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Emergency

Asthma Management

1 NFA - Asthma presentation – Feb 2013

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Objectives

Upon completion of this course you will be able to:

• Describe asthma and recognise the signs and symptoms

• List the causes (triggers) of an asthma attack

• Recognise and identify a potential asthma emergency

• Understand and discuss the various types of medication and delivery devices used for asthma management

• Apply / manage treatment for a mild/moderate and severe asthma attack

• Apply / manage first aid principles in an undiagnosed patient

• Understand the requirements for risk minimization and management strategies for an asthma emergency


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Course Outline

• What is Asthma?

• Identifying Asthma Triggers

• Stages of an Asthma Attack

• Asthma Medications

• Asthma Delivery Devices

• First Aid for Asthma

• Asthma Risk Management

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NFA - Asthma presentation – Feb 2013

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What is Asthma

• Asthma is a disease where inflammation of the airways causes airflow into and out of the lungs to become restricted

• During an asthma attack, mucus production increases, muscles of the bronchial tree tighten and the lining of the air passages swell

thereby reducing airflow, producing

the characteristic wheezing sounds

• This results in breathing difficulty


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Asthma Facts

• The cause of asthma is unknown

• Asthma can be diagnosed at any age

• Asthma can present quite differently for each

person

• An asthma attack can happen without warning

at any time

• Asthma symptoms can be mild, moderate and life-threatening

• There is no cure for asthma, however, asthma can be well managed

• Generally, people with asthma can lead quite normal lives when their asthma is well managed


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Asthma Statistics (Australia 2011)

• 1 in 10 children in Australia have diagnosed asthma

• On average more than one person dies each day from asthma, around 90% of these deaths are in people 40 years and older

• Children have higher rates of hospitalisation for asthma than adults, this spikes in February after the school holidays

• About 40% of asthmatic children live with smokers

• More boys than girls have asthma, more women than men have asthma ( it is based on the fact that boys have smaller airways and for women it is hormone related)

• Poorly controlled Asthma in children can impact on both health and learning

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Other linked allergies

• 60-80% of people with asthma have hay fever

(allergic rhinitis), often triggered by pollen

• Eczema(atopic dermatitis) occurs in 5 infants,

usually improves during the teenager years

• Food allergies occurs 1 in 20 children and

generally will resolve with time

• Anaphylaxis is the most severe form of allergic

reaction and is potentially life threatening


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Asthma Anatomy


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Asthma Airways

Three main factors cause the airways to become narrowed

Inflammation : The inside lining of the airways become swollen and red

Extra mucus : Increased amounts of mucus may be produced

Muscle Spasm : The muscle around the airways constricts or tightens


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Asthma Airways

People with asthma have sensitive

airways. When exposed to certain triggers

these airways become narrow, making

breathing difficult.

Asthma Normal

Airway Airway


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Asthma Triggers Some examples are:

• Colds and flu, respiratory infections

• Cigarette smoke and emotional stress

• Exercise, physical activity or pre exercise warm ups

• Allergic reaction to pollen, insect sting, dust, smog, food, medication, sprays, chemicals, preservatives and moulds

• Exposure to sudden changes in the

weather, particularly cold and wet

conditions

Exercise, Colds/Flu, Smoke and Pollens are the most common triggers.


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Asthma : How to Recognise Signs & Symptoms

Can vary from person to person and may include:

• A dry, irritating, persistent cough, particularly at night

• Shortness of breath especially when talking

• Rapid breathing, wheezing sounds (but not always)

as the patient exhales (this may be absent in severe

attacks due to little air movement)

• Tightness across the chest


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Asthma : How to Recognise

Signs & Symptoms continued:

• Pale, sweaty skin

• Becoming progressively anxious, distressed and tired

• Becoming blue around the lips and ear lobes (cyanosis)

• Drawing in of the air spaces between the ribs and above

the collar bones with each breathing effort

• Altered conscious responses

• Collapse, leading to respiratory arrest may occur in

severe attacks


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Stages of an Asthma Attack

Mild :

Slight breathing difficulty, wheezing, cough

Moderate :

Breathing difficulty at rest. Use of accessory muscles in order to breathe.

