Breathe Easy

We will walk you through a typical appointment on the Breathmobile. Read, look at pictures, and watch videos…however you like to learn, BreatheEasy has it for you!

Every patient is taken through a series of steps at every appointment (time between appointments is usually between 4-6 weeks, but usually 4 weeks). A patient’s first-ever appointment usually lasts about an hour, and follow ups are half an hour. A big part of asthma management is making it to every appointment. Follow up care is very important. Every appointment lets us compare data from the last, so that we can make sure that your child is getting better. If your child is not getting better, we will figure out why.

We understand that every patient is different so we make sure that every parent and child has individual time in our private doctor’s office in the back. We also want to make sure our nurses and  medical assistants have enough time to do all the tests and also educated you and your child on how to use medicine. So make it to every appointment and be on time, stick to the plan… and we have faith in your child’s improvement.

By the way, did you know we have an asthma glossary and Breathmobile glossary on our BreatheEasy blog? That’s right! So if you need reminding on any of the terms, just look up the word under its letter and it will be there!

The height of one of our youngest patients is taken by Medical Assistant Lisa.

We gather vitals signs data at every appointment. On the upper arm, blood pressure is taken, on the finger, the oximeter measures the oxygen content of blood.

The next part of vitals is measuring height.

The third step is recording the child's weight at every appointment. The Breathmobile keeps records of weight, because weight and asthma are related, and Prescott-Joseph has programs that encourage the community to stay fit and healthy.

During this time the nurse or respiratory therapist listens to the child’s lungs.

Nurse Spencer listening to lungs.

Dr. Granberg listening to the lungs in the doctors's room in the back of the Breathmobile.

The second step is the Pulmonary Function Exam or Spirometry. The child breathes into a mouthpiece that is connected to an instrument called a spirometer. The spirometer records the amount and the rate of air that they can breathe in and out over a period of time. At first, the child is supposed to breathe normally and quietly. Next they take a deep inhale and are required to forcefully exhale. Spirometry measures airflow. By measuring how much air a child exhales, and how quickly, spirometry can evaluate if there is any obstruction in the child’s lungs. Remember obstruction in the lungs is the swelling, constriction (tightening), and/or mucus production within the breathing tubes of the child’s lungs. This is asthma in the lower airways.

It also can be done to assess the effect of asthma medication and measure the progress in asthma treatment. If the spirometry show that the lungs are not functioning as well as they should (perhaps the child’s allergies are acting up, or they are very congested) we give the child a nebulizer treatment (see below for details), and then do the spirometry test again to make sure the lungs have cleared up.

Spirometry/PFT is a very important part of the Breathmobile. It is an integral component of specialty asthma treatment that is in accordance with national standards.

This is when the child takes small, easy breaths. Notice how the clown on the computer screen is very small here. The child can choose one of three pictures on the screen, as a way to be able to tell how hard he/she is blowing.

Here the child is asked to blow as hard as they can (the object or clown face, in this case, on the computer screen, has gotten bigger). This makes it easier for the child to see how hard they are blowing. The medical assistant or respiratory therapist acts as a breathing coach, trying to get the child to exhale as forcefully as possible.

The Nebulizer

Sometimes children require a nebulizer. This is a special machine that is used for quick relief on the Breathmobile. However, nebulizer treatments at home can be used for both quick relief and preventative medicine. The nebulizer humidifies the medication, rather than just having the child use their regular inhaler. Sometimes a child comes on the bus and their spirmetry tests are not what they should be. They could be very congested from a cold or allergy, or perhaps they have not yet started an asthma action plan, so we give relief by having them use the nebulizer. It does not take long, and you can leave the bus knowing that your child will breathe easy that day at school.

Nurse Spencer setting up the nebulizer.

Sometimes the patient needs to have a nebulizer treatment.

Child using the nebulizer. Their nose is plugged, and the child breathes in and out the humidified medication, which brings relief by going deep into the lungs.

If the doctor see that your child may have allergies, she will suggest that you schedule an allergy test for the next appointment. The Breathmobile blocks off an hour for an allergy test. Knowing your child’s allergies is very, very important. Allergies are a major trigger for asthma attacks (read our blog posts on this!). Our doctors, medical assistants, and nurse are highly trained in allergy testing. We do both environmental allergy testing and food allergy testing. Take advantage of this service the Breathmobile offers.

The last step of the appointment is the one on one time with the doctor. Having quality time with the doctor is something that unfortunately not eveyone has access to; so we on the Breathmobile fight health inequities by making sure that all parents have the opportunity to sit down with a doctor to discuss their child’s health and ask questions. The doctor examines the child by checking the lungs, mouth, nose, ears, and skin. The doctor fills out prescriptions, discusses the Asthma Action plan, and sometimes calls pharmacies. If the parent does not speak English, James, our patient services representative translates. We believe in giving parents and doctors lots of time to talk. No rushing and no waiting…just quality time with a doctor that really knows asthma.

No rushing, no waiting...just lots of quality time with the doctor.

Perhaps you are a BreatheEasy reader who wants to know what medicines we give out and prescribe on the Breathmobile. Maybe you are a parent that just came home and found one of our huge, ziplock bags filled to the brim with medications and devices, and you want to know what they are, why we gave them to your child, and what they do. Whatever your reason, BreatheEasy wants to explain to you what all these things are and why we encourage our patients to use them.

The Breathmobile’s allergy and asthma services are so effective, that it is only natural that people want to find out what we do, how we do it, and what medication we encourage our community to use.

The Medications

Spencer explaining the different asthma & allergy medications he is sending home with a family.

