Asthma Medication Review for School Nurses PowerPoint Presentation

Slide 1 -

Medical Treatment of Asthma and Related Equipment / Gadgets

Slide 2 -

Overview Review of asthma medications Review and demonstration of common asthma equipment and gadgets Practical tips for integrating asthma medication and equipment/gadget knowledge into daily practice E8

Slide 3 -

Medication Treatment Goals Safe and effective medication delivery Provide the least amount of medication needed to allow the student to be active and symptom- free Avoid adverse effects from medications Meet students and families expectations regarding medication

Slide 4 -

Key Aspects In The Medical Treatment Of Asthma Relationship with a primary Health Care Provider who is knowledgeable of current asthma treatment guidelines Development, sharing, and use of a personalized Asthma Action Plan or Asthma Management Plan Monitoring of symptoms with a peak flow meter and pulmonary function testing

Slide 5 -

Key Aspects Continued… Catching early warning signs and referring for assessment or treatment Well asthma check-ups Every 6 months for asthma that is under control More frequently for asthma that is out of control Stepping up and down therapy as needed

Slide 6 -

Asthma Medication Overview

Slide 7 -

Controller vs. Reliever Meds Controller medication Daily medications for all persistent asthma Long term control Anti-inflammatory Reliever or Quick-relief medication Bronchodilators - As needed for all asthma severity levels Used PRN and preventative for EIA Bronchodilators Oral corticosteroid bursts

Slide 8 -

Methods Of Delivery Medications may be given by: Metered Dose Inhaler (MDI) Dry Powdered Inhaler (DPI) Nebulizer Orally Important to review technique for all delivery methods

Slide 9 -

Inhalers Press and Breathe Breath Actuated Dry Powder Aerosol

Slide 10 -

Aerosol Metered Dose Inhalers and Chambers / Spacers Use a spacer with an aerosol inhaler Gets more medication into the lungs (~5 x more than MDI alone) Fewer side effects such as smaller amount of absorbed medication systemically, less oral thrush and dyphonia F27

Slide 11 -

How MDI Technology Works

Slide 12 -

Holding Chamber / Spacer Use

Slide 13 -

Common Valved Holding Chambers and Spacers

Slide 14 -

Chamber / Spacer Demonstration MDI with common chambers / spacers Valved holding chamber (Aerochamber, Optichamber) Spacer (Ellipse, Optihaler) MDI with Inspirease spacer Cleaning chambers/ spacers F27

Slide 15 -

How To Use Your Inhaler

Slide 16 -

MDI Not Needing A Separate Chamber / Spacer Maxair Autohaler - Reliever /Rescue med Breath actuated and should not be used with a chamber or spacer Azmacort - Controller (daily) med Has a built-in spacer

Slide 17 -

Minnesota Inhaler Law

Slide 18 -

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) R8, R9

Slide 19 -

The Statute: Key Points Public elementary and secondary school students can possess and use inhalers if The parent has not requested that school personnel administer the medication and The school district receives annual written parental authorization and The inhaler is properly labeled and

Slide 20 -

Key Points Continued... 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 OR For schools without a school nurse, the student’s physician conducts the assessment and submits written verification

Slide 21 -

Discussion What knowledge and skills do students need to obtain before being allowed to independently carry and administer their inhalers? F19, F20

Slide 22 -

Medication: Determined By Severity Level Classification Mild Intermittent Reliever only prn Mild Persistent Controller and reliever Moderate Persistent Controller plus long-acting bronchodilator and reliever Severe Persistent Controller plus long-acting bronchodilator and reliever

Slide 23 -

Order Of Medication Administration If a student is taking both an inhaled reliever and an inhaled controller at the same time: Give the reliever medication first, before taking the controller Wait a few minutes between medications

Slide 24 -

Controllers Inhaled Corticosteroids Reduces airway swelling over time, decreases airway hyper-responsiveness Must be taken daily, even if no symptoms Will not relieve acute asthma symptoms

Slide 25 -

Controllers Inhaled Corticosteroids Cont... When used consistently over time will prevent/control inflammation and acute episodes Dose/strength may need to be increased or decreased depending on season of the year (step up / step down) Inhaled steroids start to work in days to weeks, oral steroids within 6-24 hours

Slide 26 -

Inhaled Corticosteroids Flovent (Fluticasone - MDI) Pulmicort (Budesonide - DPI or nebs) Asmanex (Mometasone) Azmacort (Triamcinolone) Beclovent, Qvar, Vanceril (Beclomethasone) Aerobid (Flunisolide)

Slide 27 -

Inhaled Corticosteroids Potential adverse effects Cough, dysphonia, thrush Therapeutic issues Chambers/spacers necessary for MDIs Different inhaled corticosteroids are not interchangeable Azmacort and Aerobid reportedly have particularly bad taste, Pulmicort Turbuhaler has no taste

Slide 28 -

Steroid Phobia: Unfounded! Inhaled steroids in doses most often prescribed are very safe Inhaled meds delivered directly to lungs where they are needed Little systemic absorption if proper technique used CAMP study results

