Managing Asthma Effectively in Older Adults

D i s t r i C t O f C O L u M B i A D E PA r t M E n t O f H E A Lt H
Managing Asthma Effectively in Older Adults
An Educational Guide for Promoting Better Asthma Control Among Older Adults Living in the District of Columbia
D i s t r i C t O f C O L u M B i A D E PA r t M E n t O f H E A Lt H
Managing Asthma Effectively in Older Adults
An Educational Guide for Promoting Better Asthma Control Among Older Adults Living in the District of Columbia
ta ble of cont ent s

table of conte nts
PREFACE
Acknowledgements Letter to Instructors Introduction
i ii iii
SECTION 1
INSTRuCTORS GuIdE Background Q and A How to Use the Curriculum Health Education for Older Adults Working with Older Adults in Health Promotion Programs Cultural Competence Asthma Learning Tool: Questionnaire Instructor Questionnaire: How Much Do You Know About Asthma in Older Adults? 1 4 6 7 8 10 18
SECTION 2
CuRRICulum REvIEw Part I: Introduction A. Introduction and Icebreaker B. Goal and Objectives C. Pre-Program Questionnaire D. DVD: Asthma and the Elderly Part II: Asthma Basics A. Normal Lung Function B. Asthma Causes and Symptoms C. Asthma Episodes and Warning Signs D. Asthma Emergencies E. Asthma Triggers F. Asthma Diagnosis and Management 21 22 23 24 25 26 27 28 29 30 31 32
table of conte nts
Part III: daily Self management: Asthma Self-Care Skills A. How Do You Achieve Good Asthma Control? B. Identify Asthma Triggers C. Recognize Early Warning Signs D. Take Medicines Correctly E. Partner on a Plan Asthma Action Plan F. Maintain Good Communication Part Iv: Special Considerations for Older Adults with Asthma A. Choosing An Asthma Healthcare Provider B. When To See A Specialist C. Medication Management and Multiple Health Conditions D. Problems That Can Complicate Asthma Diagnosis E. Understanding Case Management Part v: living Your Best life A. Smoking Cessation B. Nutrition C. Exercise D. Tips for Feeling Great E. Group Activities F. Post-Program Questionnaire
33 34 35 40 41 43 44 45 47 48 49 50 51 52 53 54 55 56 57 58 59
SECTION 3
CuRRICulum PRESENTATION
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SECTION 4
lESSONS lEARNEd
101
SECTION 5
RESOuRCES & GlOSSARY Resources Glossary Toolkit Materials Handouts
105 105 107 110 111
Acknowledgements
the district of columbia department of health gratefully acknowledges Maia v. Banks-scheetz, Ms, chEs, with Building Educational alternatives together for health (B.E.a.t. for health), and the following individuals for contributing their time and professional expertise to this report Managing Asthma Effectively in Older Adults: An Educational Guide for Promoting Better Asthma Control. in addition, we thank the district of columbia Office on aging and the following senior wellness centers and senior service providers who were gracious enough to allow our use of their facilities and access to their seniors to participate in various focus groups, educational sessions and other related programs. this toolkit is all the more valuable because of the insightful feedback shared by older adults with asthma living in the district of columbia.
Pamela M. Banks, RN Nurse Consultant Joshua Holloway, MD, FAAP Medical Advisor Travonia Brown-Hughes, PhD Gerontological Consultant Edwina Davis-Robinson, MS, CHES Asthma Program Manager Community Health Administration District of Columbia Department of Health Jossolyn Edwards, EdD Educational Research Consultant Yvonne Esipila Asthma Program and Community Partners Liaison Intern Community Health Administration District of Columbia Department of Health Sharland Reed, MSW Adult Education Consultant Patricia L. Surratt, BA Principal Editor Lori Taylor, BS, RRT Asthma Education Consultant C. Olivia Williams Senior Life Advisor Consultant
Angela Diggs Congress Heights Seniors Wellness Center Stacie Thweatt Model Cities Senior Wellness Center Theresa Moore Hattie Holmes Senior Wellness Center Brenda Turner Greater Washington Urban League Aging Program Alyce Murrell Emmaus Services for the Aging Elise Nicholls United Planning Organization Washington Seniors Wellness Center
We also extend our special thanks to all those involved in the creation of the Asthma and the Elderly dvd, an integral part of the toolkit, and to thomas f. Plaut, Md, faaP, scfacaai for use of the One Minute asthma training asthma learning tool 2005 Pedipress, inc.
Managing asthMa EffEctivEly in OldEr adults
Letter to instructors
Dear Instructor, The prevalence of current asthma in the District of Columbia has been consistently higher than the national rate for the past seven years. Older residents (45-50 years of age) and elderly (65 years of age and older) suffering from the effects of this serious but manageable chronic condition is inordinately high. We appreciate the commitment you have made to empower these individuals with information about asthma and asthma management. By using this toolkit and teaching the Managing Asthma Effectively in Older Adults program, you make a substantial difference in the well-being and daily lives of older adults with asthma. Your efforts will ensure they have the tools necessary to become proactive in the management of their asthma. The Managing Asthma Effectively in Older Adults program is an effective, fundamental asthma education program specifically designed for older adults living in the District of Columbia. The 90-minute session is easy to teach and older adults respond well to it. Older adults gain helpful asthma management skills and become more confident about taking control of their disease. You do not need to be an asthma expert to teach the Managing Asthma Effectively in Older Adults program. However, the program is intended to be used by health educators, social workers, nurses, case managers and other individuals who have knowledge and experience with asthma and asthma care and work with the older adult population. If you are new to the subject of asthma or to teaching older adults, these guidelines will provide you with the necessary tools to actively engage older adults in the learning process (through discussion, reflection, role-playing, and storytelling) that will lay the foundation for them to be empowered participants in their own health care. The toolkit contains instructors guidelines, a curriculum, Asthma and the Elderly DVD, a CD containing the Managing Asthma Effectively in Older Adults power-point presentation and related handouts, as well as a copy of Dr. Tom Plauts One Minute Asthma book. To prepare for teaching the program: 1. View the Asthma and the Elderly DVD. The DVD provides a wealth of information about asthma and asthma management and documents viewpoints of older adults with asthma living in the District of Columbia. 2. Review the One Minute Asthma book and familiarize yourself with the Managing Asthma Effectively in Older Adults Curriculum and Presentation. 3. Complete the Asthma Learning Tool Questionnaire and the Instructor Questionnaire: How Much Do You Know About Asthma in Older Adults? Check your answers and review any questions you answered incorrectly. 4. Review the Instructors Guide and the remainder of the toolkit for further information about implementing the program and working interactively with older adults. Thank you again for your dedication to programs and services that benefit older adults with asthma.
The District of Columbia Department of Health Community Health Administration, Asthma Control Program DC Control Asthma Now (DC CAN)
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introduction
Overview The District of Columbia Department of Health (DOH) Asthma Control Program launched the DC Control Asthma Now (DC CAN) Program to address national Healthy People 2010 asthma objectives, and to improve the quality of life for District residents who suffer from asthma. Managing Asthma Effectively in Older Adults: An Educational Guide for Promoting Better Asthma Control is one component of a multi-pronged approach to reduce asthma morbidity and mortality among older adults in the District of Columbia. What is Asthma? Asthma is a chronic disease of long-lasting sensitivity and swelling (inflammation) of the lining of the airways in the lungs characterized by respiratory symptoms including: difficulty breathing or shortness of breath, wheezing, coughing, and chest tightness. Symptoms can vary in sensitivity from mild intermittent to severe or persistent. Asthma can be controlled with a comprehensive asthma management plan, which includes proper medication and trigger reduction. Asthma and Older Adults in the District of Columbia According to the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey data, approximately 9 percent of adult residents (40,000 adults) and 11 percent of children (13,000 children) currently have asthma, and about 15 percent of adults have been diagnosed with asthma at some point in their life. Overall, the prevalence of current asthma in the District of Columbia has been consistently higher than the national rate for the past seven years. Asthma is often thought of as a childhood disease, but it affects all age groups. In the District of Columbia certain subgroups are disproportionately affected and they include the non-Hispanic black population; very young children 0-4 years of age, adolescent females, and adults (45-50 years of age) and the elderly (65 years of age and older), tobacco smokers, overweight and obese populations, residents with less than or some high school education, and households with an income less than $15,000 appear to be the most affected by asthma. The District of Columbias middle aged and elderly populations have the highest hospitalization rate among the adult population. This is also consistent with the increased proportion of hospital admissions from emergency departments (ED) among these groups. In addition the District of Columbias older adult population had the highest asthma deaths among all age groups.
Source: DC Department of Health Burden of Asthma in the District of Columbia 2009.
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Asthma in older adults is complicated because the normal effects of aging can make asthma a diagnosis that is difficult to identify and treat. ome asthma symptoms are similar to signs of other S possible health conditions (congestive heart failure, chronic obstructive pulmonary disease). ere may be other ongoing health concerns that Th make diagnosis and/or treatment more difficult. aking different mediations and/or monitoring T asthma properly can be challenging. lder adults may be more likely to have side effects O from asthma and non-asthma medications. atient education may need to be modified to P account for possible memory problems, loss of coordination and muscle strength, hearing and visual difficulties, and depression.
The DC CAN, in collaboration with its community partners, developed Managing Asthma Effectively in Older Adults: An Educational Guide for Promoting Better Asthma Control in response to the following: isparities in asthma prevalence among older adults; d nique asthma education and management u considerations; and eedback from older adults with asthma living in the f District of Columbia.
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sectio n 1 Instructors Guide
y using this toolkit and teaching the Managing Asthma Effectively in
Older Adults program, you make a substantial difference in the well-being and daily lives of older adults with asthma. Your efforts
1: Instructors Guide
will ensure they have the tools necessary to become proactive in the management of their condition.
section 1 Creating Asthma-Friendly Schools Instructors Guide

Background Q and A How to Use the Curriculum Health Education for Older Adults Working with Older Adults in Health Promotion Programs Cultural Competence Asthma Learning Tool Questionnaire Instructor Questionnaire: How Much Do You Know About Asthma in Older Adults? 18 1 4 6 7 8 10
1: Instructors Guide
Background Q & A
Why was Managing Asthma Effectively in Older Adults Program developed? The Asthma Control Program, DC Control Asthma Now (DC CAN), District of Columbia Department of Health (DOH), recognized the necessity of a multi-pronged approach that included community-driven health education initiatives to reduce asthma morbidity and mortality among older adults in the District of Columbia. In 2004, it launched the first of several initiatives targeting those seniors residing in wards 6, 7, and 8 of the District. The decision to select this audience was based on findings from the 2002 Behavioral Risk Factor Surveillance System (BRFSS) report that indicated these wards had the highest asthma prevalence rates in the District of Columbia. While educating older adults on asthma management was the primary goal, a secondary goal was engaging older adults in developing asthma education tools and creating opportunities for them to share their perceptions of asthma self-management. In 2005, DC CAN developed Sharing the Keys to Asthma Management and launched the Senior Asthma Education Project to address this need. It provided communitybased educational outreach on asthma management to residents in wards 7 and 8, ages 55 years and over, who have been diagnosed with asthma. Pre-and post-program survey results indicated success in meeting educational objectives. However, survey responses also indicated the need for continued asthma education with this population, particularly as it relates to the use of asthma medications, and an asthma action plan. The current program Managing Asthma Effectively in Older Adults places an even greater emphasis on these topics.
Why was the toolkit developed? The purpose of this toolkit is to provide health educators, clinicians, social workers, case managers, and other professionals serving older adults with culturally appropriate information on asthma management. In return, these health professionals can better educate their patients as well their patients caregivers. This toolkit is designed to: ffer a fundamental asthma education curriculum O specifically designed for older adults. rovide a broad range of resources to assure the P success of the educational process, both for health professionals and their patients and families. ighlight asthma education initiatives implemented H in the District of Columbia and provide lessons learned from each. The toolkit is intended for educational purposes only; it is not intended to replace the medical advice or services of a licensed healthcare provider.
sEctiOn 1 / instructOrs guidE
Below we have summarized major education and focus group findings that led to the content and design of this toolkit (for a more detailed description of DC CAN asthma education initiatives for older adults, please see Section 4). Older Adults with Asthma Asthma is often misdiagnosed among older adults. lder adults often distrusted their asthma healthcare O provider unless there was a long-term relationship. Misdiagnosis or a perceived delay in the diagnosis of asthma also caused feelings of distrust. ome older adults said they relied on their higher S power to cure their illness. Many seniors said they did not claim the diagnosis of asthma or rebuked the diagnosis of asthma. lder adults in general are not managing their O asthma adequately. Many older adults did not have asthma action plans. any older adults were not using their prescription M medications properly. lder adults needed to develop strong partnerships O with their providers Asthma Healthcare Providers roviders needed to be educated on asthma P management for older patients. roviders were not aware of problems unique to P older adults with asthma.
Additionally, we found: E ducational materials need to be age- and cultureappropriate. lder adults wanted to be involved in creation of O materials and program design. lder adults preferred to have a facilitator that O reflects their age group and culture.
What is the goal of Managing Asthma Effectively in Older Adults Program? The program empowers older adults with asthma to better manage their condition through an interactive teaching curriculum. It teaches older adults how to: Identify asthma triggers and reduce or remove them. etect asthma warning signs and take appropriate D action. ake medicines according to their healthcare T providers instructions. ommunicate effectively with their healthcare C providers. ssist their healthcare provider with completing (or A updating) an Asthma Action Plan. Consequently, older adults learn to lead healthier, more active lives.
What is the educational theory behind Managing Asthma Effectively in Older Adults? The program is based on Hochbaum, Rosenstock and Kegels Health Belief Model (HBM), a psychological model that attempts to explain and predict health behaviors based on the attitudes and beliefs of individuals, and current research involving learning styles and older adults. The HBM is based on the theory that an individual will engage in a health-related action if that individual: elieves that a negative health condition can be B avoided. elieves that by taking the suggested action, he/she B will avoid a negative health condition. elieves that he/she can successfully take the B suggested health action. Learning style represents the manner in which individuals consistently respond to and process information in a learning environment. Research in this area suggests that not all older adults are active, hand-on learners; but rather, with aging, there is a tendency to become more reflective and observational in the learning environment. The activities in Managing Asthma Effectively in Older Adults that enhance older adults learning experience include: Use of reflection to share feelings abut asthma. Use of role-play to rehearse new skills. Use of storytelling to stimulate problem-solving. Use of observation to encourage retention. As an instructor, you help to create a respectful, supportive learning environment and build trust among your audience. If respect, support and trust are present, older adults become more interested in the information presented. As a result, they are more likely to apply knowledge they have learned in the Managing Asthma Effectively in Older Adults program and experience better asthma control.
What is the philosophy of Managing Asthma Effectively in Older Adults Program? The core element of the program is empowerment. Through the program, older adults learn to manage their asthma and to become advocates in their own health care. The program addresses the physical, social and psychological effects of asthma. For older adults, having control over their asthma means having more control over their lives. This program enables older adults to control their asthma symptoms and empowers them to better manage their asthma with the aid of their health care team, family and friends.
How to use the Curriculum

