Texas Children’s Center for Telehealth

Nursing and Allied Health Professionals

Distance Education and CNE/CEU Offering
Vested Interest Declaration:
The speaker has not reported any significant financial
interest or other relationships with the manufacturer(s)
or provider(s) of any commercial product(s) or
services(s) discussed in an educational presentation or
any significant financial interest or other relationship
with any companies providing commercial support for
the activity; and has agreed to disclose if the
presentation will include discussion of investigational or
unlabeled uses of a product.
 Pediatric Asthma
Management and Treatment
Janet Bujan, RN
Sheila Martinka, MSN

© Copyright 2005 Texas Children’s Hospital. All rights reserved

 Objectives
ƒ Upon completion of this
course the participant will be
able to :
– Define asthma
– Identify signs/symptoms of an
asthma attack
– Identify asthma triggers
 Objectives
ƒ Identify appropriate medications
– Maintenance
– Rescue
ƒ Recognize various types of spacer
devices
ƒ Have a basic understanding of how
to use spacers with MDIs
ƒ Be familiar with the term Vocal Cord
Dysfunction (VCD)
 Pediatric Asthma
1997 NHLBI Expert Panel Report 2
ƒ “a chronic inflammatory disorder of
the airways in which many cells and
cellular components are involved:
– Mast cells
– Eosinophils
– T lymphocytes
– Neutrophils
– Epithelial cells”
 Pediatric Asthma
“These cellular components of
inflammation causes recurrent
episodes of wheezing,
breathlessness, chest tightness, and
cough, particularly at night and in the
early a.m. These episodes are
usually associated with widespread
but variable airflow obstruction that is
often reversible either spontaneously
or with treatment.” 1997 NHLBI EPR 2
 Pediatric Asthma
ƒ “The inflammation also causes an
associated increase in the existing
bronchial hyperresponsiveness to a
variety of stimuli.” 1997 NHLBI EPR 2

ƒ In the EPR—Update 2002, the

definition has been expanded to
include that “in some patients,
reversibility may be incomplete. . .”
 Pediatric Asthma
ƒ “. . .and other individuals with
features of chronic bronchitis may
manifest some degree of
reversibility in airflow obstruction.”
NHLBI EPR 2002

