Medications
What is the most common rescue medication for Asthma?
Albuterol or Ventolin
Explain what a peak flow meter is.
Tool to determine how well asthma is being controlled and assesses the severity of asthma symptoms.
Measures patient’s Peak Expiratory Flow Rate (PEFR)
Tells you how fast air can move out of your lungs
Results depend heavily on patient’s effort as well as height, weight, age, and gender. We recommend a “personal best” measure.
The patient should compare the PFM value to their personal best in order to determine how to proceed.
Regarding patient progress, looking at how the patient’s personal best changes over time can be a good indicator of improved or diminished asthma control.
Give 3 common Asthma triggers.
Exercise
Cold air
Respiratory Infections – viruses, bacteria
Exposure to inhaled allergens (dander from pets, roaches and rodents, mold, dust mites, pollen, flowers, plants
Exposure to irritants (cigarette and other smoke from cigarettes, vapes, cannabis, wood burning, perfumes, detergent cleaning chemicals/other sprays,
GERD (heartburn / reflux)
Medications (ACE inhibitors, beta blockers)
Strong emotions – laughing, crying
Stress
Give 1 example of a relaxation practice.
Deep Breathing, Progressive Muscle Relaxation, Imagery
Explain to your patient what Asthma is.
Asthma is a condition where the airways in the lungs (bronchi and bronchioles) narrow.
During an asthma attack, airways narrow making it difficult for the patient to breathe.
Give 3 characteristics of a rescue medication.
Must be carried at all times
Must be taken as needed when asthma symptoms are present
Sometimes is used as "pre-treatment" - example use before exercise in those with exercised-induced asthma
Works fast, but not for very long (about 4 hours)
Does not control asthma in the long-term
Usually this is ALBUTEROL or LEVALBUTEROL
MDI – most common delivery
Sometimes Nebulized
Sometimes a spacer is used
*** Knowing how much someone is using their rescue inhaler is an important clue to tell how well their asthma is controlled with their controller medication
Explain the "color" zones and what they mean on the Peak Flow Meter.
Many PFMs have Green, Yellow, and Red sliders to help interpret results
Green Zone (80-100% of Personal Best): values are normal
Yellow Zone (50-80% of Personal Best): values indicate that caution is necessary as an acute episode may be looming
Red Zone (<50% of Personal Best): values indicate that immediate medical attention and action are necessary
Your patient's asthma is triggered by dust. What are some ways to help them reduce this trigger?
Dust weekly with a damp cloth
Empty the trash daily
Use Anti-Dust Mite mattress and pillow covers
Use 100% cotton blankets
Wash sheets often with hot water
Remove area rugs
Vacuum every week with HEPA filter vacuum
What are 4 examples of Lifestyle Modifications to help manage anxiety?
What are 4 causes of airway obstruction?
Airway inflammation (swelling)
Bronchoconstriction (tightening of airways in the lungs)
Mucus plug formation (mucus buildup in the airways)
Chronic airway remodeling (restructuring of airways, making them narrower)
Give 3 characteristics of a controller medication.
Must be taken every day as prescribed.
Take regardless of symptoms.
Decreases inflammation.
Will not make someone feel better quickly during an attack.
Is NOT used as a rescue.
Explain the 3 Zones of the Asthma Action Plan (AAP).
Zone 1 = GO: If the patient’s asthma is well controlled, they will feel good and have no asthma symptoms. This is the zone patients should be in every day.
Zone 2 = CAUTION: If the patient is feeling not great, their medicines may need adjusting.
Zone 3 = GET HELP: If the patient’s asthma is not well controlled, they will feel bad and should contact their doctor immediately.
Your patient's asthma is triggered by seasonal allergies. What are some ways to help them reduce this trigger?
Ask their doctor if the patient should adjust how they’re managing their asthma before the season starts
Take allergy medicine and close windows to avoid pollen/dust build up
Check the daily pollen levels at http://www.enviroflash.info/signup.cfm
Describe one way in which anxiety can worsen Asthma symptoms.
High levels of stress and anxiety can increase the frequency and severity of asthma attacks
Anxiety can exacerbate asthma symptoms by triggering an inflammatory response in the airways
Anxiety activates the autonomic nervous system, leading to bronchoconstriction and increased airway resistance
Anxiety may lead to hypervigilance about asthma symptoms, amplifying perception and distress
Anxiety can affect adherence to asthma medication regimes, leading to poorer asthma control
Anxiety can lead to behaviors such as avoidance of triggers, which may inadvertently worsen asthma symptoms
When the airways in the lungs narrow, what are some symptoms people with asthma can experience?
