AANMA Update - Virginia Head Start Association, Inc.

Transcription

2/18/2015
Allergy & Asthma Network
Asthma Basics-VAHSA
Tonya A. Winders, MBA, CEO
1
Our Mission
“To end the needless death and suffering
due to asthma, allergies and related
conditions through outreach, education,
advocacy and research.”
2
Global Strategy for Asthma
Management and Prevention (2012)
Definition and Overview
 Diagnosis and Classification
 Asthma Medications
 Asthma Management and
Prevention Program
 Implementation of Asthma
Guidelines in Health
Systems

Updated 2012
© Global Initiative for Asthma
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Definition of Asthma

A chronic inflammatory disorder of the airways

Many cells and cellular elements play a role

Chronic inflammation is associated with airway
hyperresponsiveness that leads to recurrent
episodes of wheezing, breathlessness, chest
tightness, and coughing

Widespread, variable, and often reversible
airflow limitation
Asthma Inflammation: Cells and Mediators
Source: Peter J. Barnes, MD
Mechanisms: Asthma Inflammation
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Asthma Inflammation: Cells and Mediators
Burden of Asthma

Asthma is one of the most common chronic
diseases worldwide with an estimated 300
million affected individuals

Prevalence increasing in many countries,
especially in children

A major cause of school/work absence
Burden of Asthma

Health care expenditures very high

Developed economies might expect to
spend 1-2 percent of total health care
expenditures on asthma.

Poorly controlled asthma is expensive;
investment in prevention medication likely
to yield cost savings in emergency care
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US Impact
• 19M adults & 7 M children have asthma.
That’s equal to 1 in 11 children.
• About 9 people die from asthma each
day.
• Asthma costs the United States $56
billion each year.
• The average yearly cost of care for a
child with asthma was $1,039 in
2009.
Risk Factors for Asthma

Host factors: predispose individuals to, or
protect them from, developing asthma

Environmental factors: influence
susceptibility to development of asthma in
predisposed individuals, precipitate asthma
exacerbations, and/or cause symptoms to
persist
Factors that Exacerbate Asthma

Allergens


Respiratory infections
Exercise and hyperventilation

Weather changes

Sulfur dioxide
Food, additives, drugs

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Factors that Influence Asthma
Development and Expression
Host Factors
 Genetic
- Atopy
- Airway
hyperresponsiveness
 Gender
 Obesity
Environmental Factors
 Indoor allergens
 Outdoor allergens
 Occupational sensitizers
 Tobacco smoke
 Air Pollution
 Respiratory Infections
 Diet
Is it Asthma?

Recurrent episodes of wheezing

Troublesome cough at night

Cough or wheeze after exercise

Cough, wheeze or chest tightness
after exposure to airborne allergens
or pollutants

Colds “go to the chest” or take more
than 10 days to clear
Asthma Diagnosis


History and patterns of symptoms
Measurements of lung function
- Spirometry
- Peak expiratory flow

Measurement of airway responsiveness

Measurements of allergic status to identify risk
factors

Extra measures may be required to diagnose
asthma in children 5 years and younger and the
elderly
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Asthma Management and Prevention
Program: Five Components
1. Develop Patient/Doctor
Partnership
2. Identify and Reduce Exposure
to Risk Factors
3. Assess, Treat and Monitor
Asthma
4. Manage Asthma Exacerbations
Updated 2012
5. Special Considerations
Asthma Management and Prevention Program
Goals of Long-term Management
Achieve and maintain control of symptoms
Maintain normal activity levels, including
exercise
 Maintain pulmonary function as close to
normal levels as possible
 Prevent asthma exacerbations
 Avoid adverse effects from asthma
medications
 Prevent asthma mortality


Asthma Management and Prevention
Program: Five Interrelated Components
1. Develop Patient/Doctor Partnership
2. Identify and Reduce Exposure to
Risk Factors
3. Assess, Treat and Monitor Asthma
4. Manage Asthma Exacerbations
5. Special Considerations
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2/18/2015
Asthma Management and
Prevention Program
.

Asthma can be effectively controlled in
most patients by intervening to suppress
and reverse inflammation as well as
treating bronchoconstriction and related
symptoms

Early intervention to stop exposure to the
risk factors that sensitized the airway may
help improve the control of asthma and
reduce medication needs.
Prevention Program

Although there is no cure for asthma,
appropriate management that includes
a partnership between the physician
and the patient/family most often
results in the achievement of control
Part 1: Educate Patients to
Develop a Partnership
 Guidelines on asthma management
should be available but adapted and
adopted for local use by local asthma
planning teams
 Clear communication between health
care professionals and asthma patients
is key to enhancing compliance
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Component 1: Develop
Patient/Doctor Partnership