i. Materials and Equipment What materials and equipment are needed to teach the program? To teach the program, you need the following: anaging Asthma Effectively in Older Adults M Curriculum CD it contains your power point presentation and related handouts. Laptop with LCD projector. Asthma and the Elderly DVD. Television with DVD player. A pen or pencil for each attendee. folder to collect pre- and post-program A questionnaires. Handouts for each attendee: Presentation Packet a copy of the power point presentation Pre-Program Questionnaire: What Do You Know About Asthma? What triggers Your Asthma? Recognize Your Warning Signs Asthma Action Plan ow to Use a Metered-Dose Inhaler (MDI) H Post-Program Questionnaire: What Do You Know About Asthma? What potential barriers should be considered? Keep in mind that barriers or other obstacles may hinder learning; declining hearing and vision are two potential barriers. e prepared to help individuals move closer to B sound sources. Use extra voice and media amplification. llow adequate time for adjustments when going A from light to dark area or vice versa, such as showing the Asthma and the Elderly DVD. Reduce glare and direct sunlight. Use high contrast on visuals and handout material. ead material aloud where possible, such as the pre- R and post-tests, and other handouts. ii. setting What is considered a good location to hold the session? Go where your audience is. The best places to hold the session are senior wellness centers and other locations that provide services for seniors. Look for sites that can help identify older adults with asthma and market the program. Often sites can provide someone to assist with facilitating the session. The site should have a large room (i.e., conference room) with good acoustics, an adequate number of desks or tables, a television with DVD player, a laptop computer and a LCD projector. How should the room be arranged? Create a supportive learning environment. Organize the room according to the needs of your audience. If possible, make arrangements for the facility to position tables or desks in a semi-circle if you are using a podium or circle if you will be seated among your audience. Provide each empty seat with a copy of the power point presentation and handouts; place additional materials within easy reach of your seat or podium.
iii. facilitating the session The program can be modified to meet the needs of the audience, however it should be carried out in the general order in which it is presented. The curriculum has been planned to make the 90-minute session as easy as possible to implement through: 1. Power-point slides 2. Instructions and a script to generate discussion 3. Related handouts Interactive group activities are included at the end of the program to encourage older adults to work together to address barriers to asthma self-management. The curriculum is divided into five topics: 1. Introduction 35 minutes 2. Asthma basics 10 minutes 2. Self-care practices 15 minutes 3. Special considerations for older adults with asthma 10 minutes 4. Living your best life 20 minutes Topics and activities in the lesson that are used to meet the learning objectives, materials required, and the time necessary to complete the section are indicated at the beginning of each lesson topic. The curriculum is formatted for group implementation but can be easily adapted for one-on-one instruction as well. Summary of How to Use the Curriculum 1. Gather materials needed for the session. If possible, make arrangements for the facility to store them for you. 2. When you are in the education room, arrange tables or desks in a circle or semi-circle. If possible, make arrangements for the facility to position them for you.
3. Provide each empty seat with a pencil or pen and copies of handouts; place additional materials within easy reach of your seat or podium. 4. Set up the laptop/LCD projector. Load the Managing Asthma Effectively in Older Adults Curriculum CD. 5. Load the Asthma and the Elderly DVD. 6. Open the Toolkit to SECTION 3: Curriculum Presentation and Suggested Lesson Script. 7. Begin the presentation. Discuss the topic or carry out the activity indicated for each power point slide using the script to generate discussion. How to Respond to Difficult Situations What if a participant shares information that is incorrect? If a participant shares inaccurate health information during a discussion, respectfully thank him/her for the comment or answer but ask the participant to speak further with their doctor about the information, followup with Doctors tell us that or Experts say and then give the correct answer. Re-direct the class by asking questions like What can you do instead? or What would you do in this situation? Make sure that the correct information is given to the audience without embarrassment to the participant and without shedding a negative light on the original source of the information. What if I do not know an answer to a question? Be honest. Refer them to their healthcare provider. What if I cant complete the entire curriculum within the timeframe allotted? Base learning activities and instructional approaches on the needs and interests of your audience.
Health Education for Older Adults

The fastest growing segment of the older population are elders, specifically those who are 85 years of age and older. This population is expected to double from 5 million in 2003 to 10 million in 2030, and to double again in 2050 to 20 million. Additionally, the U.S. population is becoming more culturally diverse as it ages. By 2050, older adults of color will make up 35 percent (30 million) of the 65 and older population. Older Americans comprise a diverse population and are not all the same. There is an increasing range of ages, functional and cognitive abilities, and health status. Differences among older adults are attributed to factors such as culture, race, ethnicity, religion, language, sexual identity, gender, income and education. The growth and diversity of the aging population presents challenges as well as opportunities to providers in the fields of aging and health. To create health programs that change behavior, create supportive environments and encourage good health practices, the American Journal of Health Promotion suggests a framework of four essential elements: awareness, motivation, skill-building and opportunity (ODonnell, 2005). This framework is based on the idea that people need to: Know what to do (awareness). Be ready to do it (motivation). Learn how to do it (skill-building). Have access to do it (opportunity).
Framework author Michael ODonnell suggests that Successful efforts at health behavior change will have a much greater chance of occurring if all four of these components are formally addressed in the programs design (ODonnell, 2005). These elements were considered in developing this toolkit to assure that elderly patients had the hands-on knowledge to manage their asthma and the skills necessary to partner with their healthcare providers in sustaining an effective asthma management plan. The next section is a reminder to health professionals that older adults comprise a unique group with characteristics that requires specialized attention in educational programs.
Reprinted from American Society on Agings Live Well, Live Long Issue Briefs Series. Copyright 2006 American Society on Aging. San Francisco, CA. www.asaging.org/CDC.
Working with Older Adults in Health Promotion Programs
1. Be aware that older adults are not a homogeneous group.
A room full of older adults may include a wide range of ages and functional and cognitive capacities. There may also be big differences between individuals based on culture, race, religion, language, sexual identity, gender, income, education, physical ability or other factors. Each elder is a unique individual with distinct life experiences. Make sure to find out about your audience beforehand.
2. Be aware of ageist attitudes.
a clear, simple layout. Large-size visual aids can be very helpful because they dont require that someone knows how to read (a problem that affects one-third of older adults) or understand health terminology.
5. Be aware of fears and concerns that older adults may have.
Watch out for ageist attitudes that you may be expressing inadvertently. Aging is sometimes negatively represented as a time characterized chiefly by loss loss of physical ability, loss of loved ones, and loss of social status. While it is important to acknowledge loss, use this opportunity to promote the positive side of aging. Address elders formally (using Mrs./Miss/Ms./Mr.) unless they invite you to call them by their first names. Elder and older adult seem neutral and respectful, but remember that people of varying cultural backgrounds may not be comfortable with the same descriptors. An underlying respect for the elders youre working with will speak volumes.
3. Be inclusive and nonjudgmental.
Elders may have many fears and concerns, such as losing independence, being isolated, falling, getting injured, having mixed feelings about participating, not being accustomed to doing the activity, or feeling that the activity is inappropriate. Acknowledge that societal attitudes toward aging have changed over time. Listen to their concerns, validate their reality, and appreciate that you are in a position to help them make positive changes in their lives.
6. Pay attention to learning and teaching style.
Older adults can learn new skills (physical, mental and social), but they may learn more slowly or need different instructional techniques than younger adults. Be prepared for a wide range of abilities among participants. Break down components into small parts and give clear explanations, both verbally and visually. Give participants a lot of positive reinforcement and positive feedback. And remember, every elder can improve his or her abilities. Be sure to celebrate progress with the participants!
7. Encourage social interaction among participants.
Use eye contact and other techniques to engage and include everyone in a group or class. Try to acknowledge and validate the needs of each individual while mainly focusing attention on the entire group. Base your expectations of an individual on ability, not age. Establish a positive, nonjudgmental tone that supports everyone.
4. Be aware of communication difficulties due to vision or hearing impairments or low literacy.
For elders, one of the benefits of participating in a group setting is the opportunity to engage in social interaction. Encourage peer education, sharing and interaction among participants both in and out of class (for example, use partner activities during a class).
8. Learn from elders theyre the experts!
Make sure everyone in the group can see and hear you. Use a microphone if possible. Print materials for older adults should be in a font thats at least 14-point size, should not use italics or script, and should have high contrast and
Appreciate that you are contributing to the empowerment and quality of life of elders in your program, and embrace and value the life experience they bring.
Reprinted from American Society on Agings Live Well, Live Long Issue Briefs Series. Copyright 2006 American Society on Aging. San Francisco, CA. www.asaging.org/CDC.
Cultural Competence
What is Cultural Competence?
Cultural competence begins with an awareness of your own personal beliefs and practices, and recognition that people from other cultures may not share them. this means more than speaking another language or recognizing the cultural icons of people. it means changing prejudgments or biases you may have of a peoples cultural beliefs and customs. Administration on Aging
culturally congruent Behaviors
cultural competence
appreciation and respect for cultural differences
core fundamental Beliefs: Warmth, Empathy and genuineness
How Can i Communicate More Effectively? When a person has an inherent caring, appreciation and respect for others they can display warmth, empathy and genuineness. The most important ways to enhance communication is to: Be open. Be honest. Be respectful. Be nonjudgmental. Be willing to listen and learn.
Listening and observational skills are essential. Letting people know that you are interested in what they have to say is vital to building trust. Older adults have a rich variety of life experiences and will likely want to share some of them, especially asthma experiences, during the class. Recognize individuality and the diversity of your audience and embrace them. Use these discussions to enhance the learning process.
What is Culturally Appropriate service Delivery? Moving toward culturally appropriate service delivery means being: nowledgeable about cultural differences and their K impact on attitudes and behaviors. ensitive, understanding, non-judgmental, and S respectful in dealings with people whose culture is different from your own. lexible and skillful in responding and adapting to F different cultural contexts and circumstances. According to the Office of Minority Health, cultural competency is one of the main ingredients in closing the health disparities gap because culture and language may influence: Health, healing, and wellness belief systems. ow illness, disease, and their causes are perceived, H both by the patient/consumer. e behaviors of patients/consumers who are seeking Th health care and their attitudes toward health care providers. e delivery of services by the provider who looks Th at the world through his or her own limited set of values, which can compromise access for patients from other cultures.
Adapted from U.S. Department of Health and Human Services. (2008, August 10). Administration on Aging cultural competency guidebook. Retrieved from http://www.aoa.gov/prof/adddiv/cultural/cc-guidebook.pdf.
Asthma Learning tool: Questionnaire
Copyright 2008, Pedipress, Inc. All rights reserved From Asthma Charts & Forms for the Physicians Office and Managed Care, Thomas F. Plaut, MD. Used with permission.
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Asthma Learning tool: Answers
Copyright 2008, Pedipress, Inc. All rights reserved From Asthma Charts & Forms for the Physicians Office and Managed Care, Thomas F. Plaut, MD. Used with permission.
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shortness of breath.
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2007 Guidelines for Diagnosing and Managing Asthma: instructor Questionnaire: How Much Do You Know Ages 5-11 Yearsin Older Adults? Children About Asthma
Please complete before reading Managing Asthma Effectively in Older Adults: An Educational Guide for Promoting Better Asthma Control. (check your answers again after reading the toolkit). read each question. answer each question by checking true, false or not sure.
true
false
not sure
1. asthma is often diagnosed as a new condition in older people. 2. asthma cannot be cured but it can be controlled. 3. shortness of breath is a sign of getting older. 4. Older adults with asthma shouldnt exercise. 5. Many different things can bring on an asthma episode. 6. a peak flow meter is used to monitor how lungs are functioning. 7. an older adult is not having an asthma episode unless he/she is wheezing. 8. cold and flu can trigger an asthma episode. 9. some asthma medicines are considered preventative and must be used even when people feel good 10. Most asthma episodes can be prevented. 11. in older adults, asthma episodes usually occur suddenly without any warning. 12. tobacco smoke can make asthma symptoms worse.
notes
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2007 Guidelines forQuestionnaire: Answer Key Asthma: instructor Diagnosing and Managing How Much Do You Know Ages 5-11 Yearsin Older Adults? Children About Asthma
Please complete before reading Managing Asthma Effectively in Older Adults: An Educational Guide for Promoting Better Asthma Control. (check your answers again after reading the toolkit). read each question. answer each question by checking true, false or not sure.
true
false
not sure
1. asthma is often diagnosed as a new condition in older people. 2. asthma cannot be cured but it can be controlled. 3. shortness of breath is a sign of getting older. 4. Older adults with asthma shouldnt exercise. 5. Many different things can bring on an asthma episode. 6. a peak flow meter is used to monitor how lungs are functioning. 7. an older adult is not having an asthma episode unless he/she is wheezing. 8. cold and flu can trigger an asthma episode. 9. some asthma medicines are considered preventative and must be used even when people feel good 10. Most asthma episodes can be prevented. 11. in older adults, asthma episodes usually occur suddenly without any warning. 12. tobacco smoke can make asthma symptoms worse.
x x x x x x x x x x x x
notes
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nOtEs
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sectio n 2 Introduction & Asthma Basics
here were so many other things going on in my body, I didnt think
I needed to bring that [asthma symptoms] up. I didnt think it was anything serious...I just thought it was a little cold in my throat and my chest.
Carrie Leary, age 78
Asthma in older adults is complicated because the normal effects of aging can make asthma a diagnosis that is difficult to identify and treat. The Managing Asthma Effectively in Older Adults program empowers older adults with asthma to better manage their condition through an interactive teaching curriculum.
2: Introduction & Asthma Basics
section 1 2 Creating Asthma-Friendly Schools Introduction & Asthma Basics

