Asthma

There are 2.2 million Australians with asthma. Approximately 11% of adults and 15% of children (20 to 25% of primary and 16% of secondary school students) are currently diagnosed with asthma. It is important for school staff to be aware of asthma and its management in the school environment.

What is asthma?
What is the main symptoms of asthma?
What triggers asthma symptoms?
Can asthma be cured?
Asthma medication
Recognising an asthma attack
Asthma First Aid
The Four Step Asthma First Aid Plan
What if it is a first attack of asthma?
Asthma and exercise
Links
Asthma Friendly Schools

What is asthma?

People with asthma have sensitive airways in their lungs.

When they are exposed to certain triggers, their airways narrow, making it hard for them to breathe. There are two main factors that cause the airways to become narrow:

the lining of the airways becomes red and swollen (this is called inflammation) and extra mucus (sticky fluid) may be produced
the muscle around the airways tightens (this is called broncho-constriction).

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What are the main symptoms of asthma?

The symptoms of asthma may vary from person to person and from time to time.

Wheezing – a high pitched raspy sound on breathing.
Coughing
Shortness of breath
Tightness in the chest

People may have only a wheeze or cough.

Most children and adolescents who have asthma have mild asthma with very minor symptoms.

At the other extreme, some students need medication on a daily basis and may require additional medication at school (particularly before or during exercise). Most students (even those with severe asthma) are well-controlled and able to participate in school sporting activities.

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What triggers asthma symptoms?

Each person can have different asthma triggers, varying from allergic to irritant sources. In some cases, extremes of emotion may trigger asthma.

Colds and flu
Exercise (this can be readily managed)
inhaled allergens (eg pollens, moulds, animal hair/dander and dust mites)
Cigarette smoke
Changes in weather, temperature and humidity
Certain drugs (e.g. aspirin)
Chemicals and some strong smells
Some food and food preservatives, flavourings and colourings

In some people it can be difficult to know what triggers their asthma.

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Can asthma be cured?

Asthma cannot be cured, but it can be controlled so that people with asthma are able to carry out daily activities without asthma symptoms.

The best way for the student to control asthma at school is to:

Avoid known triggers
Stay active and healthy
Take medication as directed
Use a written asthma action plan (WAAP)

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Asthma medication

There are three types of asthma medication:

Preventers
Relievers
Symptom controllers

There are also combination medications (preventers + symptom controllers).

Relievers

Usually blue coloured devices; includes Airomir™, Asmol™, Bricanyl™, Epaq™ and Ventolin™.

Relievers provide relief from asthma symptoms (coughing, wheezing and shortness of breath) within minutes. This medication relaxes the muscle around the airways, making the airways wider and breathing easier.

The need to use reliever medication more than 3-4 times per week to ease symptoms (other than before exercise), indicates that the student’s asthma is not well-controlled. These students may need to visit their doctor for a review of their asthma and update of their written asthma action plan (WAAP).

Blue reliever medication is used to reduce symptoms of asthma during an asthma attack.

Parents of children with asthma should ensure that their child has access to a blue reliever at school.

Atrovent™ is a different type of reliever that is sometimes used with one of the relievers above. However, it is not used to relieve symptoms of an asthma attack.

Preventers

Usually autumn coloured device; Inhaled medication includes Flixotide™, Pulmicort™, Qvar™, Alvesco™, Intal™, Intal Forte™, Tilade™. Tablets include: Singulair™ and Prednisolone.

Preventer medications make the airways less sensitive and keep people with asthma well.

The medication reduces the redness and swelling inside the airways and dries up the mucus. When started they may take a few weeks to provide full benefit. Preventers usually need to be taken every day, even when the student is free of symptoms.

Preventers do not provide any immediate relief of symptoms; therefore the student usually should be able to leave preventer medication at home. However, Intal™, Intal Forte™ or Tilade™ may be used in the management of exercise-induced asthma and will then need to be used at school, 10 minutes before exercise begins.

Preventer medications do not relieve an asthma attack.

