Transcript Asthma - Minnesota Department of Health

Managing Asthma In Minnesota
Schools
“A Comprehensive Resource &
Training for School Personnel”
Developed and Provided by:
Presenters For Today
Susan K. Ross RN, AE-C
MDH Asthma Program Staff
651-201-5629
[email protected]
&
Denise Herrmann LSN, CNP, AE-C
St. Paul Public Schools
[email protected]
Minnesota Department of Health
www.health.state.mn.us/asthma
Acknowledgements
Our Advisory Group consisted of participants from
every region of the state!
See the acknowledgements page at the beginning
of the manual.
Special thanks to:
Denise Herrmann from SPPS
Minneapolis Public Schools
“Healthy Learners Asthma Initiative”
Cheryl Smoot MDH
Funding grant awarded by:
Centers for Disease Control and Prevention (CDC)
Thanks To:
•
•
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GlaxoSmith Kline Pharmaceuticals
AstraZeneca Pharmaceuticals
Starbright Foundation
Hennepin County Medical Center
For contributing PFM’s, Spacers, Diskus,
asthma booklets and CD-Rom games for our
participants
Overview of Today

Asthma Basics
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
Asthma triggers and irritants
Diagnostic/ assessment process
NIH/NHLBI/NAEPP asthma guideline overview
Severity level workout
Medication Overview
 Asthma “gadgets”
 Controlling Asthma
 Tools available (MDH website-Manual)
 Coordinated School Health
Post Tests - Evaluations
C.E.U’s
Complete the post test
Complete the program evaluation
Complete your goals sheet
Hand everything in before you leave
You will be eligible to receive credit for
7.2 C.E.U’s after attending today's
presentation
As We Go Through This
Program
 Consider how you would use the tools
provided today.
 How can you take this information and use
it to establish an asthma program in your
school or district?
 How can you promote involvement by
other school personnel outside the health
office?
How To Use This Manual
 Resource and Training document
 Each Section is all-inclusive to each staff
member’s role
 Lift out the entire section - copy it and use as a
basis for teaching about asthma
 Supplemental forms/handouts are in the back
folders and provided on CD and website
 Full resources section w/websites are listed
 Power Point presentations are also on our
asthma website and CD in back of your manual
You Should Know!
This manual contains suggestions for
action and you are strongly urged to
consult your school district policies and
guidelines before implementing these
suggestions.
Staffing Models
 School health staffing varies greatly
across the entire state
 The manual provides a few suggested
staffing models in the “All Health Staff”
section
 Today’s program is based on a school
that has at least some LSN/PHN/RN
staffing in the school on regular basis
PRE- TEST
Mikey’s Mom Didn’t Know
Asthma Could Kill…
From GlaxoSmithKline and
Allergy & Asthma Network, Mothers of Asthmatics
(AANMA)
Did You Know..
Asthma kills people equally regardless of
severity level
 1/3 of deaths are in those with mild asthma
 1/3 of deaths are in those with moderate asthma
 1/3 of deaths are in those with severe asthma
Asthma:
 Accounts for 14 million lost school days annually3
 Is the most common chronic disease causing
absence from school2
 Is the 3rd leading cause of hospitalizations among
children under 152
 1 in 13 school children have asthma1
 6.3 million children under 18 have asthma1
1 Asthma Prevalence, Health Care Use, and Mortality, 2000-01, National Center for Health Statistics, CDC
2 Morbidity and Mortality Report, National Center for Health Statistics (NCHS), U.S. CDC, 2003
3 Surveillance for Asthma - United States, 1980-99, MMWR Surveillance Summaries, CDC, March 29, 2002
Minnesota Children
In a 2005 MDH re-surveyed 3,500 7th & 8th
graders at 12 junior highs outside the metro area 1 in 10 reported they currently have asthma
In a 2001 MDH survey of 13,000, 9th - 11th
graders in rural MN 1 in 11 reported they currently have asthma
This means..
In a class of 30 children, you can expect
2 to 3 students WILL have asthma
This number varies depending on age and
geographical location
“ Healthy Children Learn Better”
Do School Children Have Asthma
Action Plans?
In MDH’s survey of 7th and 8th graders in
greater Minnesota:
 40% of the children who had asthma did not know
if they had a written asthma action plan
 24% did not have an asthma action plan
 Overall, only 35% of children who have asthma
actually had asthma action plans
Asthma & Exercise
Of the 7th & 8th graders with asthma:
 31% reported missing recess, sports or
other physical activities due to asthma
symptoms
 25% reported missing a day or more of
school in the past year due to asthma
symptoms
 70% reported wheezing “sometimes” or “a
lot”
Survey Conclusions
 There is substantial uncontrolled asthma among
school children in this age group
 This lack of control is manifested by the high rate
of morbidity as measured by school absence and
missed activities among children who have been
diagnosed with asthma
 The survey also suggests that there may be
substantial undiagnosed asthma
Impact Of Asthma On Students
School Performance:
 Poorly controlled asthma has a negative
impact on school performance in both
academic achievement and physical
education
Impact Of Asthma On Students
cont...
Psychosocial:
 Poor self-esteem
 Anxiety about asthma
 Fear of becoming ill at school
 Anxiety about exercise at school
 Fear of being different
YOU Can Make A Difference!
What Is Asthma?
Asthma is a chronic disease that causes:
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Bronchoconstriction (obstruction that is reversible)
Inflammation of the bronchioles (small airways)
Hyper-responsive “twitchy” airways
Excessive mucus production in the bronchioles
Normal Bronchiole
Inflamed Bronchiole
with Mucus