Educate continually

Include the family

Provide information about asthma

Provide training on self-management skills

Emphasize a partnership among health
care providers, the patient, and the
patient’s family
Example Of Contents Of An Action Plan To Maintain Asthma Control
Your Regular Treatment:
1. Each day take ___________________________
2. Before exercise, take _____________________
WHEN TO INCREASE TREATMENT
Assess your level of Asthma Control
In the past week have you had:
Daytime asthma symptoms more than 2 times ?
No
Yes
Activity or exercise limited by asthma?
No
Yes
Waking at night because of asthma?
No
Yes
The need to use your [rescue medication] more than 2 times?
No
Yes
If you are monitoring peak flow, peak flow less than________? No
Yes
If you answered YES to three or more of these questions, your asthma is uncontrolled and you may need to
step up your treatment.
HOW TO INCREASE TREATMENT
STEP-UP your treatment as follows and assess improvement every day:
____________________________________________ [Write in next treatment step here]
Maintain this treatment for _____________ days [specify number]
WHEN TO CALL THE DOCTOR/CLINIC.
Call your doctor/clinic: _______________ [provide phone numbers]
If you don’t respond in _________ days [specify number]
______________________________ [optional lines for additional instruction]
EMERGENCY/SEVERE LOSS OF CONTROL
If you have severe shortness of breath, and can only speak in short sentences,
If you are having a severe attack of asthma and are frightened,
If you need your reliever medication more than every 4 hours and are not improving.
1. Take 2 to 4 puffs ___________ [reliever medication]
2. Take ____mg of ____________ [oral glucocorticosteroid]
3. Seek medical help: Go to _____________________; Address___________________
Phone: _______________________
4. Continue to use your _________[reliever medication] until you are able to get medical help.
Factors Involved in Non-Adherence
Medication Usage

Difficulties associated
with inhalers

Complicated regimens

Fears about, or actual
side effects


Cost
Distance to pharmacies
Non-Medication Factors

Misunderstanding/lack of
information

Fears about side-effects

Inappropriate expectations

Underestimation of severity

Attitudes toward ill health

Cultural factors

Poor communication
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Component 1: Develop
Patient/Doctor Partnership
Key factors to facilitate communication:
 Friendly demeanor
 Interactive dialogue
 Encouragement and praise
 Provide appropriate information
 Feedback and review
Component 2: Identify and Reduce
Exposure to Risk Factors
 Measures to prevent the development of asthma,
and asthma exacerbations by avoiding or reducing
exposure to risk factors should be implemented
wherever possible.
 Asthma exacerbations may be caused by a variety
of risk factors – allergens, viral infections,
pollutants and drugs.
 Reducing exposure to some categories of risk
factors improves the control of asthma and
reduces medications needs.
Component 2: Identify and Reduce
Exposure to Risk Factors

Reduce exposure to indoor allergens

Avoid tobacco smoke

Avoid vehicle emission

Identify irritants in the workplace

Explore role of infections on asthma
development, especially in children and
young infants
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Influenza Vaccination
 Influenza vaccination should be
provided to patients with asthma when
vaccination of the general population is
advised
 However, routine influenza vaccination
of children and adults with asthma
does not appear to protect them from
asthma exacerbations or improve
asthma control
Component 3: Assess, Treat
and Monitor Asthma
The goal of asthma treatment, to
achieve and maintain clinical
control, can be achieved in a
majority of patients with a
pharmacologic intervention strategy
developed in partnership between
the patient/family and the health
care professional
Global Strategy for Asthma Management and Prevention
Clinical Control of Asthma
The focus on asthma control is
important because:
 the attainment of control correlates
with a better quality of life, and
 reduction in health care use
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Global Strategy for Asthma Management and Prevention
Clinical Control of Asthma
 Determine the initial level of
control to implement treatment
(assess patient impairment)
 Maintain control once treatment
has been implemented
(assess patient risk)
Levels of Asthma Control
(Assess patient impairment)
Characteristic
Controlled
Partly controlled
(All of the following)
(Any present in any week)
Daytime symptoms
Twice or less
per week
More than
twice per week
Limitations of
activities
None
Any
Nocturnal symptoms
/ awakening
None
Any
Need for rescue /
“ reliever” treatment
Twice or less
per week
More than
twice per week
Lung function
(PEF or FEV1)
Normal
< 80% predicted or
personal best (if
known) on any day
Uncontrolled
3 or more
features of
partly
controlled
asthma
present in
any week
Assessment of Future Risk (risk of exacerbations, instability, rapid
decline in lung function, side effects)
Assess Patient Risk
Features that are associated with increased
risk of adverse events in the future include:
 Poor clinical control
 Frequent exacerbations in past year
 Ever admission to critical care for asthma
 Low FEV1, exposure to cigarette smoke,
high dose medications
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2/18/2015
Assessment of Future Risk
Risk of exacerbations, instability, rapid decline
in
lungexacerbation
function, side effects
Any
should prompt review
Features that are associated with increased
of maintenance
risk of adverse
events in the future include:
 Poor clinical
control
treatment
 Frequent exacerbations in past year
 Ever admission to critical care for asthma
 Low FEV1, exposure to cigarette smoke,
high dose medications
and Monitor Asthma
 Depending on level of asthma control,
the patient is assigned to one of five
treatment steps
 Treatment is adjusted in a continuous
cycle driven by changes in asthma
control status. The cycle involves:
- Assessing Asthma Control
- Treating to Achieve Control
- Monitoring to Maintain Control
and Monitor Asthma

