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Asthma

What is asthma?

Asthma is a chronic (ongoing) disease affecting the airway. There are two main parts of asthma, inflammation and airway obstruction:

Inflammation - People with asthma have swelling in the lining of the airways called inflammation.  This inflammation makes airways more sensitive to the things in the air that are breathed in.

Airway Obstruction - When sensitive airways become irritated the band of muscle surrounding the airway tightens, this is called obstruction.  People with asthma also have increased mucus production, this narrows the airway even more

What does asthma look like?

Asthma Diagram

When airways are healthy, they are more open so there is lots of room for air to pass through.

When asthma is uncontrolled, the airways are inflamed most of the time. There is inflammation and mucus. The muscles surrounding the airways may become tight, which means air has less room to pass in and out of the lungs. This causes breathing trouble, which might lead to wheezing or coughing.

When the sensitive airways become irritated, they swell even more. The muscle tightens further and more mucus forms, which makes the pathway for air even smaller. This causes severe breathing trouble, or an asthma flare-up/attack.

Common signs of asthma

Wheezing, coughing, chest tightness, shortness of breath, tired/decreased energy, itchy chin or tickly throat, younger children may complain of “stomach ache”

Some asthmatics display these symptoms frequently while others only have the symptoms once in a while.

There is no cure for asthma, but it can be controlled. Children who have their asthma under control can play with other kids and take part in sports. These children can sleep better because they do not wake up coughing, have more energy for school and playing. Most importantly, controlling your child’s asthma drastically decreases the risk of him/her dying because of asthma.

Medications

There are two main types: controller medications and rescue medications.

Controller medications are medications that people with asthma take every day, weather they are having symptoms or not.  These medications help to keep inflammation under control.  These medications do not work quickly and should NEVER be taken in an acute emergency.  They can be given in pill form, liquid, inhaler, or nebulizer. Common types:

  • Pumicort/Budesonide-available in nebulizer or dry powder inhaler
  • Flovent/Fluticasone-available in puffer or disk
  • Asmanex/Mometasone- twisthaler dry powder inhaler
  • Azmacort/Triamcinolone
  • Aerobid/Flunisolide
  • Qvar/ Beclomethasone
  • Combination Drugs (children over 12)
  • Advair-available in disk or puffer
  • Symbicort-available in puffer

Rescue medications are used when a person with asthma is having an attack.  These medications work quickly on the bands of muscle that tighten around the airway.  These medications should work quickly.  They are usually given in an inhaler or nebulizer, occasionally they may be a liquid.

  • Over the counter allergy medications such as Zyrtec, Claritin, and Allegra can be beneficial in helping allergy symptoms that can lead to asthma symptoms.
  • Singulair is also approved to help control asthma in children 12 months and older.

Triggers

Triggers are things that make asthma symptoms worse.  Helping people with asthma avoid there triggers is a key to asthma control.  Not all people with asthma have the same triggers. Here are some common triggers:

  • Scents and Chemicals: Aerosol sprays, perfumes, candles, air fresheners, cleaning agents, bleach and pesticides.  Try not to use around people with asthma, if it necessary use proper ventilation
  • Colds, Flu, and viruses:  Infections that cause airway inflammation can trigger asthma i.e. colds, flu, bronchitis, ear infections, sinus infections and pneumonia.  WASH HANDS FREQUENTLY! Proper hand washing is the best way to prevent the spread of infection.  Properly clean surfaces that are frequently touched or mouthed.  Flu vaccines are encouraged for people with asthma
  • Weather:  Some types of weather can trigger asthma.  Wind spreads pollen and mold.  Heat traps air pollution.  Cold air can be a trigger all by itself.  The best ways for people to control symptoms in varying weather is to take their controller medication, also to pay attention to weather conditions.  If cold air is a trigger, wearing a scarf over the nose and mouth when outside on cold days may help
  • Night Time:  The exact reason for asthma symptoms worsening at nighttime is unknown.  Some explanations of this may be, increased mucus, sinusitis, reclined position, GERD, a late phase reaction, and hormones involved with the circadian rhythm.   Ways to prevent this is to take controller medication, avoid triggers during the day and night, take GERD medication if this is a problem
  • Dust mites:  Dust mites are microscopic organisms that are present in most households.  They avoid light and absorb humidity.  They generally live in bedding, sofas, carpets, or any woven if the humidity is high enough.  Pillow and mattress covers can prevent this in beds.  Also washing bedding in 130 degree water once weekly.  Remove carpeting, use HEPA filtered vacuum.  Control humidity
  • Mold:  Mold thrives in damp environments, refrigerator dip trays, shower stalls, leaky sinks or pipes, basements.  It is necessary to remove existing mold and reduce humidity
  • Animal Dander:  Animal dander is made up of the dead skin cells or scales that are constantly shed.  Asthma can be triggered by proteins from dander, saliva, and urine.  Eliminate pets from home
  • Strong emotions such as crying or laughing can trigger asthma attacks.  Pursed lip breathing or belly breathing can be used to slow down breathing
  • Pollen (and or plant material):  Grasses, trees and weeds are the plants most likely to cause allergies.  Using air conditioners instead of opening windows during pollen seasons is best.  Limiting outdoor play when pollen counts are high can be helpful
  • Cockroaches:  Cockroach droppings contain allergens that have been proven to trigger asthma.  Cockroaches live in warm environments with easy access to food and water.  Remove garbage, food, and waste promptly.  Wash dishes immediately after use.  Eliminate water from leaky faucets and drains.  Pest removal can be done with traps or baits
  • Exercise:  Exercise can trigger asthma; however people with asthma should not avoid exercise.  Medications can be taken prior to exercise.  Warm ups prior to exercise, and starting exercise slowly can prevent symptoms.  Avoid exercise when it is very cold, very hot or humid, or air pollution or pollen levels are high
  • Air pollution:  Air pollution can be caused by car and truck exhaust, heavy construction equipment, even natural sources like fires and dust contribute to air pollution.  You can check air pollution levels at http://airnow.gov/
  • Smoke: All kinds of smoke can trigger asthma. The best way to protect your child is to quit smoking altogether (have link to UHS tobacco cessation). Urge any members of your household who smoke to quit. Keep your home and car free of tobacco smoke, incense, and smoke from a fireplace. Keep your child out of smoky places. Wear a different jacket to smoke and keep that jacket outside. Thirdhand smoke can also trigger asthma.

Asthma Control

There are three keys to control: keeping breathing tubes inside the lungs open, managing flare-ups or asthma attacks and reducing triggers.

The Asthma Action Plan is a set of guidelines for what to do when your child has symptoms. This plan is a major part of treatment and can help you determine whether or not your child’s asthma is under control.

Print an Asthma Action Plan

Talking to your doctor

Using the Asthma Diary, you can keep track of flare-ups and other incidents that you may not remember otherwise. It gives your doctor an idea of what kinds of things trigger asthma attacks and may need to change your medication or dosage.

Print an Asthma Diary

Take the “Rules of Two” quiz

Take the “Rules of Two” quiz to know if your asthma is under control

  1. Do you take your quick-relief inhaler more than TWO times per week?
  2. Do you awaken at night with asthma more than TWO times per month?
  3. Do you refill your quick-relief inhaler more than TWO times per year?

If you answer YES to any of the above questions, your asthma may not be as well-controlled as it could be.

Talk to your health care professional about your responses to these questions.

Having trouble getting medication?

Merck Patient Assistance Program

1-(800) 727-5400, 8:00am to 8:00pm ET Mon-Fri

Glaxoklinesmith assistance

http://www.bridgestoaccess.com/

http://www.gskforyou.com/

Ready to quit smoking?

The NYS Smokers Quitline can assist with nicotine replacement for up to 2 weeks for free

  • Call 1-866-NY-QUITS (1-866-697-8487)
  • UHS Nurse direct also offers a telephonic counseling service call 607-763-5091 for more info.