During an asthma attack, smooth muscles
located in the bronchioles of the lung
constrict and decrease the flow of air in
the airways. Inflammation or excess
mucus secretion can further decrease the
amount of air flow.
Airway Obstruction
Copyright 3M Pharmaceuticals 2004
A Lot Going On Beneath The Surface
Symptoms
Airflow
obstruction
Bronchial
hyperresponsiveness
Airway
inflammation
Slide courtesy of ALAMN - PACE program 2004
Immune System Response
The Asthma Cascade
© 2003 Genentech, Inc. and Novartis Pharmaceuticals Corporation.
Mediator Phases
 Early-phase reaction caused by mediator
release, usually peaks within an hour after
initial exposure to the allergen.
 Three to four hours after an acute asthma
episode, a "late-phase reaction" may
occur and may last up to 24 hours
The End Results Of The Cascade
 Localized mucosal edema in the walls
of the small bronchioles
 Secretion of thick mucus into the
bronchiolar lumens
(Clogs and narrows the airways)
 Spastic contraction of bronchiolar
smooth muscle
A CHILD CAN’T BREATHE
Group Straw Exercise
1. Stand up
2. Place the straw in your mouth
3. Try to breathe!
This is what is may feel like when a child
is having a severe asthma episode
Common Symptoms Of Asthma
Frequent cough, especially at night
Shortness of breath or rapid breathing
Chest tightness
Chest pain
Wheezing
Fatigue
Early Signs Of An Asthma
“Episode”
 Mild cough
 Drop in Peak Flow
reading
 Itchy, watery or glassy
eyes
 Itchy, scratchy or sore
throat
 Runny nose
 Stomachache
 Headache
 Sneezing
 Congestion
 Restlessness
 Dark circles under
eyes
 Irritability
Acute Asthma Episodes
What’s An “Episode”?
 An asthma episode occurs when a child is
exposed to a trigger or irritant and their asthma
symptoms start to appear
 This can occur suddenly without a lot of
warning, or brew for days before the symptoms
emerge
 Episodes are preventable by avoiding exposure
to triggers and taking daily controller
medications (if prescribed)
Handling Acute Asthma Episodes
At School
 Remain calm and reassure the child
 Have the child sit up and breathe slowly- in
through the nose slowly, out through pursed lips
very slowly
 Have the child sip water / fluids
 Check peak flow (with severe symptoms: skip PF &
give quick-relief or reliever medication immediately)
 Child should not be left alone
Handling Acute Asthma
Episodes At School Cont…
 Give asthma reliever (bronchodilator) per the child's
Asthma Action Plan / medication orders
 Assess response to medication
 After ~5-10 minutes recheck peak flow
 Call parent/guardian/health care provider prn
 Call 911 if escalating symptoms or no improvement
Call 911 if..
 Lips or nail beds are bluish
 Child has difficulty talking, walking or drinking
 Quick relief or “rescue” meds (albuterol) is
ineffective or not available
 Neck, throat, or chest retractions are visible
 Nasal flaring occurs when inhaling
 Obvious distress
 Altered level of consciousness/confusion
 Rapidly deteriorating condition
“There should not be any delay once a
child notifies school staff of a possible
problem or developing asthma episode”
What Causes Asthma?
Of the 21 million asthma sufferers in the
US, 10 Million (approx. 60%) have
allergic asthma. 3 million of those are
children1
Exposure to certain allergens trigger
asthma symptoms to begin
Exposure to certain irritants can also set
an asthma episode in motion
1
National Institute of Environmental Health Sciences
What Causes Asthma?

