Rescue Inhaler: Helping Students with Asthma Breathe Better

1. Rescue Inhaler: Helping Students with Asthma Breathe Better Rachel Gallagher, R.N., A.P.N.P. The Department of Public Instruction School Nurse Consultant 125 South Webster St. Madison, WI 53707 (608) 266-8857 Rachel.gallagher@dpi.wi.gov

2. Audio Difficulties? Make sure the volume is turned up (volume button beneath the speaker�s picture) Make sure the volume on the computer is turned up (volume icon located on the right hand side of your computer taskbar) Contact your IT department If audio and visual is lost during the program, go back to: http://media2.wi.gov/dpi/catalog/, and click on the Student Services Prevention and Wellness Team link on the left, then when the SSPW Team page of archived programs appears, select the program link desired. If problem persists contact Rachel Gallagher (608) 266-8857.

3. This power point, web cast and competency test will satisfy the knowledge portion of medication training. To complete the medication training for this emergency medication, school personnel will need to have a their medication administration skill verified and documented by a school nurse, medical provider or adequately training parent by performing an independent demonstration of the skill. Competency checklist are available at: http://dpi.wi.gov/sspw/schlnurse.html

4. Objectives What is asthma? Who has asthma? What are the signs/triggers of asthma? What is the treatment for asthma? What is the Wisconsin Asthma Inhaler Law?

5. Who has asthma? 12% of all students nationally 12 deaths/day from asthma 12.9% of all Wisconsin children <18 years of age have been diagnosed with asthma 17% boys 9% girls Higher percentages in minority populations 12 % of all students nationally have asthma 12 asthmatics die every day from asthma 13% of our Wisconsin students have been dxed with asthma at some time in their lives. More boys have asthma than girls but in adulthood, more women have asthma than men. In the African American Community, their rates of asthma are almost double non-Hispanic white population. African American Asthma tends to be more severe and less responsive to treatment. The rate of hospitalizations of African Americans with asthma is 6 times higher than non-Hispanic Whites. The mortality rate is 4 times greater. Children before the age of 3 with eczema, allergies or a severe respiratory virus are more likely to have asthma later in life12 % of all students nationally have asthma 12 asthmatics die every day from asthma 13% of our Wisconsin students have been dxed with asthma at some time in their lives. More boys have asthma than girls but in adulthood, more women have asthma than men. In the African American Community, their rates of asthma are almost double non-Hispanic white population. African American Asthma tends to be more severe and less responsive to treatment. The rate of hospitalizations of African Americans with asthma is 6 times higher than non-Hispanic Whites. The mortality rate is 4 times greater. Children before the age of 3 with eczema, allergies or a severe respiratory virus are more likely to have asthma later in life

6. In every class of 30 students, 2-3 students will have asthma.In every class of 30 students, 2-3 students will have asthma.

7. What is Asthma? Chronic inflammatory disease of the airways An obstructive disease Disease that may cause permanent changes (remodeling) if not properly treated Disease that cannot be cured but can be controlled. Asthma is a disease that affects the airways that carry oxygen in and out of the lungs. If you have asthma, the inside of these airways is irritated and swollen. This is called inflammation. The inflammation causes the airways to be more sensitive and likely to react to triggers. Every time a child has an asthma attack, there are permanent changes to the lung tissue. Asthma can be cured, now more than ever, can be controlled.Asthma is a disease that affects the airways that carry oxygen in and out of the lungs. If you have asthma, the inside of these airways is irritated and swollen. This is called inflammation. The inflammation causes the airways to be more sensitive and likely to react to triggers. Every time a child has an asthma attack, there are permanent changes to the lung tissue. Asthma can be cured, now more than ever, can be controlled.

8. What happens during an asthma attack? Muscles around the airways tighten Airways are irritated inflamed and swollen Airways produce more mucous When asthma symptoms become worse it is called an asthma attack or episode. In an asthma attack, muscles around the airways tighten up and become much narrower so less air can flow into your lungs. At the same time, the airways are irritated, inflamed and swollen. The airways produce more mucus than usual. These conditions further narrow the airways. Together theses changes make it harder to breathe.When asthma symptoms become worse it is called an asthma attack or episode. In an asthma attack, muscles around the airways tighten up and become much narrower so less air can flow into your lungs. At the same time, the airways are irritated, inflamed and swollen. The airways produce more mucus than usual. These conditions further narrow the airways. Together theses changes make it harder to breathe.

9. What triggers asthma attacks? Respiratory infection Allergens Physical exercise Irritants Asthma is stimulated or triggered by: Respiratory infections such as a cold or the influenza Allergens such as pollen, animal dander, dust, mites, cockroaches and molds Physical exercise moving large volumes of air in and out also called exercise induces asthma Irritants such as perfume, pesticides, strong odors, cigarette smoke and chalk dust Asthma is stimulated or triggered by: Respiratory infections such as a cold or the influenza Allergens such as pollen, animal dander, dust, mites, cockroaches and molds Physical exercise moving large volumes of air in and out also called exercise induces asthma Irritants such as perfume, pesticides, strong odors, cigarette smoke and chalk dust

10. Triggers of asthma cont. Changes in temperatures Cockroaches Changes in temperature � recess CockroachesChanges in temperature � recess Cockroaches

11. What are the signs of asthma? Coughing Wheezing Chest tightness Shortness of breath Fast or noisy breathing The five common symptoms that indicate you might have asthma are coughing (dry hacky cough), wheezing (the noise of the air moving through narrow airways with each effort to inhale), chest tightness (rubber band), shortness of breath (can not complete a sentence without taking breath), and fast or noisy breathing. Some people with asthma only have symptoms once every few months while others have symptoms every week or every day.The five common symptoms that indicate you might have asthma are coughing (dry hacky cough), wheezing (the noise of the air moving through narrow airways with each effort to inhale), chest tightness (rubber band), shortness of breath (can not complete a sentence without taking breath), and fast or noisy breathing. Some people with asthma only have symptoms once every few months while others have symptoms every week or every day.

