Creating Asthma Friendly Schools – Coaches Training
15
December

By Adem Lewis / in , , /


Hello, and welcome to this
presentation for coaches. This training is developed by the
Montana Asthma Control Program,
a program within the Montana Department of Public Health and
Human Services. Today, I am
going to talk to you about an important health issue that
affects many athletes- asthma.
My goal today is to help you to learn more about asthma,
especially as it relates to
physical exercise, and to make you more aware of some of the
issues that you have to address
in your day to day job as a coach and or physical education
teacher. This is an outline of
what we are going to cover today. We will cover asthma
background, asthma medications,
an overview of Exercise-Induced Bronchospasms, how to respond to
an asthma attack, what to do
before you play, and communicating about asthma with
parents, healthcare providers,
other school staff, and students. Asthma is a common
disease. According to 2014
data; 7.1%, an estimated 15,400 Montana children aged 0-17 have
asthma. 10.1% of Montana
children age 12-17 have asthma. This means that, in a classroom
of 30 students, about 2-3 will
probably currently have asthma. On a typical team of 15
athletes, at least one will
likely have asthma as well. To begin with, let’s review the
basic anatomy of the lungs and
the airways. When we breathe in, air in comes through our nose
and mouth and passes through a
system of branching tubes. These tubes start with the windpipe,
branch into the left and right
bronchi, and continue to divide again and again. When the
bronchi become very small, they
become known as bronchioles. Eventually, at the end of the
airways, the air reaches the air
sacs or the alveoli, which are indicated by number 5. This is
where oxygen is taken in from
the air and goes into your blood stream. An asthma attack is
characterized by a reversible
narrowing of the airways, which causes symptoms such as:
wheezing, chest tightness,
coughing, and shortness of breath. There are two ways in
which the airways can become
narrowed in asthma: Swelling of the walls of the airways-
caused by inflammation with
excess mucus production; and if you look at the slide on the
screen, you can see an example
of this. The other way is tightening of the muscles
surrounding the airways, which
can also be seen on the right hand side of the slide. The two
mechanisms of airway blockage
can occur separately or at the same time. No matter which
mechanism predominates at any
given time, the outcome is the same- the airway becomes
obstructed. The obstructed
airway blocks the normal flow of air and makes breathing
difficult causing some of the
symptoms I mentioned earlier. Asthma “triggers” are those
things that can start an
asthmatic reaction in the airways; many of these triggers
are things that people inhale.
Many asthma triggers can be classified into one of two
categories: allergens or
irritants. Allergens are those substances that stimulate an
allergic reaction only in people
who are allergic to the substance; those people who are
not allergic to the substance
will not show a response. Here are some of the more common
allergens that may cause an
asthma attack. This includes: pollen, mold,
furry and feathered animals, and
cockroaches.Note that pollen may cause problems for athletes
exercising outside during
certain times of the year when the pollen count is high.
Irritants are those substances
that can cause discomfort in anyone; in those people with
asthma, however, irritants may
provoke asthma symptoms. Here are some common irritants:
perfume, paints, smoke, strong
smells viral infections and emotional anxiety may also
be triggers of asthma. Cold
weather may also cause asthma attacks; thus, during the cold
times of the year, it is prudent
to pay extra attention to young people when they are outside in
cold weather. Most importantly
for our purposes today, exercise itself can also provoke symptoms
of asthma. Over the next few
slides, we are going to go over some of the basics of asthma
medications. Asthma medications
can be divided into two categories. One category is made
up of controller medications and
the other is made up of quick-relief or rescue
medications. Controller
medications are taken on a daily basis to prevent airway
swelling; usually, these
medications are not taken at school. Quick-relief medications
are taken when symptoms develop,
or are taken several minutes before exercising in order to
prevent airway narrowing; taking
quick-relief medication before exercising is known as
pre-treatment.
