Asthma Education for Health Professionals May 17 and 18, 2011 National Nursing Centers Consortium Nancy L. Rothman, MSN, EdD, RN Independence Foundation Professor of Urban Community Nursing Department of Nursing, CHP&SW Temple University
Our goal is at the end of today, participants will be able to: Assess the impact of environmental exposures related to asthma With Dion addressing exposures to pest allergens and pesticides Utilize current literature addressing environmental exposures to enhance curricula or interactions with clients
Our goal is at the end of today, participants will be able to: Identify prevalence and severity of pest allergens in the home and their relationship to asthma. Distinguish between various pesticides and the implications of pesticide usage as it relates to asthma. Understand how cleaning chemical use in the home can exacerbate asthma.
May is Asthma Awareness Month Asthma is a serious, sometimes life-threatening chronic respiratory disease that affects 25 million Americans 7 million children There is no cure, but it can be controlled with Medication Management of environmental triggers
Asthma is more common among children (7-10%) than adults (3-5%). Most common chronic health problem in children More common in male children than female children More prevalent among African Americans and Latinos than Caucasians
Asthma is not contagious, BUT It does run in families. If parents have asthma, their children are more likely to have asthma. Children in low income families tend to have more severe asthma.
Asthma is a lung disease Causing people to: Wheeze Cough Be short of breath Have difficulty breathing/an asthma attack
During an Asthma Attack Airways swell Muscles around the airways tighten Airways produce mucus Caused by air flow obstruction within the lungs that is often reversible either spontaneously or with treatment
Triggers for Asthma Attacks include: Exercise Exposure to cold air Respiratory infections Indoor and outdoor air pollution Noxious fumes Tobacco smoke A host of allergens
Common Allergens Molds Pollens Pests Animals (especially cats and dogs) Foods Medications
During Asthma Attacks Immune system chemicals (antibodies/immunoglobin E) mistakenly identify a harmless substance (e.g. tree pollen) as a dangerous invader. IgE is programmed to remember and react to specific substances and attachs to mast cells abundant in connective tissue of the skin, upper airway, lungs, stomach and intestine. Not on the initial contact, but with future contacts, the antibodies attack the allergen and release chemicals (histamine) that that cause eyes to itch, noses to run and trigger asthma symptoms in the lungs.
Confirming Allergies Symptom diary Indoors/Outdoors School/Work/Home Food History and physical Blood tests Skin tests Spirometry
Gaining control Avoiding triggers Removing triggers Medication Controller Emergency Antihistamines Immunotherapy
EPA Asthma Home Environment Check List Can be used in the home Can be used in a primary care or specialist office
Other Helpful Tools Severity Assessment Asthma Self-Management Plan Asthma Action Plan
Current literature related to asthma National Heart Blood and Lung Institute Physician Asthma Care Education (PACE) Physicians presented more clear and concise information. Patients had fewer days with symptoms, fewer ER visits and reduced hospitalizations. National Institute of Environmental Health Sciences Found new use of aldose reductase inhibitor drugs - currently being used for diabetes complications - to reduce inflammatory response in human airway epithelial cells and live mice. (Boldogh and Srivastava, 2009).
Current literature related to asthma National Institute of Environmental Health Sciences National Institute of Environmental Health Sciences Asthma symptoms in children are associated with mother using acetaminophen when pregnant. (Perera, 2010) Meta analysis confirms greater asthma risk to children born of asthmatic mothers versus fathers. (Kobzik, 2010)
Current literature related to asthma National Institute of Environmental Health Sciences National Institute of Environmental Health Sciences Study indicates a possible link between childhood obesity and allergies. (Zeldin, 2009) Mold exposure in first year of life may lead to children developing asthma. (Leaderer, 2007)
Current literature related to asthma National Institute of Environmental Health Sciences Maternal smoking and environmental tobacco smoke contribute to asthma in children. (Gauderman and Peters, 2007). National Institute of Environmental Health Sciences Low level ozone and particulate matter pollution are associated with respiratory symptoms in children. (Leaderer, 2007)
Current literature related to asthma National Institute of Environmental Health Sciences National Institute of Environmental Health Sciences Oral contraceptive use by young women (13-28 years old) may influence the occurrence of asthma and wheezing. (Gilliland, 2007) Link between thunderstorms and asthma attacks in Atlanta metro area. A likely hypothesis pollen grains rupture on contact with rain water and release allergens and the gusty winds help to spread them. (Tolbert, 2008)
Current literature related to asthma National Institute of Environmental Health Sciences Gas stove emissions worsen asthma symptoms. Each 20 point increase in nitrogen dioxide levels led to a 10% increase in coughing and 15% increase in days of limited speech due to wheezing. (Breysse and Diette, 2008) Pediatric Nursing Parents, teachers, school staff and children in grades 1-8 in one school participated in a Healthy Children, Healthy Homes Project and resulted in increased knowledge and modified some behaviors related to controlling asthma triggers. (Brooten, 2008)
Current literature related to asthma National Institute of Environmental Health Sciences Poor housing quality remained a severe detriment in keeping pest infestation down, when testing if a comprehensive integrated pest management intervention would reduce the severity of asthma symptoms. (Kinney, 2007) Good transition to Dion Lerner, BS Who will focus on pest allergens, pesticides and cleaning chemicals