Less air exchange, wheezing, persistent cough, speaking in short sentences.

Severe :

Severe breathing difficulty. Use of accessory muscles in order to breathe.

Absent or increased wheezing. Showing signs of shock.

Respiratory Failure:

Use of accessory muscles in order to breathe. No response to medication. No wheezing.


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Asthma Medications

Medications are divided in to three classes

Relievers Preventers Controllers Combinations

Airomir Alvesco Oxis Seretide

Asmol Flixotide Serevent Symbicort

Atrovent Intal Forte Foradile

Bricanyl Pulmicort

Ventolin Singular

Tilade

Qvar

Combination medications are a combination of 2 classes

symptom preventer and symptom controller medications


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Asthma Medications

Preventer

Reliever

Preventer

&

Controller Combination Medication


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Asthma Medication Relievers

• Known as Broncodilators (blue/grey)

• Relaxes the tight muscles around the airways for about four hours allowing air to move easily through the airways.

• Works quickly (within minutes), generally lasts up to 4 hours

• Should be used in asthma first aid

• Safe – cannot overdose


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Asthma Medication Preventers

• Known as Anti-inflammatories

• Preventer medication reduces the

frequency and severity of attacks if taken

regularly everyday.

• They reduce/control inflammation and

sensitivity of the airways

• Preventers should not be used in asthma

emergencies


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Asthma Symptom Controllers

• Symptom Controllers are long acting

relievers, they relax muscles around the

airways for up to 12 hours

• They are taken in conjunction with

preventer medication

• Symptom Controllers should not be used

in asthma emergencies because of the

delay in onset of action of 1-2 hours

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Asthma Medication

Combinations

• Combination Medication contains a preventer

and a symptom controller together in one inhaler

• Combination Medication should not be used in

asthma emergencies


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Asthma Medication – Side Effects

• No harm is likely to result from administering

a reliever medication to a patient who is not

experiencing asthma.

• Reliever medications are safe. An overdose is

unlikely. Some minor side effects may be

experienced (muscle tremors, elevated heart

rate).


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No Asthma Reliever Medication

Available? If you suspect an individual is experiencing an asthma attack

and reliever medication is not available

• Sit the patient upright / leaning slightly forward

• Rest and reassure

• Loosen tight / restrictive clothing

• Encourage controlled breathing (slow / deep)

• If there is little or no improvement

or you are unsure:

Call Ambulance 000


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Asthma Delivery Devices


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Using an Autohaler

Not recommended for children under 7

1. Shake the Autohaler in order to mix the medication and propellant.

2. Remove cover from the mouthpiece and hold it upright without blocking

vents at the base.

3. Lift grey lever at top of device.

4. Breathe out.

5. Tilt chin up.

6. Insert mouthpiece (seal well with lips).

7. Breathe in through mouth slow, steady and deep for 5 seconds if possible.

The Autohaler will automatically emit a dose of medication.

8. Remove Autohaler, close mouth and hold breath for

up to 10 seconds.

9. Slowly breathe out through the nose.

10. Return grey lever to its original position.

11. Repeat steps 2 to 9 until breathing is relieved


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Using an Accuhaler

Not recommended for children under age 8

1. Hold the Accuhaler in one hand by its base.

2. Place thumb of the other hand on the thumb grip.

3. Open Accuhaler by pushing thumb grip around until it clicks.

4. Slide lever until it clicks.

5. Breathe out away from Accuhaler.

6. Insert mouthpiece seal well with lips.

7. Breathe in through mouth slow, steady and deep for 5 seconds if possible

8. Remove Accuhaler and hold breath for up to 10 seconds if possible.

9. Breathe out gently - away from Accuhaler.

10. Close Accuhaler.



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Using an Turbuhaler

Not recommended for children under 7

1. Unscrew and lift the cap off.

2. Hold the Turbuhaler upright.

3. Twist the coloured base to the right then left, until it clicks.

4. Breathe out gently away from the device. Do not blow on it.

5. Insert the mouthpiece seal well with lips.

6. Breathe deeply in through the mouth with force for approximately 5 seconds.

7. Remove the Turbuhaler from mouth before breathing out.

8. Replace the cap.



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Spacer Delivery Devices


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• Recommended for both adults and children with an asthma puffer

