Asthma Basics For
Para Professionals
Minnesota Department of Health
Asthma Program
Presenter
Susan Ross RN, AE-C
MDH Asthma Program Staff
612-676-5629
Susan.Ross@health.state.mn.us
Minnesota Department Of Health
Asthma Website:
www.health.state.mn.us/divs/hpcd/cdee/asthma
As You View This Program..
 Consider how many people you know who
have asthma?
 How will you use the information you
receive here today?
 How can you help students prevent their
asthma symptoms from appearing?
 How can you help improve asthma
management at your school?
Asthma:
Accounts for 14 million lost school days
annually3
Is the most common chronic disease
causing absence from school2
Is the leading cause of hospitalizations
among children under 152
1 in 13 school children have asthma1
6.3 million children under 18 have asthma1
1 Asthma Prevalence, Health Care Use, and Mortality, 2000-01, National Center for Health Statistics, CDC
2 Morbidity and Mortality Report, National Center for Health Statistics (NCHS), U.S. CDC, 2003
3 Surveillance for Asthma - United States, 1980-99, MMWR Surveillance Summaries, CDC, March 29, 2002
Minnesota Children
In a 2003 MDH survey of more than 5,000
7th & 8th graders at 15 junior highs outside
the metro area1 in 12 reported they currently have asthma
In a 2001 MDH survey of 13,000, 9th - 11th
graders in rural MN1 in 11 reported they currently have asthma
This Means..
In a class of 30 children, you can expect
2 to 3 students WILL have asthma!
The Goal Of Asthma Management
“Children should live happy, healthy, physically
active lives, without asthma symptoms slowing
them down “
Impact Of Asthma On Students
School Performance:
 Poorly controlled asthma has a negative
impact on school performance in both
academic achievement and physical
education
Impact Of Asthma On Students cont...
Psychosocial:
 Poor self-esteem
 Anxiety about asthma
 Fear of becoming ill at school
 Anxiety about exercise at school
 Fear of being different
What Is Asthma?
Asthma is a chronic disease that causes:
 Tightening of the muscles surrounding
the airways (Bronchoconstriction/spasm)
 Swelling of the small airways
(bronchioles)
 Over production of sticky mucus in the
airways
Normal Bronchiole
Inflamed Bronchiole
with Mucus
Common Symptoms Of Asthma
Frequent cough, especially at night
Shortness of breath or rapid breathing
Chest Tightness
Chest pain
Wheezing
Fatigue
Behavior changes
What Causes Asthma?
Asthma may be caused by genetic, immune and/or
environmental factors, and is often associated with
eczema (scaly skin patches) and allergies
Researchers do not understand all of the causes of
asthma or its increasing prevalence
It boils down to “We just don’t really know for
sure”
What Causes Asthma cont..
Of the 17 million asthma sufferers in the
US, 10 Million (approx. 60%) have allergic
asthma. 3 million of those are children1
Exposure to certain allergens trigger asthma
symptoms to begin
Exposure to certain irritants can also set an
asthma episode in motion
1
National Institute of Environmental Health Sciences
Triggers And Irritants
Copyright 2004, 3M Pharmaceuticals
Common Allergens (Triggers)
 Seasonal pollens
 Animal dander
/saliva/urine
 Dust mites
 Cockroaches/mice/rat
droppings and urine
 Mold
 Some medications
 Some foods
 Strong emotional feelings
Common Irritants (Triggers)
Exercise
Chemical irritants
Cold air
and strong smells
Strong emotional
feelings
Diesel fumes
Cleaning supplies
Chalk dust
Viral/upper
respiratory
infections
Air pollution
Tobacco smoke or
secondhand smoke
Every Child Is Unique!
Wheezing and coughing are the most
common symptoms -butNo two children will have the exact same
symptoms or the same trigger
Every child who has a diagnosis of asthma
should have access to a rescue inhaler!
Every child who has asthma should have an
asthma action plan at school (AAP)
Handling Asthma Episodes
What’s An “Episode”?
An asthma episode occurs when a child is
exposed to a trigger or irritant and their
asthma symptoms start to appear
This can occur suddenly without a lot of
warning, or brew for days before the
symptoms emerge
Episodes are preventable by avoiding
exposure to triggers and taking daily
controller medications (if prescribed)
How Do I Handle An Asthma Episode At
School?
1. Remain calm and reassure the child
2. If you know what triggered their episode,
move the child away from it
3. Have the child sit up and breathe slowly- in
through the nose, out through pursed lips
4. Contact the school nurse for assistance or
whomever is responsible for providing
medications in the nurses absence
Handling An Episode cont..
5. If you are responsible for medications, check
the child's asthma action plan, emergency care
plan or medication card for actions
6. Give “rescue or reliever” medications if ordered
and available (some students carry their own asthma
inhalers with them)
7. Have the child sip room temperature water/
fluids
8. Contact the parent or guardian as necessary
-AND-
Do NOT Leave The Child Alone!
Call 911 if..
 Lips or nail beds are bluish
 Child has difficulty talking, walking or drinking
 Quick relief or “rescue” meds (albuterol) is
ineffective or not available
 Neck, throat, or chest muscles are pulling in
(retracting)
 Nasal flaring occurs when inhaling
 Obvious distress
 Altered level of consciousness/confusion
 Rapidly deteriorating condition
Exercise Induced Asthma
What Is Exercise Induced
Asthma (EIA)?
 Tightening of the muscles around the airways
(bronchospasm)
 Distinct from “chronic” asthma in that it does
NOT cause swelling and mucus production in
the airways
 Can be avoided by taking pre-exercise
medications and by warming up/cooling down
EIA - What Happens?
 Symptoms
include coughing, wheezing,
