ASTHMA and ALLERGIES 1 Asthma and Allergies 1

ASTHMA and ALLERGIES 1

Asthma and Allergies 1. Housekeeping Items: - washrooms - refreshment break 2. Introductions 2

Learning Objectives ASTHMA 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. 3

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 4

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 5

Respiratory Process 6

Normal Airway 7

Asthma Airway 8

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. 9

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 10

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 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 11

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) 12

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/ahcasc/media/advisoriesavis/_2005/2005_107 -eng. php 13

How to Use Asthma Reliever Devices Nebulizers http: //www. youtube. com/watch? v=sv G 5 S 2 wn 4 x. Q&fe ature=Play. List&p =2965 F 6 CB 6 E 1 73565&playnext _from=PL&playn ext=1&index=8 14

Inhaler Use: http: //www. youtube. co m/watch? v=rf. Av. AI 6_o CY&feature=related 15

Aero Chamber with Mask http: //www. youtube. com/watch? v=i. SS 3 Hn. Xe. YSw&fe ature=channel 16

Review of Types of Devices for Asthma http: //www. uhn. ca/Clinics_&_Services/services/ asthma/docs/devices_poster. pdf http: //www. youtube. com/watch? v=f. Hc. G 8 DX Uwd. Q&feature=Play. List&p=2965 F 6 CB 6 E 17 3565&playnext_from=PL&playnext=1&index =10 17

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. 18

Emergency Plan Call 9 -1 -1 if: 1. 2. 3. 4. 5. If ‘Reliever’ medication does not provide relief of symptoms. If breathing difficulty increases. If the child’s lips or fingertips turn blue (or bluish tinge to skin). If the child loses consciousness or becomes increasingly tired (lethargic). EACH child with asthma should have an Emergency ACTION Plan. 19

EA Role in Asthma Know 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 selfmedicate. Know emergency plan! 20

ALLERGIES 21

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. 22

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 person’s blood pressure). 23

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. 24

Symptoms of Anaphylaxis The most distinctive symptoms of anaphylaxis include: v Hives - 88% v Swelling of the lips, tongue, throat tightening -56% v 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 25

Myths vs. Facts 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: 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 26

Most Common Food Allergies PeanutsTree nuts (# 1 most fatal food induced anaphylaxis trigger in Canada) Fish/Shellfish/Seaf ood Wheat Soy Eggs Sesame Seeds Food additives (sulfites i. e. MSG) Milk products 27

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). 28

STINGING INSECTS Bees Wasps Hornets Yellow Jackets Fire ants Black flies, mosquitoes bites cause swelling and itching but rarely anaphylaxis 29

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). 30

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. 31

ANAPHYLAXIS EMERGENCY PLAN 1. 2. 3. 4. Administer Autoinjector (Epi-Pen) even if symptoms are only suspected. CALL 9 -1 -1 immediately (even if symptoms subside). Position student so breathing is comfortable. CALL student’s parents. 5. Administer second Auto-injector (if symptoms have not improved in 10 -15 minutes while waiting for ambulance). www. epipen. com 32

Epi-Pen (Auto-injector) 1. 2. Watch DVD Identify Signs of Anaphylaxis How long does an Epi-Pen’s medication last? Answer: 10 -15 minutes 3. 4. 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. 33

Anaphylaxis Prevention 1. 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 34

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. 35

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. 36