Part I: Introduction A. Introduction and Icebreaker B. Goal and Objectives C. Pre-Program Questionnaire D. DVD: Asthma and the Elderly Part II: Asthma Basics A. Normal Lung Function B. Asthma Causes and Symptoms C. Asthma Episodes and Warning Signs D. Asthma Emergencies E. Asthma Triggers F. Asthma Diagnosis and Management Part III: daily Self management: Asthma Self-Care Practices A. How Do You Achieve Good Asthma Control? B. Identify Asthma Triggers C. Recognize Early Warning Signs D. Take Medicines Correctly E. Partner on a Plan Asthma Action Plan F. Maintain Good Communication Part Iv: Special Considerations for Older Adults with Asthma A. Choosing An Asthma Healthcare Provider B. When To See A Specialist C. Medication Management and Multiple Health Conditions D. Problems That Can Complicate Asthma Diagnosis E. Understanding Case Management Part v: living Your Best life A. Smoking Cessation B. Nutrition C. Exercise D. Tips for Feeling Great E. Group Activities F. Post-Program Questionnaire 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 40 41 43 44 45 47 48 49 50 51 52 53 54 55 56 57 58 59
2: Introduction & Asthma Basics
Part i: introduction
The Managing Asthma Effectively in Older Adults program aims to empower older adults to become more confident in managing asthma so that they can lead healthier, more active lives. As a result of the program, participants will be able to 1) detect their asthma warning signs, 2) identify their asthma triggers, 3) limit their exposure to asthma triggers, and 4) prevent or reduce their asthma symptoms.
E d u c at i o n a l o b j E c t i v E s
Learning Objectives: The purpose of this section is to help establish a comfortable learning environment and identify baseline knowledge about asthma. To do this, your audience will: escribe a favorite activity/pastime and discuss D whether asthma symptoms have ever made the activity less enjoyable. Review the goal and objectives of the program. Complete Handout #2 Pre-Program Questionnaire. Discuss and view the DVD Asthma and the Elderly.
this section will cover: Icebreaker activity. Overview of the program.
topics / Activities
Materials needed
Estimated time tOtA L: 35 minutes 3 minutes
a. introduction and icebreaker B. goal and Objectives handout #1 Presentation Packet c. Pre-Program Questionnaire handout #2 Pre-program Questionnaire d. view dvd Asthma and the Elderly
nametags (optional)
handout #1
2 minutes
handout #2 dvd Asthma and the Elderly
10 minutes
20 minutes
sEctiOn 2 / curriculuM rEviEW
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introduction and icebreaker
Introductions may seem easy, however if done incorrectly it can mean the difference between a successful program and an unsuccessful one. Keep your introduction brief and avoid acronyms and jargon, say My name is Busy Bee and I am a nurse instead of My name is Busy Bee and I am an R.N. with CHES certification and I work for NIH Always thank your host, and let your audience know that you are excited to lead the discussion. Be sure to address elders formally (using Mrs./Miss/Ms./Mr.) unless they invite you to call them by their first names. An underlying respect for the older adults youre working with will speak volumes. Although asthma is a serious disease, try to maintain an environment of informality and levity. Display enthusiasm, warmth, empathy and genuineness.
Create a comfortable learning environment that is non-threatening, supportive and inviting. Group icebreakers are tools you can use to help create this type of environment. Icebreakers are activities or modes of discussion used to help individuals ease into a group setting. The icebreaker used in this program is intended to help your audience identify commonalities, recognize that asthma affects people differently, prompt them to begin thinking about what better asthma control can mean for them, and emphasize the overall goal of the program to learn how to become as free from asthma symptoms as possible. Icebreaker activities are usually met with enthusiasm, however it is important to recognize that some audience members may not want to participate. Always begin the icebreaker by allowing them to exempt themselves from the activity.
good morning/afternoon/evening everyone. Welcome to Managing Asthma Effectively in Older Adults. My name is i get started, i would like to thank (Mrs./Miss/Ms./Mr. hosts name) for allowing/ requesting me to be here. i am very excited to lead our discussion about asthma and ways to stay healthy , and im Before we talk more about asthma, lets get to know each other better by finding out things we have in common. lets talk about things we enjoy doing. think of something you like to do at home, work, with family or friends and tell us your name and what it is. if you would rather not participate in the activity, just say ill pass and i will move on to the next person. ill go first a (nurse, social worker, caregiver, etc.) Before
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Goal and Objectives
introducing the Managing Asthma Effectively in Older Adults Program The Managing Asthma Effectively in Older Adults curriculum is written to promote confidence and success by moving from easy material to more difficult. Providing the program description is no exception. Discuss the goal of the program and the learning objectives then encourage self-directed determination of learning goals. To do this, begin by introducing the program goal in general terms we are here to talk about asthma and ways to stay healthy. Next, offer a more concrete rationale for gathering together to become more confident in managing asthma so that we can lead more active lives. Lastly, describe the anticipated outcomes (objectives) of the program at the end of the program, you will be able to 1) detect your asthma warning signs, 2) identify your asthma triggers, 3) limit your exposure to asthma triggers, and 4) prevent or reduce your asthma symptoms. Next, ask your audience to share personal goals for the program, inform them that you value their feedback and want to meet their learning needs. Again, the curriculum can be modified to meet the needs of the audience, however it should be carried out in the general order in which it is presented.
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Pre-Program Questionnaire
Administering the Pre-Program Questionnaire Be aware that older adults may not be familiar with tools or tests such as Likert scales that others may take for granted. The Managing Asthma Effectively in Older Adults curriculum uses a multiple-choice questionnaire to determine change in the participants knowledge, attitudes and skills related to asthma management. Read the questionnaire directions to the group and ask if there are any questions. Read each question number followed by the question. Allow for appropriate periods of time for responding to questions. Inform your audience that they may stop you at any time. If you are fortunate enough to have a co-facilitator or helper, encourage him/her to move around the room to offer assistance. After administering the pre-program questionnaire, explain the rationale for completing the same questionnaire at the end of the program.
Before we begin our discussion, please answer a few questions about asthma. some of you may know many of the answers, and some may know only a few or none at all and thats okay. We all come with a variety of information and experiences related to asthma, and we are all here to learn more i will ask you to complete the same questionnaire at the end of the program. By doing it twice once before the program, and once after the program, i will be able to tell how much you learned and what i can do to make the program better.
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DVD: Asthma and the Elderly
introducing the Senior Citizen Asthma Education and In-Home Environmental Assessment Pilot project (sCAEiEAP) and Asthma and the Elderly DVD In 2004, the DC Department of Health Asthma Control Program (DC CAN) partnered with the Greater Washington Urban League and launched an educational program called the Senior Citizen Asthma Education and In-Home Environmental Assessment Pilot project (SCAEIEAP). Information gained from this program was the impetus for developing the Managing Asthma Effectively in Older Adults Toolkit. Begin the discussion by posing a question to your audience did you know that the District of Columbia has one of the nations highest asthma rates? Inform them that asthma affects District residents of all ages, races and ethnic groups and older residents (45-50 years of age) and elderly (65 years of age and older) are severely impacted by this serious but manageable chronic condition. Discuss the background of the SCAEIEAP program, as well as the goals, findings and results of the program per the related curriculum slides (slide numbers 6-10) and suggested lesson script. Next, introduce the Asthma and the Elderly DVD.
The DVD is an integral part of the curriculum. It provides a wealth of information about asthma and asthma management and documents viewpoints of older adults with asthma living in the District. Group activities that enhance the older adults learning experience are based on scenarios from the DVD. After viewing the DVD, provide a brief opportunity for your audience to give their initial reaction to the DVD. Pose a few questions such as: What did you think about the DVD? What, if anything, did you learn? What did you find most interesting? ould you identify with (relate to) any of the seniors C in the DVD who/why/why not? Responses to these questions will give you better insight about the learning needs of your audience. Use this information to identify curriculum topics that may require greater attention.
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Part ii: Asthma Basics

The Asthma and the Elderly DVD provides an introduction to asthma basics. In this section, you will build on that information by discussing the physiology and function of the respiratory system and answering key questions about asthma.
Learning Objectives: The purpose of this section is to help ensure that all participants have the same basic information about asthma. To do this, your audience will: efine asthma. D Answer basic questions about the disease: What happens when we breathe? What is asthma? What causes asthma? What are asthma symptoms? What is an asthma episode? What are asthma triggers? What are asthma warning signs? When is asthma an emergency? How is asthma diagnosed and treated?
this section will cover: Basic physiology of the respiratory system. Basic facts about asthma.
topics / Activities a. normal lung function
Materials needed curriculum cd or Presentation Packet curriculum cd or Presentation Packet curriculum cd or Presentation Packet curriculum cd or Presentation Packet curriculum cd or Presentation Packet curriculum cd or Presentation Packet
Estimated time
B. asthma causes and symptoms
c. asthma Episodes and Warning signs
tOtA L: 10 minutes
d. asthma Emergencies
E. asthma triggers
f. asthma diagnosis and Management
This section is adapted from the National Heart, Lung, and Blood Institute. (2008, September 5). Guidelines for diagnosis and management of asthma. Retrieved from http://www.nhlbi.nih.gov/guidelines/asthma.
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normal Lung function
What happens when we breathe? Your respiratory system makes breathing possible. With each breath, you take in air through your nose and mouth, and your lungs fill up and empty out. A normal respiratory system includes your: Nose Mouth Throat Larynx (voice box) Trachea (windpipe) Lungs Diaphragm When you breathe in (inhale), your respiratory system allows oxygen in the air to get into your lungs so that the oxygen can travel to your blood. Your blood delivers the oxygen to all parts of your body. Oxygen is important because your cells need it for energy and growth. Without oxygen, the bodys cells would die. Your lungs remove carbon dioxide (a waste product of breathing) when air is breathed out (exhaled).
What is Asthma? Asthma is a chronic (ongoing) disease that makes it more difficult for you to get air in and out of the lungs. It is often thought of as a childhood disease, but frequently asthma is diagnosed as a new condition in older adults. For some people, it may be a continuing problem from younger years. When you have asthma, your airways (breathing tubes) are sensitive. They may react to things that usually dont bother people without asthma that are called triggers. When airways react, they may tighten and become inflamed and swollen making it difficult for you to breathe. Your difficulty in breathing may change. Sometimes you will feel fine. Other times you may have breathing problems. Although asthma cannot be cured, most people with asthma can control it.
Approximately 22.9 million Americans had asthma in 2006, including almost 2.5 million people over the age of 65. More than one million people over the age of 65 had an asthma attack or episode. the District of Columbia has one of the nations highest asthma rates. Older residents, 45 years and older, are severely impacted by this chronic disease.
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Asthma Causes and symptoms
What Causes Asthma? The exact cause of asthma isnt known. Many health experts believe that several factors come together to cause asthma, such as: A family tendency to develop allergies (atopy). Parents with asthma. Respiratory infections during childhood. Exposure to certain viruses at an early age. Other risk factors include, but are not limited to the following: ender - Childhood asthma occurs more frequently G in boys than in girls; but by age 40, more females than males have adult asthma. irway Hyperactivity - Asthma is more likely to A develop in people with a very reactive (sensitive) airway. llergies - Allergies and asthma often go together. A Many people with asthma also have allergies. Sources of indoor allergens include pet dander, dust mites, cockroaches, and mold. Sources of outdoor allergies include pollen, grass and mold. igarette Smoke - Several studies confirm that C cigarette smoking is linked with an increased risk for developing asthma. Numerous findings link secondhand smoke exposure to the development of asthma in early life. besity - Asthma is more common in overweight O adults and nearly twice as common among obese adults.
Health experts have been focusing attention, over the past few years, on the disproportionate burden of asthma on minorities, particularly African-American and Hispanic children residing in inner cities (NIAID). Research on the causes, treatments, and prevention of asthma is being conducted to help reduce disparities in the incidence and prevalence of this disease. Minorities experience higher rates of emergency department (ED) visits, hospitalization, and deaths due to asthma. African-American women, for example have the highest death rate due to asthma among all races. These differences in rates, diagnosis, and treatment may be linked to poverty, urban air quality, indoor allergens, lack of education about asthma, and inadequate medical care. There is still a lot unknown about causes of asthma, and more research is being done to understand better the causes of this chronic condition, including genetics differences between races and their responses to allergens. Studies have shown, however, that education programs are needed for low-income African American patients to improve asthma healthcare. What are Asthma symptoms? Symptoms may include, but are not limited to the following: Coughing. Breathing hard and fast. Shortness of breath at rest or with exercise. Trouble exhaling. heezing (a whistling noise in the chest W while breathing). Chest pain or tightness. Coughing up phlegm. Nighttime awakening with shortness of breath. Headaches. Fatigue, tiredness, or lethargy.
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Asthma Episodes and Warning signs
What is an Asthma Episode? When your asthma symptoms are worse than usual, you may experience an asthma episode. The words asthma attack, asthma problem, asthma episode, and asthma flare-up all mean the same thing. Not all asthma episodes are the same. Sometimes symptoms can get worse, and additional symptoms may appear to cause an asthma episode. Some are worse than others. During an asthma episode, it gets harder for you to breathe and to keep your airways clear. One or more signs of asthma trouble characterize an asthma episode: Coughing. Wheezing. Chest tightness. Shortness of breath. What Are Asthma Early Warning signs? What Happens During an Asthma Episode? During an asthma episode, air has more trouble getting in and out. It gets harder to get rid of the used air and bring in new air. Three things happen to the airways during an asthma episode: 1. Inflammation The airways become swollen and irritated. This also makes the airways smaller and makes breathing more difficult. 2. Bronchospasm (or bronchoconstriction) The muscles around the airways tighten up and make the airways smaller. 3. Mucus Production Inflamed airways produce excess mucus, which clogs the already narrowed openings. Mucus normally helps the airways stay moist. But during an asthma episode, too much mucus is produced. Airways are tubes through which air passes on the way to and through the lungs. The following illustration shows the difference between a normal airway and one in the midst of an asthma attack. Early warning signs are changes that happen just before or at the beginning of an asthma episode. If you have asthma, you have to know your own body well enough to recognize when these changes happen. By recognizing these signs, you can stop an asthma episode or prevent one from getting worse. Early warning signs may include, but are not limited to the following: igns of a cold, or allergies (sneezing, cough, nasal S congestion, sore throat and headache). Frequent coughing, especially at night. Loosing your breath easily or shortness of breath. rouble sleeping because of due to difficulty T breathing, coughing or wheezing. Feeling tired, upset, grouchy, or moody. Reduced peak flow readings. Wheezing or coughing after exercise.
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Asthma Emergencies
When is asthma an emergency? An asthma episode can lead to a medical emergency if asthma symptoms are not controlled. Go to the emergency department (ED) or call 911 right away if you notice any of these signs: You hunch over when you breathe. Your lips or the tips of your finger are blue. You have trouble walking or talking. You are sucking in the skin between your ribs. You are breathing very slowly. ou feel worse after your medicine has had time to Y start working (within 10-15 minutes).
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Asthma triggers
What are Asthma triggers? When people have asthma, the airways in their lungs react to things that usually do not bother people without asthma. These things are called asthma triggers. For many people, triggers may be: Allergic reactions to: Pets. Dust mites. Cockroaches. Mold. Pollen. Grass. Food. Irritants: Dust. Cigarette smoke. Cleaning products. Perfume or other strong odors. Other factors: Physical responses to changing weather, or cold air. Stress or strong emotions. iral infections, especially upper respiratory tract V infections like the common cold. ome medicines may trigger asthma symptoms and S others may make asthma medicines less effective.
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Asthma Diagnosis and Management
How is Asthma Diagnosed? A proper diagnosis of asthma is the first step toward reducing your symptoms and improving your health. Your healthcare provider may base a diagnosis of asthma on: Your medical history. A physical examination. Any family history of asthma or allergy problems. Chest X-rays - to rule out other potential causes. pirometry - to measure how much air the lungs can S hold and how well the respiratory system is able to move air into and out of the lungs. onitoring peak expiratory flow (PEF) - using a M peak flow meter to monitor the amount of force with which air is blown out of your lungs. Diagnosis and treatment in older adults may present some special concerns, including: ome asthma symptoms are similar to signs of other S possible health problems (congestive heart failure, chronic obstructive pulmonary disease). ere may be other ongoing health concerns that Th make diagnosis and/or treatment more difficult. aking many different mediations and/or monitoring T asthma properly can sometimes be challenging. lder adults may be more likely to have side effects O from asthma and non-asthma medications.
ntermittent asthma - when asthma symptoms come I and go. For example, you may have symptoms two times a week or less, or you may wake up because of asthma two times per month or less. In addition, the time between these symptoms may be a few weeks or a few months. ersistent asthma - when you experience asthma P symptoms all the time. Persistent asthma is classified as mild, moderate, or severe. Your healthcare provider decides which type you have based on: 1. What you can and cant do because of your asthma. 2. How much and what type of medicine you need. 3. Tests of your breathing ability. Asthma can be controlled. For intermittent asthma, being controlled may mean your asthma rarely bothers you. For severe persistent asthma, control means having fewer symptoms that keep you from doing what you want to do. In the following sections we will discuss ways to keep your asthma under control. How is asthma managed? Asthma can be controlled success depends largely on self-care skills. Self-care skills include: Avoiding triggers.
What type of asthma do you have? To assess your long-term asthma status, your healthcare provider will check how often you had asthma symptoms when you were not taking any asthma medication. There are two main types of asthma:
Recognizing symptoms and taking action. Taking medicines appropriately. Monitoring your response to treatment. Getting regular follow-up care. Getting immediate help when needed.
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Part iii: Daily self Management: Asthma self-Care skills
this section will cover: Identifying Asthma Triggers. Recognizing Early Warning Signs. Partnering on a Plan. Taking Medicines Correctly. Maintaining Good Communication.
dentify personal asthma triggers and discuss ways to I remove or reduce them. Review Handout #3 What Triggers Your Asthma? ecognize early warning signs and identify R appropriate action to take when they occur. eview Handout #4 Recognize Early Warning Signs. R Identify key components of an asthma action plan. Review Handout #5 Asthma Action Plan. istinguish between rescue and daily controller D medicines and discuss medicine delivery devices. eview Handout #6 How To Use A Metered-Dose R Inhaler (MDI). iscuss ways to enhance communication with D healthcare providers.
Learning Objectives: The purpose of this section is to discuss asthma selfcare practices. The audience will use information gained to better manage asthma symptoms and assist their healthcare provider with completing a personalized asthma action plan. To do this, your audience will:
topics / Activities a. how do you achieve good asthma control? B. identify asthma triggers handout #3 What triggers your asthma? c. recognize Early Warning signs handout #4 recognize Early Warning signs d. Partner On a Plan asthma action Plan handout #5 asthma action Plan E. take Medicines correctly handout #6 how to use a Metered-dose inhaler (Mdi) f. Maintain good communication
Materials needed curriculum cd or Presentation Packet handout #3
Estimated time
handout #4 tOtAL: handout #5 15 minutes
handout #6
curriculum cd or Presentation Packet
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How Do Your Achieve Good Asthma Control?
Successful asthma control takes cooperation between the person diagnosed with asthma, their healthcare provider, and all members of their healthcare team (respiratory therapists, pharmacists, asthma educators, dieticians and nutritionists especially if food allergies cause asthma symptoms, and anyone else helping them to manage their asthma). Family and close friends can help also. Control of asthma depends on three things: Being able to get good medical care. orking with your doctor to develop an asthma W action plan. Having asthma self-care skills.
Getting good medical care is essential. In the next section we will talk more about medical care and what to look for when choosing an asthma doctor. An asthma action plan is a written plan you get from your healthcare provider and help to complete. The action plan is important because it gives you information on how to control your asthma it is your personal guide to staying healthy. It includes information about your asthma triggers, symptoms, medicines, and more. Self-care skills are things that you do yourself to help keep your asthma under control. The most important self-care skills are: dentifying asthma triggers, reducing or removing I them when you can. ecognizing early warning signs, and taking R appropriate action. orking with your healthcare provider to develop W an asthma action plan and following it. aking your medicine according to your healthcare T providers instructions. aintaining good communication with your M healthcare provider, other members of your care team, and your family and close friends.
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identify Asthma triggers
xercise exercise can irritate airways. E

