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Asthma at School

Role of the Teacher

Identify the high-risk students with asthma:

  • Previous life-threatening episodes
  • Three or more emergency room visits in one year
  • Prior hospitalizations within one year
  • History of non-adherence to asthma treatment regimen
  • Recurrent nighttime asthma requiring medications
  • Know the early warning signs
  • Have a copy of the students Asthma Action Plan in your classroom
  • Understand the student may feel tired, different from other students, anxious
    about easy access to medications, embarrassed about asthma, worried about
    activities that induce asthma

Asthma Facts

  • Asthma is the most common chronic disease of children
  • There are approximately 22 million people in the USA diagnosed with asthma
  • Asthma is the leading cause of school absenteeism in the United States
  • Children with uncontrolled asthma miss approximately 14 days of school per year
  • Asthma education is a vital component of asthma management
  • Asthma specialists (Allergist, Pulmonologist) are needed to care for mild
    persistent, moderate persistent and severe persistent asthma
  • If properly managed, people with asthma can live a happy, healthy, active life

Early Warning Signs

  • Low peak flows
  • Chronic cough (especially at night)
  • itchy, scratchy, sore throat
  • headache, stopped up head, sneezing
  • shortness of breath with exertion restlessness, more irritable,
    or at even rest
  • dark circles under the eyes
  • restlessness, more irritable
  • increased fatigue
  • tired, itchy watery, glassy eyes

Asthma Action Plan

An action plan is a treatment plan for worsening asthma. The action plan adjusts to the severity of symptoms so that students can control their asthma. People with asthma should have a treatment and management plan developed by their health care team. An Asthma Action Plan is a special road map to know how to take care of asthma each day.

When peak flow rates are:

Green Zone
  • Everything is all "go"
  • 80% or more of what your peak flow rate should be
Yellow Zone
  • Caution
  • 60 to 80% of what your peak flow rate should be
Red Zone
  • Medical emergency - peak flow rates are less than 50% of what it should be

Peak Flow Monitoring

A peak flow meter is a device that measures how well air moves in and out of the lungs. During an asthma episode, the airways become inflamed and narrowed. Many people who take asthma medicine daily use a peak flow meter several times a day.

How to Use the Peak Flow Meter

  • Set the marker to the bottom of the numeric scale.
  • Take a deep breath. Be sure you are standing up.
  • Place your lips tight around the mouthpiece.
  • Talk a big deep breath in.
  • Blow as hard and fast as possible. Blast the air out fast!
  • Note the final position of the marker. This is your peak flow rate.

Inhalers

Metered dose inhaler:

This is a small canister that contains the medication you need to control your asthma or relieve bronchospasms during an asthma episode (Advair HFA, Symbicort, ProAir HFA, Xopenex HFA, Albuterol HFA, Flovent HFA, Q-Var HFA, etc.). Proper inhaler technique must be performed to efficiently receive the medicine.

  1. Shake inhaler and place in your spacer. You may need to remove the inhaler from the canister if your spacer requires no case.
  2. Take 2 or 3 slow and deep warm up breaths.
  3. Sit up straight and be sure you are holding your head looking straight ahead.
  4. Slowly exhale.
  5. Place inhaler in your mouth, and then spray one spray.
  6. Slowly breathe in and hold your breath at least 10 seconds.
  7. Remove the spacer from your mouth and slowly exhale.
  8. Properly place spacer back into your mouth and slowly breathe in again.
  9. Hold your breath at least 10 seconds then slowly exhale.
  10. Wait 1 to 3 minutes and repeat as ordered by your doctor. (Be sure to shake your inhaler again!) Rinse your mouth after using anti-inflammatory medications.

Dry powdered inhalers:

This is medication that is in powder form. (Advair Diskus, Pulmicort Flexhaler, Asmanex, etc.)

  1. Breathe out slowly.
  2. Put your mouth on the mouthpiece.
  3. Take a big deep breath in real fast.
  4. Hold your breath for 10 seconds.
  5. Blow out slowly.

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Pregnancy and Allergies

A woman’s body experiences many changes when pregnant. Some women may develop allergies during pregnancy. It’s more common for women to already have allergies before conception.

Can allergies worsen during pregnancy?

About one-third of moms-to-be find their allergy symptoms get worse during pregnancy. The same number of women said their allergies stayed the same. Another one-third found their symptoms actually improved during pregnancy.

Common Symptoms

Symptoms are basically the same for those not pregnant which includes: itchy, watery eyes; sneezing; sore or itchy throat; runny nose and sinus congestion.