ƒ Asthma includes bronchospasm,

airway inflammation and airway
remodeling.
 Pediatric Asthma
ƒ Two processes occur during an
asthma attack
– Bronchospasm-is the tightening of
the muscles around the airways.
This reaction can happen rapidly
and can be relieved quickly as
well.
 Pediatric Asthma
ƒ The second process is
– Inflammation—the swelling of the
lining inside the airways. When
airways are inflamed, mucus is
produced. This combination of
inflammation and mucus production
constricts the airways and makes it
difficult for air to pass through the
airways, causing symptoms such
as wheezing and cough.
Risk Factors for Development
of Asthma
ƒ Genetic predisposition
– Family history
• If there is parent w/asthma, 3-6 x
more likely to develop asthma
– High IgE levels
ƒ Environmental exposures
ƒ Contributing factors
 Asthma Severity
Symptoms Symptoms FEV1 or PF
(days) (nights)
Severe Continual Frequent ≤ 60%
persistent
Moderate Daily › 1/week ≥ 60-≤ 80%
Persistent
Mild › 2/week › 2/month › 80%
persistent ‹ 1x/day
Mild ≤ 2/week ≤ 2/month › 80%
intermittent NAEPP Expert Panel
Guidelines, 2002
Update
Signs & Symptoms of Asthma
ƒ Early signs
– Cough
– Wheeze
– Increase work of breathing (WOB)
ƒ Late signs
– Nasal flaring
– Retractions
– Cyanosis
 Signs & Symptoms
ƒ Vocal Cord Dysfunction (VCD)
– Abnormal closing of the vocal cords-
not airway inflammation
– Symptoms can mimic asthma
– Symptoms do not improve with
asthma meds
– Some persons do have a combination
of asthma and VCD
– Pulmonary Function Tests may be wnl
 Signs & Symptoms
ƒ Vocal Cord Dysfunction (VCD)
– Usually type “A” personality,
competative
– Females › Males
– Treatment includes
• Relaxation/breathing techniques
• Counseling
• Avoidance of triggers
– Triggers may be similar to that of
asthma
 Asthma Triggers
ƒ Pollution
ƒ Pollen
ƒ Pets (dander)
ƒ Molds/grasses/trees
ƒ Strong odors (cleaning
products, perfumes, colognes)
ƒ Dust (dust mites)
 Asthma Triggers
ƒ Exercise
ƒ Weather changes
ƒ Tobacco smoke
ƒ Stress/anxiety/emotions
 Management Goals
ƒ Control symptoms
ƒ Prevent exacerbation
ƒ Maintain lung function
ƒ Prevent irreversible airway
obstruction
ƒ Prevent asthma mortality
ƒ Avoid adverse effects from
medications
Asthma Management & Treatment
ƒ Medications used to treat asthma
– Rescue medications
• Fast acting bronchodilators
– Maintenance medications
• Nonsteroidal
• Corticosteroids
• Inhaled
• oral
• Leukotrienes Modifiers
 Rescue Medications
ƒ Bronchodilators or Quick-relief
Medicines
– Albuterol
• MDI (metered dose inhaler)
• Aerosolized solution
• Oral albuterol
• Oral steroids
– Xopenex
• Aerosolized solution
 Rescue Medications
ƒ Anticholinergics
– Atrovent
– Combivent
 Maintenance Medications
ƒ Non-steroidal preparations
– Oral
– Inhaled
• Nebulizer
• MDI
ƒ Steroid preparations
– Oral
– Inhaled
• Nebulizer
• MDI
• Diskus/dry powder
 Maintenance Medications
ƒ Long-acting beta agonists
– Serevent (Salmeterol)
– Foradil
ƒ Combination Medications
– Advair (Fluticasone and
salmeterol)
ƒ Leukotriene Modifiers
– Singulair
– Accolate
 Maintenance Medications
ƒ Xolair(Omalizumab)
– Anti-IgE medication (injection)
– 1-2 x/month SC
ƒ Xanthines
– Theophylline
– The-odur
– Uniphyll
 Medication Delivery
EVERYONE SHOULD
BE USING SOME
TYPE OF SPACER
WITH MDIs
(Metered Dose Inhalers)
 Medication Delivery
ƒ Nebulizers
– Infants, toddlers and older children not able
to use a mouthpiece, should be using a mask
– Face mask must be tightly fitted to face
• 1 cm from face = 50% reduction in delivery
• 2 cm from face = 80% reduction in delivery
ƒ Not all nebulizers are the same
ƒ No sleeping while administering
medications
 Medication Delivery
ƒ Spacers
– Aerochamber with mask
• Infant (orange)
• Pedi (yellow)
• Adult (blue)*
ƒ Spacers with mouthpieces
– Aerochamber-blue*
– Inspirease
– Optihaler
 Medication Delivery
ƒ Dry Powder Inhalers
– Diskus
– Turbohaler
– Others (dry powder capsules)
 Asthma Actions Plans
ƒ Should include the following
– Preventative Plan (everyday meds)
– Rescue Plan (fast acting beta 2’s)
– Any other instructions—antibiotics,
labs, tests, etc.
– Office contact person and #, after
hours #
– Follow up visit
 Asthma Camps
ƒ Camp Wenoweez
– Located in Burton, Texas at “Camp for
All”
– Special camp for special kids
ƒ July 3-8, 2005
ƒ For information call Tracy Mosely or
Carolyn Cotton 832-822-3300
Resources/References/Web Sites
ƒ Asthma and Allergy Foundation of
America www.aafa.org 1-800-727-8462
ƒ American Lung Association
www.americanlungassociation.com 1-
800-LUNGUSA
ƒ Allergy and Asthma Network, Mothers of
Asthmatics www.aanma.org 1-800-878-
4403
Resources/References/Web Sites
ƒ National Jewish Hospital
www.nationaljewish.org
ƒ Center for Disease Control
www.cdc.gov
ƒ The Consortium on Children’s
Asthma Camps
www.asthmacamps.org
 Janet Bujan, RN
Sheila Martinka, MSN
Texas Children’s Hospital
Asthma Center and Pulmonary
Medicine Clinic
832-822-3300
www.texaschildrenshospital.org/carecenters/
PulmonaryMedicine/Asthma.aspx
 Please join us for the next
Center for TeleHealth
Nursing and Allied Health Professionals
Distance Education and CNE/CEU Offering

Obesity in Children
June 21, 2005 (Tuesday)
5:30 – 6:30 PM
For reservations, please contact:
832-824-1127 or 1-800-TCH-TELE
 Texas Children’s Center for Telehealth
Nursing and Allied Health Professionals
Distance Education and CNE/CEU Offering
1.2 CNE contact hours available to Nurses and
1 CEU for Social Workers:
Texas Children’s Hospital is an approved provider of
continuing nursing education by the Texas Nurses
Association, an accredited approver by the American
Nurses Credentialing Center’s Commission on
Accreditation. This activity meets Type I criteria for
mandatory continuing education requirements toward
re-licensure as established by the Board of Nurse
Examiners for the State of Texas.