Medical Treatment  of Asthma and Related Equipment / Gadgets
Overview <ul><li>Review of asthma medications </li></ul><ul><li>Review and demonstration of common  asthma equipment and g...
Medication Treatment Goals <ul><li>Safe and effective medication delivery </li></ul><ul><li>Provide the least amount of me...
Key Aspects In The Medical Treatment Of Asthma <ul><li>Relationship with a primary Health Care  Provider who is knowledgea...
Key Aspects Continued… <ul><li>Catching early warning signs and referring for assessment or treatment  </li></ul><ul><li>W...
Asthma Medication Overview
Controller vs. Reliever Meds <ul><li>Controller medication   </li></ul><ul><li>Daily medications for all persistent asthma...
Methods Of Delivery   <ul><li>Medications may be given by: </li></ul><ul><ul><li>Metered Dose Inhaler (MDI)  </li></ul></u...
Inhalers <ul><li>Press and Breathe  Breath Actuated  Dry Powder </li></ul><ul><li>  Aerosol </li></ul>
Aerosol Metered Dose Inhalers and Chambers / Spacers <ul><li>Use a spacer with an aerosol inhaler </li></ul><ul><ul><li>Ge...
How MDI Technology Works
Holding Chamber / Spacer Use
Common Valved Holding Chambers and Spacers
Chamber / Spacer Demonstration <ul><li>MDI with common chambers / spacers </li></ul><ul><ul><li>Valved holding chamber (Ae...
How To Use Your Inhaler
MDI Not Needing A Separate Chamber / Spacer <ul><li>Maxair Autohaler  - Reliever /Rescue med </li></ul><ul><ul><li>Breath ...
Minnesota Inhaler Law
MN Asthma Inhaler Law Summary (2001) <ul><li>Allows MN students to self-carry and administer inhalers </li></ul><ul><li>In...
The Statute: Key Points <ul><li>Public elementary and secondary school students can possess and use inhalers  if </li></ul...
Key Points Continued... <ul><ul><li>The school nurse or other appropriate party assesses the student’s knowledge and skill...
Discussion <ul><li>What knowledge and skills do students need to obtain before being allowed to independently carry and ad...
Medication: Determined By  Severity Level Classification <ul><li>Mild Intermittent   </li></ul><ul><ul><li>  Reliever only...
Order Of Medication Administration <ul><li>If a student is taking both an inhaled reliever and an inhaled controller at th...
Controllers   Inhaled Corticosteroids <ul><ul><li>Reduces airway swelling over time, decreases airway hyper-responsiveness...
Controllers  Inhaled Corticosteroids Cont... <ul><ul><li>When used consistently over time will prevent/control inflammatio...
Inhaled Corticosteroids <ul><ul><li>Flovent  (Fluticasone  - MDI ) </li></ul></ul><ul><ul><li>Pulmicort  (Budesonide -  DP...
Inhaled Corticosteroids  <ul><li>Potential adverse effects </li></ul><ul><ul><li>Cough, dysphonia, thrush </li></ul></ul><...
Steroid Phobia: Unfounded! <ul><li>Inhaled steroids in doses most often prescribed are very safe </li></ul><ul><li>Inhaled...
Turbuhaler Use Demo <ul><li>Need deep, forceful inhalation </li></ul><ul><li>May use Turbutester to help determine if an i...
Non-Steroidal Anti-inflammatories <ul><li>Intal   (Cromolyn)  (also available as Intal HFA) </li></ul><ul><li>Tilade  (Ned...
IgE Blocker Therapy <ul><li>Xolair  (Omalizumab) </li></ul><ul><ul><li>Dosing based on IgE levels and weight </li></ul></u...
Serevent Diskus (Salmeterol) <ul><li>Foradil (Formoterol ) </li></ul>
Long-acting Beta-agonists <ul><li>Serevent   (Salmeterol )  (Diskus ) </li></ul><ul><li>Foradil  ( Fomoterol )  ( DPI ) </...