Asthma may be caused by genetic, immune
and/or environmental factors, and is often
associated with eczema and allergies

Researchers do not understand all of the
causes of asthma or its increasing prevalence

It boils down to “We just don’t really know for
sure”
Triggers and Irritants
Copyright 2004, 3M Pharmaceuticals
Common Allergens (Triggers)
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Seasonal Pollens
Animal dander
saliva/urine
Dust Mites
Cockroaches/Mice/Rat
droppings and urine
Mold
Some medications
Some Foods
Common Irritants (Triggers)
 Exercise
 Cold Air
 Chalk Dust
 Viral/upper respiratory
infections
 Air pollution
 Tobacco smoke or
secondhand smoke
 Chemical irritants
and strong smells
 Strong emotional
feelings
 Diesel fumes
 Cleaning supplies
Role of Viral Respiratory
Infections In Asthma
Exacerbations
VRIs And Hospitalizations
For Asthma
Hospital admissions for asthma correlate
with virus isolation peaks and school terms
URIs
20
Total pediatric and
adult hospitalizations
15
School holidays
10
5
0
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Adapted with permission from Johnston SL et al. Am J Respir Crit Care Med. 1996;154:654. Official Journal
of the American Thoracic Society. ©American Lung Association.
RV-Induced Airway Inflammation
Plasma
leakage
Inflammatory
cell recruitment
and activation
Mucus
hypersecretion
Virus-infected
epithelium
Airway
Hyperresponsiveness
Neural activation
Adapted from Gern JE, Busse WW. J Allergy Clin Immunol. 2000;106:201.
Summary
 Viruses
cause asthma exacerbations in children
 RVs cause ~60% of virus-induced
exacerbations of asthma
 RVs directly infect the bronchial airways
 The response to viral infection is shaped by
the host’s antiviral response
Exercise Induced Asthma
What Is Exercise Induced Asthma
(EIA)?
 Tightening
of the muscles around the airways
(bronchospasm)
 Distinct from allergic asthma in that it does
NOT cause swelling and mucus production in
the airways
 Can be avoided by taking pre-exercise
medications and by warming up/cooling down
EIA - What Happens?
 Symptoms include coughing, wheezing, chest
tightness and shortness of breath
 Symptoms may begin during exercise and can
be worse 5 to 10 minutes after exercise
 EIA can spontaneously resolve 20 to 30
minutes after starting
 Can be avoided by doing the following:
Preventing Exercise Induced
Asthma (EIA)
 Become familiar with Asthma Action Plans
 Use reliever (Albuterol) 15 -30 minutes before
activity
 Do warm-up/ cool-down exercises before and
after activities
 Check outdoor ozone/air quality levels
www.aqi.pca.state.mn.us/hourly/
 Never encourage a child to “tough it out” when
having asthma symptoms
Exercise As A Trigger!
 Exercise can be a trigger for those who have
“chronic” asthma
 Their pre-exercise treatment is the same but-
 These children will have the underlying
inflammation and require daily controller
medication
Assess Need For Pre-Medication
 Take note of medication order wording
“As needed” vs. “prior to exercise”
 Evaluate if activity level requires premedication
 Pre-medicate for strenuous activity only
 Contact parent/ HCP if questioning need for
pre-exercise medication
Coach’s Asthma Clipboard Program
“Winning With Asthma”