sElf-carE skill #1
identify your asthma triggers and eliminate or reduce your exposure to them.
motions strong emotions can cause asthma E symptoms. hemicals many people have asthma reactions C from breathing in certain chemicals. Seasonal Changes some people have more asthma symptoms during a particular time of year, usually the fall and spring because there is more pollen in the air. edicines some medicines may cause problems M for people with asthma, some may trigger asthma symptoms and others may make your asthma medicines less effective. oods - for some people milk, wheat, corn, soy, nuts, F sugar, or other foods may irritate or trigger asthma symptoms. ERD (acid reflux disease) may be an underlying G cause or contributor of asthma. In such cases, successful treatment of the digestive problem will often clear up the asthma. Different people may have different triggers. Once you know your triggers, you can do more to keep yourself healthy.
When you have asthma, certain things can irritate your airways. These things are called triggers because they can trigger asthma symptoms by causing: e airways become swollen and irritated Th (inflammation). e muscles around the airways tighten up and make Th the airways smaller (bronchospasm). oo much mucus production, which clogs the T already narrowed openings. The first step toward asthma control is figuring out what triggers your asthma symptoms. The most common asthma triggers are: espiratory Infections colds, flu, and sinus R infections. Respiratory infections are one of the most common asthma triggers. llergens things that can trigger an allergic A reaction and irritate your airways. Irritants irritants can bother anyones airways, but if you have asthma they can cause asthma symptoms.
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What triggers Your Asthma?
1. review the list of common asthma triggers. 2. check the ones that seem to make your asthma worse. 3. if you are not sure, keep the handout with you and use it to describe the circumstances surrounding each asthma episode you have. check the list to see which triggers may have been present and make a note. 4. share this information with your doctor, family and close friends.
Breathing cold air changes in the weather
strong chemical smells paint, cleaning agents colds, other respiratory infections
Physical activity Mold, mildew Medicines tobacco smoke food air pollution smoke, fumes, etc. Pollen cockroaches-their waste and dried body parts dust and dust mites tiny insects often found in house dust strong emotional responses laughing, crying, etc. stress Perfume, body deodorants, etc. Other animals - their waste, saliva and dander (flakes from their skin)
now that you know what triggers your asthma, you can do three things. 1. remove or avoid the trigger. start with your home. if you need help ask. your family and close friends may be able to assist you. 2. limit being around the trigger. if you cant completely avoid the trigger, you can do things like leaving a room if someone starts smoking or asking friends to visit you at your home if they have triggers, like pets, in theirs. 3. if the trigger is unavoidable, ask your doctor about taking your quick-relief medicine before you are around a trigger.
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Ways to remove or Avoid triggers Review the following ways you can remove different kinds of triggers. Check the ones that you will try. After removing or reducing your asthma triggers, share any results with your doctor. Indoor Air Pollution Change air filters once a month. This is a simple and effective way to filter the air that is circulated throughout your home. Buy special allergen filters (available at most hardware and home stores) if possible. They last up to three months and are designed to remove more allergens, irritants and other unwanted things from the air. Outdoor Air Quality Limit outdoor activities when news reports indicate pollen counts are high or air quality is poor due to high humidity or high heat-index (code yellow and code red days).
Mold and Mildew Reduce air humidity with a dehumidifier. Stay out of damp places, like basements, etc. se a bleach solution to prevent mold and mildew in U sinks and tubs; wear a mask or have someone else do it for you. White distilled vinegar may be an alternative. It is excellent for killing mold and bacteria. Have heating, ventilation and air conditioning systems cleaned and serviced regularly. Fix all water leaks. Some forms of mold are toxic (very harmful to your body) and require immediate attention and removal by a professional. Animals Pets are great company. Research shows that older adults who have pets can actually live longer than those who live alone. However, pets shed hair and dander (flakes from their skin), which can be triggers for people with asthma or allergies. Wash hands immediately after contact with pets or other animals. Vacuum floors daily using a HEPA air filter. Keep pets outdoors or in certain rooms keep them out of your room and never let pets sleep in your bed. In some cases your doctor may tell you that finding a new home for your pet is best.
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Dust Mites Dust mites are tiny insects that are too small to be seen without a microscope. They live in bedding, pillows, comforters, stuffed animals, quilts, and blankets. Dust with a damp cloth and vacuum frequently using a HEPA air filter remove carpet if possible, especially from your bedroom. Encase your mattress and pillows with vinyl covers. Wash your sheets and blankets weekly in hot water. Avoid feather pillows and down comforters. se a dehumidifier. Reduce indoor humidity to U less than 50%, if you can. Dust mites thrive in high humidity. Remove stuffed toys and other dust-collecting objects from your bedroom. Any that are not removed should be cleaned often. Clean curtains and woodwork often. Replace furnace filters each month during the winter season, if possible. Cockroaches Cockroach waste, eggs and remains can be significant triggers for people with asthma and allergies. Keep food in tightly sealed containers. Wash dishes daily and dry all dishes thoroughly. Keep bathtubs and sinks dry when not in use. Keep rooms as clutter-free as possible. Keep trash in enclosed bins and remove from your home daily. Use poison bait or traps; try to avoid chemical treatments unless absolutely necessary. Be out of your home when used. Foods Eliminate polyunsaturated vegetable oils, margarine, vegetable shortening, all partially hydrogenated oils that might contain trans-fatty acids, all foods that might contain trans-fatty acids (such as deep-fried foods). Experiment with eliminating (one at a time) wheat, corn, soy and sugar for six to eight weeks to see if the condition improves. Cold Air Try to breathe through your nose when outdoors. Wear a scarf that covers your nose and mouth. Pollen Use air conditioning to avoid having to open windows, if possible. Limit outdoor activities when the news reports indicate pollen counts are high.
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Smoke and other Irritants Smoking can trigger asthma and cause sudden symptoms. So can smoke from someone elses cigarette called secondhand smoke. If you smoke quitting now can help your lungs work better. Ask family and friends not to smoke in your home or car. Avoid places where people smoke indoors. Limit the use of wood-burning stoves. Avoid using strong-smelling cleaners and other products. Infections (Colds and Flu, etc.) Wash hands frequently with soap and warm running water. Stay away from people who have colds or other viral infections, if possible. Get prompt medical treatment for cold symptoms and respiratory infections. Get a flu shot each year and the pneumonia vaccine if you are 65 years of age or older, or if your doctor recommends it.
Medicine Some medicines may cause problems for people with asthma. Tell your doctor if any medication triggers your asthma or causes an irregular heartbeat. Do not stop taking any prescriptions without your doctors approval. Some common drugs that can affect asthma include: Blood pressure medicine, heart medicine, and some medicines used to treat glaucoma may trigger asthma symptoms they include: Beta-blockers (propranolol, nadolol, timolol, atenolol) and ACE inhibitors. Aspirin, ibuprofen, and naproxen may trigger asthma symptoms these medicines may be found in cold medicines or pain remedies also. Sleeping pills, tranquilizers, and other sedatives can slow breathing this can be unsafe for people with asthma.
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recognize Early Warning signs
sElf-carE skill #2
recognize Early Warning signs.
The second self-care skill is recognizing asthma early warning signs. Early warning signs are changes that happen just before or at the beginning of an asthma episode. They may appear hours or days before your asthma gets out of control. If you have asthma, you have to know your own body well enough to recognize when these changes happen. By recognizing these signs, you can stop an asthma episode or prevent one from getting worse. Think about the symptoms you have had before an asthma episode. Review the list below and check the symptoms that you have experienced. Talk to your doctor so that you can take action to get your asthma under control. Signs of a cold, or allergies (sneezing, cough, nasal congestion, sore throat and headache). A tight feeling in your chest. Frequent coughing, especially at night. Cant do normal activities. A need to clear your throat often. Loosing your breath easily or shortness of breath. Trouble sleeping due to difficulty breathing, coughing or wheezing. Feeling tired, upset, grouchy, or moody. Restlessness. Reduced peak flow readings. Fever. Wheezing. Wheezing or coughing after exercise. Rapid heartbeat.
a peak flow meter tells you how well your lungs are functioning. it measures how fast you can blow air out of your lungs after a deep breath. the key to using a peak flow meter is finding your personal best score. your personal best score is the highest of 3 peak flow scores taken when you are not having any asthma symptoms. your healthcare provider will show you how to: Use a peak flow meter. Find your personal best score. se the personal best score to define U your treatment zones. using your peak flow meter every day can help you identify changing asthma symptoms early and treat them before they worsen.
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take Medicines Correctly
Quick-relief medicines taken by inhaler or nebulizer:

sElf-carE skill #3
take Your Medicine the right Way.
Common brand names for inhaled rescue medicines are: Albuterol (Proventil, Ventolin, or generic albuterol), Xopenex, Maxair, Combivent, and Alupent. Quick-relief medicines taken by mouth: Oral corticosteroids (such as prednisone) can be used over a short (3- to 10-day) course to gain initial control of asthma and to speed resolution of exacerbations. When oral corticosteroids are used short-term, the risk of side effects is low. There are serious side effects associated with long-term use of oral corticosteroids. Long-term Control Medicines How do you know when your quick-relief medicine is not enough?
Medicines are a key part of controlling asthma. They are prescribed for two main reasons: (1) to avoid asthma symptoms before they start, and (2) to stop symptoms once they have started. You can keep your asthma under control by knowing how and when to use medicines your healthcare provider prescribes. There are two main types of asthma medicines: 1. Quick-Relief (Rescue) Medicines To be taken when you need them. sed to relax muscles that tighten around your U airways. ork fast to provide immediate relief of asthma W symptoms. 2. Long-Term (Daily) Controller Medicines To be taken daily even if you feel fine. Used to control inflammation in your airways. Prevent symptoms and attacks.
follow the rules of two

