Four
DISCLOSURES:
Worms and aNONE
Lesson
A minister decided that a visual demonstration would add emphasis
to his Sunday sermon. Four worms were placed in four separate
jars. The first worm was put into a container of alcohol, the
second worm was put into a container of cigarette smoke. The
third worm was but into a container of chocolate syrup. The
fourth worm was put into a container of good clean soil.
At the conclusion of the sermon the minister reported the following
results: The first worm in alcohol- Dead. The second worm in
cigarette smoke- Dead.The third worm in chocolate syrupDead.The fourth worm in good clean soil- Alive.
So the minister asked the congregation “What can you learn from this
demonstration?” Maxine was sitting in the back quickly raised
her hand and said
“As long as you drink, smoke and eat
chocolate, you won’t have worms!” That
pretty much ended the service.
More Facts
Asthmatics in West Virginia
48.8% of adults diagnosed during childhood(18)
24.6% adults have symptoms everyday; 22%
nocturnal
37% high school students missed school
15.6% adults unable to do usual activities or missed
work
Total hospitalization cost increased from
$10.3 million in 1996 to$ 23.2 million in 2005
Rate of seniors hospitalized rose from 15.5 in 1996
to 25.1 in 2006 with the
highest reported of 33.2 in 2004
(straw)
3M Resource Cards
Doctors Designers
11-96
3M Resource Cards
Doctors Designers
11-96
Aftermath of Inflammation
 Reversibility
– Occurs in most
asthma episodes
– Airway returns to
normal caliber
– Flow of air through
airways returns to
normal “speed”
 Remodeling
– Airway lining builds up
persistent fibrotic
changes
– Airway caliber remains
abnormal
– Air flow is decreased
– Permanent changes
appear to begin in
childhood, but become
recognizable in adults
Asthma is. . .
1. Chronic inflammatory disorder of the airways
– Mast cells, eosinophils and lymphocytes infiltrate
into airway lining
– Airway hyperresponsiveness develops
2. Excessive reaction to “minor” irritants results in a
host of deleterious airway changes
– Bronchial wall edema
– Smooth muscle contraction
– Excess mucus production
3. Patchy, mostly reversible regions of airway
narrowing cause asthma symptoms
Why Do People Get Asthma?
– We Don’t Know, Really
 Most likely a complex interaction between
– Host Factors/Predisposition
– Environmental Challenges
Risk Factors for Developing
Asthma





Genetic predisposition
Atopy
Airway hyperresponsiveness
Gender
Race/Ethnicity
Multiple Triggers Can Stimulate
Acute Reaction
 Upper Respiratory Infections (URI’s)
– Viral Respiratory infections are the #1 trigger behind asthma
hospitalizations
– Influenza vaccines are recommended for people with asthma





Allergens
Irritants
Sudden or extreme changes of weather
Exercise
Intense emotions
Acute Reaction to Triggers
1. Irritated airways become
more inflamed after
exposure to stimuli
2. Muscle layers around
airway constrict
3. Airway lining swells
4. Excess mucus builds up
in lumen
5. Result: symptoms of
cough, wheeze,
shortness of breath,
chest tightness
Environmental Risk Factors for
Development of Asthma






Indoor allergens
Outdoor allergens
Occupational sensitizers
Tobacco smoke
Air Pollution
Respiratory Infections
 Parasitic infections
 Socioeconomic
factors
 Family size
 Diet and drugs
 Obesity
 Hygiene hypothesis
A Lot Going On Beneath The Surface
Symptoms
Airflow
obstruction
Bronchial
hyperresponsiveness
Airway
inflammation
2007 NHLBI Guidelines
Add your text here
CLASSIFICATION OF SEVERITY

2007 NHLBI Guidelines
Stepwise Approach > 12 years
MANAGEMENT OF ASTHMA EXACERBATIONS:
School Treatment
Suggested
Emergency
Nursing
Protocol for
Students with
Asthma
Symptoms Who
Don’t Have a
Personal Asthma
Action Plan
MANAGEMENT OF ASTHMA EXACERBATIONS: School Treatment
Suggested
Emergency
Nursing Protocol
for Students with
Asthma
Symptoms Who
Don’t Have a
Personal Asthma
Action Plan
Schools: Potential Concerns

Poor indoor air quality
 Leaky roofs/wet carpeting
= Molds
 New carpeting/chemicals
= Toxic fumes
 Building
repairs/renovations =
Dust
 Idling school busses =
Diesel fumes
 Unventilated portable
classrooms

Fragrances (Magic
Markers, air fresheners,
art supplies)
 Animals in classroom
 Cleaning supplies
 Classroom environment
(old carpeting, furniture)
 Insecticides, herbicides,
fungicides
 Chalk dust, foods
 Access to medications
 Access to a school nurse
Questions?
Sign up to
be a
member
WV
Asthma
Coalition
Sunset Currituck
Sound OBX,NC
July 2011
len.picha@
camc.org