A stepwise approach to pharmacological
therapy is recommended

The aim is to accomplish the goals of
therapy with the least possible medication

Although in many countries traditional
methods of healing are used, their efficacy
has not yet been established and their use
can therefore not be recommended
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2/18/2015
and Monitor Asthma
The choice of treatment should be guided by:

Level of asthma control

Current treatment

Pharmacological properties and availability
of the various forms of asthma treatment

Economic considerations
Cultural preferences and differing health care
systems need to be considered
Controller Medications
Inhaled glucocorticosteroids
Leukotriene modifiers
 Long-acting inhaled β2-agonists in combination
with inhaled glucocorticosteroids
 Systemic glucocorticosteroids
 Theophylline
 Cromones
 Anti-IgE


Reliever Medications
 Rapid-acting inhaled β2-agonists
 Systemic glucocorticosteroids
 Anticholinergics
 Theophylline
 Short-acting oral β2-agonists
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Component 4: Asthma Management and Prevention Program
Allergen-specific Immunotherapy


LEVEL OF CONTROL
REDUCE

Greatest benefit of specific immunotherapy
using allergen extracts has been obtained in
the treatment of allergic rhinitis
The role of specific immunotherapy in asthma is
limited
Specific immunotherapy should be considered
only after strict environmental avoidance and
pharmacologic intervention, including inhaled
glucocorticosteroids, have failed to control
asthma
Perform only by trained physician
TREATMENT OF ACTION
controlled
maintain and find lowest
controlling step
partly controlled
consider stepping up to
gain control
INCREASE

uncontrolled
exacerbation
step up until controlled
treat as exacerbation
REDUCE
INCREASE
TREATMENT STEPS
STEP
STEP
1
2
STEP
STEP
STEP
3
4
5
TO STEP 3 TREATMENT,
SELECT ONE OR MORE:
TO STEP 4 TREATMENT,
ADD EITHER
Shaded green - preferred controller options
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2/18/2015
Treating to Maintain Asthma Control
 When control as been achieved,
ongoing monitoring is essential to:
- maintain control
- establish lowest step/dose treatment
 Asthma control should be monitored
by the health care professional and
by the patient
Component 4: Manage Asthma
Exacerbations
 Exacerbations of asthma are episodes of
progressive increase in shortness of breath,
cough, wheezing, or chest tightness
 Exacerbations are characterized by decreases
in expiratory airflow that can be quantified and
monitored by measurement of lung function
(FEV1 or PEF)
 Severe exacerbations are potentially lifethreatening and treatment requires close
supervision
Exacerbations
Treatment of exacerbations depends on:
 The patient
 Experience of the health care professional
 Therapies that are the most effective for
the particular patient
 Availability of medications
 Emergency facilities
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Exacerbations
Primary therapies for exacerbations:
• Repetitive administration of rapid-acting inhaled
β2-agonist
• Early introduction of systemic
glucocorticosteroids
• Oxygen supplementation
Closely monitor response to treatment with serial
measures of lung function
Special Considerations
Special considerations are required to
manage asthma in relation to:
 Pregnancy
 Surgery
 Rhinitis, sinusitis, and nasal polyps
 Occupational asthma
 Respiratory infections
 Gastroesophageal reflux
 Aspirin-induced asthma
 Anaphylaxis and Asthma
Global Strategy
for the Diagnosis
and Management
of Asthma in
Children 5 Years
and Younger
2009
www.ginasthma.org
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2/18/2015
Prevention Program: Summary


Asthma can be effectively controlled in most
patients by intervening to suppress and reverse
inflammation as well as treating
bronchoconstriction and related symptoms
Although there is no cure for asthma,
appropriate management that includes a
partnership between the physician and the
patient/family most often results in the
achievement of control
Prevention Program: Summary
 A stepwise approach to pharmacologic
therapy is recommended. The aim is to
accomplish the goals of therapy with the
least possible medication
 The availability of varying forms of
treatment, cultural preferences, and
differing health care systems need to be
considered
What Can You Do To Help?
• Be aware! Watch for early signs or
symptoms of asthma.
• Communicate frequently—child, parents,
other caregivers, etc.
• Control triggers in the environment---dust,
mold, pollens, cockroaches, pet dander, etc.
• Provide support, encouragement and
resources.
10
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2/18/2015
Allergy & Asthma Network Resources
•
•
•
•
•
•
•
•
Understanding Asthma Guide
Allergy & Asthma Today Magazine
Medication Posters
Asthma & Physical Activity in School
Mikey’s Mom Book
My Personal Asthma Guide Workbook
RX Assistance Program
Discounts on Environmental Control
products
10
Thank you!
“To end the needless death and suffering
due to asthma, allergies and related
conditions through outreach, education,
advocacy and research.”
10
18

AANMA Update - Virginia Head Start Association, Inc.

Transcription

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