What is an asthma educator?

A certified asthma educator can be another member of your asthma management team. A certified asthma educator, is an expert in the education and counseling that you or your child needs. A certified asthma educator has up-to-date knowledge about asthma. This would include not only best practices in health education, but also knowledge about: Pathophysiology of asthma, medications, and how to take medications, triggers, and trigger reduction options, asthma diaries and asthma action plans.

For more information call
Jenny English RN AE-C
Asthma Coordinator UHS, New York 
(607) 763-6055 or 1-(800) 295-8088

ACOST supports asthma programs in Broome, Chenango,Tioga, Delaware, and Otsego counties of New York.

Asthma Education

Asthma or reactive airway disease is a chronic disorder that results in restricted breathing due to inflammation of the bronchial tubes, the main air passages in the lungs. Asthma affects 3 to 5 percent of adults and 7 to 10 percent of children in the United States. Severe asthma attacks cause approximately 11 deaths a day.

Three changes occur inside the airways of the lungs in people with asthma: the first change is inflammation, or swelling, whereby the airway becomes inflamed and produces thick mucus. Inflammation then leads to constriction of the muscles around the airways, causing the airways to narrow. This narrowing is also referred to as bronchospasm. The third change is increased sensitivity of the airways, causing the asthma patient to become overly sensitive to animal dander, pollen, cold air and tobacco smoke, just to name a few.

The primary symptoms of asthma are coughing, wheezing, and shortness of breathe. A child who has frequent coughing or respiratory infections should be checked for asthma.

UHS is the lead agency in providing pediatric asthma education services to local children since 1997.

Asthma Coalition of the Southern Tier

UHS works in conjunction with ACOST (Asthma Coalition of the Southern Tier). ACOST is a coalition partially funded by the American Lung Association and the NYS Health Department. The primary aims of the program are to:

  1. Reduce hospital admissions, emergency room visits, and missed school days
  2. Enhance the quality of life of children with asthma
  3. Develop a sustainable strategy for asthma management in the community
    • People who have asthma experience well over 100 million days of restricted activity each year, and asthma is believed it is to be the most common reason that students miss school.
    • Asthma is the leading cause of hospitalizations in children under 15.
    • Visits to the emergency rooms due to asthma are increasing. It is estimated that costs will exceed 14.5 billion.

The high prevalence of childhood asthma puts a huge burden on healthcare utilization and health care costs. To ensure appropriate management for all children with asthma remains available, existing healthcare resources are made available by ACOST coalition and UHS.

Coalition efforts include improving access to quality medical services, education, family community support, and support to schools introducing the Open Airway Program (OAS). OAS is designed to help previously diagnosed children to understand the warning signs, triggers, and use of asthma medications. OAS is a free asthma education program for ages 8-12 years of age. OAS is taught in 6 weekly sessions of 45 minutes each by specially trained nurses from Decker School of Nursing at Binghamton University.

Currently 130 children from 35 area schools are involved in OAS. Over 600 children diagnosed with asthma have been educated in one of the many programs offered by the coalition. Parents or guardians of OAS and are contacted by telephone for 1 year from start of program by an asthma nurse. Free packets of asthma education materials are sent to the home of children in the OAS program. These free packets help to assist parents and children how to “ control their asthma”. A free appointment may be scheduled with a certified asthma educator to provide one on one education.

In addition a case management program by physician referral provides a free home visit by a respiratory therapist medical personnel from UHS Home Care PHC. The purpose of this visit is to assess the environment of the home, provide education, and provide hypoallergenic mattress and pillow case covers. Professional education is also provided to school nurses, school transportation personnel, teachers, physical education instructors, coaches, head start programs, daycare centers, primary care providers, emergency departments and walk-in clinics in the five counties.

For more information call:
Jenny English RN, Certified Asthma Educator
763-6055

Acost supports asthma programs in Broome, Chenango, Tioga, Delaware, and Otsego counties.

View an Asthma Action plan for an Asthma Action plan that you can share with your doctor.