do you use your quick-relief inhaler more than two times a week? do you use wake up at night with asthma more than two times a month? do you refill your asthma prescription more than two times a year?
Quick-relief Medicines The names quick-relief , rescue, reliever, and emergency medicines all mean the same thing. Everyone with asthma needs a quick-relief medicine to stop asthma symptoms before they get worse. These medicines, also known as fast-acting beta2-agonists, are taken at the first sign of asthma symptoms or when you are experiencing an asthma episode or attack. Quick-relief medicines work fast, usually within 10-15 minutes after taking them. Your healthcare provider may recommend that you take this medicine at other times like before exercise.
2001 Baylor Health Care System. All rights reserved. Rules of Two is a federally registered service mark of Baylor Health Care System.
If you answered yes to any of these questions, your asthma is not under control. Talk to your healthcare provider about adding a long-term controller medicine to your treatment plan. The names controller, preventive, and long-term control medicines all mean the same thing. Long-term controller medicine works to reduce inflammation of the airways. Controller medicines are inhaled using a metered-dose-inhaler (MDI), discus inhaler or taken by mouth.
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Taken by metered-dose inhaler (MDI) or discus inhaler: Combination Therapy Two-in-one medicines containing corticosteroids and long acting beta2-agonists (including Advair and SYMBICORT) reduce inflammation of the airways and relax muscles around the airways. Inhaled corticosteroids These medicines are the most effective anti-inflammatory medicines for most people. They are very different from the steroids taken by some athletes. Like many other medicines, inhaled corticosteriods can have side effects. But doctors agree that the benefits far outweigh the risks of side effects. Brand names of inhaled corticosteroids include: AeroBid, Asmanex, Azmacort, Beclovent, Flovent, Pulmicort Turboinhaler, Pulmicort Respules, QVAR, Vanceril. Inhaled long-acting beta2-agonists These medicines can help to prevent symptoms when taken with inhaled corticosteroids. They should not be used alone. They also should not be used to treat serious symptoms or an attack. Brand names of inhaled longacting beta2-agonists include: Serevent and Floradil. Taken by mouth Leukotriene modifiers, or anti-leukotriene medicines are available in pill form and used alone to treat persistent asthma or with inhaled corticosteroids to treat moderate asthma. They are not as effective as inhaled corticosteroids for most patients. Brand names include: Singulair, Zyflo, and Accolate.
Asthma Medicine Delivery Devices Make sure the medicine gets to your lungs! Inhalers Many asthma medicines come as sprays and powders in an inhaler. An inhaler is a hand-held device that delivers the medication right to the airways in your lung where it is needed. There are several kinds of inhalers; the most common is a metered-dose inhaler (MDI). Holding Chamber (commonly referred to as a spacer) Your doctor may instruct you to use a spacer with your MDI. A spacer is a device that helps asthma medicine get deep into your lungs. It fits together with your inhaler like a puzzle. Nebulizer A nebulizer is a device that creates a mist out of your asthma medicine, which makes it easy to breathe the medicine into the lungs. Many older adults have conditions such as arthritis that limit the ability to use a MDI. Use of spacers with inhalers or nebulized medicines may improve drug delivery to lower airways and reduce symptoms more effectively. Be sure to review the best ways to use inhalers, spacers and other medicine delivery devices with your healthcare provider. Tell your healthcare provider if you notice changes in your ability to use medicine delivery devices.
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Partner on a Plan
sElf-carE skill #4
Partner on a Plan
Most asthma action plans are based on 3 separate zones. Each zone describes a level of asthma control based on asthma symptoms and PEF levels. The plan provides a specific treatment and action tied to each zone. Remember, successful asthma control begins with you. You know your body better than anyone else so it is important that you and your healthcare provider work together to complete the plan. The plan should be in large print, if necessary, and reviewed at each office visit.
If you have asthma you need an asthma action plan. What is an Asthma Action Plan? An asthma action plan is a personalized, written plan you get from your health care provider and work with him/her to complete. It gives you information on how to control your asthma, including: 1. Recommended doses and frequencies of medicines. 2. How to adjust medicine at home in response to signs and symptoms. 3. Symptoms indicating the need for closer monitoring. 4. Listing of PEF (peak expiratory flow) levels based on a personal best. 5. A list of your asthma triggers. 6. Emergency telephone numbers.
Zone
What does it mean? Go asthma is in good control. Caution asthma
Peak flow Meter (if used) More than 80% of personal best. Between 50-80% of personal best.
What do i do? Keep up the good work. continue to follow your asthma action plan. asthma symptoms are starting. follow your asthma action plan for instructions on regaining asthma control.
Green
Yellow
control is getting worse.
red
stop danger! asthma is out of control.
Between 0-50% of personal best.
you may need immediate medical assistance. follow your asthma action plan for instructions.
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Maintain Good Communication
sElf-carE skill #5
Maintain Good Communication
Individuals diagnosed with asthma must recognize that they are the most important members of their healthcare team. They must advocate for themselves one way for them to do this is to communicate effectively with everyone involved in helping to manage their asthma and to expect the same in return. Encourage your audience to use the following strategies to maintain successful communication with healthcare providers. rite down questions and things you want to talk W with the healthcare provider about. Include any new symptoms. Take the list with you to medical appointments. hare the information from the What Triggers Your S Asthma? handout with your healthcare team, family and friends. eep a copy of your medical records and a list of all K of the medicines you are currently using, including prescribed and over-the-counter medicines, herbs, supplements, and home remedies. Take copies with you to your medical appointments and share with family and friends.
hen it comes to your health, dont be shy ask W questions if you dont understand something. Your healthcare team is there to do everything they can to help you better manage your asthma they wont mind repeating something, explaining something in a different way, or using different words. e-evaluate your asthma action plan with your R healthcare provider on a regular basis. If you have difficulty reading your asthma action plan, ask your healthcare provider for a plan with a larger font size. equest instructions if your asthma symptoms are R worsening. sk for a demonstration on how to properly use A your metered dose inhaler and/or spacer and other asthma tools. Tell your healthcare provider if it is becoming more difficult to use your medicine delivery devices.
Adapted from American Academy of Allergy Asthma and Immunology. (2008, November 7). Seniors and asthma. Asthma control for the mature adult. Retrieved from http://www.aaaai.org.
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Communication Problems / solutions
Problems the healthcare provider or staff member uses words i do not understand.
Possible solutions ask them to go over words you do not know if you need to, ask them to do this more than one time and in different words.
the healthcare provider or staff member talks too fast.
ask them to slow down they wont mind because they want you to understand. repeat what was said, in your own words, to make sure you understand.
it seems the healthcare provider and staff are very busy and do not have time to answer a lot of questions.
it is your right and responsibility to ask questions. remember, the medical staff is working to help you improve your health. if necessary, make more appointments and write down questions before you go.
im embarrassed to ask questions.
healthcare providers are asked hundreds of questions every day. One of the most important parts of their jobs is to give you health information, and most are glad to do this.
i cant remember everything the healthcare providers say.
take a pen and pad to your appointments. take notes or ask the healthcare provider to write down what you should do. if this isnt enough, take a tape recorder.
the healthcare provider and medical staff do not tell me enough about asthma and treatment management options.
ask for more information and for other places you can get information (websites, library, etc.)
Source: American Lung Association. (2005). Breathe well, live well an asthma management program for adults. New York, NY: Author.
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Part iV: special Considerations for Older Adults with Asthma
Learning Objectives: The purpose of this section is to review the characteristics of a good asthma healthcare provider, recognize when the need to see a specialist arises, discuss management of multiple health conditions, including the role and benefit of case management, and discuss potential social and psychological effects of asthma. To do this, your audience will: escribe characteristics of a good asthma healthcare D provider. Discuss when to see a specialist. escribe approaches to asthma management when D other health conditions are present. ompare similarities and differences of asthma and C COPD. Discuss the role and benefit of case management.
this section will cover: How to choose an asthma healthcare provider. When to see a specialist. edication management and multiple health M conditions. Problems that can complicate an asthma diagnosis. Understanding case management.
topics / Activities a. choosing an asthma healthcare Provider
Materials needed curriculum cd or Presentation Packet curriculum cd or Presentation Packet curriculum cd or Presentation Packet curriculum cd or Presentation Packet curriculum cd or Presentation Packet
Estimated time
B. When to see a specialist c. Medicine Management and Multiple health conditions d. Problems that can complicate an asthma diagnosis
tOtAL: 10 minutes
E. understanding case Management
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Choosing An Asthma Healthcare Provider
When choosing an asthma healthcare provider, it is important to identify one who knows how to effectively manage asthma and will work closely with you to control it. A good asthma healthcare provider is one who: ets realistic, mutually developed goals for good S asthma management goals for lung function may need to be lower since some lung function may decrease as a person ages. eaches you how to reduce or avoid triggers, T including tobacco smoke and other airborne irritants. hows you how to take inhaled medicines and S reviews their technique. eviews all medicines on a routine basis to reduce R adverse medicine side-effects and potential for drug interactions age-related changes in the body can lead to greater adverse medication side-effects and potential for drug interactions. orks with you to complete an asthma action plan W the plan should be in large print, if necessary, and reviewed during each visit. djusts for cognitive or physical limitations that may A make it more difficult for you to fully participate in your treatment plan. rovides resources that can assist with asthma P education, prescription costs, transportation, or emotional stress.
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When to see A specialist
Allergists/immunologists An allergist or immunologist is specifically trained to provide education regarding ways to avoid allergens. Studies indicate that asthma in older adults is associated with higher prevalence of allergic sensitivities to indoor allergens, i.e. dust/dust mites, mold spores, pet dander, feathers, etc. A person should see an allergist/ immunologist for allergy testing so they can learn to avoid allergic triggers. If asthma symptoms are clearly linked to allergies, the allergist may recommend allergy shots for the specific allergen. Pulmonologist/Pulmonary specialist A pulmonologist or pulmonary specialist has specialized knowledge about lung conditions, including asthma. If asthma symptoms do not improve, or worsen after treatment is initiated it may be time to consider an appointment with a pulmonologist. Additionally, a person should see a pulmonologist when another careful evaluation is required to determine the cause of asthma symptoms. It can be difficult to determine the exact cause of asthma symptoms in older adults because of the high prevalence of other obstructive lung diseases (e.g., chronic bronchitis, emphysema) among older adults.
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Medication Management and Multiple Health Conditions
Treatment of asthma in older adults can be difficult because many older adults take medicines for other health problems. Sometimes medicine for one condition can be a trigger for asthma and sometimes asthma medicines can contribute to other conditions. Older adults diagnosed with asthma should discuss all medicines on a routine basis with their healthcare provider. Some medicines to consider carefully include: Beta-blockers and ACE inhibitors: Heart Disease and High Blood Pressure Beta-blockers are medicines that may be used for problems such as high blood pressure or heart disease. They may be used to treat migraine headaches, or found in eye drop form for treatment of eye the disease glaucoma as well. Beta-blockers are classified in one of two groups, nonspecific or specific. Non-specific beta-blockers, such as propanalol (Inderal) are the most important to avoid. However, people with asthma taking either group of betablockers (and any other medicines) should discuss the risks and benefits with their healthcare provider. ACE Inhibitors are another type of medicine that may be used to treat high blood pressure or heart disease. These medicines include lisinopril (Zestril) and enalopril (Vasotec). They do not necessarily make asthma worse, but may cause people to develop a significant cough that may be confused with asthma in some people and trigger wheezing in others.
Aspirin and other non-steroidal antiinflammatory drugs (nsAiDs) Common over-the-counter pain relievers, such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve) may trigger asthma. People with known aspirin sensitivity must be careful to avoid these medicines all people with asthma should use these medicines with caution. Medicines that usually dont cause increased asthma in aspirin-sensitive people include acetaminophen (Tylenol), propoxyphene (Darvon) and prescribed narcotics (such as codeine). Oral Corticosteroids and Osteoporosis People with asthma who use oral corticosteroids over long periods of time may be at increased risk for osteoporosis, a bone-thinning disease that can lead to fractures, loss of height and independence. Corticosteroids taken by mouth over long periods of time decrease calcium absorbed from food, increase calcium loss from kidneys, and decrease bone formation. Older adults with asthma should talk with their healthcare provider about their risk for bone loss.
Adapted from American Academy of Allergy, Asthma and Immunology. (2008, October 28). Seniors and asthma. When a treatment becomes an asthma trigger: Medications that can worsen asthma. Retrieved from http://www.aaaai.org.
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Problems that Can Complicate Asthma Diagnosis
Chronic Obstructive Pulmonary Disease (COPD) COPD is a progressive disease that makes it hard to breathe. It can cause coughing that produces large amounts of mucus, wheezing, shortness of breath, chest tightness and other symptoms. The term COPD includes two main conditions emphysema and chronic obstructive bronchitis. Normal aging-associated changes in the lungs often exaggerate asthma symptoms. These changes often make it difficult to distinguish between asthma and COPD, especially in patients who have smoked. The differences in asthma and COPD are shown below.
Gastroesophageal reflux Disease (GErD) Gastroesophageal reflux disease is a more serious form of gastroesophageal reflux (GER), which is common. GER is also called acid reflux or acid regurgitation, because stomach acids back up (reflux) into the esophagus. When acid reflux occurs, food or fluid can be tasted at the back of the mouth. Persistent reflux that occurs more than twice a week is considered GERD. Among asthmatics, the acid, particularly during sleep, may trigger asthma symptoms. Asthma medications, such as corticosteroids, can stimulate an increase in stomach acid making GERD worse. Healthcare providers usually recommend lifestyle and dietary changes to relieve symptoms of GERD. Many people with GERD also need medication. If severe, it may require consultation with a gastroenterologist, a doctor who treats diseases of the stomach and intestines.
Characteristic H i s t O rY Episodic wheeze nocturnal dyspnea or cough cough with phlegm Other allergic symptoms (rhinitis, conjunctivitis) smoking history Past history of asthma family history of allergy P H Y s i C A L E x A M i n At i O n Wheeze
Atham
COPD
common common Present more than 40 percent of cases; common in those who smoke frequent less common common frequent
less common; may occur with exacerbations not common characteristic of chronic bronchitis infrequent almost always associated uncommon less frequent
common
common after forced expiration or cough
Source: Asthma Initiative of Michigan. Asthma in Seniors Distinguishing Asthma from COPD. www.getasthma help.org.
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understanding Case Management
The Centers for Medicare and Medicaid (CMS) report that 23 percent of Medicare beneficiaries have five or more chronic medical conditions frequently requiring multiple services from multiple healthcare providers and difficult medicine regimes. Case management, often performed by nurses or social workers, is a utilization management technique that focuses on coordination of these services to help meet a patients healthcare needs. Case management programs may help to: dentify gaps in care communicate with healthcare I providers to ensure appropriate and coordinated delivery of healthcare services. xplain how diseases and medications interact with E each other. dentify and coordinate community resources I such as asthma education, prescription costs, transportation, home repair and home modification. Schedule appointments and arrange transportation.
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Part V: Living Your Best Life
Learning Objectives: The purpose of this section is to discuss briefly the positive effects of quitting smoking and reducing second hand smoke exposure, benefits of adequate calcium and fluid intake, and the importance of engaging in daily physical exercise. Potential social and psychological effects of asthma are addressed, and group activities offer a creative way to discuss barriers to asthma control. To do this, your audience will: iscuss the role of smoking and smoking cessation D in asthma severity. eview the benefits of adequate calcium, fluid intake, R and exercise in asthma control. iscuss ways to maintain or improve mental, D physical and psychological well being. xamine barriers to asthma care and work together E to problem solve.
this section will cover: Smoking cessation. Nutrition. Exercise. Tips for Feeling Great. Group activities.
topics / Activities
Materials needed curriculum cd or Presentation Packet curriculum cd or Presentation Packet
Estimated time tOtA L: 20 minutes
a. smoking cessation
B. nutrition
5 minutes c. Exercise curriculum cd or Presentation Packet curriculum cd or Presentation Packet curriculum cd or Presentation Packet handout #7 10 minutes
d. tips for feeling great
E. group activities f. Post-Program Questionnaire handout #7 Post-Program Questionnaire
5 minutes
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smoking Cessation
Smoking and exposure to second-hand smoke makes asthma and other lung problems worse. According to the American Lung Association, older smokers are at greater risks from smoking because they have smoked longer (an average of 40 years), tend to be heavier smokers and are more likely to suffer from smoking-related illnesses. Smoking is directly responsible for more than 90 percent of chronic obstructive pulmonary disease (COPD, or emphysema and chronic bronchitis) deaths. Quitting has proven health benefits, even at a late age. When an older person quits smoking, circulation improves immediately, and the lungs begin to repair damage. Asthma experts highly recommend that older adults with asthma stop smoking and decrease prolonged exposure to second-hand smoke. Older adults are encouraged to speak with their healthcare provider about enrolling in smoking cessation programs and obtaining related resources.
they tell me id be a lot better if i stopped smoking. i know its true. But its a hard thing to do. Asthma is a bad thing to have, its no picnic.
rita, age 74
Adapted from American Lung Association. (2008, October 16). Smoking among older adults fact sheet. Retrieved from http://www.lungusa.org.
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nutrition
A good diet in later years reduces the risk of osteoporosis, high blood pressure, heart disease and certain cancers. Good nutrition is also important in the management of asthma. Calcium Several factors can increase the likelihood that a person will develop osteoporosis, including taking corticosteroids. It is very important that older adults diagnosed with asthma make certain that their calcium intake is adequate. Some individuals are allergic to dairy or lactose intolerant. However, many foods contain calcium, including tofu, broccoli, collards, turnip greens, raisins and sardines with bones. Calcium supplements are also available. Older adults with asthma should speak with their healthcare provider about supplement use and dietary needs. fluid intake Increased fluid intake can help reduce asthma symptoms by thinning mucus in the lungs. However, due to other medical problems, many older adults reduce their fluid intake. The American Academy of Allergy Asthma and Immunology suggests increasing fluid and calcium intake by drinking lots of milk or mineral water with high calcium content. Remember, Vitamin D is essential for calcium absorption and weight-bearing exercise is vital to retain strong bones.
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Exercise
Regular exercise is beneficial for everyone, regardless of age. Some people with asthma avoid exercise because they fear asthma symptoms. Many people with chronic asthma will have asthma symptoms when they exercise; others have asthma symptoms only when they exercise. Individuals with exercise-induced asthma (EIA) may experience breathing difficulty within 5-20 minutes after exercise. Symptoms may include wheezing, chest tightness, coughing and chest pain. Other EIA symptoms include prolonged shortness of breath, often beginning 5-10 minutes after brief exercise. Inhaled medicines used 15 minutes before exercise are helpful in controlling and preventing asthma symptoms. The American College of Allergy, Asthma and Immunology (ACAAI) provides the following exercise tips for people with asthma and allergies:
n exercise program should be planned in A consultation with a healthcare provider, such as an allergist/immunologist. sing an inhaled bronchodilator before exercising U may control exercise-induced asthma symptoms. e nose should be clear when exercising. The nasal Th passages act as natural filters and humidifiers to keep air at proper temperatures and filter out pollutants, irritants and allergens. wimming is often considered a great activity for S people with asthma. Walking, leisure biking and stop-and-go exercises such as softball and doubles tennis are also considered very good for people with asthma. void outdoor exercise in cold, windy weather or A when pollen counts are high. person with a known severe allergy to insect stings A should always carry injectable epinephrine when exercising outdoors. hen exercising indoors, stay away from open W windows and doors to limit contact with outdoor allergens. Use a mat if exercising on carpeting, which can harbor allergy triggers such as dust mites and animal dander.
Source: ACAAI. Allergy, Asthma and Exercise Facts. www.medem.com.
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tips for feeling Great
Managing asthma in older adults is complicated due to interactions among effects of aging, asthma and coexisting conditions. Research suggests that in older adults with long-standing asthma, asthma severity may significantly impair quality of life. Moreover, decreased quality of life may be partly related to psychological status indicators such as depression and anxiety disorders which can worsen asthma. Better asthma management and subsequent reduction in asthma symptoms may lead improvement in physical, emotional and social areas of life. Other tips to improve mental, psychological and physical wellbeing include: aintain social supports stay in touch with family, M friends and the community. ngage in regular physical activity no matter the E age or condition there is an activity just right for you. Reduce stress take 20 minutes a day just to relax. mprove memory and mental sharpness do I crossword puzzles, play cards or strategy games. at a healthy, balanced diet avoid high sodium and E high fat foods, increase fruit and vegetable intake and drink plenty of water. eek help if you think you may be depressed or S have other mental health concerns, talk to a mental health professional.
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Group Activities
Group / Activity 1. role-Play Helping My Friend: Multiple health concerns there were so many other things going on in my body, i didnt think i needed to bring that [asthma symptoms] up. i didnt think it was anything serious... i just thought it was a little cold in my throat and my chest. carrie leary, age 78 2. storytelling My Own Way: home remedies Part of it is self-denial. a lot of seniors, when they get sick or feel ill, dont go to doctors; they dont trust them unless theyve been going to them for 30-40 years. Even then, they may use old home remedies, ones their mom and dad gave them, like tea, honey, a shot of brandy that they think will cure most ills. Wesley, age 74 3. reflection A Visit To Remember: unforgettable Office visits 4. role-Play So Much To Remember: Multiple Medications
Discussion talk with your friend about preparing for her medical appointment. she has several health problems and is currently experiencing new symptoms. she is shy about communicating these new symptoms to her doctor.
have you ever used a home remedy to cure an illness? tell your story. how did you/would you communicate using the remedy to your healthcare provider?
have you ever had an unforgettable office visit due to a positive or negative experience? reflect on this experience. What did you learn about yourself and the healthcare provider? talk with your friend about organizing his medications. he has several health conditions and was recently diagnosed with asthma. he wants to make sure he takes his medications correctly, but feels overwhelmed because there is so much to remember.
divide participants into 4 groups. assign an activity to each group. allow 10 minutes for group discussion and sharing.
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Post-Program Questionnaire
Administering the Post-Program Questionnaire Be sure each participant has a copy of the Post-Program Questionnaire (Handout #7) and a pencil. Read the questionnaire directions to the group and ask if there are any questions. Read each question number followed by the question. Allow for appropriate periods of time for responding to questions. Collect completed questionnaires and store them in a marked folder. At a later time, score the pre and post-questionnaires to determine knowledge gained.
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nOtEs
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sectio n 3 Curriculum Presentation
3: Curriculum Presentation
he Managing Asthma Effectively in Older Adults program can be modified
to meet the needs of the audience, however it should be carried out in the general order in which it is presented. The curriculum has been planned to make the 90-minute session as easy as possible to implement through: 1. Power-point slides 2. Suggested lesson script 3. Related handouts