• Greatly increases the amount of medication reaching the lungs

• Reduces medication deposited at the back of the mouth and throat

• For children up to 5 years old a mask and small volume spacer is recommended

Infection Control

• Spacers are for use by one person only

• The National Health and Medical Research Council guidelines have removed the cleaning of spacers for multiple people (unless the spacer can be autoclaved). This avoids infection transmission by mucus.


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Using a spacer is more effective


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Using a Metered Dose Inhaler

(Puffer with spacer)

• Shake the inhaler

• Place the mouthpiece into the spacer

• Place the spacer mouthpiece into the patient’s mouth

• Administer one puff into the spacer and ask the patient to breathe in and out normally for four breaths.

• Repeat this promptly until four puffs have been given

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Using a Metered Dose Inhaler

(Puffer without spacer)

• Shake the inhaler.

• Place the mouthpiece into the patient’s mouth and administer one puff as the victim inhales slowly and steadily.

• Ask the patient to hold their breath for four seconds and then take four normal breaths.

• Repeat this promptly until four puffs have been given.

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Asthma First Aid

Step 1

• Sit the patient upright, leaning forward with

elbows extended, resting on a soft support like

pillow. This helps to expand the rib spaces.

• Remove any tight or restrictive clothing

• Do not leave the patient alone. (Send someone

else to get the asthma first aid kit)

• Be calm and reassuring.


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Asthma First Aid Step 2

• Shake blue reliever puffer medication

• Use spacer if available

• Put 1 puff into spacer

• Take 4 breaths from spacer

• Repeat until 4 puffs have been taken

Note : shake puffer, 1 puff to 4 breaths, repeat 4 times


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Asthma First Aid

Step 3

• Wait 4 minutes and closely monitor the patient’s condition.

• If there is little or no improvement, keep giving 4 puffs, 4 breathes for a further

4 minutes

If oxygen is available, it should be administered at a flow rate of 8 litres per minute via a face mask, by a first aider trained in its use.


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Asthma First Aid Step 4 If :

• there is still little or no improvement

• you are unsure

• there is no blue reliever puffer medication

Then you:

• CALL AMBULANCE 000 immediately – tell the operator the patient is having an asthma attack

• Keep repeating the 4 puffs x 4 breaths x 4 minutes until Ambulance arrives


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First Asthma Attack ?

If a patient is in respiratory distress and you suspect

it may be asthma:

• Call Ambulance 000 first

• Follow the 4 x 4 x 4 Asthma first aid

• Keep repeating the until Ambulance arrives

• Rest and reassure the patient

Treatment can not cause harm even if it is not asthma

A first attack can be as serious as any other attack


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Is it Asthma or Anaphylaxis?

If the patient is known to be at risk of anaphylaxis and

you are unsure you should:

• Give the adrenaline auto injector first

• Then give asthma reliever medication

Adrenaline will also help relieve the asthma symptoms


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Unconscious Asthmatic

• Follow DRSABCD

• Call Ambulance 000

• Place into the recovery position and

closely monitor response, airway,

normal breathing while waiting for the Ambulance

• Be prepared to resuscitate

In some cases where breathing has stopped due to severe asthma, you may need to blow harder to

inflate the lungs and at a slower rate to allow air to escape when performing rescue breaths.


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Asthma First Aid Plan

• The Asthma First Aid Plan is developed in consultation with the individuals doctor

• It is a written plan outlining their asthma management

• The plan includes use of medications

• It outlines the individuals signs, symptoms & triggers

• Is a precise 4 step plan to be followed in the event of an asthma episode

• Most people with asthma do not have an Asthma Plan

• If the individual Asthma Plan is not available, follow the standard 4x4x4 Asthma First

Aid Plan

Plans can be downloaded from www.nationalasthma.org.au


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http://www.nationalasthma.org.au/

My Asthma Action Plan


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Asthma First Aid Kit • An Asthma first aid kit contains all of the necessary items that are

needed in case of an asthma attack.