Slide 29 -

Turbuhaler Use Demo Need deep, forceful inhalation May use Turbutester to help determine if an individual is able to use Counter (dots in window) turns red when doses running out

Slide 30 -

Non-Steroidal Anti-inflammatories Intal (Cromolyn) (also available as Intal HFA) Tilade (Nedocromil) For symptom prevention or as preventive treatment prior to allergen exposure or exercise Potential adverse effects None (Tilade tastes bad) Therapeutic issues Must be taken up to 4 times a day, maximum benefit after 4-6 weeks

Slide 31 -

IgE Blocker Therapy Xolair (Omalizumab) Dosing based on IgE levels and weight Only for ages over 12 years old Use in conjunction with other meds Must have evidence of specific allergy sensitivity Used for those with poorly controlled asthma and non-compliant with standard recommended therapy Delivered by SQ injection

Slide 32 -

Serevent Diskus (Salmeterol) Foradil (Formoterol)

Slide 33 -

Long-acting Beta-agonists Serevent (Salmeterol) (Diskus) Foradil (Fomoterol) (DPI) Potential adverse effects Tachycardia, tremors, hypokalemia Therapeutic issues Should not be used in place of anti-inflammatory therapy

Slide 34 -

Methylzanthines Theophyline For prevention of symptoms (bronchodilation, and possible epithelial effects) Potential adverse effects Insomnia, upset stomach, hyperactivity, bed wetting Therapeutic issues Must monitor serum concentrations, not helpful in acute exacerbations, absorption and metabolism affected by many factors

Slide 35 -

Combination Medication Advair (Flovent + Serevent) Combo corticosteroid and long acting beta-agonist 3 strengths: 100/50, 250/50, 500/50 Strengths based on Flovent doses, Serevent dose remains the same in all three strengths. Diskus Dry Powdered Inhaler Usual dosing, 1 inhalation every 12 hours Has remaining-dose counter F28

Slide 36 -

Diskus Demonstration Diskus (Advair and Serevent) Breath in deep and steady 1 breath per dose Counter tracks remaining doses 3 strengths Advair 100 (green label), 250 (yellow label), 500 (red label) 60 doses per diskus

Slide 37 -

Leukotriene Modifiers Singulair (Montelukast) Accolate (Zafirlukast) Zyflo 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 Potential adverse effects None significant elevation of liver enzymes Therapeutic issues Drug interactions, monitor hepatic enzymes (esp. Zyflo)

Slide 38 -

“Relievers” (Bronchodilators) Relaxes muscles in the airways to help relieve asthma symptoms Should be taken as needed for symptoms Need to wait 1-2 minutes between puffs for best deposition of medication in the lungs Overuse is a big warning sign indicating the child’s asthma may not be well controlled

Slide 39 -

Short-acting Inhaled Bronchodilators Proventil, Ventolin (Albuterol) Xopenex (Levalbuterol) Maxair Autohaler (Pirbuterol) Alupent (Metaproterenol) For relief of acute symptoms or as preventive treatment prior to exercise Potential adverse effects Tremors, tachycardia, headache Therapeutic issues Drugs of choice for acute bronchospasm F29

Slide 40 -

Anticholinergics Atrovent (Ipatromium Bromide) Combivent (Albuterol + Atrovent) For relief of acute bronchospasm, especially if albuterol alone isn’t effective Potential adverse effects Dry mouth, flushed skin, tachycardia Therapeutic issues Does not reverse allergy-induced bronchospasm or block exercise-induced asthma May have additive effect to beta-agonist, slower onset

Slide 41 -

Systemic Corticosteroids Pediapred Prelone Prednisone Orapred Prevents progression of moderate to severe exacerbations, reduces inflammation Potential adverse effects Short-term- increased appetite, fluid retention, mood changes, facial flushing, stomachache. Long term- growth suppression, hypertension, glucose intolerance, muscle weakness, cataracts

Slide 42 -

Systemic Steriods continued… 2 or more bursts a year signifies poor control and need for daily controller 5 bursts/year in asthma is considered “steroid dependent’’ and caution should be used Tapering of oral steroids Not needed if less than 10-14 days of burst

Slide 43 -

Herbal Therapy Ephedra (Ma Huang) Dangerous and should be avoided Potent CNS and CV stimulant Can be a precursor for methamphetamine FDA recently banned it’s use Many other herbal folk remedies used by different cultures

Slide 44 -

Remember To... Ask about daytime and nighttime symptoms and the frequency of albuterol use Assess current severity/control If poor control, refer to Health Care Provider to assess for need for controller/s or dosage change (step up or step down)

Slide 45 -

Remember To (Continued)… Be aware of meds that are not being used appropriately and educate student and family accordingly Give guidance and suggestions how to better obtain meds and gadgets for home AND school Consider family dynamics when communicating Check inhaler technique at every opportunity Reinforce successful behavior