[music] (Sarah Cosgrove) Asthma is a chronic inflammation of the airways. There’s inflammation of the lining of the airways, which is the swelling. So as the airway swells, that hole that the air gets through gets less and less. As it squeezes smaller, it also squeezes mucus out into the airway, so not only is the airway small now, it’s got all kinds of mucus inside it. So that’s that noisy breathing that goes along with it, where people are feeling the tightness of the chest. It’s a chronic illness – meaning that people have it their entire life. It may become controlled through some parts of their life where they’re not experiencing daily symptoms, but people have it throughout their entire life, so you do not outgrow asthma. You can control it, but it doesn’t go away. Triggers are things that make people’s asthma act up much worse. If you have allergies to something – whether it’s pollens, molds, pets, food allergies, those are are all triggers that can interfere and makes people’s asthma worse. The next one is irritants, and those are those strong smells, and I like to say if you can smell it you can breathe it. So the irritants would be perfumes, air fresheners, cigarette smoke – cigarette smoke being a huge contributor to uncontrolled asthma. (Corissa Burnell) When we go into the home and sit down with the patients and we discuss with them what triggers are and we find out if they know what triggers they have. Oftentimes people will have pet allergies or other triggers in the home that they already know about, so we might focus a little bit more around that. My partner also does asthma education so she focuses on whether or not the patients know how to use their inhaler correctly, what they should be and shouldn’t be doing for medications, and asthma education. After speaking with the family we do a walk-through of the home, and we look for triggers that people might not necessarily know are triggers. A good example of that would be air fresheners or anything that puts particles into the air. (Dr. Stephen Wood) So it’s very important to be in touch with those things in your household that may be aggravating your respiratory symptoms. Sometimes pets, sometimes kittens, sometimes dogs, sometimes a lot of stuffed animals. These things need to be considered as a aggravate for respiratory issues. Certainly the biggest issue that we see in our community is smoking and the prevalence of that toxin in the house can be dreadfully aggravating for kids with asthma. (Cosgrove) And then the last one people don’t think of is behaviors and those behaviors such as laughing, crying, anxiety – people tend to take shallow breaths and start breathing through their mouths. Well when you breathe through your mouth, it’s cold dry air and the lungs don’t like it, so they want to tighten up, so people can trigger asthma attacks by the breathing associated with strong emotions or behaviors. So we work on controlled breathing, which is getting people to breathe in through their nose because it’s warm and humidified and also filters out some of the stuff in the air – so they breathe in through the nose and then through the pursed lips out. And we work on getting people to control that breathing, so that is a huge factor that we add in with triggers is that behavioral piece and learning to control the breathing associated with those behaviors. (Burnell) Pets can be a common trigger in the home and the reason that pets are a trigger is because they carry dust and dander and outside pollens inside the home, which then transfer on to patient’s bedrooms, carpets, couches, and their saliva can also trigger asthma. (Cosgrove) I would never say get rid of the family pet but there are things you can do to modify. First of all, you know pets, the licking that they do, the pollen that can collect on their hair, the dirt that can collect on their hair, you pet the pet, and then kids come in contact with their face and they can trigger them in that manner so teaching kids to regularly wash their hands after playing with the pets is very important. Wiping down your pets even if it’s like a wet washcloth is also very important because I mean as I said that dust that pollen can all stick to the hair. Another one is keep the pets out of the bedroom. You’ve got to figure you’re spending up to eight hours of direct contact in that room so having all those triggers and allergens from the pet directly in contact with you is not good. (Dr. Wood) It is very important to know how to take your medication. Typically that’s an inhaled steroid something like Flovent or Advair, and these are steroids that are inhaled into the lungs. If it comes in and a metered dose inhaler like this. You should always use a spacer with that. The spacer ensures that the medication is going maximally into the lungs. The steroid is your controller and that should be used regularly according to your pulmonologist or your physician. I should emphasize that these steroids are different than abused steroids that people link to athletic competitions. This is not testosterone. This is not a body building steroid, so it’s an extra dose that reduces the amount of inflammation that the body is experiencing. (Cosgrove) How do you know your asthma is not in control? We do something called the rule of two. Do you take your rescue inhaler more than two times a week? If you do, your asthma is not in control. Do you wake up at night with asthma symptoms more than two times a month? So that would be coughing, shortness of breath, wheezing. More than two times a month? Well that would tell me your asthma is not in control. Do you refill your rescue inhaler more than two times a year? If you do that’s telling me also that your asthma is not in control. We want to control it through proper use of medication and avoiding triggers. (Burnell) We’ve seen great success with the program. We’ve seen individuals who are no longer missing work because their asthma is in control. We see children who weren’t able to participate in school sports or school functions who are now running along with other kids. We’ve seen adults and children who weren’t sleeping through the night before – who are now sleeping through the night and confident in their asthma skills.