Asthma Education

You Can Breathe Easier Knowing We Are Here for You

The goal of Central Ohio Primary Care’s Asthma Disease Management Program is to provide comprehensive education and disease management to our pediatric and adult patients who have been diagnosed with asthma.

Since the inception of the program in 2001, we have seen asthma-related emergency room and urgent care visits reduced by 84 percent, hospitalizations reduced by 93 percent, and unnecessary office visits reduced by 60 percent. We attribute this to the fact that our patients and their families now feel empowered with the tools they need to self-manage their asthma.


Asthma is a chronic lung disease that affects both adults and children. The good news is that asthma is a manageable disease. If you are an individual with asthma, we can personalize a plan that is right for you. By following the recommendations in your asthma action plan, you can gain control over your asthma and improve your quality of life.


The Asthma Disease Management Program is offered at 15 designated COPC offices and is delivered by Barb Mulford, a registered respiratory therapist and certified asthma educator.


Central Ohio Primary Care patients who are diagnosed with asthma are referred to the program by their physician. Once in the program, each family is provided individualized asthma education discussing anatomy, triggers – recognition and avoidance, early warning signs, symptoms, medication and a treatment plan.


Pulmonary function testing is completed on individuals who are 5 years of age and older. This diagnostic tool helps your physician and our asthma educator determine what level of treatment is needed. If there is concern about exercise-induced asthma, you also will run for 10 to 15 minutes as part of your pulmonary function testing to see if exercise is a problem for you.


Each patient walks away from the office with an Asthma Action Plan, and has been instructed on proper use of asthma devices such as inhalers, spacers and peak flow meters. You are followed by the asthma educator and are seen in follow up visits no less than every six months or sooner. Your disease is then managed by your Central Ohio Primary Care physician and the asthma educator with the ultimate goal of decreasing emergency room/urgent care visits, hospitalizations, unnecessary physician office visits and improved quality of life.


How You Breathe

The purpose of the lungs is to deliver oxygen to your blood. Your heart then pumps this blood full of oxygen to other parts of the body. A steady flow of oxygen is needed by your body to work properly.


The lungs are located in your chest and sit above the stomach. There is a large muscle called the diaphragm that separates the lungs from the stomach. The diaphragm moves up and down as you breathe allowing the air to enter and exit from the lungs. It is dome shaped. Everyone’s lungs work the same taking air in and out.


When you breathe, fresh air (full of oxygen) enters through the mouth and nose. The nose cleans the air by trapping small particles from the air, adds water and controls the temperature of the air going into your lungs. The air then travels through a series of tubes (airways) which resembles the branches of a tree. The main tube is the trachea or windpipe (tree trunk). The trachea branches off into the left and right bronchi, and these tubes (airways) further break down into smaller air tubes (airways). Wrapped around the air tubes (airways) are smooth muscle bands. The tubes (airways) are hollow which allows open space for the air to freely travel through the network of tubes (airways). At the end of these tubes (airways) are air sacs (alveoli) which deliver oxygen into the blood stream and allow the stale air (full of carbon dioxide) back into the lungs which is exhaled out of the body. Each time you breathe in, the lungs get bigger (expand). When you breathe out, the lungs get smaller (contract). These words (airways, bronchioles, windpipes and air tubes) all refer to the air passages in the lungs.


How Asthma Affects the Airways

Asthma affects how the lungs work and how much oxygen is delivered to the body. Asthma is a disease of the lungs that a person can have for a long time. Asthma cannot be cured but it can be controlled.


The lungs of a person with asthma work the same way as someone who doesn’t have asthma. The only difference is that the inside lining of the airway is inflamed (swells) and this goes on all the time unless treated. The lungs are hyper-responsive (sensitive) or twitchy. The airways react to asthma triggers more intensely than in people who don’t have asthma. During an asthma episode, the lining of the airways becomes more inflamed & sensitive, thick mucus begins to gather in the airways, which makes the opening in the airways smaller. The muscles around the airways tighten, making the opening in the airways even smaller. These three events block the flow of air in the airways, making it harder for air to pass down the airways, which in turn makes it hard to breathe. The person begins to cough, wheeze and have difficulty breathing. This is an asthma episode (attack).