Methylzanthines   <ul><li>Theophyline   </li></ul><ul><ul><li>For prevention of symptoms (bronchodilation, and possible ep...
Combination Medication <ul><li>Advair   (Flovent + Serevent)  </li></ul><ul><ul><li>Combo  corticosteroid  and  long actin...
Diskus Demonstration <ul><li>Diskus (Advair and Serevent )   </li></ul><ul><li>Breath in deep and steady  </li></ul><ul><l...
Leukotriene Modifiers <ul><li>Singulair  (Montelukast) </li></ul><ul><li>Accolate  (Zafirlukast ) </li></ul><ul><li>Zyflo ...
“ Relievers”   (Bronchodilators) <ul><ul><li>Relaxes muscles in the airways to help relieve asthma symptoms </li></ul></ul...
Short-acting Inhaled Bronchodilators <ul><li>Proventil, Ventolin   (Albuterol) </li></ul><ul><li>Xopenex   (Levalbuterol) ...
Anticholinergics <ul><li>Atrovent   (Ipatromium Bromide) </li></ul><ul><li>Combivent  (Albuterol + Atrovent) </li></ul><ul...
Systemic Corticosteroids <ul><ul><li>Pediapred </li></ul></ul><ul><ul><li>Prelone </li></ul></ul><ul><ul><li>Prednisone </...
Systemic Steriods c ontinued… <ul><li>2 or more bursts a year signifies poor control and need for daily controller </li></...
Herbal Therapy <ul><li>Ephedra (Ma Huang) </li></ul><ul><ul><li>Dangerous and should be avoided </li></ul></ul><ul><ul><li...
Remember To... <ul><li>Ask about daytime and nighttime symptoms and the frequency of albuterol use </li></ul><ul><li>Asses...
Remember To  (Continued) … <ul><li>Be aware of meds that are not being used appropriately and educate student and family a...
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Medical Treatment of Asthma and related Equipments or Gadgets Medical Treatment of Asthma and related Equipments or Gadgets

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  • Medical Treatment of Asthma and related Equipments or Gadgets Medical Treatment of Asthma and related Equipments or Gadgets

    1. 1. Medical Treatment of Asthma and Related Equipment / Gadgets
    2. 2. Overview <ul><li>Review of asthma medications </li></ul><ul><li>Review and demonstration of common asthma equipment and gadgets </li></ul><ul><li>Practical tips for integrating asthma medication and equipment/gadget knowledge into daily practice E8 </li></ul>
    3. 3. Medication Treatment Goals <ul><li>Safe and effective medication delivery </li></ul><ul><li>Provide the least amount of medication needed to allow the student to be active and symptom- free </li></ul><ul><li>Avoid adverse effects from medications </li></ul><ul><li>Meet students and families expectations regarding medication </li></ul>
    4. 4. Key Aspects In The Medical Treatment Of Asthma <ul><li>Relationship with a primary Health Care Provider who is knowledgeable of current asthma treatment guidelines </li></ul><ul><li>Development, sharing, and use of a personalized Asthma Action Plan or Asthma Management Plan </li></ul><ul><li>Monitoring of symptoms with a peak flow meter and pulmonary function testing </li></ul>
    5. 5. Key Aspects Continued… <ul><li>Catching early warning signs and referring for assessment or treatment </li></ul><ul><li>Well asthma check-ups </li></ul><ul><ul><li>Every 6 months for asthma that is under control </li></ul></ul><ul><ul><li>More frequently for asthma that is out of control </li></ul></ul><ul><ul><li>Stepping up and down therapy as needed </li></ul></ul>
    6. 6. Asthma Medication Overview