Symptom controllers

Usually green coloured devices; includes Forodile™, Oxis™ and Serevent™.

Symptom controllers (also called long-acting relievers) help to relax smooth muscle around the airways for up to 12 hours. Therefore, students should not need to use them at school.

Symptom controllers should only be used by people taking regular preventer medication.

Symptom controllers do not relieve an asthma attack.

Combination Medications

Seretide™ (purple device) and Symbicort™ (red and white device).

A combination medication contains both preventer and symptom controller in the one device.

Combination medications do not relieve an asthma attack.

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Recognising an asthma attack

An asthma attack can take anything from a few minutes to a few of days to develop.

During an asthma attack coughing, wheezing or breathlessness can quickly become worse.

Assessing an asthma attack

Mild attack

Cough
Soft wheeze
Monitor difficulty breathing
No difficulty speaking in sentences

Moderate attack

Persistent cough
Loud wheeze
Obvious difficulty breathing
Able to speak in short sentences only

Severe attack (Always Dial 000 for an ambulance)

Very distressed and anxious
Gasping for breath
Unable to speak more than a few words in one breath
Pale and sweaty
May have blue lips

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Asthma First Aid

If a student has any of the signs and symptoms above, and has not responded to their usual reliever medication, then follow the Four Step Asthma First Aid Plan.

The school’s emergency asthma kit should contain one blue reliever puffer and a spacer device.

The puffer and spacer combination is considered the most effective delivery system to use in an asthma emergency.

Note: Other devices used to deliver reliever medication, such as Autohaler™ and Turbuhaler™, may be used if a puffer and spacer are unavailable.

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The Four Step Asthma First Aid Plan

Step 1

Sit the patient upright

Be reassuring
Do not leave the patient alone
Stay calm

Step 2

Preferably use a spacer and give

One puff from a blue reliever puffer then ask patient to take FOUR breaths
Repeat the process three more times
Use the blue puffer on its own if no spacer available

Blue reliever medication will be Airomir™, Asmol™, Bricanyl™, Epaq™ or Ventolin™.

Step 3

Wait FOUR minutes

Step 4

If no improvement

Repeat Steps 2 and 3
If no improvement and if not already done call ambulance on 000
Keep repeating Steps 2 and 3 until ambulance arrives.

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What if it is a first attack of asthma?

If someone has difficulty in breathing call an ambulance on 000 whether or not the person is known to have asthma.

Follow the Four Step Asthma First Aid Plan immediately. It could be lifesaving.

No harm is likely to result from giving a blue reliever puffer to someone without asthma and in such circumstances it is acceptable to use the Asthma First Aid Plan.

How to use a puffer

Shake the puffer well and place the mouthpiece in the mouth, with the lips closed around it
Press down firmly once on the puffer canister
Breathe in and hold the breath for ten seconds.

What is a spacer?

A spacer is a clear plastic chamber (football or tube-shaped) that acts as a reservoir for the puffer medication. A puffer and spacer deliver 4 times more medication to the lungs than using just the puffer alone.

How to use a puffer with a spacer

Assemble firmly the spacer device.
Remove the cap from the blue reliever puffer
Hold puffer upright and shake it
Fit the puffer, into the end of the spacer opposite the mouthpiece, so that it fits securely
Place spacer mouthpiece in the person's mouth and close lips around it. If using a spacer with a face mask, place mask over nose and mouth.
Press the puffer to release one puff into the spacer and ask the person to breathe in and out through the spacer FOUR times.
Repeat 3 or more times until a total of FOUR puffs of medication have been given

Do not put more than one puff into the spacer at a time.

Note: there are other medication delivery devices: Turbohaler™, Accuhaler™, Aeroliser™, Autohaler™, and Nebuliser™. To avoid confusion only the inhaler (puffer)/spacer combination, for asthma emergencies has been described here.

Cleaning of devices

Devices such as puffers and spacers that may be used by more than one person must be cleaned appropriately after each use.

