Asthma awareness asthma management in
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Asthma awareness asthma management in
- 1. Asthma Awareness & Management in the workplace Presenter: Elaine Peet Asthma Management Course Health (Drugs and Poisons) Legislation 1996 Amended 2008 Brought to you by
- 2. At end of workshop, you will be able to… Understand the need for blue reliever medication to a person having an asthma attack, within your current work setting. Have knowledge of the Asthma Friendly Workplace Guidelines. Brought to you by
- 3. Contents What is asthma? General asthma symptoms Signs of worsening asthma Asthma medications Why use a spacer Recognising and assessing an asthma attack Managing an asthma attack Exercise induced asthma Relevant Queensland legislation Brought to you by
- 4. Asthma in Australia 1 in 9 children (0 – 15 years) – Most common reason for presenting to emergency 1 in 10 adults 1 in 10 over 65 years of age – Most deaths from asthma occur in people over 65 years of age 10% 11% Brought to you by
- 5. Where does asthma occur? nose throat wind pipe airways air sacs diaphragm Brought to you by
- 6. What is asthma? People with asthma have trouble getting air in and out of their lungs The airways in the lungs become narrow, making it difficult to breathe Normal airway or when asthma is well managed The lining of the airways becomes red, swollen and sensitive The muscles around the airways tighten Brought to you by
- 7. Airways Normal airway or asthma well managed – pink – open – muscles relax Brought to you by
- 8. Airways during asthma The lining of the airway becomes red, swollen and sensitive and may produce extra mucus The muscles around the airway tighten Brought to you by
- 9. General asthma symptoms Cough – the body’s attempt to open up and clear the narrowed airways Wheeze – the whistling sound made as the air is pushed out through narrowed airways Shortness of breath – difficulty moving air in and out of the narrowed airways Chest tightness – the feeling when the muscles have tightened round the airways Brought to you by
- 10. Worsening asthma: what you may see Mild worsening Moderate worsening Severe worsening No problem speaking Speaking in short sentences only Only able to say few words in one breath Soft wheeze Loud wheeze Very stressed and anxious, pale, sweaty Minor trouble breathing Clear difficulty breathing Gasping for breath Cough Persistent cough May have blue lips Brought to you by
- 11. Other signs of worsening asthma Needing blue reliever more than 3 x a week Symptoms more than 3 x a week Blue reliever not working as well as usual or lasting as long Waking overnight or in morning with symptoms Reduced ability to do usual activities Brought to you by
- 12. Exercise induced asthma Trigger for 80% of people with asthma Can occur during and/or after exercise More likely if unwell or asthma is poorly controlled Brought to you by
- 13. Exercise induced asthma: How do you know? “Do you feel more breathless, tight in chest or wheezy 5 to 10 mins after you stop exercising than during exercise?” Brought to you by
- 14. Asthma medications Preventer USE DAILY Use to stop redness, swelling, sensitivity and extra mucus Reliever USE WHEN NEEDED Use to relax muscle around the airways Brought to you by
- 15. Medication - short acting relievers Use in Asthma First Aid Blue/grey colour Relieves symptoms within 4 minutes Can be used before exercise Safe and non-addictive Ventolin, Airomir, Asmol, Bricanyl Side effects – shaky hands, racing heart Store medication below 30 degrees celsius Brought to you by
- 16. Using a blue reliever to prevent exercise induced asthma Before exercise: – Warm up effectively – Use blue reliever at least 5 minutes before exercise – Do not exercise if unwell with asthma After exercise: - Cool down effectively - Monitor for signs of worsening asthma Brought to you by
- 17. Using a blue reliever to manage exercise induced asthma During exercise, if symptoms occur: – Stop activity and take blue reliever medication – Return to activity only when symptoms subside – If symptoms recur, take blue reliever medication. – Do NOT return to activity Brought to you by
- 18. Medications: Preventers Not for Asthma First Aid Reduce frequency and severity of attacks Taken regularly every day at home Various types and colours Brought to you by
- 19. Medication: Longer Acting Relievers Not for Asthma First Aid Relaxes airways for 12 hrs Takes up to 30 mins to work Not to be used without a preventer Serevent, Oxis Brought to you by
- 20. Medication: Combination Not for Asthma First Aid Combined preventer and longer acting reliever Dries up mucus, reduces swelling and relaxes muscles Taken regularly every day at home Seretide, Symbicort Brought to you by
- 21. Delivery devices Puffer and spacer with a facemask Puffer and spacer Brought to you by
- 22. What is a spacer? A clear plastic tube Stores puffed medication, allowing it to be breathed in Brought to you by