100% online education for:
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
Coaches
Referee’s
Physical Education Teachers
Coaches will receive:
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Coach’s asthma clipboard
Special Coach’s asthma education booklet
Certificate of completion
The satisfaction of knowing what to do during an
asthma episode!
www.WinningWithAsthma.org
Where Can Coaches See It?
www.WinningWithAsthma.org
Myths and Truths
Myths & Truths
Asthma Myths
Asthma Truths
 It is a psychological /  Asthma is a very real,
physical disease
emotional illness
 Asthma is a chronic
 It is only an acute
disease, even when
disease
symptoms are not active
 It always limits normal
 Taking proper asthma
activities
 It limits a child's ability medications allow
children to fully
to fully participate in
participate in any
physical activities,
activity, including sports
especially sports
Myths & Truths Continued..
Asthma Myths
 Medication is
addictive
Asthma Truths
• Asthma medications
are not addictive
 Medication becomes
ineffective if used
regularly
• Anti-inflammatories
(controllers) are most
effective when used
everyday
 Children do not die
from asthma
• Children and adults
die from asthma each
year
One Last Myth
Myth
Truth
• Reactive airway
• Use “reactive airway
disease’s code is the
disease” instead of
same code used for
“asthma” for a
diagnosis – that way
asthma!
the insurance company • Any order for
will never know
albuterol (or other
rescue inhaler) flags
the insurance
company
Treatment Myths
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Gecko liquid tonic
Herbal supplements
Acupuncture/pressure, chiropractic adj.
Cockroach tea
Asthma diets
Pranic healing with mantras
Owning a Chihuahua
Small Group Exercise
 Report back a couple activity
steps appropriate to that role
 Each table will review a section
Assessing Asthma
Measures Of Assessment
And Monitoring
Two Aspects:
 Initial
assessment and diagnosis of
asthma
 Periodic
assessment and monitoring
Excerts from NHLBI/NIH presentations @http://nih.nhlbi.nih.gov/naepp_slds/menu.htm
Initial Assessment &
Diagnosis of Asthma
Determines That:
 Patient has a history or presence of episodic
symptoms of airflow obstruction
 Airflow obstruction is at least partially reversible
 Alternative diagnoses are excluded
Methods for Establishing
Diagnosis
 Detailed
medical history
 Physical exam
 Spirometry to demonstrate
reversibility
History or Current Episodic
Symptoms of Airflow
Obstruction?
 Wheezing, shortness of breath, chest
tightness, or cough?
 Asthma symptoms vary throughout the day?
 Absence of symptoms at the time of the
examination does not exclude the diagnosis
of asthma!
Asthma Lung Assessment
Spirometry
 Spirometry is Gold standard to assist in asthma
diagnosis
 Assess need to start, step up, or step down
asthma medications
 Should be done at least yearly in children with
persistent asthma
 Spirometry is easily done at any health care
providers office
Spirometry Continued…
 Performed before and after bronchodilator
dose to look for airway obstruction
reversibility
 Can also be done with a cold-air or
methylcholine challenge, or an exercise
challenge in the case of exercise-induced
asthma