• Mobile kits should be accessible at all times and available in the

event of excursions, camps or off site activities.

• The kit needs to include:

– Blue reliever puffer

– 2 spacer devices (and two masks if under 5 year old are in your

care) – these are single use spacers

– An incident record book needs to be included (detailing the

management procedure undertaken).

– Instructions for asthma first aid

Regularly check the first aid kits to ensure

all equipment is in date, clean and good condition


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Asthma First Aid Kit

Location

• Visible / accessible

• Portable

• Not in direct sunlight

Maintenance

• Procedures – who is responsible for checking?

• Checking procedures (expiry date of MDI)

• Who can access the kit?

It is recommended that at least two kits are available – one for on-site

and one mobile kit.


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Asthma - Risk Management

A risk management policy is required to document strategies for implementation of best practice asthma management .

Key points:

• All staff are aware of which individuals are asthmatic.

• All individuals who have asthma can receive appropriate attention as required.

• Staff can respond to the needs of those who have not been diagnosed with asthma and who may be having an asthma attack or difficulty breathing.

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Risk Management - Management

• Identify individuals with asthma during the enrolment process.

• Provide parents with a copy of the school’s Asthma Policy upon enrolment if requested.

• Provide all staff with a copy of the Asthma Policy and brief them on asthma procedures upon their appointment .

• Provide opportunity and encouragement for staff to attend regular asthma training and ensure that at least one trained member of staff is present during all onsite and offsite activities and excursions.


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• Provide an Asthma Record upon enrolment. The

completed Asthma Record is to be returned promptly,

reviewed annually and filed in the medication file.

• Ensure that all teachers are informed of students with

asthma in their care.

• Formalise and document school procedures for Asthma

First Aid for all individuals diagnosed with asthma and also

for those with no known diagnosis (first asthma attack).


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•Ensure that Asthma First Aid charts / posters are

displayed in key locations in the school.

• Ensure that the Asthma First Aid Kits contain a blue

reliever puffer, individual spacer devices (disposable)

and concise written instructions on Asthma First Aid

procedures.

• Provide a mobile Asthma First Aid Kit for use on

excursions and activities.

• Identify and where possible, minimise asthma

triggers.

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Risk Management - Staff

• Ensure that staff maintain current training in managing an asthma emergency (currently every three years).

• Ensure that staff are aware of any individual in their care

with asthma.

• Optimise the health and safety of each student through

supervised management of their asthma where required.

• Ensure that all regular prescribed asthma medication is

administered in accordance with the information on the

student’s personal Asthma Record or Asthma Action Plan.


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•Administer emergency asthma medication if required according to the Asthma Action Plan. If an Asthma Plan is unavailable, the Standard Asthma First Aid Plan should be followed immediately.

• Promptly communicate to the Principal and where applicable, families, any concerns about asthma limiting a student’s ability to participate fully in all activities.


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• Regularly maintain all asthma components of the first aid

kit to ensure all medications are current and individual

devices are available and ready to use.

• Encourage asthmatics to carry their reliever medication

and use their medication as soon as symptoms develop.

• Identify and where possible, minimise asthma triggers.


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Risk Management - Families

Families will:

• Inform staff, either upon enrolment or initial diagnosis, if there is a history or medical condition of asthma.

• Provide all relevant information regarding the student’s asthma via the Asthma Action Plan in consultation with their doctor.

• Notify management in writing, of any changes to the Asthma Action Plan throughout the year.


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Risk Management - Families

• Ensure that an adequate supply of appropriate

medication (reliever) and a spacer device (clearly

labelled) is provided where applicable with the

student’s name.

• Ensure that all medication is within valid use by

dates.

• Communicate all relevant information and concerns

with staff as the need arises.

e.g. if asthma symptoms were present during the night


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Activity

• PRACTICE:

– Demonstrate use of MDI/spacer

– Follow Asthma Plan

– Scenario/Role play

– Risk Management


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