April 7, 2003

"Asthma Care Training for Child Care Providers" Video Discussion Guide This discussion guide is a companion piece to the inhaled medications video, "Asthma Care Training for Child Care Providers." You may use this guide during pause points in the video. There are three places where the video can be stopped so the instructor may answer trainees' questions regarding the information provided in that specific section of the video. The three sections of the video are: 1. "What is Asthma?" 2. "Medications and

Delivery Devices" and 3. "Cleaning the Equipment."

Section I

What is Asthma?

· A chronic inflammatory disease of the lungs and the airways · A chronic disease for which there is no cure · Can be treated successfully · In asthma, inflammation occurs when an asthmatic person's bronchi come into

contact with irritants or "triggers." Triggers cause: o airways to swell

o bronchial muscles to tighten; broncho constriction occurs when bands of

muscles surrounding the asthmatic person's bronchial tubes contract, causing the airways to narrow

o excess mucous to build up. o As a result of all these, breathing becomes difficult and results in: o chest tightness

o wheezing o coughing o shortness of

breath

o anxiety

Recognizing Asthma Symptoms · Whistling or wheezing sounds with each breath

· Coughing

· Tight feeling in the chest · Rapid and labored breathing

· Blue lips or skin color · Coughing up mucous (Some children vomit when they have a lot of mucous to cough up.) · Restless sleep or wakefulness at night · Any of these symptoms accompanied by a rash on the neck or chin

1

April 7, 2003

Asthma Triggers Many different things may cause an asthma attack in people who suffer from asthma: · Mold, pollen, grasses, weeds, animal dander, pets, cockroaches, dust, dust mites, foods such as nuts, beans, wheat, milk, seafood, eggs, soy, and food additives such as nitrites, nitrates, and MSG. Some medications such as aspirin, or medications with aspirin or salicylates in them, may also cause problems for children with asthma; · Cigarette smoke, wood fire smoke, air pollution, fumes or strong odors from paint, perfumes, house cleaning products, or other chemicals, and changes in air temperature. Chemicals used in the yard may also trigger an asthma attack; . Cold or hot air; . Viral illnesses or infections;

. Sinus problems (A constant drip from the sinuses down the throat may exacerbate

asthma symptoms); · Night time (Night asthma problems are connected to the body's rhythms and

hormones); · Acid reflux disease (may occur when a person is lying flat and the stomach acids travel up to the throat and then down the windpipe. This can cause asthma symptoms); . Exercise;

· Unvented stoves or heaters may also cause indoor air pollution that could trigger an asthma attack; or . Stress or strong emotions (laughing or crying).

Babies with Asthma An infant with asthma may exhibit the following characteristics: . Recurring cough; . Excema or hives;

. Wheezing; . Spit up mucous; . Not sleep well; . Often have a runny nose; or

· Congestion during and after a viral illness. A toddler with asthma may exhibit these same symptoms.

If the Rescue

Medication isn't Working or If Child is:

. Struggling to breathe;

. Hunching over to breathe; or

· Unable to walk or talk; Then, you must:

. Call 9-1-1; . Provide first aid for a breathing emergency;

2

April 7, 2003

. Do not leave the child alone during a breathing emergency; and . Call the child's parents or guardian to tell them about the breathing emergency.

Note: In some instances, when an asthma attack is severe, a child's doctor may prescribe an extra dose of rescue medication for the child. Only if the child's doctor prescribes another dose of rescue medication, in addition to the regular dosage of rescue medication already provided to the child, can an extra dose of medication be provided to the child. Do not exceed dose limits on the medication labeL.

Some children are prescribed epinephrine emergency kits for severe allergic reactions, which may include asthma. If a child in your care has such a kit prescribed to him, you must receive the information regarding its use from the child's parent or guardian, and you must have a medical permission form from the child's doctor describing when and how this kit is to be used, and if it can be used during a severe asthma attack that does not respond to the rescue medication. The form must be signed by the child's doctor. You must also have a permission form signed by the parents for the use of an epinephrine kit. Use of an epinephrine kit is for

emergencies only, and emergency medical personnel must be alerted (call 9-1-1)

when a child has been given a shot of epinephrine.