Interactive group activities are included at the end of the program to encourage older adults to work together to address barriers to asthma self-management.
3: Curriculum Presentation
section 1 3 Creating Asthma-Friendly Schools Curriculum Presentation
slidE 1: introduction
instructions
Provide participants with nametags. (Optional) introduce yourself and give a brief overview of your background. describe the reason for gathering together: to talk about asthma and ways to stay healthy.
Generate Discussion
good morning/afternoon/evening everyone. Welcome to Managing Asthma Effectively in Older Adults. My name is , and im a (nurse, social worker, caregiver, etc.) Before i get started, i would like to thank (Mrs./Miss/Ms./Mr. hosts name) for allowing/requesting me to be here today. i am very excited to lead our discussion about asthma and ways to stay healthy.
Make sure everyone has a copy of the presentation packet.
does everyone have a copy of the presentation packet? all of the important information from our session today is there for you to follow along. this information is yours to keep.
sEctiOn 3 / curriculuM PrEsEntatiOn
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slidE 2: icEbrEakEr
instructions
introduce icebreaker activity.
Generate Discussion
Before we talk more about asthma, lets get to know each other better by finding out things we have in common. lets talk about things we enjoy doing. think of something you like to do at home, work, with family or friends and tell us your name and what it is. if you would rather not participate in the activity, just say ill pass and i will move on to the next person. ill go first My name is and i really enjoy .
Point out activities that they have in common. Prompt them to begin thinking about what better asthma control can mean for them.
What is your name and what activity do you enjoy doing? great! it sounds like many of you have something in common. now, i have another question. does asthma ever keep you from enjoying an activity? for some, asthma rarely interferes with activities but for others, asthma symptoms may limit them.
you will receive a variety of answers.
give a more specific reason for gathering together.
today we are going to talk about things you can do to help keep asthma under control so that you will be as free from asthma symptoms as possible.
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slidE 3
instructions
introduce goal of the program.
Generate Discussion
Our overall goal today is to become more confident in managing asthma so that we can lead healthier, more active lives. Would anyone like to share his or her personal goals for the program what you hope to learn from the program?
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slidE 4
instructions
introduce objectives of the program.
Generate Discussion
When you leave here today, you will be able to: Detect your asthma warning signs Identify your asthma triggers Limit your exposure to triggers Prevent or reduce your asthma symptoms.
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slidE 5
instructions
Be sure each participant has a copy of the Pre-program Questionnaire (handout #2) and a pencil.
Generate Discussion
Before we begin our discussion, please answer a few questions about asthma. some of you may know many of the answers, and some may know only a few or none at all and thats okay. We all come with a variety of information and experiences related to asthma, and we are all here to learn more. does everyone have a copy of the questionnaire and a pencil? great.
read the directions. ask if there are any questions. read each question number, followed by the question.
Please answer each question by checking true, false or not sure. feel free to stop me if you have a question or need assistance. are there any questions before we begin? i will read each question, but feel free to move ahead if you would like. you dont have to wait for me. Okay, lets begin. Question #1
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slidE 5 (continuEd)
instructions
allow time for participants to answer the question before moving forward to the next one. continuously scan the room to make sure everyone is following along. if you have a co-facilitator, he/she can walk around the room and offer assistance to anyone who needs it.
Generate Discussion
collect completed questionnaires and store in a marked folder: anaging Asthma Effectively M in Older adults Location Date
is everyone finished? great. Please pass your questionnaires to the front so i can collect them. i will ask you to complete the same questionnaire at the end of the program. By doing it twice once before the program, and once after the program, i will be able to tell how much you learned and what i can do to make the program better.
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slidE 6
instructions
Provide a brief overview of the scaEiEaP project.
Generate Discussion
lets talk about asthma in the district. did you know that the district of columbia has one of the nations highest asthma rates? asthma affects district residents of all ages, races and ethnic groups and older residents (45-50 years of age) and elderly (65 years of age and older) are severely impacted by this chronic disease. Educating older adults about asthma and asthma management is a key priority for the district. in 2004, the district of columbia department of health and the greater Washington urban league launched an educational program called the senior citizen asthma Education and in-home Environmental assessment Pilot project (scaEiEaP) to do just that. information gained from this program helped us to develop todays presentation. im going to take the next few minutes to tell you more about the project.
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slidE 7
slidE 8
slidE 9
slidE 10
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slidE 11
instructions
introduce and play dvd.
Generate Discussion
lets take the next 20 minutes to view the dvd Asthma & the Elderly. the dvd provides a wealth of information about asthma and asthma management and documents viewpoints of older adults with asthma living in the district. dont be surprised if you see someone you know!
Provide brief opportunity for audience to give initial reaction to dvd. Pose a few questions do not take more that a couple of minutes.
What did you think about the dvd? did you learn anything new? What did you find most interesting? could you identify with (relate to) any of the older adults in the dvd who/why/why not?
give 5-minute break (optional) introduce next section: asthma Basics.
lets take a short break. When we return we will begin our discussion on asthma basics.
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slidE 12
instructions
give overview of asthma basics.
Generate Discussion
asthma is a condition that affects our ability to breathe. during the next 10 minutes we will learn what happens when we breathe and answer some basic questions about asthma, including: hat is Asthma? W hat Causes Asthma? W hat are Asthma Symptoms? W hat is an Asthma Episode? W hat are Asthma Warning Signs? W hen is Asthma an Emergency? W hat are Asthma Triggers? W ow is Asthma Diagnosed and Treated? H
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slidE 13
instructions
read slide.
Generate Discussion
give more detailed description of airflow.
When you breathe in (inhale), your respiratory system allows oxygen in the air to get into your lungs so that the oxygen can travel to your blood. your blood delivers the oxygen to all parts of your body. Oxygen is important because your cells need it for energy and growth. Without oxygen, the bodys cells would die. your lungs remove carbon dioxide (a waste product of breathing) when air is breathed out (exhaled).
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slidE 14
instructions
read slide.
Generate Discussion
Offer relevant asthma statistics.
approximately 22.9 million americans had asthma in 2006, including almost 2.5 million people over the age of 65. More than one million people over the age of 65 had an asthma attack or episode.
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slidE 15
instructions
read slide.
Generate Discussion
discuss additional risk factors.
Other risk factors include, but are not limited to the following: ender - Childhood asthma occurs more frequently in boys than in girls; G but by age 40, more females than males have adult asthma. irway Hyperactivity - Asthma is more likely to develop in people with a A very reactive (sensitive) airway. llergies - Many people with asthma also have allergies. A igarette Smoke - Cigarette smoking is linked with an increased risk for C developing asthma. numerous studies link second-hand smoke exposure to the development of asthma in early life. besity - Asthma is more common in overweight adults and nearly twice as O common among obese adults. inorities experience higher rates of emergency department (ED) visits, M hospitalization, and deaths due to asthma. this may be linked to poverty, urban air quality, indoor allergens, lack of education about asthma, and inadequate medical care.
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slidE 16
slidE 17
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slidE 18
instructions
define the term airways.
Generate Discussion
airways are tubes through which air passes on the way to, through, and from the lungs.
read slide.
discuss illustration.
the illustration shows the difference between a normal airway and one in the midst of an asthma episode. figure a shows the location of the lungs and airways in the body. figure B shows a cross-section of a normal airway. figure c shows a cross-section of an airway during asthma symptoms.
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slidE 19
instructions
read slide.
Generate Discussion
discuss importance of recognizing early warning signs.
if you have asthma, you have to know your own body well enough to recognize when these changes happen. By recognizing these signs, you can stop an asthma episode or prevent one from getting worse.
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slidE 20
instructions
read slide.
Generate Discussion
reinforce seriousness of asthma.
remember, all asthma is serious. Even mild symptoms can suddenly become severe. later in our discussion we will talk about the importance of having a written asthma action plan with instructions to prevent and treat asthma emergencies.
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slidE 21
78
slidE 22
instructions
discuss importance of accurate diagnosis.
Generate Discussion
a proper diagnosis of asthma is the first step toward reducing your symptoms and improving your health.
read slide.
Explain rationale for chest X-ray and define terms spirometry and peak expiratory flow.
chest X-rays may be done to rule out other potential causes of asthma symptoms. spirometry is a way to measure how much air the lungs can hold and how well the respiratory system is able to move air into and out of the lungs. Monitoring peak expiratory flow (PEf) means using a peak flow meter to monitor the amount of force with which air is blown out of your lungs.
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slidE 23
instructions
discuss how asthma status is determined.
Generate Discussion
there is a broad range of asthma severity. to assess your longterm asthma status, your healthcare provider will check how often you had asthma symptoms when you were not taking any asthma medication.
read slide.
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instructions
read slide.
Generate Discussion
review handout #3 What triggers your asthma?
handout #3 What triggers your asthma? contains a list of common asthma triggers. after the program, review the list and check the ones that seem to make your asthma worse. discuss this information with your healthcare provider, family and close friends.
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instructions
read slide.
Generate Discussion
continue to review handout #3 What triggers your asthma?
attached to handout #3 is a list of ways to remove or avoid triggers. after the program, check the ones that you will try. discuss this information with your healthcare provider, family and close friends and share your results.
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instructions
read slide.
Generate Discussion
review handout #4 recognize Early Warning signs
handout #4 recognizing Early Warning signs contains a list of common asthma early warning signs. after the program, check the warning signs that occur just before or at the beginning of your asthma episodes. discuss this information with your healthcare provider and make sure your asthma action plans tells you what to do when these signs occur. share this information with your family and close friends.
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instructions
read slide.
Generate Discussion
Provide additional details regarding peak flow meters.
does anyone here use a peak flow meter? the key to using a peak flow meter is finding your personal best score. your personal best score is the highest of 3 peak flow scores taken when you are not having any asthma symptoms. your healthcare provider will show you how to: Use a peak flow meter. Find your personal best score. Use the personal best score to define your treatment zones. the zones will match the colors of a traffic light. scores between 80%-100% of your personal best score are in the green zone. your asthma is in good control. continue to follow your asthma action plan. scores between 50%-79% of your personal best score are in the yellow zone. this means caution asthma control is getting worse. follow your asthma action plan. scores less than 50% of your personal best score are in the red zone. this means danger- your asthma is out of control. you may need immediate medical assistance. follow your asthma action plan for instructions.
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instructions
read slide.
Generate Discussion
discuss possible need for addition of a long-term controller medicine.
if you answered yes to any of these questions, you asthma is not under control. talk with your healthcare provider about adding a long-term controller medicine to your treatment plan.
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instructions
read slide.
Generate Discussion
review handout #6 how to use a Metered-dose inhaler (Mdi)
handout #6 how to use a Metered-dose inhaler (Mdi) gives you step-by-step instructions on using a Mdi with or without a holding chamber/spacer. When you use a Mdi by itself, more of the medicine is left in your mouth and throat, wasting your dose and causing an unpleasant aftertaste. if you do not have a spacer, talk with your healthcare provider about getting one.
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instructions
introduce group activities. read slide.
Generate Discussion
We are going to end todays discussion with a few fun group activities.
divide participants into 4 groups or as many as time permits. assign an activity to each group. allow 10 minutes for group discussion and sharing.
lets divide into 4 groups. Each group will have a different scenario to discuss. after a few minutes of discussion, ill ask each group to share their thoughts with the rest of the class.
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instructions
Be sure each participant has a copy of the Post-program Questionnaire (handout #7) and a pencil.
Generate Discussion
Before we end our session, please complete handout #7 Postprogram Questionnaire. By doing this, i will be able to tell how much you learned and what i can do to make the program better.
re-read the directions. ask if there are any questions. read each question number, followed by the question.
i will read each question, but feel free to move ahead if you would like. you dont have to wait for me. Okay, lets begin. Question #1
collect completed questionnaires and store in a marked folder anaging Asthma Effectively in M Older adults Post-program Questionnaire Location Date
is everyone finished? great. Please pass your questionnaires to the front so i can collect them.
*Optional Ask participants to complete a Program Survey. Collect program surveys and store them in the same folder with the Post-program Questionnaires.
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sectio n 4 lessons learned
he prevalence of current asthma in the district of Columbia has been
consistently higher than the national rate for the past seven years. The Asthma Control Program, dC Control Asthma Now (dC CAN),
4: lessons learned
district of Columbia department of Health (dOH), recognized early on the necessity of a multi-pronged approach that included communitydriven health education initiatives to reduce asthma morbidity and mortality among older adults.
section 1 4 Creatinglearned lessons Asthma-Friendly Schools
4: lessons learned
senior Citizen Asthma Education & in-Home Environmental Assessment Pilot Project
Overview In June 2004, DC CAN and the Greater Washington Urban League Division (GWUL) of Aging & Health launched the Senior Citizen Asthma Education and In-Home Environmental Assessment Pilot Project (SCAEIEAP). The goal of the project was to demonstrate and document the benefits of a community/government partnership to increase asthma awareness and promote self-care practices among urban older adults clinically diagnosed with asthma. The project, more specifically, intended to initiate behavior changes, including effective self-care practices that can improve quality of life, and to increase positive health care outcomes. Project components included: Home visits and education by case managers. Home environmental assessments. Group asthma education. Incentives for participation. Creation of a DVD titled Asthma and the Elderly.
Older adults were reluctant to change certain behaviors related to the medical management of their asthma. Older adults did not view asthma as a major concern unless they were experiencing asthma attacks or difficulty breathing. Unless asthma symptoms were exacerbated, asthma management was considered a low priority in view of other existing health conditions. Asthma management was more often reactive verses proactive. Many aspects of the SCAEIEAP project were captured on film, and an educational DVD was ultimately produced. Lessons Learned ag-time between participant recruitment and L program implementation must be minimized to maintain level of enthusiasm. eneration gaps exist between program facilitators G and audience that can be addressed by encouraging older adults to assist with program planning and facilitation. ome-visits and environmental inspections work H for some, but not all. There are some older adults who feel excessively vulnerable and therefore skeptical about home visits and/or the need for an environmental inspection. articipants need to establish a strong patientP provider partnerships. esired outcomes of the program must be realistic D and attainable.
Outcomes The Senior Asthma project findings included: any older adults have respiratory illness that M present the symptoms and behaviors described by patients with asthma, yet the patient or the providers office do not confirm a diagnosis of asthma. sthma management in older adults remains limited A and inadequate. lder adults did not have action plans at the O beginning of the project. lder adults asthma patients were using prescribed O medications improperly.
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sharing the Keys to Asthma Management
Overview Results from the Senior Citizen Asthma Education and In-Home Environmental Assessment Program and related DVD provided further evidence of the critical need to increase educational opportunities for asthmatic older adults and their clinicians. DC CAN launched phase two of the project one year later, in June 2005. The Senior Asthma Education Project provided educational outreach on asthma management for seniors to health care providers, as well as community-based educational outreach on asthma management to asthmatic residents in ward 7 and 8, ages 55 years and over. The overall goals of the program were specific to the target audiences: Goals for Older Adults o help reduce the incidence of asthma-related T hospitalizations for all DC residents, more specifically, among residents in Wards 7 and 8 who are 55 years of age and older. o develop age-appropriate and culturally sensitive T educational material for the target population. o increase self-management techniques among T older adults. Goals for Providers o increase awareness among providers about T mismanagement of asthma among older adults. o increase the use of the guidelines, Considerations T for Diagnosing and Managing Asthma in the Elderly (NIH-February 1996), developed by the National Institute of Health Asthma Education and Prevention Program (NAEPP).
Project components ducational workshops specifically designed for E health care providers treating older adult asthmatics. ducational sessions for asthmatic older adults E conducted in medical and community-based settings. ocus groups to elicit seniors participation in F planning, developing, and evaluating user-friendly asthma education tools.
Outcomes Pre- and post-program survey responses indicated the need for continued asthma education with older adults asthmatics, particularly as it relates to asthma medicines and their use; peak flow meter use; and the importance of an asthma action plan. Additionally, findings from this project warrant further research regarding older adults perceptions of asthma action plans. Prior to the educational session, many participants were confused about the nature and use of asthma action plans, believing that unwritten, self-developed action plans without provider involvement was sufficient. Lessons Learned se font that is at least 14-point size in educational U materials. efine all asthma-related terminology verbally with D the patient. xplain the nature and purpose of an asthma action E plan that should be completed jointly by the healthcare provider and patient.
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seniors Perceptions of the District of Columbia Department of Health, Asthma Control Programs DVD Asthma and the Elderly
Overview The DVD, entitled Asthma and the Elderly, documents the viewpoints of the Senior Citizen Asthma Education and In-Home Environmental Assessment Pilot Project (SCAEIEAP) participants and highlights specific questions and comments of participants during the project. The DVD was produced in conjunction with SCAEIEAP; thus the Project served as a mechanism for real-time formative evaluation of the DVD. The purpose of the project was to utilize focus groups to explore older adults attitudes, beliefs and perceptions of the DVD, including educational objectives, characters, dialogue, and comprehension. The findings of the focus groups would serve as research for developing other educational programs and materials about asthma among the elderly. Outcomes Overall, the DVD was seen as an enjoyable, comprehensive asthma education tool that fostered dialogue regarding asthma among participating seniors. After viewing the DVD, participants were eager to share personal anecdotes regarding experiences with asthma triggers. Key topics of interest among viewers included: Environmental home assessments. Medication regimes. istrust of doctors unless there was a long-term M relationship. Home remedies for asthma. Use and misuse of quick-relief medications.
A major theme prevalent among the participants was frustration related to providers and provider treatment. Several participants discussed difficulty with finding a provider that they believed took a sincere interest in them and their asthma symptoms. Consequently, they stated, their diagnosis was delayed because the provider simply did not recognize or acknowledge symptoms. Lessons Learned 1. Asthma education tools that foster dialogue among patients are imperative. 2. Focus groups with members of the target audience provide important feedback in the development of health messages and materials on asthma.
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Empowered for success: A seniors Guide to Asthma Control
Overview The District of Columbia Department of Health (DOH) Asthma Control Program (DC CAN) sought asthmarelated health education materials specific to the older adult population that were culturally relevant. To address this issue, they funded an initiative in early 2005 to produce an educational brochure specifically targeting African American seniors diagnosed with asthma. The initial focus group (pre-production) elicited comments regarding proposed content of the brochure, while the second focus group (pre-testing) elicited comments regarding the final draft. The Allies Against Asthmas publication, Tools for Assessing Asthma Education Materials4 served as a reference for developing a moderators guide for the second focus group. Outcomes During the pre-production focus group (focus group 1), eight potential topics were discussed: asthma definition respiratory system asthma triggers asthma medication (long term/quick-relief) inhaled medications asthma action plans smoking and asthma asthma and other health conditions
Participants suggested several additional topics, and many were included in the final brochure. The final draft brochure pre-testing occurred during the second focus group using the Allies Against Asthmas publication, Tools for Assessing Asthma Education Materials, as a guide. Seven areas were assessed: format text layout graphics overall appearance cultural appropriateness key asthma topics The final brochure, entitled Empowered For Success: A Seniors Guide to Asthma Control, incorporated the participants feedback; and overall, the brochure is a comprehensive asthma education brochure created with extensive input from the target audience, AfricanAmerican seniors diagnosed with asthma. Lessons Learned ngaging the target audience in decision-making E processes related to the development of health education material is essential. ocus group participants and target audience F members provided valuable feedback regarding the pre-production and final draft of the brochure.
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resources
District of Columbia resources Asthma and Allergy Foundation of America Maryland/Greater DC Chapter 410-484-2054 www.aafa-md.org American Lung Association of the District of Columbia 530 7th Street, SE Washington, DC 20003 202-546-5864 www.aladc.org DC Quitline Smoking Cessation 1-800-QUIT-NOW (1-800-784-8669) www.dctff.info District of Columbia Asthma Partnership 202-546-5864 www.dcasthmapartnership.org District of Columbia Department of Health DC Control Asthma Now Program (DC CAN) 825 North Capitol Street, NE Washington, DC 20002 202-442-5925 District of Columbia Office on Aging Government of the District of Columbia One Judiciary Square 441 4th Street, NW Washington, DC 20001 Phone: 202-724-5622 Fax: 202-724-4979 TTY: 202-724-8925 www.dcoa.dc.gov national resources Allergy & Asthma Network Mothers of Asthmatics 2751 Prosperity Ave., Suite 150 Fairfax, VA 22031 Phone: 800-878-4403 Fax: 703-573-7794 www.aanma.org/breatherville.htm Allergy and Asthma Disease Management Center (AADMC) www.aaaai.org/AADMC American Academy of Allergy, Asthma & Immunology 555 East Wells Street, Suite 1100 Milwaukee, WI 53202-3823 414-272-6071 Patient Information and Physician Referral Line: (800) 822-2762 www.aaaai.org American College of Allergy, Asthma and Immunology (ACAAI) 85 West Algonquin Road, Suite 550 Arlington Heights, IL 60005 www.acaai.org American Dietetic Association 120 South Riverside Plaza, Suite 2000 Chicago, Illinois 60606-6995 1-800-877-1600 www.eatright.org American Lung Association 61 Broadway, 6th Floor NY, NY 10006 1-800-LUNG-USA (586-4872) www.lungusa.org
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Asthma and Allergy Foundation of America 1233 20th Street, NW Suite 402 Washington, DC 20036 1-800-7-ASTHMA (727-8462) www.aafa.org Asthma and Allergy Information Association Vaughan Professional Centre, 1-111 Zenway Boulevard, Vaughan, ON L4H 3H9 (905) 265-3322 Fax: (905) 850-2070 1-800-611-7011 www.aaia.ca Asthma Under Control (Site sponsored by GlaxoSmithKline Inc.) www.asthmacontrol.com
Eldercare Locator 1-800-677-1116 www.eldercare.gov National Institute of Allergy and Infectious Diseases 6610 Rockledge Drive, MSC 6612 Bethesda, MD 20892-6612 (301) 496-5717 Fax: (301) 402-3573 www3.niaid.nih.gov National Heart, Lung, and Blood Institute (NHLBI) PO Box 30105 Bethesda, MD 20824-0105 (301) 592-8573 www.nhlbi.nih.gov Northwest Asthma & Allergy Center 1-800-437-4055 www.nwasthma.com
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sectio n 5 Resources & Glossary
esources, including websites, are mentioned in this guide as suggestions
and should not be construed or interpreted as an endorsement by the authors of this publication.
5: Resources & Glossary
section 1 5 Creating Asthma-Friendly Schools Resources & Glossary