chest tightness and shortness of breath
 Symptoms may begin during exercise and
can be worse 5 to 10 minutes after exercise
 EIA can spontaneously resolve 20 to 30
minutes after starting
 Can be avoided by doing the following:
Preventing Exercise Induced
Asthma (EIA)
 Become familiar with Asthma Action Plans, preexercise medication orders and or health care plan
 Student should use reliever (Albuterol) 15 -30
minutes before activity
 Do warm-up/ cool-down exercises before and after
activities
 Check outdoor ozone/air quality levels
www.aqi.pca.state.mn.us/hourly/
 Never encourage a child to “tough it out” when
having asthma symptoms
Medications
Medication: Determined By
Severity Level Classification
1. Mild Intermittent
Reliever only prn
2. Mild Persistent
Controller and reliever
3. Moderate Persistent
Controller plus long-acting bronchodilator and
reliever
4. Severe Persistent
Controller plus long-acting bronchodilator and
reliever
Two Categories Of Medications
 Controller Medications
 Taken every day to prevent swelling in
the lungs
 Reliever or Rescue Medications
 Taken only when needed to relieve
symptoms
 Or to prevent exercise induced asthma
from developing (taken before strenuous
exercise)
Controller Medications
 Keep swelling and mucus from developing
in the lungs
 Must be taken EVERY day even when the
child is not having symptoms
 Inhaled corticosteroids (ICS’s) are the most
common and effective way to control
asthma
 Help prevent asthma exacerbations from
developing!
Rescue Or Reliever Medications
 Are taken when asthma symptoms are
appearing (asthma episode)
 Are taken 15-30 minutes before strenuous
exercise/activity by children with EIA
 Do NOT reduce or prevent swelling from
developing in the lungs
 May be carried in school by a student only
IF approved by the doctor, school nurse and
parent!
Picture courtesy of American Lung Association of the Inland Counties CA 2004
Typical Spacers/Holding
Chambers
Spacers Or Holding Chambers
 Most MDI’s (metered dose inhalers) must be
used with a spacer or holding chamber
 This device attaches to the MDI and allows the user
to breathe in more medication effectively
 The physician must write an order for it when
prescribing your reliever medication
 Dry powder inhalers do NOT require spacers
How MDI Technology Works
How To Use Your Inhaler
How To Use:
Metered Dose Inhalers w/Spacers
1. Stand up (or sit up straight)
2. Shake the inhaler well to mix up the medicine
3. Remove the cap and check the spacer/inhaler for
foreign objects
4. Insert the inhaler into the spacer
5. Exhale all your air out fully
6. Before inhaling, put the mouthpiece of the spacer into
your mouth, over your tongue and between your teeth.
Close your lips around it while tilting your head and the
inhaler back slightly
Using An MDI Cont..
Press down on the inhaler canister and breathe in
slowly and deeply through your mouth
8. Hold your breath for 10 seconds, exhale
normally
9. If using a “reliever”, wait 1-2 minutes between
puffs
10. Repeat starting with #5 if a 2nd puff is ordered
11. Rinse your mouth and spit after using a
“controller” inhaler
7.
Minnesota Inhaler Law
MN Asthma Inhaler Law
Summary (2001)
Allows MN students to self-carry and administer
inhalers
In order for a child to carry his/her inhaler at school,
authorization and signatures from the following
individuals are required:
Child’s health care provider
Parent/guardian
Assessment and approval of the school nurse (if
present in district)
Be sure to check and follow policies and procedures in
local school district
Para Professionals Role
 Identify students with asthma
 Distribute & collect communication forms
 In the health office the RN may delegate specific tasks
such as:
 Documenting asthma visits by completing or initiating
student asthma records
 Asking about symptoms & check PFM levels
 Providing episodic care to students with asthma
symptoms including medication administration
 Communicating with parents regarding asthma
care/episodes
Communicate With The NURSE
 You are the eyes and ears for the nurse
 Be aware of students with asthma and their typical
symptoms
 Help remind students to pre-medicate before exercise
 Always document clearly and neatly what you see,
hear and what the student tells you
 Call the nurse with questions or urgent situations
 If you don’t know- ask!
 Don’t be afraid to call 911 in emergencies
Tools To Help Manage Asthma
Peak Flow Meters (PFM)
Peak Flow Meters
Measures how well the student’s lungs are
doing at that moment
Associated with the Green-Yellow-Red
system of managing asthma symptoms
Congruent with asthma action plans
Helps students and families self-manage
asthma
How to use a Peak Flow Meter
1. Review the steps
6. Blow out into the
meter as hard and
fast as possible
3. Place indicator at the
7. Write down the
base of the numbered
achieved number
scale
8. Repeat the process
4. Take a deep breath
twice more
5. Place the meter in the 9. Record the highest of
mouth and close lips
the three numbers
achieved
around the
mouthpiece
2. Stand up
Asthma Action Plan (AAP)
Asthma Action Plan Zones

Green Zone: All Clear/Breathing Good/Go
– No asthma symptoms and/or
– Peak flow 80-100% Predicted or Personal best

Yellow Zone: Caution/Slow Down
– Some asthma symptoms and/or
– Peak flow 50-80% Predicted or Personal best

Red Zone: Medical Alert/Stop
– Severe asthma symptoms and/or
– Peak flow < 50% Predicted or Personal best
Successful Asthma Management
Requires Everyone's Cooperation
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Teachers
Parents
Students
Medical Providers
Coaches
All School Personnel
Talk with your school Nurse to find out what YOU can do to
help manage asthma in your school