    7. 7. Controller vs. Reliever Meds <ul><li>Controller medication </li></ul><ul><li>Daily medications for all persistent asthma </li></ul><ul><ul><ul><li>Long term control </li></ul></ul></ul><ul><ul><ul><li>Anti-inflammatory </li></ul></ul></ul><ul><li>Reliever or Quick-relief medication </li></ul><ul><li>Bronchodilators - As needed for all asthma severity levels </li></ul><ul><ul><ul><li>Used PRN and preventative for EIA </li></ul></ul></ul><ul><ul><ul><li>Bronchodilators </li></ul></ul></ul><ul><ul><ul><li>Oral corticosteroid bursts </li></ul></ul></ul>
    8. 8. Methods Of Delivery <ul><li>Medications may be given by: </li></ul><ul><ul><li>Metered Dose Inhaler (MDI) </li></ul></ul><ul><ul><li>Dry Powdered Inhaler (DPI) </li></ul></ul><ul><ul><li>Nebulizer </li></ul></ul><ul><ul><li>Orally </li></ul></ul><ul><li>Important to review technique for all delivery methods </li></ul>
    9. 9. Inhalers <ul><li>Press and Breathe Breath Actuated Dry Powder </li></ul><ul><li> Aerosol </li></ul>
    10. 10. Aerosol Metered Dose Inhalers and Chambers / Spacers <ul><li>Use a spacer with an aerosol inhaler </li></ul><ul><ul><li>Gets more medication into the lungs (~5 x more than MDI alone) </li></ul></ul><ul><ul><li>Fewer side effects such as smaller amount of absorbed medication systemically, less oral thrush and dyphonia F27 </li></ul></ul>
    11. 11. How MDI Technology Works
    12. 12. Holding Chamber / Spacer Use
    13. 13. Common Valved Holding Chambers and Spacers
    14. 14. Chamber / Spacer Demonstration <ul><li>MDI with common chambers / spacers </li></ul><ul><ul><li>Valved holding chamber (Aerochamber, Optichamber) </li></ul></ul><ul><ul><li>Spacer (Ellipse, Optihaler) </li></ul></ul><ul><li>MDI with Inspirease spacer </li></ul><ul><li>Cleaning chambers/ spacers </li></ul><ul><li>F27 </li></ul>
    15. 15. How To Use Your Inhaler
    16. 16. MDI Not Needing A Separate Chamber / Spacer <ul><li>Maxair Autohaler - Reliever /Rescue med </li></ul><ul><ul><li>Breath actuated and should not be used with a chamber or spacer </li></ul></ul><ul><li>Azmacort - Controller (daily) med </li></ul><ul><ul><li>Has a built-in spacer </li></ul></ul>
    17. 17. Minnesota Inhaler Law
    18. 18. MN Asthma Inhaler Law Summary (2001) <ul><li>Allows MN students to self-carry and administer inhalers </li></ul><ul><li>In order for a child to carry his/her inhaler at school, authorization and signatures from the following individuals are required: </li></ul><ul><ul><ul><li>Child’s health care provider </li></ul></ul></ul><ul><ul><ul><li>Parent/guardian </li></ul></ul></ul><ul><ul><ul><li>Assessment and approval of the school nurse (if present in district) </li></ul></ul></ul><ul><li>R8, R9 </li></ul>
    19. 19. The Statute: Key Points <ul><li>Public elementary and secondary school students can possess and use inhalers if </li></ul><ul><ul><li>The parent has not requested that school personnel administer the medication and </li></ul></ul><ul><ul><li>The school district receives annual written parental authorization and </li></ul></ul><ul><ul><li>The inhaler is properly labeled and </li></ul></ul>
    20. 20. Key Points Continued... <ul><ul><li>The school nurse or other appropriate party assesses the student’s knowledge and skills to safely possess and use the inhaler and enters a plan into the student’s health record </li></ul></ul><ul><ul><li>OR </li></ul></ul><ul><ul><li>For schools without a school nurse, the student’s physician conducts the assessment and submits written verification </li></ul></ul>