Asthma Early Warning Signs

Asthma episodes rarely occur without warning. Most people with asthma have physical signs that occur hours before symptoms appear. Warning signs are not the same for everyone. You may have different signs at different times. By knowing your warning signs and acting on them, you may be able to avoid a serious episode of asthma.


To find your early warning signs, think back to your last asthma episode. Did you have any of the signs below before your episode started? Read the warning signs below and check the ones you’ve experienced.

  • Drop in peak flow reading
  • Dry hacking cough
  • Tired
  • Itchy, watery or glassy eyes
  • Itchy, scratchy or sore throat
  • Itchy chin
  • Sneezing or runny nose
  • Fast breathing
  • Headache
  • Fever
  • Restless
  • Pale, clammy skin
  • Dark circles under the eyes
  • Feeling out of sorts, nervous, grumpy
  • Chest feeling heavy or tight
  • Weakness

Recognize and remove asthma triggers

Your child’s airways are very sensitive to objects, acts or events that do not normally bother people who don’t have asthma. They are called triggers, when you are near or come in contact with them, an asthma episode may start. Exposures to triggers build up over time. It may take one exposure to one trigger or numerous exposures to several triggers for asthma symptoms to begin. It depends on how sensitive the lungs are at the time of the exposure.


To understand this lets compare your lungs to a cup of water. The level of the water represents the twitchiness of the airways as the airways are exposed to numerous triggers over a period of time. The cup of water may already be half full because you are constantly around a certain trigger like cigarette smoke. You are having no symptoms but sensitivity of the lungs has increased as well as the swelling of the airways. Then over the next couple of weeks/days the lungs become exposed to numerous triggers. The twitchiness and swelling (inflammation) of the airways increases. The water level in the cup begins to rise. Then at some point the lungs are so twitchy and inflamed that the person begins to have asthma symptoms, and an episode begins. The cup of water overflows.


To make the airways less sensitive, you must reduce the exposure to triggers that the lungs are sensitive to. Everyone’s lungs are sensitive to different triggers and may take different amounts of exposure to triggers before an episode begins. Below is a list of triggers and steps you can take to reduce exposure to certain triggers. At the very least these changes should be made in the child’s bedroom. Although, it would be very helpful to make these changes in the entire house. Your healthcare professional will talk with you about steps to take to eliminate or reduce triggers in your child’s surroundings.


Molds

  • Remove carpets that are laid on concrete.
  • Keep humidity level in the home at 50% or lower.
  • Use a dehumidifier, especially in the basement (clean and empty often).
  • Use a diluted bleach and water mixture to clean areas where mold grows (bathroom, kitchen, basement).
  • Wash shower curtain liner often.
  • Avoid house plants.
  • Do not use humidifiers or vaporizers.
  • Do not store books in the open.
  • Repair water leaks, wet walls and ceiling panels.
  • Run the fan in the bathroom and kitchen.
  • Keep a small light on in the closet and bathroom. Molds grow in dark moist places.
  • Do not hang up damp garments in the closet.
  • Do not store firewood in the house.
  • Avoid sources of mold such as wet leaves, garden debris, and stacked wood.
  • Avoid standing water or areas of poor drainage.

Strong odors or fumes

  • Do not use room air fresheners, deodorizers, potpourri, incense, perfume, talcum powder, perfumed cosmetics, scented candles, paint, or permanent markers. Do not use scented products.
  • Use pump instead of aerosol sprays.
  • Do not stay in the home when painting. Use latex or low VOC paints (volatile organic component) instead of oil base paint.
  • Reduce strong cooking odors (frying) Open windows and use an exhaust fan.

Weather

  • Wear a scarf over the mouth and nose during cold, windy times.
  • Dress warm on cold, windy days.
  • Stay indoors when pollen counts are high or during air quality alerts. Avoid exercising during this time.

