ASTHMA and ASTHMA and ALLERGIESALLERGIES

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Asthma and AllergiesAsthma and Allergies

1. Housekeeping Items:- washrooms- refreshment break

2. Introductions

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Learning ObjectivesLearning Objectives

ASTHMA and ALLERGIESASTHMA and ALLERGIES

Describe Asthma and the effects on the airway.

List common triggers for asthma.

Identify symptoms of asthma and EA’s role.

Discuss prevention strategies.

Common interventions and Emergency Plans.

Discuss allergies and their symptoms.

Identify common allergens that cause anaphylaxis.

Define Anaphylaxis and Emergency treatment plan.

Identify strategies to increase knowledge of Anaphylaxis, Asthma, Allergens and Avoidance.

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ASTHMAASTHMA Facts:

10-15% of Canadian children have asthma

75% of children with asthma also have allergies

Asthma is the most common reason children miss school

Asthma can develop at any age, but most common in childhood

Can seem to get better in teenage years but may return later in adulthood 4

AsthmaAsthmaWhat is it?

◦Chronic lung disease affecting the airway of the lungs.

◦Causes inflammation, bronchospasms, excess mucus production in the airways.

◦Tends to run in families: Risk increases if family members have

allergies or asthma. Risk increases if you have allergic skin

problems i.e. eczema5

Respiratory ProcessRespiratory Process

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Normal AirwayNormal Airway

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Asthma AirwayAsthma Airway

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Asthma SymptomsAsthma Symptoms

Cough (most common symptom in children).

Whistling or wheezing sound in chest.

Chest tightness.Feeling short of breath:

◦ Symptoms vary in severity and not all are present in all persons. They can appear unexpectedly.

◦ Persons can experience asthma with colds or seasonal allergies.

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Triggers of AsthmaTriggers of AsthmaInhaled allergensDust mitesMouldsPets (can be any

type with feathers, skin, saliva, urine, or hair/fur)

Pollens◦ Trees, grasses, and

weeds

IrritantsAir pollutionPerfumesStrong cleaners,

paint, chemicalsSmoke (cigarette,

wood)Other:Viral infections

(common cold)Exercise-induced

bronchospasms

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Managing AsthmaManaging Asthma

Controllers (usually red or orange in colour)Also known as “Preventers”Anti-inflammatory medication that reduces

inflammation and mucous in the airways.Are taken every day and will reduce symptoms

over time. Should not be stopped when symptoms decrease (without doctor’s order) as they may return.

Common Controllers:◦ Pulmicort, Flovent which are inhalers with

corticosteroid medication to reduce inflammation.

◦ Newer tablet medications are Singulair and Accolate (Leukotriene Receptor Antagonists (LTRAs) are a class of oral medication that is not a steroid but also are anti-inflammatory that work on bronchospasms. 11

Asthma ManagementAsthma ManagementRelievers (usually BLUE colour)Also known as “Rescuers”.Are bronchodilators that relax the muscles of the

airway during a spasm and decrease mucous.Fast acting (usually within 1-5 minutes).Are short term fix only but can be used before

exercise or exposure to irritants/allergens. If used more than 4 times/week, controllers are

not effective enough and doctor should be consulted.

Common relievers- ◦ Ventolin (salbutamol)◦ Bricanyl (terbutaline)

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Combination Combination MedicationsMedications

Recent development of medications that contain both ‘controller and reliever’ components in one inhaler:◦Symbicort and Advair ◦Health Canada has issued an advisory

(October 2005) regarding use of these medications and treatment guidelineshttp://www.hc-sc.gc.ca/ahc-asc/media/

advisories-avis/_2005/2005_107-eng.php

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How to Use Asthma Reliever How to Use Asthma Reliever DevicesDevices