Quick-relief/rescue medications are used when symptoms develop,
or approximately 10-15 minutes
before exercising. As coaches, you need to make sure that if an
athlete is using
quick-relief/rescue medication that his/her medication is
readily available during
sporting events. We will now go through the required steps in
using a metered-dose inhaler. We
will demonstrate these steps, so that you may better be able to
assist your athletes with using
their inhalers. Step one is to:
1. Remove the cap and shake
the inhaler. 2.Tilt your head back and breathe out. 3. Put the inhaler mouthpiece
between the teeth, with tongue
underneath it. 4- Compress the canister.
5- Breathe in slowly for 3 to 5
seconds. 6-Hold breath for five to ten
seconds.
7-Exhale. 8-Wait at least one
minute;repeat as
recommended. 9- Repeat as necessary.
Note that some students will use
a spacer with their inhaler which has the potential to
increase the amount of drug that
reaches the lungs. However, some students find the spacer
cumbersome, especially at
athletic events. To help a student use their inhaler with a
spacer, follow these
steps: 1.Remove the cap from the inhaler
2.Shake the inhaler. 3. Put
the inhaler in the spacer. 4. Put your lips around the
spacer mouthpiece and exhale
through your nose. 5. Press the inhaler and take a
deep, slow breath in (for five
seconds). 6. Hold breath for 10 seconds.
7. Exhale. 8. Wait one to three minutes
before administering a second
puff. 9. Repeat as necessary. Some
students will use a peak flow
meter to monitor their asthma over time and to help them
decide what steps to take when
they have an asthma exacerbation. To assist the
child with using a peak flow
meter, have the child stand up and position the indicator at
the bottom of the numbers. Place
the mouthpiece between lips and teeth, forming a tight seal.
Have the child take a deep
breath in and exhale quickly and strongly through the mouthpiece.
Read the number at the position
of the indicator. Repeat again to get the most accurate reading
and make sure to have the child
clean the mouthpiece when done. As I mentioned before, exercise
can trigger narrowing of the
airways. This narrowing can occur in both people who do and
do not have asthma.
“Exercise-induced asthma,” or “EIA,” refers to the airway
narrowing that can take place in
people with asthma during exercise.”Exercise-induced
bronchoconstriction,” or “EIB” refers to airway narrowing
during exercise in people who do
not have asthma. The symptoms experienced are the ones I
mentioned earlier in this
presentation: chest tightness, difficulty breathing, wheezing,
and coughing. Although symptoms
can occur during exercise, the symptoms are often experienced
shortly after exercising. Often,
the symptoms peak five to ten minutes after exercise is
completed. The airway narrowing
often spontaneously resolves 20-60 minutes after starting,
although in some cases it can
last longer. Narrowing of the airways during exercise is very
common among people who have
asthma; as many as 90% of people with asthma may experience
exercise-induced asthma.
Exercise-induced bronchoconstriction among people
who do not have asthma is much
less common, although still not that rare; about 10% of the
general population experiences
exercise-induced bronchoconstriction. What are
some of the causes of exercise
induced asthma? There is a direct relationship between the
temperature and the humidity of
the air you breathe in and the degree to which narrowing of the
airways is provoked; colder and
drier air is more likely to cause airway narrowing. The more
aerobic a sport is, or in other
words more high ventilation, the more likely it is to cause
airway narrowing as well.
Examples of low-ventilation sports, that are less likely to
cause airway narrowing and the
symptoms associated with exercise induced asthma,
include: baseball, football, and
weightlifting. Examples of high-ventilation sports include:
soccer, cross-country, and ice
hockey. When you notice that a child is developing some of the
signs of an asthma attack-
coughing, shortness of breath, wheezing, and/or chest pain- you
should keep several things in
mind. Firstly, it is important to remain calm; this will help
to reassure the child that
he/she will be able to make it through the present attack. You
should then check the child’s
asthma action plan or emergency card for the next step to take;
this form tells you what
medication and actions the child should take based on his/her
current symptoms. Quick
relief/rescue medications should then be administered; if an
older child, the child will
likely carry their asthma inhaler with them; if a younger
child, this medication should be
obtained from the school nurse. There are several other useful
tips that you can keep in mind
when a child is having an exercise induced asthma attack.