Dust mites

  • Remove carpet from the house. Use tile or hardwood floors.
  • Avoid sleeping on upholstered (stuffed) furniture. Replace with leather, vinyl, wood or bean bags.
  • Encase mattress, box springs and pillows in airtight zippered covers.
  • Remove stuffed animals from the bedroom. Keep a few washable ones, but wash them weekly.
  • Wash sheets, blankets, comforters, and pillows weekly in 130° water.
  • Cover air vents
  • Keep humidity at 50% or lower. A dehumidifier or humidity gauge is helpful.
  • Replace furnace filters monthly.
  • Remove pictures and wall hangings, and knick knack’s including books.
  • Use shades or washable curtains. Clean monthly.
  • Use a damp cloth to clean surface dust often. Avoid aerosols or scented cleaners.
  • Damp mop the floors weekly.
  • Do cleaning when the child is not around.
  • Avoid sleeping or lying on the carpeted floor.
  • Vacuum once or twice a week when the child is not around or at least 1-2 hours before he or she returns.
  • Use a high efficiency vacuum bag.
  • Store only necessary clothes in the closet. Put the remaining clothes in a zippered plastic garment bag.
  • Clean walls, baseboards, shelves and furniture once a month.

Exercise

  • Warm up 30 minutes before and cool down after.
  • Set up a plan with your doctor that lets you exercise without symptoms. Ask especially if you are having symptoms such as cough, wheeze or tiring quickly during exercise.

Cockroaches

  • Don’t leave food or garbage sitting out.
  • Keep food in airtight containers.
  • Keep trash bags closed.
  • Use poison bait, boric acid or traps. If a chemical agent is used, stay out of the house for 24 hours.
  • Throw away piles of paper and grocery sacks.
  • All units in multi-family dwellings must be treated.

Colds, influenza, respiratory illness

  • Get the flu shot.
  • Avoid others with colds and flu.
  • Wash hands often and encourage others to do so.

Wood smoke

  • Do not use wood stoves or fireplaces.

Tobacco smoke

  • Don’t allow smoking inside the house, car, or in small areas.
  • Smoke outside away from the doors. Wear an overcoat and remove it before entering the house.
  • Choose non-smoking areas in restaurants, hotels and public buildings.
  • Begin a Stop Smoking program.

Pets

  • Remove animals from the home. It may take 6-10 months to remove the dander.
  • Keep pets outside.
  • Keep pets out of the child’s bedroom.
  • Seal or cover the air ducts that lead to the child’s bedroom.
  • Wash pets weekly.
  • Choose a pet without fur such as a fish or turtle.
  • Avoid other homes with pets. If the child must visit, give asthma medicine before visiting.

Other

  • Avoid products made with fur or feathers.
  • Avoid kapok (silky fiber from seed pods of silk-cotton tree).

Asthma Symptoms

Many changes take place in the lungs during an asthma episode. If these changes have not been controlled by asthma medicines, the body reacts by showing physical symptoms. These symptoms tell you that “asthma is out of control”. The goal of asthma care is to keep the asthma under control and to keep these symptoms from developing. If you have the following symptoms, it means the asthma episode is bad, and you should get immediate care from your doctor.


Wheezing or Coughing

The sound of air passing through tightened airways sounds like a whistle or wheeze. This is one of the most common symptoms of asthma. You can hear this sound by listening to the chest with a stethoscope. You may be able to hear it without this tool. Not all people with asthma wheeze. Others may have a nagging cough that disturbs other people and the child’s normal day.


Sucking in of the Chest (Retractions)

As you try to take in air into the tightened airways, the tissue of the chest wall may be sucked in also. You may notice this in the area above the collarbone or between or below the ribs.


Prolonged Breathing Out

Normally it takes the same time to get the air into the lungs as it does to blow it out. During an asthma episode the air coming out of the lungs is blocked more than the air coming into the lungs. Because of this, breathing out may take longer than breathing in. Breathing out may take twice as long as breathing in when asthma episodes occur.


Fast Breathing

This is one of the earlier signs of asthma. Know your breathing rate during daily activities. Then compare it with rates during an asthma episode. If you have problems counting the breathing, look at your belly. Count its rise and fall with each breath.


Nasal Flaring

As you try to get air into the tightened lungs, the soft tissue of the nose may flare with each breath in.


Unable to Finish a Word or Sentence

During an asthma episode it is hard to breathe. This also makes it hard to talk. Your sentences or words may be choppy and hard to understand. The care giver should ask “yes” or “no” questions to make communicating easier.


Blue-Gray Lips and Nail Beds

The airways in the lungs tighten and make it hard to get the air in and out of the lungs. This lowers the amount of oxygen available to the body. When the oxygen level is low, the lips and nail beds turn a gray-blue color.