- 23. Why use a spacer? Results in up to 40% of medication reaching lungs (compared to 10% with puffer alone) Reduces side effects Easier to use AFQ recommends all puffer medications are delivered via a spacer. Brought to you by
- 24. Why use a spacer? Using spacer and puffer 40% reaches lungs Using puffer alone 10% reaches lungs Brought to you by
- 25. Which spacer for whom? Infant – 4/5 years of age use a small volume spacer use a facemask with the spacer. Children above 4/5 years of age may use a large volume spacer Brought to you by
- 26. How to use a puffer and spacer 1. Assemble spacer, if required 2. Remove the cap from the puffer 3. Hold puffer upright and shake well 4. Put the puffer mouthpiece into the end of the spacer 5. Tilt chin up and breathe out 6. Place the mouthpiece into your mouth and make a good seal with your lips. If using a spacer with a facemask, make a good seal over mouth and nose 7. Fire one puff of the puffer into the spacer 8. Breathe in and out for 4 breaths, maintaining seal 9. For additional puffs, repeat steps 3 - 8 Brought to you by
- 27. Cleaning a spacer Clean after each use Dismantle spacer and wash in detergent and hot water Do not rinse or wipe dry – allow to air dry When dry, wipe mouth piece with 70% alcohol swab Discard and replace spacer if contaminated with blood Ensure spacer is dry before returning to first aid kit Do not store in a plastic bag Brought to you by
- 28. Recognising and assessing an asthma attack Mild Attack – Cough – Soft wheeze – Minor trouble breathing – No problem speaking in sentences Severe Attack – (Dial 000 for an ambulance) – Very stressed and anxious – Gasping for breath Moderate Attack – Persistent cough – Loud wheeze – Clear difficulty breathing – Able to speak in short sentences only – Unable to speak more than a few words in one breath – Pale and sweaty – May have blue lips Brought to you by
- 29. To manage an asthma attack… time is critical Either: Follow the person’s Asthma Action Plan (if readily available) Or Follow the nationally recognised 4 step Asthma First Aid procedure Brought to you by
- 30. Asthma First Aid Brought to you by
- 31. Asthma First Aid Step 1 Sit the adult or child down Remain calm Provide reassurance Do not leave the person alone Brought to you by
- 32. Asthma First Aid Step 2 Give 4 puffs of a blue reliever One puff at a time through a spacer Ask the adult or child to take 4 breaths from the spacer after each puff Brought to you by
- 33. Asthma First Aid Step 3 Wait 4 minutes. Brought to you by
- 34. Asthma First Aid Step 4 If there is little or no improvement, repeat steps 2 and 3. If there is still little or no improvement, call an ambulance immediately. Continue to repeat steps 2 and 3 while waiting for the ambulance. Brought to you by
- 35. Asthma First Aid 1 2 3 4 Brought to you by
- 36. Health (drugs and poisons) Regulation 1996 – Queensland Health Amended September 2008: “To the extent necessary to perform first aid at a workplace or community event, a person who has completed an asthma management course approved by the chief executive is authorised to administer S3 salbutamol or S3 terbutaline.” – In this section – community event includes a sporting or recreational event. Brought to you by
- 37. Health (drugs and poisons) Regulation 1996 To purchase salbutamol or terbutaline: Must have completed Asthma First Aid Workshop (as approved by Queensland Government) Must have certificate or document that is available for viewing at time of purchasing reliever medication Brought to you by
- 38. What you can now do… Recognize an asthma attack and if needed assist in giving blue reliever medication Help to keep your workplace Asthma Friendly Understand the need to have Asthma First Aid available in the workplace Brought to you by
- 39. The Asthma Foundation of Queensland Services include: Nationally accredited courses for health professionals Free monthly community asthma workshops Community asthma education programs Research grants Support and information Asthma Info Line 1800 645 130 Website: www.asthmaqld.org.au Brought to you by
- 40. 011-25464531, 011-41425180, 011-66217387 +91-9818308353,+91-9818569476 othermotherindia@gmail.com www.other-mother.in https://www.facebook.com/pages/Other-Mother-Nursing-Crusade/224235031114989?ref=hl http://www.linkedin.com/profile/view?id=326103341&trk=nav_responsive_tab_profile https://twitter.com/othermotherindi https://cparveen.wix.com/other-mother A WORLDWIDE MISSITION Contact Us:- JOIN US
Notes de l'éditeur
- The Queensland Government has recently amended legislation to enable persons with appropriate asthma management training to purchase and administer blue reliever medications to manage a person suspected of having an asthma attack. This one hour workshop will provide you with the information you need to be able to purchase and administer blue reliever medication, within your current setting.