    21. 21. Discussion <ul><li>What knowledge and skills do students need to obtain before being allowed to independently carry and administer their inhalers? </li></ul><ul><li>F19, F20 </li></ul>
    22. 22. Medication: Determined By Severity Level Classification <ul><li>Mild Intermittent </li></ul><ul><ul><li> Reliever only prn </li></ul></ul><ul><li>Mild Persistent </li></ul><ul><ul><li>Controller and reliever </li></ul></ul><ul><li>Moderate Persistent </li></ul><ul><ul><li>Controller plus long-acting bronchodilator and reliever </li></ul></ul><ul><li>Severe Persistent </li></ul><ul><ul><li>Controller plus long-acting bronchodilator and reliever </li></ul></ul>
    23. 23. Order Of Medication Administration <ul><li>If a student is taking both an inhaled reliever and an inhaled controller at the same time: </li></ul><ul><ul><li>Give the reliever medication first, before taking the controller </li></ul></ul><ul><ul><li>Wait a few minutes between medications </li></ul></ul>
    24. 24. Controllers Inhaled Corticosteroids <ul><ul><li>Reduces airway swelling over time, decreases airway hyper-responsiveness </li></ul></ul><ul><ul><li>Must be taken daily, even if no symptoms </li></ul></ul><ul><ul><li>Will not relieve acute asthma symptoms </li></ul></ul>
    25. 25. Controllers Inhaled Corticosteroids Cont... <ul><ul><li>When used consistently over time will prevent/control inflammation and acute episodes </li></ul></ul><ul><ul><li>Dose/strength may need to be increased or decreased depending on season of the year (step up / step down) </li></ul></ul><ul><ul><li>Inhaled steroids start to work in days to weeks, oral steroids within 6-24 hours </li></ul></ul>
    26. 26. Inhaled Corticosteroids <ul><ul><li>Flovent (Fluticasone - MDI ) </li></ul></ul><ul><ul><li>Pulmicort (Budesonide - DPI or nebs ) </li></ul></ul><ul><ul><li>Asmanex (Mometasone) </li></ul></ul><ul><ul><li>Azmacor t (Triamcinolone) </li></ul></ul><ul><ul><li>Beclovent, Qvar, Vanceril (Beclomethasone) </li></ul></ul><ul><ul><li>Aerobid (Flunisolide) </li></ul></ul>
    27. 27. Inhaled Corticosteroids <ul><li>Potential adverse effects </li></ul><ul><ul><li>Cough, dysphonia, thrush </li></ul></ul><ul><li>Therapeutic issues </li></ul><ul><ul><li>Chambers/spacers necessary for MDIs </li></ul></ul><ul><ul><li>Different inhaled corticosteroids are not interchangeable </li></ul></ul><ul><ul><li>Azmacort and Aerobid reportedly have particularly bad taste, Pulmicort Turbuhaler has no taste </li></ul></ul>
    28. 28. Steroid Phobia: Unfounded! <ul><li>Inhaled steroids in doses most often prescribed are very safe </li></ul><ul><li>Inhaled meds delivered directly to lungs where they are needed </li></ul><ul><li>Little systemic absorption if proper technique used </li></ul><ul><li>CAMP study results </li></ul>
    29. 29. Turbuhaler Use Demo <ul><li>Need deep, forceful inhalation </li></ul><ul><li>May use Turbutester to help determine if an individual is able to use </li></ul><ul><li>Counter (dots in window) turns red when doses running out </li></ul>