Remove canister from puffer device
Separate the spacer into 2 parts (if using Volumatic™)
Wash devices in hot water and detergent solution - DO NOT RINSE
Allow devices to air dry - DO NOT DRY WITH A CLOTH
When dry, wipe the mouthpiece with a 70% alcohol swab available from pharmacies
If any device is contaminated by blood, dispose of the device immediately

(Please refer to NHM&RC Infection Control Guidelines 2004)
For information on other medication delivery devices please visit the Asthma Foundation's website.

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Asthma and exercise

85% of students with asthma will notice symptoms when they exercise, that is, exercise induced asthma, EIA.

Symptoms may include:

Wheezing - a high pitched raspy sound on breathing
Coughing
Shortness of breath
Tightness in the chest

Exercise is the one asthma trigger that should not be avoided as it can be readily managed. Being physically fit can increase the intensity of exercise required to provoke EIA. After training the student is likely to:

Have less exercise-induced Asthma
Be less breathless
Be less anxious about activity
Feel good
Be less dependent on treatment
Lose less time from school

What causes EIA?

At rest we breathe through our nose.As the air moves through the nose, it is warmed and moistened. When we exercise we breathe faster through our mouths, inhaling large volumes of air. This means we breathe colder, drier air. If a student has asthma, the muscles round the airways tighten and the airways become narrow, making breathing difficult and producing asthma symptoms.

How do students avoid EIA?

Students should:

Take regular asthma medication as prescribed
Use blue reliever medication (Airomir™, Asmol™, Bricanyl™, Epaq™ and Ventolin™) 5-10 minutes before warm up
Follow their doctor's advice on the most suitable medication. (Some preventer medications (Intal™, Intal Forte™ or Tilade™) and some symptom controllers (Forodile™, Oxis™ and Serevent™) may also be used to help prevent EIA.)
Always warm up before exercise or activity by doing 15-20 minutes of light, intermittent exercises and stretching or 5-7 x 30 second sprints every 2-3 minutes about 30 minutes before exercise
Always carry their blue reliever medication
Always cool down after exercise or activity.

What to do if the student gets EIA during sport

Students should:

Stop the exercise/activity
Take FOUR separate puffs of the blue reliever (Airomir™, Asmol™, Bricanyl™, Epaq™ or Ventolin™) preferably via a spacer device
Wait FOUR minutes
Only resume exercise if free of symptoms and are breathing easily.

If symptoms persist or reappear on resumption of exercise the student should:

Use the blue reliever as before
Not return to exercise/activity for the rest of the day
See the doctor for review of asthma management and Written Asthma Action Plan.

If symptoms persist follow the Four Step Asthma First Aid Plan.

Exercise should be avoided when:

Asthma is not well controlled
The student is unwell
When they have a cold or flu
If the Peak Expiratory Flow measure is 80% of their normal value.

Before exercise:

Always warm up before activity
Use blue reliever / recommended medication if required 5-10 mninutes before warm up

After exercise:

Cool down and be alert for asthma symptoms

During exercise, if symptoms occur:

Stop activity and take medication (using Written Asthma Action Plan or Asthma First Aid)
Return to activity only if free of symptoms
If symptoms reoccur, take medication as above. Do not return to activity
Notify parents/carers of incident; recommend review by their GP

All students with asthma should have a Written Asthma Action Plan (WAAP) which is provided by the student’s doctor and reviewed at each consultation. This plan gives step-by-step instructions to help students manage their asthma. It is preferable that the school also has a copy of the student’s WAAP.

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Links

For general information on Asthma
www.asthmatas.org.au

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Asthma Friendly Schools

The Asthma Friendly Schools program is a Commonwealth initiative to educate and support students, school staff and parents to better manage asthma in the school environment. It is entrusted to the Asthma Foundations.

For further information and to register schools in the program contact the Asthma Friendly Schools coordinator at Asthma Foundation of Tasmania:

Free call: 1800 645 130 or
Email: afs_asthmatas@bigpond.com

This information was updated by the Asthma Foundation of Tasmania in March 2007.

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