Nebulizers

http://www.youtube.c

om/watch?v=svG5S2wn4xQ&feature=PlayList&p=2965F6CB6E173565&playnext_fro

m=PL&playnext=1&index=8

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Inhaler Use:Inhaler Use:

http://www.youtube.com/

watch?v=rfAvAI6_oCY&fe

ature=related

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Aero Chamber with MaskAero Chamber with Mask http://www.youtube.com/watch?http://www.youtube.com/watch?v=iSS3HnXeYSw&feature=channelv=iSS3HnXeYSw&feature=channel

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Review of Types of Devices Review of Types of Devices for Asthmafor Asthmahttp://www.uhn.ca/Clinics_&_Services/services/asthma/docs/devices_poster.pdf

http://www.youtube.com/watch?v=fHcG8DXUwdQ&feature=PlayList&p=2965F6CB6E173565&playnext_from=PL&playnext=1&index=10

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Treatment PlanTreatment Plan

Asthma Attack Symptoms:

Chest tightensCoughingShortness of

breathWheezing

Treatment Plan:Assist child to take

‘Reliever’ medication.

Sit them up straight.

If allergen induced, remove from area.

Stay calm.Help child relax

and breathe.

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Emergency PlanEmergency PlanCall 9-1-1 if:Call 9-1-1 if:

1. If ‘Reliever’ medication does not provide relief of symptoms.

2. If breathing difficulty increases.3. If the child’s lips or fingertips turn

blue (or bluish tinge to skin).4. If the child loses consciousness or

becomes increasingly tired (lethargic).

5. EACH child with asthma should have an Emergency ACTION Plan. 19

EA Role in AsthmaEA Role in AsthmaKnow your student’s triggers and their

asthma care plan. Educate others!Watch for triggers as symptoms can

occur unexpectedly. Be aware of potential increase in

symptoms for both spring and fall.Assist with “Reliever” medication

administration if student unable to self-medicate.

Know emergency plan!20

ALLERGIESALLERGIES

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ALLERGIESALLERGIES

What is an allergy?◦An overactive immune system

response in which the body releases ‘antibodies’ to attack the foreign particles.

◦The antibodies then stick to the particles and release many chemicals, one which is known as ‘histamine’.

◦Histamine causes inflammation and can create allergy symptoms.

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Allergic SymptomsAllergic Symptoms◦Runny nose, sneezing◦Itchy eyes◦Hives◦General swelling◦Vomiting◦Trouble breathing◦Quickened heart rate ◦And finally, loss of consciousness

(due to drop in person’s blood pressure).

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ANAPHYLAXISANAPHYLAXISIs the life-threatening, most

severe form of an allergic reaction.

A medical EMERGENCY!Usually involves more than

one body system (i.e. respiratory, gastrointestinal, cardiovascular).

Can progress through systems quickly causing swelling and breathing difficulty.

Can occur at any time following exposure to allergen.

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Symptoms of AnaphylaxisSymptoms of AnaphylaxisThe most distinctive symptoms of anaphylaxis

include: Hives - 88% Swelling of the lips, tongue, throat tightening -

56% Difficulty breathing or swallowing/ wheezing -47%Generalized flushing, itching, or redness of the

skin -46%Abdominal cramps, nausea, vomiting, or diarrhea

-30%Rapidly decreasing blood pressure (and

accompanying paleness) -33%A sudden feeling of weakness, dizziness -33% Anxiety or an overwhelming sense of

doom/panic/anxietyA metallic taste or itching in the mouth Collapse Loss of consciousness

(http://www.epipen.com/page/causes-of-anaphylaxis-index)

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Myths vs. FactsMyths vs. FactsMyth:Myth:Anaphylaxis is

rare.Cause is always

known.Previous allergic

reaction will predict symptoms of next one

It is easy to AVOID what your allergic to.

Everyone has allergies.

Fact:Fact:Anaphylaxis

reaction is underreported.

Originating cause is often unexplainable.

No predictable pattern as reaction can change from mild to severe (anaphylaxis).

Most cases are due to accidental exposure.