Shortness of breath
Chest tightness or pain
Wheezing
Coughing
Trouble sleeping
Name 2 controller medications.
Inhaled Corticosteroids (ICS)
Beclomethasone HFA (Qvar RediHaler)
Budesonide DPI (Pulmicort Flexhaler)
Ciclesonide HFA (Alvesco)
Fluticasone propionate HFA (Flovent HFA)
Fluticasone propionate DPI (Flovent Diskus)
Fluticasone furoate DPI (Arnuity Ellipta)
Mometasone DPI (Asmanex Twisthaler)
Mometasone HFA (Asmanex HFA)
Long-Acting Beta Agonists (LABA) + Inhaled Corticosteroids (ICS) –usually together in the same delivery device
Budesonide-formoterol HFA ( Symbicort, Breyna)
Fluticasone furoate-vilanterol DPI ( Breo Ellipta)
Fluticasone propionate-salmeterol DPI (Advair Diskus, Wixela Inhub)
Fluticasone propionate-salmeterol HFA (Advair HFA)
Fluticasone propionate-salmeterol DPI (AirDuo RespiClick, AirDuo Digihaler)
Mometasone-formoterol HFA (Dulera)
Leukotriene receptor blockers – oral medications (in combination with ICS/ICS+LABA, or alone)
Montelukast (Singulair)
Zafirlukast (Accolate)
What is an Asthma Action Plan?
Asthma Action Plans tell you what to do when your breathing gets worse. They tell you what medicines to take, when to take them, and when to call your doctor or go to the ER.
All people with Asthma should have an Asthma Action Plan
As a Diverge coach you will empower patients to ask their doctor for a written AAP. When a patient has an AAP, you will review it with them to ensure they understand how to use it.
Using the "cup" analogy. Explain how triggers are cumulative and which medicine can help reduce their effects.
Exposure to triggers fills up the cup. When the cup overflows, the person will have an asthma attack.
How much each trigger fills the cup will vary from person to person.
Using a controller medicine can help reduce the effects of the triggers (cup level increases by the controller medicine).
Name 3 common symptoms of Anxiety.
Physical symptoms: Increased heart rate, Rapid breathing (hyperventilation), Sweating, Trembling or shaking, Feeling weak or tired, Gastrointestinal problems, Difficulty sleeping, Muscle tension, Dizziness, Dry mouth
Psychological symptoms: Feelings of apprehension or dread, Trouble concentrating, Irritability, Restlessness, Anticipating the worst, Feeling tense and jumpy, Watching for signs of danger, Uncontrollable worry / rumination, Excessive nervousness, Avoidance, Feelings of being out of control
How is Asthma diagnosed?
Healthcare providers use a variety of tools, including Personal & Medical History and a Lung Function Test.
Sometimes allergy testing is done to determine what people are allergic to.
If your patient with Asthma does not currently have a controller medication on their medication list, what would you do? What advice would you give to the patient?
Escalation to NP. Education regarding use of a controller medication
Based off the Asthma Control test (ACT), what symptoms are assessed to evaluate the patient's asthma control (Hunt: there are 5 questions).
how much of the time did your asthma keep you from getting as much done at work, school, or home?
how often have you had shortness of breath?
how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?
how often have you used your rescue inhaler or nebulizer medication (such as Albuterol, Proventil, Ventolin inhaler)?
How would you rate your asthma control during the past 4 weeks?
What are 3 recommended vaccines for people with Asthma?
Flu, Pneumovax, COVID-19
These are techniques that help with anxiety symptoms by turning attention away from thoughts, memories or worries and refocusing on the present moment.
Grounding Techniques
Describe 3 common myths about Asthma.
Asthma is curable
Asthma is all in your head
People with asthma shouldn’t exercise
All asthmatics wheeze when they’re experiencing an attack
Needing asthma medication means you aren't following trigger-avoidance guidance
Asthma is a psychological condition – if I just relax, it will get better , without medication
It is OK to stop using controller medications once you feel better
Asthma is a childhood illness
Adults who did not have asthma as a child will not have asthma when they get older.
When strong emotions such as fear, laughter and sadness can trigger an asthma attack, it’s not real asthma, it’s all in the person’s head.
Rescue inhaler is more important than the controller medication because it saves your life when you are having an asthma attack.
Inhaled corticosteroids like those found in controller medicine are the same as the steroids taken by athletes to bulk up and run faster.