ASTHMA%20and%20ALLERGIES

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ASTHMA and ALLERGIES
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Asthma and Allergies

• Housekeeping Items
• - washrooms
• - refreshment break
• Introductions

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Learning Objectives ASTHMA and ALLERGIES

• Describe Asthma and the effects on the airway.
• List common triggers for asthma.
• Identify symptoms of asthma and EAs 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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ASTHMA

• 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

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Asthma

• What 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. eczema

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Respiratory Process
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Normal Airway
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Asthma Airway
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Asthma 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 Asthma

• Inhaled allergens
• Dust mites
• Moulds
• Pets (can be any type with feathers, skin,
  saliva, urine, or hair/fur)
• Pollens
• Trees, grasses, and weeds

• Irritants
• Air pollution
• Perfumes
• Strong cleaners, paint, chemicals
• Smoke (cigarette, wood)
• Other
• Viral infections (common cold)
• Exercise-induced bronchospasms

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Managing 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 doctors 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.

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Asthma Management

• Relievers (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 Medications

• 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 guidelines
• http//www.hc-sc.gc.ca/ahc-asc/media/advisories-av
  is/_2005/2005_107-eng.php

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How to Use Asthma Reliever Devices

• Nebulizers

• http//www.youtube.com/watch?vsvG5S2wn4xQfeature
  PlayListp2965F6CB6E173565playnext_fromPLplay
  next1index8

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Inhaler Use

• http//www.youtube.com/watch?vrfAvAI6_oCYfeature
  related

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Aero Chamber with Mask http//www.youtube.com/w
atch?viSS3HnXeYSwfeaturechannel
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Review of Types of Devices for Asthma

• http//www.uhn.ca/Clinics__Services/services/asth
  ma/docs/devices_poster.pdf
• http//www.youtube.com/watch?vfHcG8DXUwdQfeature
  PlayListp2965F6CB6E173565playnext_fromPLplay
  next1index10

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Treatment Plan

• Asthma Attack Symptoms
• Chest tightens
• Coughing
• Shortness of breath
• Wheezing

• 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 PlanCall 9-1-1 if

1. If Reliever medication does not provide relief
   of symptoms.
2. If breathing difficulty increases.
3. If the childs 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.

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EA Role in Asthma

• Know your students 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!

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ALLERGIES
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ALLERGIES

• 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 Symptoms

• Runny nose, sneezing
• Itchy eyes
• Hives
• General swelling
• Vomiting
• Trouble breathing
• Quickened heart rate
• And finally, loss of consciousness (due to drop
  in persons blood pressure).

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ANAPHYLAXIS

• Is 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 Anaphylaxis

• The 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/anxiety
• A 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. Facts

• 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.

• 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.

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Most Common Food Allergies

• Peanuts\Tree nuts
• ( 1 most fatal food induced anaphylaxis trigger
  in Canada)
• Fish/Shellfish/Seafood
• Wheat
• Soy
• Eggs
• Sesame Seeds
• Food additives (sulfites i.e. MSG)
• Milk products

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Medication Anaphylaxis

• Penicillin 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).

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STINGING INSECTS

• Bees
• Wasps
• Hornets
• Yellow Jackets
• Fire ants
• Black flies, mosquitoes bites cause swelling and
  itching but rarely anaphylaxis

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LATEX

• 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 Anaphylaxis

• 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 PLAN

• Administer Auto-injector (Epi-Pen) even if
  symptoms are only suspected.
• CALL 9-1-1 immediately (even if symptoms
  subside).
• Position student so breathing is comfortable.
• CALL students parents.

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

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Epi-Pen (Auto-injector)

• Watch DVD
• Identify Signs of Anaphylaxis
• How long does an Epi-Pens medication last?
• Answer 10-15 minutes
• Practice with Epi-Pen trainers
• 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 Prevention

• 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 Continued

• 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 Prevention

• 2. 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.