Stuffy Nose

Many pregnant women can develop stuffy noses. Nasal congestion normally starts in the second trimester cause mucus membranes to swell and soften. Some doctors call it pregnancy rhinitis.

Pregnancy rhinitis can feel like a cold or an allergy. It can also cause nosebleeds during pregnancy and even a post nasal drip that can cause coughing and even gag at nighttime. Typically, pregnancy rhinitis goes away after the pregnancy ends.

What is the difference between allergies and pregnancy rhinitis? For those who have allergies, symptoms experienced included congestion, coughing, sneezing and itchy eyes. If itchiness and sneezing isn’t causing issues, it could be hormone-related pregnancy congestion. Discuss any issues you are having with your doctor.

Allergy Medicines for Pregnant Women

Women need to be very careful taking any medications during pregnancy and most importantly during the first trimester. It’s important to discuss any allergy medications with your doctor. Reducing allergens in the home without using medications could be a first line of defense for the mom-to-be. Allergy proofing the home, avoiding allergy triggers and trying a saline nasal spray, nasal irrigation or nasal strips.

After the first trimester – oral antihistamines treat nasal and eye allergy symptoms of allergic rhinitis.

Considered safe for pregnancy according to multiple studies – Loratadine and cetirizine are second-generation antihistamines. These drugs do not cause drowsiness like first-generation oral antihistamines do – chlorpheniramine, diphenhydramine and tripelennamine.

Corticosteroid nasal sprays are mostly safe and can be prescribed to pregnant women with moderate to severe allergy symptoms that last more than a few days. Budesonide is considered the safest. Mometasone and fluticasone are also considered safe.

Decongestant nasal sprays can cause issues. Some studies point to a risk of birth defects when pregnant women use these products. They are not recommended during pregnancy especially in the first trimester.

Pregnant women should avoid any antihistamine nasal sprays since there is not enough research to prove their safety.

Always discuss which nasal spray might be right and any medication risks to the pregnant woman and her baby with her physician.

Allergy Shots during Pregnancy

Women can continue allergy shots that began before they were pregnant. They should stay at the current dose during pregnancy and if there are any reactions, the allergist may reduce allergy shot dosage. Generally, it is best not to begin allergy shots during pregnancy which can trigger changes in an already-changing immune system and may cause a systemic reaction.

Anaphylaxis treatment is the same during pregnancy as for non-pregnant women with food, insect venom or latex allergy. Use epinephrine at the first sign of symptoms.

Breastfeeding and Allergy Medications

Medications used during pregnancy can be continued while nursing. The baby gets less medicine through the breast mile than in the womb. Your allergist can discuss the best medications for nursing moms to use.

Do Allergies Cross Over to the Baby while Pregnant?

Allergy symptoms experienced by the mom during pregnancy are not believed to have an impact on the baby and developing allergies. Genetics play a major factor in developing allergies. For children with a parent or sibling with allergies, they have an increased risk of getting allergies.

A pregnant mother’s diet can be a factor in developing the child’s allergic rhinitis, food allergies, asthma or eczema. One study found that moms who ate plenty of food-based vitamin D reduced the child’s risk of developing allergic rhinitis. Foods with lots of vitamin D include dairy products, cereals, fish, eggs and mushrooms.

Reducing Allergy Symptoms without Taking Medications

Stay away from people who are smoking which can make allergies worse. Plus, secondhand smoke is not good for mom or her baby.

Pollen Allergies – stay inside as much as possible. Try wearing wrap-around sunglasses to keep pollen out of the eyes. Coming back inside, take off shoes, washing hands and face and changing clothes will help keep the pollen off. Put clothes in the wash. Shower and wash hair before bedtime to reduce nighttime symptoms.

Dust allergies – have someone clean the home regularly (if possible) and use a HEPA filter vacuum. A wet mop and a sweeper can help avoid stirring up the dust. Microfiber is better than a duster to trap the dust.

Pet allergies – for those allergic to their own pets, try to make one room that is pet-free.

Avoidance diets do not prevent allergic disease according to the American Academy of Pediatrics. This means that pregnant women shouldn’t worry about avoiding common food allergens such as peanuts, tree nuts, milk or wheat. Studies have shown that consuming peanuts, milk and wheat in the first and second trimesters can reduce the risk of a child developing a peanut allergy, allergic rhinitis and asthma. Unfortunately, no specific diet or food can prevent allergic disease.

Always discuss with your doctor before making any changes in diet during pregnancy.

The post Pregnancy and Allergies appeared first on Oklahoma Allergy and Asthma Clinic.

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