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Most Common Food Most Common Food AllergiesAllergiesPeanuts\Tree nuts

(# 1 most fatal food induced anaphylaxis trigger in Canada)

Fish/Shellfish/Seafood

WheatSoyEggsSesame SeedsFood additives

(sulfites i.e. MSG)Milk products 27

Medication AnaphylaxisMedication AnaphylaxisPenicillin and

cephalosporin based antibiotics.

Aspirin (ASA) and NSAIDS (non-steroidal anti-inflammatory drugs) i.e. ibuprofen.

Anesthetic agents. Intravenous radio

contrast media (used for x-rays, dyes for contrast).

Immunizations and vaccines (often contain other ingredients such as milk protein, egg, sulfites). 28

STINGING INSECTSSTINGING INSECTS

BeesWaspsHornetsYellow JacketsFire ants

Black flies, mosquitoes bites cause swelling and itching but rarely anaphylaxis

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LATEXLATEX

Latex allergies are caused by the protein in natural rubber.

Allergies are on the increase due to:

Increased exposure to latex (increased glove use, band aids).

Children who have had multiple surgeries (with exposure to medical products….gloves, catheters, IV tubing).

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Exercise-Induced Exercise-Induced AnaphylaxisAnaphylaxis

Exercise can cause asthma or allergy anaphylaxis in some people.

Less common in children than teens and adults.

Most persons have a family history of allergies.

May be related to gender (females more than males), food intake before, other allergies and menses.

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ANAPHYLAXIS EMERGENCY ANAPHYLAXIS EMERGENCY PLANPLAN

1. Administer Auto-injector (Epi-Pen) even if symptoms are only suspected.

2. CALL 9-1-1 immediately (even if symptoms subside).

3. Position student so breathing is comfortable.

4. CALL student’s parents.

5. Administer second Auto-injector (if symptoms have not improved in 10-15 minutes while waiting for ambulance).

www.epipen.com32

Epi-Pen (Auto-injector)Epi-Pen (Auto-injector)

1. Watch DVD2. Identify Signs of Anaphylaxis

How long does an Epi-Pen’s medication last? Answer: 10-15 minutes

3. Practice with Epi-Pen trainers4. Review emergency plan

• www.epipen.com is a free resource to order Epi-Pen trainers and DVD for sharing the EDUCATION about anaphylaxis.

Discuss ways you can diminish the risk for children with allergies/anaphylaxis in your school.

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Anaphylaxis PreventionAnaphylaxis Prevention1. Avoidance

“avoidance is the cornerstone of preventing an allergic reaction. Much can be done to reduce the risk when avoidance strategies are developed”(Anaphylaxis in Schools and Other Settings, Canadian Society of Allergy and Clinical Immunology)

Create an allergy aware environment : Encourage hand washing as prevention to cross

contamination. Read ALL food labels for potential ‘hidden’

ingredients. Avoid all home baked and sharing of food.

Student should bring ALL own treats/ food from home.

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Avoidance Avoidance ContinuedContinued::

Plan for activities◦ Outdoors (for stinging insects):

avoiding areas where bees/wasps congregate Carry 2 Epi-Pens at all times. Each will last 15

minutes only. Avoid bright clothing and bold/flower prints. Wear shoes and long pants when walking in fields. Avoid using products with fragrance i.e. Cologne. Avoid eating outdoors. Avoid public trash baskets. Keep garbage containers closed and waste wrapped. Do not drink out of cans, bottles. Use a clear

container or protective lid.

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Anaphylaxis PreventionAnaphylaxis Prevention2. Education

Teaching others (parents, students, colleagues) about anaphylaxis reactions and cross contamination.

Emphasize difference between Anaphylaxis and seasonal allergies (common myth amongst people that food allergies only cause sneezing, itchy eyes etc. Most do NOT realize it could mean the ‘death of a child’).

3. Emergency Plans Know the anaphylaxis emergency plan of

each student! Know where the Epi-pens are located.

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