Spirometry is a painless study of air
volume and flow rate within the lungs.
Spirometry is frequently used to evaluate
lung function in people with obstructive or
restrictive lung diseases such as asthma or
cystic fibrosis.
Is Airflow Obstruction At
Least Partially Reversible?
Use spirometry to establish airflow obstruction
 FEV1 < 80% of predicted
 FEV1/FVC <65% or below the lower limit of
normal
Use spirometry to establish reversibility
 FEV1 increases >12% and at least 200 mL
after using a short-acting inhaled beta2-agonist
Have Alternative Diagnoses
Been Excluded?
Examples:
 Vocal cord dysfunction
 Vascular rings
 Foreign body aspiration
 Other pulmonary diseases
 Cystic Fibrosis
 Gastroesophageal reflux
Under Diagnosis Of Asthma
In Children
The majority of people who have asthma
experience onset before age 5
Commonly misdiagnosed as:
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Chronic or wheezy bronchitis
Bronchiolitis
Recurrent croup
Recurrent upper respiratory infection
Recurrent pneumonia
National Heart, Lung, and
Blood Institute (NHLBI)
NAEPP
Guidelines for the Diagnosis &
Management of Asthma
EPR 2002 Update
NAEPP, NHLBI, NIH- EPR2 2002
NHLBI- NAEPP Asthma
Severity Levels
1. Mild Intermittent
2. Mild Persistent
3. Moderate Persistent
4. Severe Persistent
NAEPP Classification of Asthma Severity:
Clinical Features Before Treatment
Days With
Symptoms
Variability
Step 4
Continuous
Nights With
Symptoms
Frequent
PEF or
FEV1
PEF
60%
30%
Severe
Persistent
Step 3
Daily
>1night/week
60%-<80%
30%
Moderate
Persistent
Step 2
>2/week, <1x/day
>2 nights/month
80%
20-30%
80%
20%
Mild
Persistent
2 days/week
Step 1
2/month
Mild
Intermittent
Footnote: The patient’s step is determined by the most severe feature.
Peak Flow Variability
 Is
the difference between the child’s
morning and evening PFM readings
 Peak
flow readings tend to be higher in
the evening than in the morning
NAEPP Stepwise Approach To
Asthma Therapy
Outcome:
Control of Asthma
Outcome:
Best Possible Results
Controller:

Controller:

Controller:


Reliever:

Inhaled beta
agonist prn
PEF: ≥80%
STEP 1:
Intermittent

One daily medication
Possibly add long
acting bronchodilator
Anti-leukotrienes
Reliever:

Inhaled beta
agonist prn
PEF: ≥80%
STEP 2:
Mild Persistent


Daily inhaled
corticosteroid
Daily long acting
bronchodilator
Anti-leukotriene
Reliever:

Inhaled beta
agonist prn


Daily inhaled
corticosteroid
Daily long acting
bronchodilator
Daily/alternate day
oral corticosteroid


When controlled,
reduce therapy
Monitor
Reliever:

Inhaled beta
agonist prn
PEF: 60-80%
PEF: <60%
STEP 3:
Moderate Persistent
STEP 4:
Severe Persistent
Step-down
Mild Intermittent
 Symptoms  2 days/week with nighttime
symptoms 2 nights/month
 Asymptomatic with normal peak flows between
exacerbations
 Exacerbations are brief (hours to a few days)
 Peak Flows  80% predicted with variability
 20%
Mild Persistent
 Symptoms > 2 days /week but < 1x/day with
nighttime symptoms greater than 2 nights/month
 Exacerbations may affect activity
 Peak flow 80% of predicted with variability of
< 20-30%
Moderate Persistent
 Child is likely to have daily symptoms and use
reliever daily
 Child is waking up at least once a week due to
asthma symptoms
 Peak flows 60-80% of predicted with variability of
>30%
 Activity is affected and exacerbations may last
days
Severe Persistent
 Continual daytime symptoms with frequent
nighttime symptoms
 Very limited physical activity
 Frequent exacerbations
 Peak flows  60% of predicted and variability of
more than 30%
 Treatment involves a combination of many drug
therapies
Rules Of “Two”
IF a child has:
 Daytime symptoms greater than two times per week
-or-
 Nighttime symptoms greater than two times per
month -or-
 Albuterol (reliever) refills of canisters more than two
times per year
*The child needs to be assessed if he/she
requires controller medication or a step up in
therapy
MDH Interactive Asthma
Action Plan (IAAP)
Available at MDH website:
www.health.state.mn.us/asthma
 Click on “Asthma Action Plan”
 Click on “Medical Professionals”
 Choose to download desktop version or
use online version
Which of These Does Not Fit With
Severe Persistent Asthma?
A. Continual coughing, wheezing or
shortness of breath during day, frequent
nighttime symptoms
B. Limited physical activity
C. Near normal Pulmonary Function Test
(Spirometry)
D. Frequent asthma exacerbations
Which Of These Does Not Fit
With Severe Persistent Asthma?
A. Continual coughing, wheezing or
shortness of breath during day, frequent
nighttime symptoms
B. Limited physical activity
C. Near normal Pulmonary Function Test
(Spirometry)
D. Frequent asthma exacerbations
Which Of These Does Not Fit With
Moderate Persistent Asthma?
A. Daily daytime symptoms, nighttime
symptoms > 1 night per week
B. Nighttime Symptoms < 2 times a week
C. Daily use of albuterol/bronchodilators
D. Asthma exacerbations can last for days
Which Of These Does Not Fit With
Moderate Persistent Asthma?
A. Daily daytime symptoms, nighttime
symptoms > 1 night per week
B. Night time Symptoms < 2 times a week
C. Daily use of albuterol/bronchodilators
D. Asthma exacerbations can last for days
Which Of These Does Not Fit With
Mild Persistent Asthma?
A. Daytime symptoms > 2 times a week,
but < 1 time a day
B. Symptoms may affect activity
C. Need for albuterol 3 times a week, sometimes
twice a day (not related to EIA)
D. Nighttime symptoms > 2 times a month
Which Of These Does Not Fit With
Mild Persistent Asthma?
A. Daytime symptoms > 2 times a week,
but < 1 time a day
B. Symptoms may affect activity
C. Need for albuterol 3 times a week,
sometimes twice a day (not related to EIA)
D. Nighttime symptoms > 2 times a month
Which Of These Does Not Fit
With Mild Intermittent Asthma?
A. Daytime symptoms < 2 times a week
B. Nighttime symptoms > 2 times a month
C. No symptoms and normal Peak Flow
between exacerbations
D. Exacerbations are brief and may last from a
few hours to a few days
Which Of These Does Not Fit
With Mild Intermittent Asthma?
A. Daytime symptoms < 2 times a week
B. Nighttime symptoms > 2 times a month
C. No symptoms and normal Peak Flow
between exacerbations
D. Exacerbations are brief and may last from a
few hours to a few days
Which Level Does Not Need Daily
Controller Medication?
A. Mild Intermittent
B. Mild Persistent
C. Moderate Persistent
D. Severe Persistent
Which Level Does Not Need Daily
Controller Medication?
A. Mild Intermittent
B. Mild Persistent
C. Moderate Persistent
D. Severe Persistent
Severity Level Workout
Case Scenario Group Interactive
Format
Assessing Asthma
When Assessing Asthma Ask..
 Whether or not the child is taking his/her
controller medication at home (are they
prescribed for him/her)
 Is he/she taking it everyday and how often
 How often is he/she using reliever inhalers
 About his/her home environment
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Pets
Adults smoking in the home
Moist basements or obvious mold
Mattress and pillow covers
Cockroaches, mice, rats etc.
E2, E3
Physical Assessment Of Asthma
In The School Health Office
Symptoms (daytime, nighttime and exerciserelated)
 Peak Flow Meter readings
 Respiratory assessment (breath Sounds / lung
auscultation, respiratory rate, physical
assessment)

