Asthma Speaker Kit

8/18/2019 Asthma Speaker Kit

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AsthmaAsthmaA Presentation on Asthma Management and Prevention


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What is Asthma?

Chronic disease of the airways that may causeWheezingBreathlessnessChest tightness

Nighttime or early morning coughing

Episodes are usually associated withwidespread, but variable, airflow obstruction

within the lung that is often reversible eitherspontaneously or with treatment.


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Pathology of Asthma

Source: “What You and Your Family Can Do Aout Asthma! y the "loal #nitiative For Asthma

Created and funded y $#%&$%'(#) *++,

$ormal Asthma

Asthma

involves

inflammation of

the air-ays


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What is ./idemiology?

The study of the distribution and

determinants of diseases and

inuries in human populations.

Source: Mausner and 0ramer) Mausner and (ahn ./idemiology1 An #ntroductory 2e3t) *+4,5


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Child and Adult Asthma Prevalence

6nited States) *+4718779

*81Month

'ifetime• Child

Adult

Source: $ational %ealth #ntervie- Survey CDC $ational Center for %ealth Statistics

Current


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Asthma Prevalence y Se3

6nited States) *+4718779

*81Month

'ifetime• Female

Male


Current


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*81Month Asthma Prevalence y ;ace

6nited States) *+471*++<


(lac=

White


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Asthma Prevalence y ;ace&.thnicity

6nited States) *++918779

'ifetime

Current

▲ (lac= $%

White $%

%is/anic

Source: $ational %ealth #ntervie- Survey $ational Center for %ealth Statistics


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Current Asthma Prevalence for Youth

y ;ace&.thnicity) Ages ,1*9) 877,18779

Centers for Disease Control and Prevention5 $ational Center for %ealth Statistics5 %ealth

Data #nteractive5 ---5cdc5gov&nchs&hdi5htm5 >uly *,) 877+@5

*75* Bverall


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Asthma Dis/arities Among 65S5 Children

!ow"income populations, minorities, and children living ininner cities e#perience more E$ visits, hospitalizations,

and deaths due to asthma than the general population.%

The burden of asthma falls disproportionately on non"&ispanic blac', (merican )ndian*(las'an Native and

some &ispanic +i.e., uerto -ican populations./, 0

*'ieu 2A et al5 ;acial&.thnic ariation in Asthma Status and Management PracticesAmong Children in Managed Medicaid5 Pediatrics 8778 *7+:4,94


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Po/ulation Dis/arities in Asthma

Current asthma /revalence is higher

among

children than adults

boys than girls

women than men

Asthma moridity and mortality is

higher among

(frican (mericans than Caucasians

Source: MMWR 8779,


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AsthmaJ %os/ital Discharge ;atesK

y Se3 6nited States: *+471877<

Source: $ational %os/ital Discharge Survey) CDC $ational Center for %ealth Statistics) J First1listeddiagnosis) K Age1adLusted to 8777 65S5 /o/ulation

Males

Females

Ad lt d Child A th % it l Di h


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Adult and Child Asthma %os/ital Discharge

;ates

6nited States) *++


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Asthma %os/ital Discharge ;ates

y ;ace

6nited States) *+471877<

White

Bther

(lac=

Source: $ational %os/ital Discharge Survey) CDC $ational Center for %ealth Statistics) J First1listeddiagnosis) K Age1adLusted to 8777 65S5 /o/ulation


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Asthma Mortality ;ates y Age

6nited States: *+9+1877,


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Asthma Mortality ;ates y ;ace

6nited States: *+9+1877,

White

(lac=

Source: 6nderlying Cause of Death CDC $ational Center for %ealth Statistics

1 Age1adLusted to 8777 65S5 /o/ulation

ICD-9 ICD-10

Bther


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;is= Factors for Develo/ing Asthma

"enetic characteristics

Bccu/ational e3/osures .nvironmental e3/osures


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;is= Factors for Develo/ing Asthma:

"enetic CharacteristicsAto/y

The body2s predisposition to develop an antibody

called immunoglobulin E +)gE in response toe#posure to environmental allergens

Can be measured in the blood

)ncludes allergic rhinitis, asthma, hay fever, and

eczema


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;is= Factors for Develo/ing Asthma:

.nvironmental .3/osure

Clearing the Air:

Asthma and Indoor Air Exposures

htt/:&&---5iom5edu GPulicationsH)nstitute of 3edicine, /444

Committee on the (ssessment of (sthma and )ndoor (ir

-eview of current evidence about indoor air e#posures

and asthma


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Clearing the Air:

Categories for Associations of arious

.lements

5ufficient evidence of a causal relationship

5ufficient evidence of an association

!imited or suggested evidence of anassociation

)nade6uate or insufficient evidence to

determine whether an association e#ists!imited or suggestive evidence of noassociation

http://www.iom.edu/http://www.iom.edu/


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Clearing the Air:

#ndoor Air .3/osures N Asthma Develo/ment

(iological Agents

Sufficient evidence of causal

relationshi/

&ouse dust mite

Sufficient evidence of association

None found

'imited or suggestive evidence of

association

Coc'roach +among pre"school aged

children

-espiratory syncytial virus +-57

Chemical Agents Sufficient evidence of causal

relationshi/ None found

Sufficient evidence of association Environmental Tobacco 5mo'e

+among pre"school aged children

'imited or suggestive evidence ofassociation None found


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Clearing the Air:

#ndoor Air .3/osures N Asthma .3aceration

(iological Agents

Sufficient evidence of causal

relationshi/

Cat

Coc'roach

&ouse dust mite

Sufficient evidence of an association

$og

8ungus*3olds

-hinovirus

'imited or suggestive evidence ofassociation

$omestic birds

Chlamydia and 3ycoplasma pneumonia

-57

Chemical Agents Sufficient evidence of causal

relationshi/ Environmental tobacco smo'e

+among pre"school aged children

Sufficient evidence of

association N9/, N9: +high levels

'imited or suggestive evidence ofassociation Environmental Tobacco 5mo'e

+among school"aged, older children,and adults

8ormaldehyde 8ragrances


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;educing .3/osure to %ouse Dust Mites

;se beddingencasements

Wash bed linens wee'ly

(void down fillings

!imit stuffed animals tothose that can be washed

-educe humidity level+between 04< and =4<

relative humidity perE-"0

Source: “What You and Your Family Can Do Aout Asthma! y the "loal #nitiative For

Asthma Created and funded y $#%&$%'(#) *++,


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;educing .3/osure to

.nvironmental 2oacco Smo=e

.vidence suggests an

association et-een

environmental toacco smo=e

e3/osure and e3acerations of

asthma among school1aged)

older children) and adults5

.vidence sho-s an association

et-een environmental toaccosmo=e e3/osure and asthma

develo/ment among /re1school

aged children5


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;educing .3/osure to Coc=roaches

-emove as many water and food sources aspossible to avoid coc'roaches.


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;educing .3/osure to Pets

eople who are allergic to pets should not

have them in the house.

(t a minimum, do not allow pets in the

bedroom.


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;educing .3/osure to Mold

Eliminating mold and the moist conditions that permit

mold growth may help prevent asthma e#acerbations.


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Bther Asthma 2riggers

(ir pollution

Trees, grass, and weed pollen


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Clinical Management of Asthma

E#pert anel -eport 0National (sthma Education and revention rogram

National &eart, !ung and Blood )nstitute, /44>

Source: htt/:&&---5nhli5nih5gov&guidelines&asthma&asthgdln5/df


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8779 $A.PP .P;1

Treatment recommendations based on?5everity

Control

-esponsiveness

rovide patient self"managementeducation at multiple points of care

-educe e#posure to inhaled indoorallergens to control asthma"multifacetedapproach

Source: htt/:&&---5nhli5nih5gov&guidelines&asthma&asthgdln5/df


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What is "#P?

@uidelines )mplementation anel -eport for

E#pert anel -eport 0

-ecommendations and strategies to

implement E-"0

5i# 'ey messages

Source: htt/:&&---5nhli5nih5gov&guidelines&asthma&gi/Er/t5/df


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"#POs Si3 0ey Messages

)nhaled

Corticosteroids

(sthma (ction lan

(sthma 5everity

(sthma Control

8ollow"up 7isits

(llergen and )rritant

E#posure Control

Source: htt/:&&---5nhli5nih5gov&guidelines&asthma&gi/Er/t5/df

http://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdfhttp://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdfhttp://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdfhttp://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.pdf


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Diagnosing Asthma:

Medical %istory

5ymptoms

Coughing

Wheezing

5hortness of breathChest tightness

5ymptom atterns

5everity

8amily &istory


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Diagnosing Asthma

Troublesome cough, particularly at night (wa'ened by coughing

Coughing or wheezing after physical

activityBreathing problems during particular

seasons

Coughing, wheezing, or chest tightness

after allergen e#posure

Colds that last more than %4 days

-elief when medication is used


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Diagnosing Asthma

Wheezing sounds during normal breathing

&ypere#pansion of the thora#

)ncreased nasal secretions or nasal polyps

(topic dermatitis, eczema, or other allergic

s'in conditions


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Diagnosing Asthma:

S/irometry

Test lung function when diagnosing asthma


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Medications to 2reat Asthma

Medicationscome in severalforms5

2-o maLorcategories ofmedications are:!ong"term control

Auic' relief


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Medications to 2reat Asthma:

'ong12erm Control

2a=en daily over a long /eriod of time

6sed to reduce inflammation) rela3 air-aymuscles) and im/rove sym/toms and lung

function

)nhaled corticosteroids

!ong"acting beta/"agonists

!eu'otriene modifiers


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uic=1;elief

6sed in acutee/isodes

"enerally short1acting eta8agonists


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%o- to 6se a S/ray #nhaler

The health"care

provider should

evaluate inhaler

techni6ue at each

visit.

Source: “What You and Your Family Can Do Aout Asthma! y the "loal #nitiative forAsthma Created and funded y $#%&$%'(#


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#nhalers and S/acers

5pacers can help patients who

have difficulty with inhaler use

and can reduce potential for

adverse effects from

medication.


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$euliQer

3achine produces a mist of

the medication

;sed for small children or

for severe asthma episodes

No evidence that it is more

effective than an inhaler

used with a spacer


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Managing Asthma:

Asthma Management "oals

(chieve and maintain control of symptoms3aintain normal activity levels, including

e#ercise3aintain pulmonary function as close to

normal levels as possiblerevent asthma e#acerbations (void adverse effects from asthma

medicationsrevent asthma mortality


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Managing Asthma:

Asthma Action Plan

$evelop with a physician

Tailor to meet individual needs

Educate patients and families about all aspects ofplan-ecognizing symptoms

3edication benefits and side effectsroper use of inhalers and ea' E#piratory 8low +E8

meters


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Managing Asthma:

Sam/le Asthma Action Plan

$escribes medicines

to use and actions to

ta'e

$ational %eart) (lood) and 'ung #nstitute .3/ert Panel ;e/ort G.P; H: "uidelines for theDiagnosis and Management of Asthma5 $#% Pulication no5 741I7,*) 87795


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Managing Asthma:

Pea= .3/iratory Flo- GP.FH Meters

(llows patient to assess status of his*her asthma

ersons who use pea' flow meters should do so fre6uently

3any physicians re6uire for all severe patients


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Managing Asthma:

Pea= Flo- Chart

Peo/le -ithmoderate orsevere asthmashould ta=ereadings:Every morningEvery evening (fter an

e#acerbationBefore inhaling

certain medications

Source: “What You and Your Family Can Do Aout Asthma! y the "loal #nitiative ForAsthma Created and funded y $#%&$%'(#


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Managing Asthma:

#ndications of a Severe Attac=

Breathless at rest

&unched forward

5pea's in words rather than complete sentences

(gitated

ea' flow rate less than 4< of normal


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Managing Asthma:

2hings Peo/le -ith Asthma Can Do

&ave an individual management plan containing

our medications +controller and 6uic'"relief

our asthma triggers

What to do when you are having an asthma attac'Educate yourself and others about

(sthma (ction lans

Environmental interventions

5ee' help from asthma resourcesDoin an asthma support group


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A Pulic %ealth ;es/onse to Asthma

( call to action for organizations and people withan interest in asthma management to wor' as

partners in reducing the burden of asthma within

our nation2s communities.


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A Pulic %ealth ;es/onse to Asthma:

Surveillance

Bver timeR

&ow much asthma does the population have

&ow severe is asthma across the population

&ow well controlled is asthma in the populationWhat is the cost of asthma


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6ses of Surveillance Data

Basis for planning andtargeting interventionactivities

Evaluating interventionactivities


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A Pulic %ealth ;es/onse

to Asthma .ducation

.ducation /rograms can e targeted to:

eople with asthma

arents of children with asthma3edical care providers

5chool staff

ublic


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Coalition

5uccessful asthma campaigns need the

cooperation of committed partners.

A P li % lth ; t A th


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Advocacy

(sthma needs to be addressed

comprehensively by multiple government and

non"government agencies.