- The Queensland Government established specific learning objectives that must be covered in this workshop. This workshop contains all of these as outlined here.
- Currently, approximately 1 in 9 children aged 0 – 15 years will develop asthma. Asthma is the most common reason children under five years of age present to emergency departments and one of the most common reason for unplanned visits to a GP. 1 in 10 adults are diagnosed with asthma. 1 in 10 older persons are diagnosed with asthma, although it is estimated the prevalence is higher as many go undiagnosed. Most deaths from asthma occur in people over 65 years of age and the risk of dying from asthma increases as you age. The Queensland average is on par with the national average. Statistics indicate that there is no “good” or “bad” spot for asthma throughout the country.
- Asthma affects the very small airways located right at the bases of the lungs. It does not affect the larger breathing tubes leading down to the lungs. It is important to consider how we breathe in understanding asthma. When breathing normally, we breathe in through our nose and out through our mouth. The nose acts to warm and humidify the air, meaning that this warm, moist air is reaching our lungs. When a person is involved in physical activity or has a blocked nose, they are more likely to breathe in through their mouth, meaning that colder, drier air is reaching their airways. This cold, dry air is irritating to the airways, meaning they are more likely to experience a worsening of their asthma symptoms at these times. This also includes when sleeping, as we tend to mouth breathe when asleep.
- What is asthma? People with asthma have difficulty getting air into and out of their lungs. The airways in the lungs narrow due to three main changes: The lining of the airway becomes red and swollen The airway produces extra mucus and The muscles around the airways tighten. This results in a reduced amount of space for the air to travel through the airway.
- This image is of a normal airway. You can note that the airway is: Open, as the muscles are relaxed Free of mucus and Free of swelling.
- Airway during asthma In comparison, this airway has been affected by asthma. You will notice that the airway: Is much more swollen Is producing additional mucus and The muscle bands are tightening around the airways.
- There are 4 main symptoms that will alert someone to the fact they may have asthma. These include: Cough - this is the body’s attempt to open up and clear the narrowed airway; this cough may be a dry cough or it may be moist Shortness of breath – difficulty in catching breath Chest tightness – a feeling that the muscles have tightened around the airways and Wheeze – a whistling sound that is made as the air is pushed out narrowed airways. Whilst many people know about a wheeze, you may not always hear a wheeze. It is important to note that people may not experience all of these symptoms, they may only experience one or a combination of 2 or 3. Symptoms vary between individuals and may also vary for the same individual in different asthma attacks.
- This workshop is about preparing you to be able to assess and manage an asthma attack. Let’s cover the things to look out for if you suspect someone is having an asthma attack. The most helpful way to ascertain the seriousness of someone’s possible asthma attack is to ascertain how they are speaking. If they are able to speak almost normally, in sentences, their exacerbation is not serious. If however they are only able to speak in short sentences before needing to take a breath, this is a sign their asthma exacerbation is more serious. If a person is only able to say a few words before gasping for air, they are experiencing a serious asthma attack. Other things you can look and listen for: (progress through slide) We shall cover what you do to manage these situations shortly.
- People who have previously been diagnosed with asthma and take medication to manage it, will often have some indicators that their asthma is worsening over prior days – week. Of course, you are more likely to be needing to assess a person based on the criteria on the previous slide. However, if you work with someone everyday, or train children several times per week, you may have the opportunity to notice a few other things that could indicate their asthma is worsening. These include: (read slide) Please note: Needing blue reliever more than three times per week – this does not include the blue reliever a person may take before they exercise.
- Exercise is a major trigger of asthma. Approximately 80% of people with asthma will have their asthma triggered by being active/exercising. However, due to the overwhelming evidence on the benefits of physical activity for our general health, people with asthma should be encouraged to exercise as normal. Exercise induced asthma is much more likely to occur if the person is unwell or if their asthma is poorly controlled. If a person has been unwell with a cold, virus or if their asthma has been playing up, it is ESSENTIAL they do not exercise until they are well again and their asthma back under control. They are much more likely to experience a serious asthma attack if they exercise when unwell.