    30. 30. Non-Steroidal Anti-inflammatories <ul><li>Intal (Cromolyn) (also available as Intal HFA) </li></ul><ul><li>Tilade (Nedocromil) </li></ul><ul><ul><li>For symptom prevention or as preventive treatment prior to allergen exposure or exercise </li></ul></ul><ul><ul><li>Potential adverse effects </li></ul></ul><ul><ul><li>None (Tilade tastes bad ) </li></ul></ul><ul><ul><li>Therapeutic issues </li></ul></ul><ul><ul><li>Must be taken up to 4 times a day, maximum benefit after 4-6 weeks </li></ul></ul>
    31. 31. IgE Blocker Therapy <ul><li>Xolair (Omalizumab) </li></ul><ul><ul><li>Dosing based on IgE levels and weight </li></ul></ul><ul><ul><li>Only for ages over 12 years old </li></ul></ul><ul><ul><li>Use in conjunction with other meds </li></ul></ul><ul><ul><li>Must have evidence of specific allergy sensitivity </li></ul></ul><ul><ul><li>Used for those with poorly controlled asthma and non-compliant with standard recommended therapy </li></ul></ul><ul><ul><li>Delivered by SQ injection </li></ul></ul>
    32. 32. Serevent Diskus (Salmeterol) <ul><li>Foradil (Formoterol ) </li></ul>
    33. 33. Long-acting Beta-agonists <ul><li>Serevent (Salmeterol ) (Diskus ) </li></ul><ul><li>Foradil ( Fomoterol ) ( DPI ) </li></ul><ul><li>Potential adverse effects </li></ul><ul><ul><li>Tachycardia, tremors, hypokalemia </li></ul></ul><ul><li>Therapeutic issues </li></ul><ul><ul><li>Should not be used in place of anti-inflammatory therapy </li></ul></ul>
    34. 34. Methylzanthines <ul><li>Theophyline </li></ul><ul><ul><li>For prevention of symptoms (bronchodilation, and possible epithelial effects ) </li></ul></ul><ul><li>Potential adverse effects </li></ul><ul><ul><li>Insomnia, upset stomach, hyperactivity, bed wetting </li></ul></ul><ul><li>Therapeutic issues </li></ul><ul><ul><li>Must monitor serum concentrations, not helpful in acute exacerbations, absorption and metabolism affected by many factors </li></ul></ul>
    35. 35. Combination Medication <ul><li>Advair (Flovent + Serevent) </li></ul><ul><ul><li>Combo corticosteroid and long acting beta-agonist </li></ul></ul><ul><ul><li>3 strengths: 100/50, 250/50, 500/50 </li></ul></ul><ul><ul><li>Strengths based on Flovent doses, Serevent dose remains the same in all three strengths. </li></ul></ul><ul><ul><li>Diskus Dry Powdered Inhaler </li></ul></ul><ul><ul><li>Usual dosing, 1 inhalation every 12 hours </li></ul></ul><ul><ul><li>Has remaining-dose counter </li></ul></ul><ul><ul><li>F28 </li></ul></ul>
    36. 36. Diskus Demonstration <ul><li>Diskus (Advair and Serevent ) </li></ul><ul><li>Breath in deep and steady </li></ul><ul><li>1 breath per dose </li></ul><ul><li>Counter tracks remaining doses </li></ul><ul><li>3 strengths Advair 100 (green label), </li></ul><ul><li> 250 (yellow label), 500 (red label) </li></ul><ul><li>60 doses per diskus </li></ul>
    37. 37. Leukotriene Modifiers <ul><li>Singulair (Montelukast) </li></ul><ul><li>Accolate (Zafirlukast ) </li></ul><ul><li>Zyflo </li></ul><ul><ul><li>Oral: Prevention of symptoms in mild persistent asthma, and/or to enable a reduction in dosage of inhaled steroids in moderate to severe persistent asthma </li></ul></ul><ul><ul><li>Potential adverse effects </li></ul></ul><ul><ul><li>None significant elevation of liver enzymes </li></ul></ul><ul><ul><li>Therapeutic issues </li></ul></ul><ul><ul><li>Drug interactions, monitor hepatic enzymes (esp. Zyflo) </li></ul></ul>
    38. 38. “ Relievers” (Bronchodilators) <ul><ul><li>Relaxes muscles in the airways to help relieve asthma symptoms </li></ul></ul><ul><ul><li>Should be taken as needed for symptoms </li></ul></ul><ul><ul><li>Need to wait 1-2 minutes between puffs for best deposition of medication in the lungs </li></ul></ul><ul><ul><li>Overuse is a big warning sign indicating the child’s asthma may not be well controlled </li></ul></ul>