Symptoms
Ask about:
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

Coughing / wheezing / tight chest
Frequency of daytime symptoms
Frequency of nighttime symptoms
Symptoms with activity or exercise
Respiratory Assessment
Respiratory Assessment in the
School Health Office
Physical inspection
(including respiratory rate)
Auscultation of the lung fields
Normal Respiratory
Rates For Children
Age
Newborn
1-11 mo.
2 years
4 years
6 years
8 years
Rate
35
30
25
23
21
20
(rate=breaths/minute)
Age
10 years
12 years
14 years
16 years
18 years
Whaley & Wong, 1991
Rate
19
19
19
17
16-18
Why Lung Assessment Is
Important
 It provides additional clinical information
 Provides a good baseline for comparison in
future assessments
 Gives a better picture of the child’s perception
of symptoms vs. what is actually assessed
 When consulting w/the HCP, they will ask for
lung sounds
Form F26
Physical Respiratory Inspection

Respiratory rate

Rhythm (regular, irregular or periodic)

Depth (deep or shallow, presence of retractions)

Quality (effortless, automatic, difficult, or
labored)

Character (noisy, grunting, snoring, or heavy)
Auscultation
Breath sounds best heard in a quiet environment
 Wheezing and crackles are best heard as the
student takes deep breaths
 Absent / diminished breath sounds are abnormal
and should be investigated
 Absence of wheezing does not necessarily mean
absence of asthma

Breath Sounds: Crackles
 Coarse Crackle: Intermittent, interrupted
explosive sounds, loud, low in pitch (heard when
airs passes through larger airways containing
liquid) Crackles of a 9 yo boy with pneumonia
 Fine Crackle: Intermittent, interrupted explosive
sounds, less loud and of shorter duration; higher
in pitch than coarse crackles (heard when airs
passes through smaller airways containing liquid)
This wheezing and coarse crackles were recorded over the right posterior lower lung of an 8 month old boy with viral
bronchiolitis.
Breath Sounds: Wheeze And
Rhonchus (Rhonchi)
 Wheeze: continuous sounds,
high pitched; a
hissing sound (e.g. with airway narrowed by
asthma)
Expiratory wheezing was recorded over the right anterior upper chest of an 8 yo boy with asthma
Wheezing over trachea and right lower lung of 11 yo girl with asthma

Rhonchus: continuous sounds, low-pitched; a
snoring sound (caused by large upper airway
partially obstructed by thick secretions)
Sounds from The R.A.L.E. Repository @http://www.rale.ca/Recordings.htm
Peak Flow Meters
Peak Flow Meters
 Measures how well the student’s lungs are doing
at that moment
 Associated with the Green-Yellow-Red system of
managing asthma symptoms
 Congruent with asthma action plans
 Helps students and families self-manage asthma
Form F31
How to use a Peak Flow Meter
 Review the steps
 Place indicator at
the base of the
numbered scale
 Stand up
 Take a deep breath
 Place the meter in
the mouth and close
lips around the
mouthpiece
 Blow out into the
meter as hard and
fast as possible
 Write down the
achieved number
 Repeat the process
twice more
 Record the highest
of the three
numbers achieved
Group Peak Flow Exercise
Personal Best Peak Flow Values
Determined by twice daily Determined when
healthy and not experiencing symptoms
 PFM measurements over the course of two
weeks
 Is the BEST reading obtained during those two
weeks
 Is used to calculate percentages for AAP’s

Predicted Peak Flow Values
 Are based on a child's height
 Are not individualized
 Do not take into account other personal factors
 Can be identified immediately
 Are used when it is impossible or difficult to
obtain personal best peak flow levels
Form F6
Every Child Is Unique!
 Wheezing and coughing are the most common
symptoms -but No two children will have the exact same
symptoms or the same trigger
 Every child who has a diagnosis of asthma
should have access to a rescue inhaler!
 Every child with persistent asthma should have
an asthma action plan at school (AAP)
Together- We Can Make A
Difference!