- True exercise induced asthma often occurs several hours after the end of physical activity. A normal example being a child playing school sport on Friday afternoon may feel a little breathless during the game, however, their symptoms will actually progressively worsen once the game has ended, sometimes up to many hours later. This is a true exercise induced asthma. A question that will provide the most information about whether it is exercise induced bronchoconstriction or exercise induced asthma is “Do you feel more breathless/wheezy 5 – 10 mins after you stop exercising?”. If yes, it is more likely to be exercise induced asthma.
- There are two main types of medication that are used to manage asthma: Preventers – which are used daily and aim to reduce the swelling and mucus that is produced by the airways and Relievers – which are used when needed to relax the muscles around the airways. Not everyone will be on a preventer. Some people’s asthma will be managed adequately on a blue reliever alone.
- Short acting relievers These are the most important medications for you to be aware of, as someone who will be able to manage an asthma attack. These are the only medications to be used if someone is having difficulty breathing. Short acting relievers are blue/grey in colour. They work to relax the muscles that are tightening around the airways, which are making breathing difficult. They work within four minutes to relieve the muscle tightening. There is no limit to the amount of blue reliever medication a person can be administered during an asthma attack. The drug is safe and non-addictive. The most common drug name is Ventolin. However, there is also Airomir, Asmol and Bricanyl. When receiving high doses of a blue reliever, a person may expect to feel jittery, have shaky hands etc. This is a normal response to the medication. Storage is an important consideration also – the current recommendations are that this medication is stored below 30 degrees celsius. Whilst this can be difficult in Queensland, it is important it is not left in a closed car or exposed to direct sunlight for hours on end.
- As mentioned earlier, people with asthma should not be avoiding exercise/being active, simply due to their asthma. Those who find their asthma does tend to be triggered by periods of physical activity do have options to enable them to prevent exercise induced asthma from occurring and to manage it when it does. To prevent exercise induced asthma, five minutes prior to physical activity, the person should administer themselves 2 puffs (or as directed by doctor) of blue reliever medication. This will relax any tightening of the airway muscles before exercising begins. Warming up is also essential, so the affected person can approach physical activity slowly and remain focused on their breathing. At the conclusion of the exercise/activity, it is again important to cool down effectively and to monitor the person for signs their asthma may be worsening, particularly after the game/activity has ended. Careful communication with the person’s carer/partner etc is important to ensure they aware of any symptoms experienced during or after physical activity. It is very important that people with asthma, who are unwell, do not exercise or participate in physical activity until their asthma improves.
- If a person does develop asthma symptoms (shortness of breath, coughing etc ) during physical activity, there are several important steps to take: Remove that person from the activity and assist them in administering blue reliever medication (as directed by doctor) Ensure the person sits down for sufficient time to enable the medication to work (4 – 5mins). If their symptoms have subsided, they are able to recommence activity, with your close supervision. If their symptoms do not subside, they must not resume physical activity at that time and need to be closely monitored for signs their asthma is worsening. Further blue reliever medication may be necessary. If they have recommenced activity and their asthma symptoms recur, they are to be removed from the activity and to again take puffs of their blue reliever medication. They should not return to physical activity at that time and must be closely monitored for signs their asthma is worsening.
- Preventers Preventer medications are designed to reduce the underlying swelling/inflammation in the airways and to dry up the mucus being secreted by the airways. Consistent use of preventer medications result in a reduced number of asthma attacks and a reduced severity of asthma attacks. Preventers will not be taken by every person with asthma. However, if a person has been prescribed a preventer, they are to take it everyday, often twice/day. This medication is not suitable for asthma first aid. It has no effect on relaxing the muscles around the airways
- Long Acting Relievers Long acting relievers, green in colour, work to relax the muscles around the airways. However, they are not to be used for managing an asthma attack. They take at least 30 mins to work in relaxing the airway muscles, which is obviously too long for a person experiencing an asthma attack.
- Combination medications Combination medications incorporate both a preventer (to reduce the swelling and mucus production) and a longer acting reliever (to relax the airway muscles in 30 mins). These medications are not to be used for asthma first aid, as they do not work quickly enough to relax the muscles around the airways.