You should have the child sit up
and breathe slowly- in through the nose and out through the
mouth. In addition, the child
should sip room temperature water or other liquid. Contact
the school nurse or another
designated staff member; also call the parent/guardian if
necessary. Importantly, remember
that you should not leave the athlete unattended during any of
the time they are experiencing
symptoms of exercise induced asthma. There are some symptoms
that a child could develop that
would indicate a severe asthma attack; in these cases, you need
to dial 911 or the other
emergency number in your juristiction. These
symptoms include:
*Lips/nailbeds are blueish. *The child is having difficulty
talking, walking, or drinking.
*The quick-relief/rescue
med(like Albuteral)
ineffective or not available. *The neck,throat, or chest
muscles of the child are pulling
in. *Nasal flaring occurs
when inhaling. *The child appears to be in
obvious distress. *The child is
experiencing an altered level
of consciousness or is very confused about what it
happening. • Or, if in general,
the child appears to have
a rapid deteriorating condition If any
of these symptoms are present,
call 911 immediately for emergency medical help! The good
news is that, although asthma is
a serious disease, it can be controlled. Consequently, there
should be no reason why young
people with asthma cannot be fully involved in sports. For
example, with proper control and
management, many world-class athletes with asthma have been
able to become highly successful
at their respective sports. For example, Olympic athletes with
well-controlled asthma have been
shown to perform as well as those without asthma; In fact,
30 percent of the US athletes
with asthma in the 1996 Summer Olympics took home medals. How
can exercise-induced asthma be
prevented? There are several things you can do. First, make
sure you know which of your
students have asthma. This will enable you to keep an eye out
for any athletes whose asthma is
not well controlled. Secondly, obtain an asthma action plan for
students who have asthma;
keeping it with you on a clipboard may be useful. Also
remember athletes with asthma
should use their quick-relief/rescue medication
approximately 10-15 minutes
before engaging in strenuous physical activity (per the
instructions of the health care
provider). Warm-up and cool-down exercises for five to ten
minutes can prevent
exercise-induced asthma as well, and therefore, should be
undertaken by students with
asthma. Checking air quality levels is also important; air
quality in Montana can be
checked at the website listed on the slide, which is
http://svc.mt.gov/deq/todaysair/
Guidelines for when to cancel sporting events due to wildfires
are posted on the Montana Asthma
Control Program’s website; these guidelines are explained on the
next slide. This handout is
meant to be used during wildfire season in Montana. As wildfire
smoke is an asthma trigger, it
can be necessary to cancel outdoor sporting events or to
move them inside during wildfire
season. The handout provides a way to classify the health
effects of wildfire smoke by
making an estimation of visibility. Visibility can be
determined by, while looking
away from the sun, estimating the distance to outdoor objects
that totally disappear. After
determining the visibility, consult the handout to determine
the proper health effect
category recommended about whether or not to hold
outdoor sporting events and/or
if any modifications need to be made. To access an electronic
version of the Recommendations
for Outdoor Activities Based on Air Quality for Schools and
Child Care Facilities, visit the
Montana Asthma Control Program Website. You can also check out
DEQ’s air quality monitoring
page mentioned on the previous slide. It also critically
important that you open lines of
communication with your athletes and parents. Asthma should be
controlled; it is not an excuse
for students to get out of physical education classes. Do
not allow an athlete to continue
to play who is complaining of difficulty in breathing; take
action and remove him/her from
play! Do not allow a child to play again until breathing has
returned to normal! If you
notice a child has had breathing difficulties, inform the child’s
parents/guardians and request
that the child be examined by a healthcare provider. Most
importantly, remember that
asthma is a disease just like any other and you should ensure
that athletes with asthma
symptoms are not teased. Today, we have covered many of the