Resources Glossary Toolkit Materials Handouts 105 107 110 111
5: Resources & Glossary
Glossary
Action plan: A written set of directions or a chart that tells you what to do if asthma symptoms occur, depending on their severity. Your action plan also should tell you what to do when you do NOT feel any symptoms (i.e., preventive care). Albuterol: An asthma medication (see short-acting betaagonist). Allergic asthma: A chronic, inflammatory disorder of the airways characterized by wheezing, breathing difficulties, coughing, chest tightness, wherein these sypmtoms are caused by an allergic reaction to an inhaled allergen, rather than an irritant or other non-allergy factor. (See nonallergic asthma for more information.) Allergen: A substance that triggers an allergic reaction. Many allergens are responsible for triggering asthma, including dust mites, animal dander, mold, and cockroaches. Allergist: A doctor that has specific training in the care of asthma and in some cases may be more familiar with current clinical guidelines than a pediatrician or general practitioner. Alveoli: Tiny air sacs where oxygen is transferred into your lungs and carbon dioxide waste enters the airways in order to be exhaled out. Asthma: A chronic, inflammatory disorder of the airways characterized by wheezing, breathing difficulties, coughing, chest tightness, and other possible symptoms. People with asthma have very sensitive airways that are constantly on the verge of over-reacting to asthma triggers. Beta-agonists: Asthma drugs that relax the muscles around the bronchial tubes (bronchodilators), thus opening the airways or helping keep them open. There are two main types. The long-acting type is taken every day to prevent symptoms, often in combination with a steroid. The short-acting type is used for quick relief of symptoms during an asthma episode/attack. Albuterol is the most commonly used short-acting beta-agonist. Bronchial tubes: Airways in the lungs. There is one major branch going into each lung, and these then divide into many smaller branches. Bronchioles: The smallest airways in the lungs. Bronchoconstriction: This is when the muscles that wrap the airways constrict tighter and tighter, pinching the airways closed. Bronchodilators: Drugs that relax the muscles around the airways, thus opening the airways up. Some bronchodilators are used for quick relief of symptoms during an asthma attack. Others are taken every day to prevent symptoms. Control drug: A drug that some people take on a daily basis to prevent asthma symptoms and asthma attacks. Corticosteroids: The most common and effective drugs used for long-term daily control of asthma (prevention of symptoms). They are most frequently inhaled using a metered dose inhaler, dry powder inhaler, or nebulizer. Corticosteroids primarily decrease or prevent inflammation. Cromolyn: An anti-inflammatory drug that may be used on a daily basis to prevent symptoms of asthma.
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Dry Powder Inhaler: A small device similar to a metered dose inhaler, but where the drug is in powder form. The patient exhales out a full breath, places the lips around the mouthpiece, and then quickly breathes in the powder. Holding chamber: See Spacer. Immunotherapy: A series of shots that help build up the immune systems tolerance to an asthma trigger. Ipratropium bromide: A bronchodilator sometimes used for quick relief of asthma symptoms, often for people who do not tolerate beta-agonists. It is also used for people whose asthma is triggered by beta-blocker medication for the heart. Leukotriene modifiers: A class of medications used in asthma and allergies to block the action of leukotrienes in the body and prevent the common symptoms of an allergic reactions and asthma. These are considered control medications in the form of tablets for patients with mild to moderate persistent asthma. For mild asthma, they are sometimes considered as an alternative to inhaled steroids. For moderate asthma, they may be considered as a supplement to inhaled steroids in place of long-acting beta agonists. Metered dose inhaler (MDI): The most common device people use to take asthma medication. An MDI allows you to inhale a specific amount of medicine (a metered dose). It consists of a metal canister, which keeps the medication under pressure, and a plastic sleeve, which helps to release the medication. When you press the canister, medicine particles are propelled toward your throat where you can inhale them.
Nebulizer: A device that creates a mist out of your asthma drug, which makes it easy and pleasant to breath the drug into the lungs. The drug is placed into a small cup. Air from a small compressor converts the drug into an aerosol mist, which travels through a hose with a mouthpiece attached. By taking slow, deep breaths, the medicine is delivered into your lungs. Nedocromil sodium: An inhaled medication that may be used on a daily basis to treat inflammation in the airways and prevent asthma attacks. Non-allergic asthma: A chronic, inflammatory disorder of the airways characterized by wheezing, breathing difficulties, coughing, chest tightness, wherein these sypmtoms are caused by an inhaled irritant or other non-allergy factor; when these symptoms are not caused by allergic reactions. (See allergic asthma for more information.) Peak flow: A measurement of how well you can blow air out of your lungs. If your airways become narrow and blocked due to asthma, you cant blow air out as well, and your peak flow values drop. Relief drug: A drug used as needed to relieve asthma symptoms during asthma attacks. Also called a quick-relief or rescue drug. Rescue drug: Relief or quick-relief drug. Sinusitis: An inflammation or infection of one or more sinuses. The sinuses are hollow air spaces located around the nose and eyes.
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Spacer: This works with your MDI to deliver medication more easily and effectively, and can reduce side effects. When you use an MDI by itself, more of the medicine is left in your mouth and throat, wasting your dose and causing an unpleasant aftertaste. Spacers hold the medicine between you and the MDI, so that you can inhale it slowly and more completely. Spacers are also called holding chambers. Spirometry: Test for diagnosing asthma. A spirometer is an instrument that measures the maximum volume you can exhale after breathing in as much as you can. Small spirometers are available for home use, although peak flow meters are more appropriate for most people. Steroids: See Corticosteroids. Theophylline: This drug is sometimes used to help control mild asthma, especially to prevent nighttime symptoms. The drug works by relaxing the muscles of your bronchial tubes.
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toolkit Materials
The following toolkit materials are included in the accompanying document sleeve: Managing Asthma Effectively in Older Adults Curriculum CD it contains your power point presentation and related handouts Asthma and the Elderly DVD Dr. Tom Plauts One Minute Asthma book Handouts for each attendee (Curriculum CD): andout #1 H Presentation Packet: A copy of the power point presentation andout #2 H Pre-Program Questionnaire: What Do You Know About Asthma? andout #3 H What Triggers Your Asthma? andout #4 H Recognize Early Warning Signs andout #5 H Asthma Action Plan andout #6 H How to Use a Metered-Dose Inhaler (MDI) andout #7 H Post-Program Questionnaire: What Do You Know About Asthma?
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2007 Guidelines for Diagnosing and Managing Asthma: Pre-Program Questionnaire What ChildrenKnow 5-11 Years Do You Ages About Asthma?
read each question. answer each question by checking true, false or not sure.
true
false
not sure
1. asthma is often diagnosed as a new condition in older people.
2. for most people, asthma can be controlled.
3. shortness of breath is a sign of getting older.
4. Older adults with asthma should not exercise.
5. having an asthma action plan can help you control your asthma.
6. there are two main types of asthma medicines.
7. cold and flu can trigger an asthma episode.
8. Most asthma episodes can be prevented.
9. asthma episodes always occur suddenly.
10. tobacco smoke can make asthma symptoms worse.
notes
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What triggers Your Asthma?
1. review the list of common asthma triggers. 2. check the ones that seem to make your asthma worse. 3. if you are not sure, keep the handout with you and use it to describe the circumstances surrounding each asthma episode you have. check the list to see which triggers may have been present and make a note. 4. share this information with your doctor, family and close friends.
Breathing cold air changes in the weather Physical activity Medicines food Pollen dust and dust mites tiny insects often found in house dust strong emotional responses laughing, crying, etc. stress Perfume, body deodorants, etc.
strong chemical smells paint, cleaning agents colds, other respiratory infections Mold, mildew tobacco smoke air pollution smoke, fumes, etc. cockroaches-their waste and dried body parts animals - their waste, saliva and dander (flakes from their skin) Other
now that you know what triggers your asthma, you can do three things. 1. remove or avoid the trigger. start with your home. if you need help ask. your family and close friends may be able to assist you. 2. limit being around the trigger. if you cant completely avoid the trigger, you can do things like leaving a room if someone starts smoking or asking friends to visit you at your home if they have triggers, like pets, in theirs. 3. if the trigger is unavoidable, ask your doctor about taking your quick-relief medicine before you are around a trigger.
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recognize Early Warning signs
Early warning signs are changes that happen just before or at the beginning of an asthma episode. they may appear hours or days before your asthma gets out of control. if you have asthma, you have to know your own body well enough to recognize when these changes happen. By recognizing these signs, you can stop an asthma episode or prevent one from getting worse. think about the symptoms you have had before an asthma episode. review the list below and check the symptoms that you have experienced. talk to your doctor so that you can take action to get your asthma under control.
signs of a cold, or allergies (sneezing, cough, nasal congestion, sore throat and headache).
feeling tired, upset, grouchy, or moody. restlessness.
a tight feeling in your chest. reduced peak flow readings. frequent coughing, especially at night. fever. cant do normal activities. Wheezing. a need to clear your throat often. Wheezing or coughing after exercise. losing your breath easily or shortness of breath. trouble sleeping due to difficulty breathing, coughing or wheezing. rapid heartbeat.
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How to use A Metered-Dose inhaler (MDi)
Getting ready
1. take off the cap and shake the inhaler. 2. Breathe out all the way. 3. hold your inhaler the way your doctor said (a or B below).
Breathe in slowly
4. as you start breathing in slowly through your mouth, press down on the inhaler one time. if you use a spacer or holding chamber, first press down on the inhaler. Within 5 seconds, begin to breathe in slowly. 5. Keep breathing in slowly, as deeply as you can.
Hold your breath
6. hold your breath as you count to 10 slowly, if you can. 7. for inhaled quick-relief medicine, wait about 15-30 seconds between puffs. usually, a single treatment is 2 puffs. review your asthma action plan for your recommended dose.
a. hold inhaler 1 to 2 inches in front of your mouth (about the width of two fingers).
B. use a spacer/holding chamber. these come in many shapes and can be useful to any patient.
clean your inhaler as needed, and know when to replace your inhaler. for instructions, read the package insert or talk to your healthcare provider or pharmacist.
Source: Guidelines for the Diagnosis and Management of Asthma. www.nhlbi.nih.gov.
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2007 Guidelines for Diagnosing and Managing Asthma: Post-Program Questionnaire What ChildrenKnow 5-11 Years Do You Ages About Asthma?
true
false
not sure
notes
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2007 Guidelines for Diagnosing and Managing Asthma: Program Questionnaire Answer Key What ChildrenKnow 5-11 Years Do You Ages About Asthma?
true
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x x x x x x x x x x
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Managing Asthma Effectively in Older Adults