- We shall now have a look at the delivery of asthma medications using a puffer and spacer or spacer with a facemask.
- A spacer is a clear tube into which asthma medications are sprayed, enabling the person to breathe the medication out of the tube. A spacer eliminates the need to coordinate the firing and breathing in that is necessary when using a puffer by itself.
- Evidence shows that using a spacer with a puffer is more effective than using a puffer by itself as: The use of a spacer results in four times more medication reaching the lungs (when using a puffer alone, approx 10% of medication reaches the lungs; when using a puffer and spacer, 40% reaches the lungs). It reduces side effects of medications such as shaking, as more medication is going into the lungs. It makes puffer medications easier to take than using the puffer alone and enables a person to assist in administering medication when necessary. The Asthma Foundation of Queensland recommends that all people with asthma use a spacer to take their puffer medications.
- This slide highlights the difference between the use of a puffer alone (resulting in 10% of medication reaching the lungs and the majority being swallowed) and a puffer and spacer (resulting in 40% of medication reaching the lungs)
- It is recommended children under 4-5 years of age, use a small volume spacer. However, a large volume spacer will suffice if it is the only type available. Children up to 4 years of age should also have a facemask attached to the spacer to make the medications easier to breathe in. However, this is very individual as many younger children will be able to use the spacer alone. Providing the child can manage to close their lips around the mouthpiece of the spacer, they should not need a facemask.
- People are encouraged to keep a spacer (and facemask, if required) with them at all times, however one should be kept in the first aid kit in case someone has forgotten their own. For this reason, strict cleaning procedures are essential. Follow steps on slide. The way in which you clean the spacer is also important to ensure the device is working properly. Because a spacer has a closed field of static electricity, medication can cling to the sides of the spacer when you spray it in. To prevent this happening, before its first use, the spacer (and facemask) should be washed in warm, soapy water and allowed to drip dry. You do not rinse out the soap and you do not towel dry the spacer and facemask. You are aiming for a build up of soap on the inside of the spacer. This then removes the static electricity field and allows the medication to stay in the air inside to be breathed in. Most importantly, in a workplace setting or at a sports club, where it may be used by multiple people, the spacer should be washed in this way after each person’s use. The mouthpiece and facemask should then be alco-wiped as above. Storage of spacers - spacers should not be stored in plastic bags, as this promotes the static electricity. They should either be stored in the box in which they come, or a lunch box or similar.
- One of the most important things to be aware of is how to assess if someone is having an asthma attack and how to manage the asthma attack. If we looked at a person who was having a mild asthma attack, they may look like they are having a little trouble breathing or are coughing, but probably won’t have any trouble speaking in sentences. As their condition is worsening, their cough is more likely to become persistent and it will become obvious that they are having difficulty breathing. They will only be able to speak in short sentences and you may be able to hear a wheeze. A person who is having a severe asthma attack will appear very stressed and anxious, pale and sweaty, will be gasping for breath and will be unable to speak more than a few words in one breath. As we discussed at the beginning of this workshop, one of the easiest things for people to remember to watch is how the person is speaking. If they are having little problem speaking, it is likely a mild attack. However, if the person is unable to say more than a word or two before gasping for breath, it is more likely to be a severe attack. You may be wondering when you intervene. A person who is having a mild asthma attack is likely to benefit from their blue reliever medication at this point in time. You do not wait until their condition becomes severe. However, it is incredibly important that the person is monitored ongoingly as they may need repeat doses of their medication. Another important note is that not everyone will follow these symptoms. Children in particular can deteriorate very rapidly, so ongoing careful monitoring is essential.
- Asthma first aid can be administered to people within your setting, under this amended legislation, whether or not they have been diagnosed with asthma
- Refer to slide: Additional notes It is important to only provide one puff at a time into the spacer. The puffer should be removed and shaken after each puff. The person must take 4 breaths to clear the medication from the spacer. If a child is crying, a facemask will assist you to hold the spacer on their face. Remember that even when they are crying, they still need to stop crying to take a breath – at this point they will breathe the medication in.
- Additional notes It is essential that the person is closely monitored during this time. 4 puffs of their blue reliever can be given every 4 minutes until medical help arrives. There is no limit to how much medication they can have.
- This legislation allows people with the appropriate asthma management training to purchase and administer blue reliever medication. The certificate must have an individual’s name on it and only the individual named can purchase and administer the reliever medication.