Pediatric asthma update and School Environments

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Pediatric asthma update and School Environments

• Anne Turner-Henson
• Linda Gibson
• UAB School of Nursing

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Objectives

• To describe diagnosis and management of an acute
  asthma exacerbation in school age populations.
• To demonstrate correct technique for use of
  asthma products such as peak flow meters, metered
  dose inhalers, nebulizers, spacers, and dry
  powder inhalers and describe patient education
  strategies for children/adolescents and families.
  
• To discuss common environmental triggers and
  specific avoidance counseling as it relates to
  the school environment. 
• To describe strategies used to promote healthy
  school environments and reduce environmental
  risks for children/adolescents and school
  personnel. 

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Asthma

• A Chronic Inflammatory Disorder of the Airways
• Cannot be Cured Can be Controlled

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Pathophysiology

• Airways become swollen
• Airways are squeezed
• Airways make mucus

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Pathology of Asthma
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Symptoms

• Cough
• Chest Tightness
• Wheeze
• Breathlessness

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Risk Factors

• Genetic characteristics
• Environmental exposures leading to diagnosis
• Environmental exposures leading to attack

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Prevalence

• 9 million children under age 17
• Rates highest in minority children and those
  living in urban areas
• One of the most common chronic illnesses in
  children
• 50 of children with asthma miss 6 or more days
  per year
• 45 report having an exacerbation in the past
  year
• Approximately 12 of school age children in the
  US have asthma

Vital Health Statistics 2006
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Prevalence

• 1 Inpatient Hospital Diagnosis in Children
• 1 Reason for missed school days
• 1 Reason for missed work days

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Differences between children and adults
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Upper Airway Differences

• Small naso-pharynx oropharynx
• Rapid lymph tissue growth
• Small nares
• Large tongue
• Long, floppy epiglottis

• Larynx glottis higher in neck
• Cartilage in neck very flexible
• Fewer functional muscles in airway
• Large amount of soft tissue loose mucus
  membranes

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Lower Airway Differences

• Immature alveoli
• Small airway lumen lung volume
• Diaphragmatic breather
• Obligatory nose breather

• Bronchiole lining loosely attached
• Immature accessory muscles
• Flexible thoracic
• Cavity

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UNNECESSARY LIMITATIONS DUE TO ASTHMA

• Sporting events
• School trips
• Physical education
• Play activities
• Playing instruments

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Mechanisms Underlying the Definition of Asthma

• Risk Factors
• (for development of asthma)
• Airway
• Hyperresponsiveness Airflow Obstruction
• Symptoms
• Risk Factors
• (for exacerbations)

INFLAMMATION
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DIAGNOSIS

• WHEEZING DOES NOT ALWAYS MEAN ASTHMA
• ASTHMA MAY BE PRESENT WITHOUT WHEEZE

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Patient Checklist

• Nighttime cough
• Cough or wheeze with increased physical activity
• Cough, wheeze, or chest tightness after exposure
  to allergen
• Relief of symptoms with bronchodilator

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School Issues

• Mold and mildew
• Animals in the classroom
• Carpets in the classroom
• Cockroaches
• Air quality fumes, vapors, cigarette smoke

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NHLBI, 2007

• Diagnosis
• Classification
• Medical Management
• Environmental Control

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Quick-Relief

• Short-acting B2 agonist bronchodilator
• Proventil (Albuterol, Ventolin)
• Maxair (Pirbuterol)
• Xopenex
• Prednisone