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D i s t r i C t O f C O L u M B i A D E PA r t M E n t O f H E A Lt H

Managing Asthma Effectively in Older Adults

Managing Asthma Effectively in Older Adults

ta ble of cont ent s

Acknowledgements Letter to Instructors Introduction

table of conte nts

RESOuRCES & GlOSSARY Resources Glossary Toolkit Materials Handouts

105 105 107 110 111

Managing asthMa EffEctivEly in OldEr adults

Managing asthMa EffEctivEly in OldEr adults

Source: DC Department of Health Burden of Asthma in the District of Columbia 2009.

Managing asthMa EffEctivEly in OldEr adults

Managing asthMa EffEctivEly in OldEr adults

sectio n 1 Instructors Guide

y using this toolkit and teaching the Managing Asthma Effectively in

section 1 Creating Asthma-Friendly Schools Instructors Guide

sEctiOn 1 / instructOrs guidE

Managing asthMa EffEctivEly in OldEr adults

sEctiOn 1 / instructOrs guidE

How to use the Curriculum

Managing asthMa EffEctivEly in OldEr adults

sEctiOn 1 / instructOrs guidE

Health Education for Older Adults

Managing asthMa EffEctivEly in OldEr adults

Working with Older Adults in Health Promotion Programs

1. Be aware that older adults are not a homogeneous group.

sEctiOn 1 / instructOrs guidE

What is Cultural Competence?

culturally congruent Behaviors

appreciation and respect for cultural differences

core fundamental Beliefs: Warmth, Empathy and genuineness

Managing asthMa EffEctivEly in OldEr adults

sEctiOn 1 / instructOrs guidE

Asthma Learning tool: Questionnaire

Managing asthMa EffEctivEly in OldEr adults

sEctiOn 1 / instructOrs guidE

Managing asthMa EffEctivEly in OldEr adults

sEctiOn 1 / instructOrs guidE

Asthma Learning tool: Answers

Managing asthMa EffEctivEly in OldEr adults

sEctiOn 1 / instructOrs guidE

Managing asthMa EffEctivEly in OldEr adults

sEctiOn 1 / instructOrs guidE

Managing asthMa EffEctivEly in OldEr adults

sEctiOn 1 / instructOrs guidE

Managing asthMa EffEctivEly in OldEr adults

sectio n 2 Introduction & Asthma Basics

here were so many other things going on in my body, I didnt think

2: Introduction & Asthma Basics

section 1 2 Creating Asthma-Friendly Schools Introduction & Asthma Basics

2: Introduction & Asthma Basics

this section will cover: Icebreaker activity. Overview of the program.

Estimated time tOtA L: 35 minutes 3 minutes

handout #2 dvd Asthma and the Elderly

sEctiOn 2 / curriculuM rEviEW

introduction and icebreaker

Managing asthMa EffEctivEly in OldEr adults

Goal and Objectives

sEctiOn 2 / curriculuM rEviEW

Managing asthMa EffEctivEly in OldEr adults

DVD: Asthma and the Elderly

sEctiOn 2 / curriculuM rEviEW

Part ii: Asthma Basics