Peak Flow in the Red Zone

When the peak flow reading falls below 50% of normal, you’re in the red zone. This occurs along with some or all of the above asthma symptoms. This drop says asthma is bad and the doctor should be called according to the care plan.


What triggers asthma?

There are six general categories that are recognized as potential asthma triggers. If we can identify what triggers the child’s asthma and then attempt to eliminate or reduce the exposure to that trigger, you should see a decrease in the number of asthma episodes.

  • Allergies - Affect about 80-85% of the children who have asthma. Most common allergies are: grass, trees, ragweed, dust mites, mold, cockroaches, dog, cats, and foods such as peanuts, wheat, milk and eggs. Along with reduction and elimination of exposures to these allergens, a child may be treated with a combination of antihistamine medications, allergy shots, nasal sprays and eye drops.
  • Viral/bacterial Infections – Recurrent bouts of rhinitis, sinusitis, bronchitis, cold, flu,etc.
  • Weather Change – dramatic changes in weather such as: extra moisture, cold, warm, humidity.
  • Exercise – Participation in any sport especially outdoors with continuous running, it is important to warm up and cool down.
  • Emotions – Being really happy or sad/angry about something.
  • Indoor Pollutants – Cigarette smoke, incense, potpourri, perfume, nail polish, air fresheners, scented candles, fire places smoke, perfumed cosmetics & cleaners, paint.

What is an allergy and how is it treated?

An allergy is a reaction by the body’s immune system to harmless substances that normally don’t bother most people. Children are more likely to develop allergies if their parents have allergies. People are usually sensitive to more than one substance. The immune system is the body’s defense against invading agents such as bacteria and viruses. In most allergic reactions the immune system is responding to a false alarm. When an allergic person first comes in contact with an allergen, the immune system treats the allergen as an invader. It does this by producing large amounts of antibody’s called immunoglobulin E (IgE). Each IgE is specific to one allergenic substance. The IgE molecule attaches itself to different cells in the body. When the allergen encounters the IgE it attaches to the antibody, then the cell that this antibody is attached to releases powerful inflammatory chemicals. These chemicals move to various parts of the body, like the respiratory system, and cause the symptoms of allergy. These symptoms can be itchy, watery eyes, itchy nose & throat, coughing & postnasal drip, sneezing with runny or clogged nose, allergic shiners. Some people develop asthma as well.


There are 3 approaches to treating allergies; avoidance of the known allergen, medication such as nasal sprays, anti-histamine medicines and eye drops, and lastly allergy shots. One of these strategies or a combination of them can provide varying degrees of relief from allergy symptoms.

Will my child outgrow asthma?

This is a very difficult question to answer. Your child will always have sensitive airways. They may just go through periods of time where they experience no symptoms. If they have non-allergic asthma there is a higher chance for the child to be symptom free when they get older. As the child gets older their airways get bigger and their symptoms may be less severe because their airways are bigger.

Why does my child have to take daily medications for asthma?

The inflammation/swelling of the lining in the airways is a constant physical change that occurs in the asthma lungs. It is the underlying cause of an asthma episode. The inflammation or swelling can be reversed by taking medications everyday to reduce the inflammation. When you decrease the inflammation/swelling, bronchial reactivity decreases which results in less frequent asthma episodes. The full effect of the medication will not be experienced unless the medicine is taken daily as prescribed.

If a child has asthma can they play sports?

Yes. It is important to note that most children with asthma can fully participate in any sport. The child and parents need to follow the doctor’s orders and take the daily medications as prescribed to keep the asthma under control. The child will need to warm up and cool down and may need to pre-medicate with the rescue medications prior to participating in the sport.

If my family moves to a different climate will the asthma get better?

The individual with asthma may be symptom free for a period of time. This is usually during the first couple of months while the body adjusts to a different climate and exposures to different allergens. Once the body’s defense system adjusts to this exposure of different trees, grasses, pollens etc. the allergic response is triggered and the episodes may become worse or better than before. It is important for the child with asthma to live in the environment for 3-4 months prior to moving the entire household, especially if this is the only reason to relocate.

The COPC Asthma Disease Management Program is offered at 15 designated COPC offices and is delivered by Barb Mulford, our registered respiratory therapist and certified asthma educator.