12. Conditions Affecting Exercise-Induced Asthma Extremely hot and cold temperatures High pollen count Heavy air pollution/ozone days Respiratory infection Tobacco smoke Conditions Affecting Exercise-Induced Asthma extremely hot and cold temperatures high pollen count heavy air pollution/ozone days respiratory infection tobacco smoke Conditions Affecting Exercise-Induced Asthma extremely hot and cold temperatures high pollen count heavy air pollution/ozone days respiratory infection tobacco smoke

13. Basic Asthma Management Stop physical activity Remove trigger Upright position and stay calm Administer rescue medication as prescribed Allow medication time to work

14. What is the treatment for Asthma? rescue medications relieves bronchospasms used during an asthma episode may be used prior to exercise controller medications reduce inflammation and prevent episodes used correctly will decrease the use of rescue medications Two type of inhalers Rescue inhalers are use to treat active or obvious symptoms of airway constriction. Signs of airway constriction include: rapid breathing, rising of shoulders, difficulty in taking in complete sentences and color of the skin and lips. Give only as prescribed. Controller inhalers are corticosteroids used to treat the airways so when they are exposed to a possible trigger, the lungs do not respond. These inhalers are not needed at school Two type of inhalers Rescue inhalers are use to treat active or obvious symptoms of airway constriction. Signs of airway constriction include: rapid breathing, rising of shoulders, difficulty in taking in complete sentences and color of the skin and lips. Give only as prescribed. Controller inhalers are corticosteroids used to treat the airways so when they are exposed to a possible trigger, the lungs do not respond. These inhalers are not needed at school

15. Side Effects rescue increased heart rate shaky hands

16. Metered Dose Inhaler (MDI) most common inhaler in school rescue medication frequent use suggests inadequate asthma control

17. Peak Flow Monitoring

18. Check the 5 rights or 5 Rs Right Student Right Medication Right Dosage Right Time Right Route

19. Steps in use of rescue inhaler without a spacer 1. Shake inhaler well and remove cap. 2. If inhaler is new or not used in two week, or been dropped, prime the inhaler by depressing canister four times into air away from face (or as indicated by instructions). 3. Breath out completely. 4. Place lips around inhaler mouthpiece.

20. Steps in use of rescue inhaler without a spacer cont. 5. Depress canister and take a deep breath in. 7. Hold breath for 10 seconds and breath out. 8. Repeat process (steps 3-7) if indicated by medical provider and parent authorizations. 9. Secure inhaler and wash hands.

21. Steps in use of rescue inhaler with a spacer 1. Shake inhaler well and remove cap. 2. Prime inhaler as needed. 3. Attach inhaler canister to spacer. 4. Place spacer mouthpiece or mask around the student�s face or mouth.

22. Steps in use of rescue inhaler with a spacer cont. 6. Depress inhaler canister. 7. Take a deep, slow breath in (if you hear a whistling sound, you are breathing in too quickly). 8. Hold breath for about ten seconds, then breathe out through the mouthpiece.

23. Steps in use of rescue inhaler with a spacer cont. 7. Breathe in again but do not press canister. 8. Remove mouthpiece from mouth and breathe out. 9. Repeat process (steps 4-7) if indicated by medical provider and parent authorizations. 10. Wash and store inhaler as indicated.

24. Demonstration Rescue inhaler With Without spacer

25. Documentation Every dose of medication needs to be documented with the date, time and initials of the person administering the medication on the medication log.

26. Initiate Emergency Action if: Prolonged wheezing Inability to talk in a complete sentence without stopping to breath Changes in color Change in respiratory rate Shoulders rise while breathing Call 911, school nurse and parent

27. What is the Asthma Inhaler Law? Chapter 118.291 � Asthmatic Pupil; possession and use of inhalers. A students may possess and use a metered dose inhaler or dry powder inhaler during school day and all school sponsored events or with supervision of a school authority if the following are true: This law was develop to empower children to manage their own disease have ready access to medication as need. While during school day, all school sponsored event or with supervision of a school authority, a students may possess and use a metered dose inhaler or dry powder inhaler is the following are true: This law was develop to empower children to manage their own disease have ready access to medication as need. While during school day, all school sponsored event or with supervision of a school authority, a students may possess and use a metered dose inhaler or dry powder inhaler is the following are true:

28. Inhaler Law Cont. Inhaler used to prevent or treat existing asthma symptoms (rescue inhaler) Written approval of parent (if minor) and medical provider for use of the inhaler Approval letters of parent and medical provider need to be given to principal

29. Any comments regarding this webcast? Any suggestions on future school nursing topics? Contact: Rachel Gallagher (608) 266-8857 E-mail: rachel.gallagher@dpi.wi.gov

30. Take test.Upon completion, take test to nurse or administrator for scoring.