basics of asthma and how it
relates to your jobs as coaches. However, I would like to point
you toward an excellent resource
that can provide you with some more relevant information. This
resource is called “Winning with
Asthma” and is an online program specifically designed for
coaches; it can be found at the
web address shown on the slide, www.winningwithasthma.org. It
contains information on asthma basics, asthma medication,
exercise-induced asthma,
guidelines for responding to an asthma attack, guidelines for
creating an athletic environment
where the chances of an asthma attack are minimized, as well as
tips for communicating with
others about asthma. There is also a glossary on their website
containing useful terms to know
when discussing asthma. This extra program provides more
information about asthma and how
it affects an athlete’s ability to compete successfully. It is a
good source of information about
how coaches can help athletes manage their symptoms and play
to their very best. Some people
with asthma do not have allergies; however, at least 80%
of children with asthma do have
allergies. Non-allergic asthma and allergic asthma are the same
disease, except for the absence
of allergies to specific triggers. Anaphylaxis is an
allergic reaction that affects
the whole body; it occurs if the body has an especially intense
reaction to an allergy-causing
substance. Common allergy-causing substances that
may cause anaphylaxis include
food, for example peanuts and bee stings. Anaphylaxis is a
life-threatening condition, as
blood pressure can drop dramatically and the child can
go into cardiac arrest. There
are several symptoms of anaphylaxis to watch out for.
These include: sweating or
paleness of the skin; light-headedness or fainting;
hives and itching; swelling of
the skin, lips, mouth, or throat; stomach cramps or
vomiting; and difficulty
breathing. These symptoms usually occur within a few
minutes after contact with the
allergy-causing substance, but can also occur hours after
contact. If a child is
experiencing symptoms of anaphylaxis, it is necessary to
immediately call 911.
Additionally, if you believe a child is experiencing
anaphylaxis, you should give an
injection of epinephrine; one of the most commonly used devices
for injecting epinephrine is
called the EpiPen. To use an EpiPen form a fist around the
EpiPen, with the black tip
pointing downward. With your other hand, remove the gray
safety cap. DO NOT touch the
black tip after removing the cap. Push the black tip firmly
against the outer thigh of the
child who is having the severe allergic reaction for 5-10
seconds. You can the remove the
EpiPen and massage the injection area for a few seconds. Check
the black tip to ensure that the
needle is exposed so that you know that the child has received
the dose. If they have not
received the dose and the needle is not sticking out, repeat the
previous steps. Ensure that you
have called 911 so that the child can go to the closest
emergency room. The effects of
the EpiPen will only last 15-20 minutes and anaphylaxis is a
life-threatening condition. If
you’re interested in learning more about anaphylaxis and
allergies, the Montana Asthma
Control Program also has an Allergies and Anaphylaxis
Training for school personnel.
In conclusion, I want to reiterate some of the key points
that I made earlier. Asthma is a
common disease that is often triggered
by exercise. During a student’s
asthma attack, follow the protocol outlined in his/her
asthma action plan. To prevent
exercise-induced asthma students may:
•Pre-treat with rescue inhaler
10-15 minutes before activity. Also, remember to allow adequate
time for warm up and cool down
periods. Finally, a student with asthma
that is well-controlled should
be able to participate in both sports and physical
education classes. •If a student is not able to
participate because of asthma
symptoms, ensure that you inform
his/her parents/guardians that
the athlete’s asthma is not well-controlled and direct them
to the appropriate health care
professional. That concludes our overview of asthma and some of
the relevant issues that you
need to be familiar with as coaches. Thank you for taking
the time to learn a little about
asthma and physical activity. If you have any comments or
questions about this
presentation, please do not hesitate to contact us. The
contact information for the
Montana Asthma Control Program is on the slide.


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