The Asthma Action Plan should include: . Child's name, address, and birth date;

. Parent's or guardian's name and address;

. Parent's or guardian's home telephone and cell phone numbers;

. Emergency telephone numbers - Parent's work, Doctor's, emergency contact in

case parent or guardian cannot be contacted during an emergency with the child; . Medical care and medication permission forms signed by the parents or guardian

and the child's doctor; . List of the regular medications child must take:

medication, dosage, times to be taken what medical condition the medication is for and what is the desired effect of the medication the medication's common side effects; o Description of o Name of

o Description of

. Kinds of equipment used with the asthma medications, how to use the equipment,

and cleaning instructions for the equipment; . Specific symptoms to look for that signal that particular child's asthma attack; . List ofthe child's particular triggers and allergies;

. What to do in case of a mild to moderate asthma attack; . What to do in case of a severe asthma attack (Call 9-1-1, provide first aid, then call the child's parents or guardian); and . How the peak flow meter works and a child's best peak flow reading (number), moderate peak flow reading, and worst peak flow reading.

3

April 7, 2003

Cleaning the Day Care Facility or Home · Do not use harsh or strong-smelling cleansers when an asthmatic child is present.

Cleansers with bleach, ammonia, or those for tile are harsh and can cause asthma attacks. · Use a wet cloth to dust surfaces instead of using dry dusting cloths or feather dusters. · Do not dust, sweep, or vacuum around the asthmatic child. These chores release dust into the air and can cause asthma attacks.

· Wet mop non-carpeted floors. · Remove carpets, if possible, or keep the child with asthma away from carpets. · Wash bedding with non-scented detergent and hot water once a week. Dry the bedding using the hot setting on the dryer.

· Cover pillows and mattresses with mite covers. Ask the parent of the asthmatic child to provide the mite covers. Pillows should be hypoallergenic. Do not use feather- or down- filled pillows or covers. · Do not use fabric softeners or static-removing dryer sheets. Section II

Medications and Delivery Devices

Controller Medication-Medication for the Prevention of Asthma Symptoms: · Provided by an inhaler, or comes in liquid or pill form; · Reduces the swelling and sensitivity of the airways; · Not to be used for rescue during an asthma attack; · Given on a daily basis; and · May be a steroid. If a child uses an inhaled steroid, the child must rinse out his mouth after using this type of medication, because the steroid left on the tongue can cause a yeast infection on the tongue.

Rescue Medication: · Provided by an inhaler or nebulizer; and · Works quickly to help a child breathe during an asthma attack.

Long Term Reliever Medication-Medication for the Prevention of Asthma Symptoms: · Provided by an inhaler, or comes in liquid or pill form; · Does not work quickly;

· Not to be used for rescue during an asthma attack; · Works over a long period of time to reduce asthma symptoms; and · Given on a daily basis. Note: For more information on using asthma medications, you may go to www.emsa.ca.gov. and click on the "childcare link." There, you will find the EMSA "Inhaled Medications Curriculum." Detailed instructions on how to put asthma medication into a nebulizer may be found in the "Inhaled Medications Curriculum" on pages 9 and 10, "Use and Care

4

April 7, 2003

of a Nebulizer". Information on using an inhaler is found in the curriculum on pages 12 to 14, "Steps for Using an Inhaler." Further instruction on a specific child's dose of

medication and how to use a specific child's nebulizer or inhaler should be provided by the child's parent or guardian.

The Equipment Special equipment used to deliver asthma medications to babies and toddlers: . Spacer with mask and inhaler; or

. Nebulizer with mask. Make sure the mask is the correct size for the child and is fitted correctly against the face. Special equipment used for older children: . Spacer with inhaler; or . Nebulizer with or without mask (Some children prefer the mask to the

mouthpiece); and . Peak flow meter with mouth insert (The mouth insert is usually cardboard or

plastic and makes the hole for the mouth smaller so that a child can get his mouth around the meter more easily).

Dosing of Medication . Parent should explain to the child care provider when the various medications

must be given to the child. . When a parent drops a child off at day care, the parent should alert the child care

provider to the time at which the last dose of medication was given to the child. . This information from the parent should be noted on a daily medicine log.

e The times at which medication is given and the types of medication given should

be recorded in a daily log each time a medication is given to a child by a child care provider. This information should be provided to the child's parent or guardian at the time the child is picked up from the child care facility.

Note: These actions are precautions against over-medicating a child. Asthma medications can

cause a variety of side effects, and must not be over-used, unless the child's doctor prescribes additional use of the medications.

Section III

Cleaning the Equipment

. Tubing. Do not wash or wet the tubing. Tubing should be replaced every two

weeks when the nebulizer is used on a daily basis. If tubing has moisture in it after a treatment, run the machine with tubing until the tubing is dry (about 5-10 minutes). . Nebulizers should be washed daily and allowed to air dry before their next use.

Nebulizers should be replaced every two weeks when used on a daily basis.

5

April 7, 2003

. When cleaning nebulizers, inhaler cradles, spacers, and peak flow meters, do not use hot water or lemon-scented detergents. These can deteriorate the equipment.

6