medicine in the cup. Connect one end of the tubing to the cup and the other end to the machine. Attach the mouthpiece to cup.
Put the mouthpiece between and close your lips around it.

Turn on the machine.

Take slow, deep breaths through the mouthpiece until all of the medicine is gone. This usually takes 10 to 15 minutes.
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How is Asthma Treated?

Cleaning a Nebulizer:
Regularly cleaning the nebulizer is important because a dirty nebulizer may cause an infection. A good cleaning routine also keeps the nebulizer from clogging up and helps it last longer. After each use:

Remove the mask or mouthpiece and T-shaped part from the cup. Rinse the mask or mouthpiece and T-shaped part in warm running water for 30 seconds. The tubing should not be washed or rinsed. After rinsing, shake off excess water. Air-dry pieces on a clean cloth or paper towel. Put the mask or mouthpiece and T-shaped part, cup, and tubing back together and connect the device to the machine. Run the machine for 10-20 seconds to dry the inside of the nebulizer. Disconnect the tubing from the machine. Store the parts in a zip-lock bag.
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How is Asthma Treated?

Cleaning a Nebulizer:
Regularly cleaning the nebulizer is important because a dirty nebulizer may cause an infection. A good cleaning routine also keeps the nebulizer from clogging up and helps it last longer. Once every week when used:

After washing with mild dishwashing soap, soak the parts in a solution made of one part distilled white vinegar and two parts distilled water for 30 minutes.

Throw out the vinegar water solution after use. Do not reuse it.

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How To Manage Asthma

For good asthma control, you must:
Learn

about asthma, allergies, and asthma triggers.

Develop

- an Asthma Action Plan with your doctor and/or health care provider.
Use

- your medications and delivery devices.

(inhalers, spacers, nebulizers, and peak flow meters).

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How To Manage Asthma

The Asthma Rules of Two
Do

you use your quick-relief inhaler more that two times a week? Do you wake up at night with asthma symptoms more than two times per month? Do you refill your quick-relief inhaler more that two times per year?
*If you answered yes to any of these questions, your asthma may not be well controlled.

*The Rules of Two is a registered trademark of the Baylor Health Care System.

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How To Manage Asthma

To help prevent exercise-induced asthma symptoms:
Be

sure to warm up before exercising.

Take

2 puffs of your fast-acting inhaler, such as Albuterol,15 to 20 minutes before starting a sport or physical activity.

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How To Manage Asthma

Some conditions can worsen your asthma, or make it more difficult to control.
GERD (Gastroesophageal Reflux Disease) Obesity OSA (Obstructive Sleep Apnea) Rhinitis

Sinusitis
Speak to your doctor about treating these conditions in order to help control your asthma.
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How To Manage Asthma

People

who have asthma can use a peak flow meter to get an idea of how well they are breathing that day.

Peak

flow meters measure how well air moves out of your lungs.

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How To Manage Asthma

Using a Peak Flow Meter
1. Set the meter to zero.

2. Stand in an upright position

3. Take a deep breathand hold it in.

4. Place the meter in your mouth, close your lips around it. 5. Blow hard and fast!!!!

6. Record your meter reading.

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How To Manage Asthma

Green

Peak Flow Zones

80% to100% of personal best: Signals all clear. No asthma symptoms are present Routine treatment plan for maintaining control can be followed.

Yellow
50% to 80% of personal best: Signals caution. An acute flare-up may be present and you may be having symptoms. A temporary increase in medication may be indicated.

Red
Below 50% of personal best: Signals a medical alert. An immediate bronchodilator should be taken. If symptoms dont improve call your doctor or seek medical help.
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How To Manage Asthma

Asthma Action Plan:
Physician and emergency contact information Personal Best peak flow number

Three-zone model (green, yellow, and red zones for assessing severity and what to do)

Medication list (Quick-relief and long-term control)

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How To Manage Asthma

Question:

What device measures how well air moves out of your lungs?
Answer:

Peak flow meter

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How To Manage Asthma

Question:
A Peak flow measurement below 50% of your personal best would indicate which zone?
A. Green zone B. Yellow zone C. Red zone

Answer:
C. Red zone

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Sources
The Asthma Educators Handbook Asthma and Allergy Foundation of America
(website: www.aafa.org)

Riley Hospital for Children

(website: rileychildrenshospital.com/)

The Childrens Asthma Education Center

(website: www.asthma-education.com/content/

National Heart Lung and Blood Institute

(website: www.nhlbi.nih.gov/guidelines/asthma/)

Kids Health
(website: www.kidshealth.org)
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Understanding Asthma

Thank You! Please feel free to ask any questions.

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