    39. 39. Short-acting Inhaled Bronchodilators <ul><li>Proventil, Ventolin (Albuterol) </li></ul><ul><li>Xopenex (Levalbuterol) </li></ul><ul><li>Maxair Autohaler (Pirbuterol) </li></ul><ul><li>Alupent (Metaproterenol) </li></ul><ul><ul><li>For relief of acute symptoms or as preventive treatment prior to exercise </li></ul></ul><ul><li>Potential adverse effects </li></ul><ul><ul><li>Tremors, tachycardia, headache </li></ul></ul><ul><li>Therapeutic issues </li></ul><ul><ul><li>D rugs of choice for acute bronchospasm F29 </li></ul></ul>
    40. 40. Anticholinergics <ul><li>Atrovent (Ipatromium Bromide) </li></ul><ul><li>Combivent (Albuterol + Atrovent) </li></ul><ul><ul><li>For relief of acute bronchospasm, especially if albuterol alone isn’t effective </li></ul></ul><ul><li>Potential adverse effects </li></ul><ul><ul><li>Dry mouth, flushed skin, tachycardia </li></ul></ul><ul><li>Therapeutic issues </li></ul><ul><ul><li>Does not reverse allergy-induced bronchospasm or block exercise-induced asthma </li></ul></ul><ul><ul><li>May have additive effect to beta-agonist, slower onset </li></ul></ul>
    41. 41. Systemic Corticosteroids <ul><ul><li>Pediapred </li></ul></ul><ul><ul><li>Prelone </li></ul></ul><ul><ul><li>Prednisone </li></ul></ul><ul><ul><li>Orapred </li></ul></ul><ul><ul><li>Prevents progression of moderate to severe exacerbations, reduces inflammation </li></ul></ul><ul><li>Potential adverse effects </li></ul><ul><ul><li>Short-term- increased appetite, fluid retention, mood changes, facial flushing, stomachache. Long term- growth suppression, hypertension, glucose intolerance, muscle weakness, cataracts </li></ul></ul>
    42. 42. Systemic Steriods c ontinued… <ul><li>2 or more bursts a year signifies poor control and need for daily controller </li></ul><ul><li>5 bursts/year in asthma is considered “steroid dependent’’ and caution should be used </li></ul><ul><li>Tapering of oral steroids </li></ul><ul><ul><li>Not needed if less than 10-14 days of burst </li></ul></ul>
    43. 43. Herbal Therapy <ul><li>Ephedra (Ma Huang) </li></ul><ul><ul><li>Dangerous and should be avoided </li></ul></ul><ul><ul><li>Potent CNS and CV stimulant </li></ul></ul><ul><ul><li>Can be a precursor for methamphetamine </li></ul></ul><ul><ul><li>FDA recently banned it’s use </li></ul></ul><ul><li>Many other herbal folk remedies used by different cultures </li></ul>
    44. 44. Remember To... <ul><li>Ask about daytime and nighttime symptoms and the frequency of albuterol use </li></ul><ul><li>Assess current severity/control </li></ul><ul><li>If poor control, refer to Health Care Provider to assess for need for controller/s or dosage change (step up or step down) </li></ul>
    45. 45. Remember To (Continued) … <ul><li>Be aware of meds that are not being used appropriately and educate student and family accordingly </li></ul><ul><li>Give guidance and suggestions how to better obtain meds and gadgets for home AND school </li></ul><ul><li>Consider family dynamics when communicating </li></ul><ul><li>Check inhaler technique at every opportunity </li></ul><ul><li>Reinforce successful behavior </li></ul>

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