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#nterventions

3edical managementEducation

Environment

5chools


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Medical Management #nterventions

Ensure people with asthma

'now about their disease and

are empowered to demand

appropriate management



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.nvironmental #nterventions

%el/ /eo/le create andmaintain healthy home) school)

and -or= environments5

.nvironmental interventions

may consist of:

(ssessments to identifyasthma triggers

Education on how to remove

asthma triggers

-emediation to remove

asthma triggers


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School #ntervention Science1(ased "uidance

3anagement and supportsystems

&ealth and mental health

services (sthma education for

students, staff, and parents

&ealthy school environment

hysical education and activity 5chool, family, and community

efforts

Source: ---5cdc5gov&%ealthyYouth&asthma&strategies


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0ey As/ects

-e6uire team effort

Coordinate health, including mental and physical

health, education, environment, family, and

community efforts

(ssess needs of school and prioritize +every

action step is not feasible to every school or

district

8ocus on students with fre6uent asthmasymptoms, health room visits, and absenteeism


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%. 3anagement F5upport 5ystems

8amily*Community

)nvolvement

hysical

Education

Nutrition

5ervices

&ealthy 5chool

Environment

&ealth romotion

8or 5taff

&ealth

Education

&ealth

5ervices

Counseling,sychological, and

5ocial 5ervices

G. &ealthy 5chool

Environment

/. &ealth F

3ental &ealth

5ervices

0. (sthma

Education

. 5chool, 8amily,

F Community

Efforts

=. hysical

Education F

(ctivity


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School ( leading chronic disease cause of school absence

Common disease addressed by school nurses

(ffects teachers, administrators, nurses, coaches, students,bus drivers, after school program staff, maintenancepersonnel

B hild i l f 7


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are li=ely to have asthma5J

Bn average) children in a classroom of 7

J

./idemiology and Statistics 6nit5 2rends in Asthma Moridity and Mortality5 $YC: A'A) uly 877


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A Pulic %ealth ;es/onse to

Asthma:

What can ma=e asthma -orse in the school?

3old and mildew

(nimals in classroom

Carpeted classroomsCoc'roaches

oor air 6uality


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Asthma1Friendly School

DD and 2ool=it

BLectivesersonal stories to relate to

viewer (spects of an asthma"friendly

school5i# strategies for addressing

asthma in a coordinated school

health program

otential impact of asthma"friendly schools



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School Actions

Establish policies and procedures to support children withasthma.

Heep students2 asthma action plans at the school.

3a'e medications available

$uring school hours Before physical activity and sports

$uring before" and after"school programs

9n field trips or when away from campus

Train school staff to recognize signs of an asthma attac'and to use appropriate medications.


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.valuation

2he systematic investigation of thestructure) activities) or outcomes of

asthma control /rograms5 (re we doing the right thing

(re we doing things right


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(enefits of Program .valuation

Evaluations help asthma programs3anage resources and services effectively;nderstand reasons for current performance

Build capacity

lan and implement new activities

$emonstrate the value of their efforts

Ensure accountability


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6sing .valuation to #m/rove Programs

%ighlight effective /rogram com/onents-ecognize achievements-eplicate successes

Assess and /rioritiQe needs

2arget /rogram im/rovements

Advocate for the /rogram


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Frame-or= for Program .valuation


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Summary

(sthma is a comple# disease that is not yet preventable or curable.

(sthma can be managed with medication, environmental changes, and behavior

modifications.

By wor'ing together, we can ensure that people with asthma enoy a high 6uality of life.


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;esources

National (sthma Education and revention rogram http?**www.nhlbi.nih.gov*about*naepp *

(sthma and (llergy 8oundation of (merica http?**www.aafa.org

(merican !ung (ssociation http?**www.lungusa.org

(merican (cademy of (llergy, (sthma, and )mmunology http?**www.aaaai.org

(llergy and (sthma Networ'*3others of (sthmatics, )nc. http?**www.aanma.org


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;esources

(merican College of (llergy, (sthma, and)mmunology

http?**www.acaai.org

(merican College of Chest hysicians

http?**www.chestnet.org

(merican Thoracic 5ociety http?**www.thoracic.org

The Centers for $isease Control and revention

http?**www.cdc.gov*asthma
http://www.nhlbi.nih.gov/about/naepp/http://www.aanma.org/http://www.aanma.org/http://www.aanma.org/http://www.aanma.org/http://www.aaaai.org/http://www.aaaai.org/http://www.lungusa.org/http://www.lungusa.org/http://www.aafa.org/http://www.aafa.org/http://www.nhlbi.nih.gov/about/naepp/http://www.nhlbi.nih.gov/about/naepp/

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Asthma Speaker Kit