 

There are two types of inhalers that we have our Breathmobile patients use. The most important is the quick relief inhaler, also known as Albuterol. All kids with asthma need to have quick-relief medicine that works fast and stops asthma attacks. When to use the quick-relief inhaler and how many times is detailed in the asthma action plan that the nurses and doctor write up for every patient. The doctor, the school, and the patient all get a copy of the asthma action plan. But, more about the asthma action plan later.

The controller inhaler,  is the preventative medication. This helps asthma attacks from even starting. This is long term control medicine. It is important not to use the quick-relief inhaler too much (see Rule of 2 blog post). Common names of the controller inhaler are Qvar, Flovent, or Advair.

For each of these medications, we always teach patients and their parents to use a spacer with their inhaler. Watch the end of this movie from our YouTube channel to see our Respiratory Therapist Priscilla training a little girl on how use her spacer/inhaler. Making sure your child uses the spacer and knows how to use the spacer is very important to the Breathmobile. The spacer allows for the medication in the inhaler to be inhaled into the lungs, not just end up in the child’s mouth. It helps the medicine work better, because the medicine is delivered into the airways. We very often send patients home with spacers along with their inhalers. We also make sure that the school has an inhaler and a spacer as well, so that the child can take their medication during the day.

More medications…

Another medication we often prescribe is Singulair. This is a very important medication because it is preventative. If taken as your our doctor’s recommend, it can greatly help asthma attacks from even starting. It can also relieve sneezing and runny noses from allergies. Another medication that we give samples of is Zyrtec. This medication can also be bought over the counter. Zyrtec helps treat allergy symptoms such as watery eyes, runny nose, sneezing, and itching.

Nasal sprays

Another important part of our medication plans are the nasal sprays we encourage some of our patients to use. These are controller medications, that children use everyday to decrease inflammation. For example, Nasonex and Nasacort. These medications contain steroids which help decrease the swelling in the nose that happens when allergens such as pollen and grass are breathed in by the child.

Making sure the nose is healthy is very important for an asthmatic child. Here Nurse Spencer shows a parent how to correctly spray nasal spray.

Making sure mom can do it right...

It is very important that the child can breathe through the nose. That is why we ask parents in the beginning of the appointment (Health Risk Assessment Survey aka HRA) certain questions, such as Does your child have trouble sleeping at night? Do they snore? Does your child rub or itch their nose often? These questions if answered yes indicate to us that the child may be having trouble breathing in through the nose.

Why is breathing through the nose so important? Well because the upper respiratory airways (also known as the nose) humidify, filter, and warm the air before it reaches the lungs. The nose is an amazing machine, so we have to do what we can to take care of it. The nose serves a very important function, so we here on the Breathmobile want to make sure your child’s nasal airways are taken care of and functioning well!

The Asthma Action Plan

The main goal of the Breathmobile is to give the community the tools to manage their asthma. Medical management is key to our success and the health of the children we treat. In order to provide individualized care we provide each patient a tailored care plan, which is called the Asthma Action Plan. That piece of paper that is yellow, green, and red, that you see Spencer, Priscilla, or the doctor filling out on your first visit or when referring to later, is the Asthma Action Plan. This is the medical and symptom management formula that will help your child feel a whole lot better.

Nurse Spencer is filling out and stamping the Asthma Action Plan. He makes sure the parent, Breathmobile, and school has a copy.

 Parents should know how to manage their child’s asthma by following the instructions on the asthma action plan sheet. It clearly states what medicine the child should be taking, how much AND when. It includes allergy treatment instructions as well. The purpose is to make sure that parents are in control and responsive to their child’s asthma attack, instead of taking them to the hospital or emergency room upon the onset of a common symptom. They need to refer to their plan, which should be pinned on the refrigerator or put in the medicine cabinet, for themselves, other gaurdians, relatives, or sitters. 

Dr. Kushnir and Nurse Spencer working together to put together an Asthma Action Plan for a Breathmobile mother.

So what is with the green, yellow, red colors? Well, this is to show parents what to do if their child’s symptoms worsen . Green is what to do on a regular basis. They are not sick and their asthma is under control. But, for example lets say the child catches a cold or allergies really start flaring up or they notice any asthma symptoms (wheezing, coughing, chest tightness, trouble breathing). This is considered the yellow zone or the cautious zone. The parent should look on the yellow portion of the plan, and see what they need to do. So the yellow portion says specifically, for example, if your child isn’t as active or is having signs of breathing trouble, then refer to any additions or increases of medication in the yellow zone. An example would be an increase in controller mediciation dosage or an additional asthma or allergy medication, until the child is back in the green zone. The point is that it is a doctor’s standing order, so the parent can follow the medication plan without fear of harming the child; the doctor has already approved the proper steps of care found on the asthma action plan. It gives the parent responsibility, without having to depend on the ER or the ICU.

Here Nurse Spencer is filling out the Asthma Action Plan according to Dr. Piltch's (back of her head shown) instructions, in the private area in the back of the Breathmobile.

The patients are encouraged to follow the adjusted plan for 1 or 2 days, and if the symptoms do not go away, than the patient should call the doctor for medical advice. If the child reaches the red zone, which is dysfuntional breathing, inability to speak, or is showing signs of fatigue, give them their rescue inhaler, call the doctor, and go to the ER or call 911. The goal of asthma management is to make sure that children do not go into the red zone.  The purpose of all this is to give our Breathmobile patients and parents autonomy in their own care.

It encourages parents and children to be proactive in taking care of their asthma and allergies. We do not want our asthma patients to be dependant on the medicine forever, we want them to get better, perhaps even grow out of their asthma. We want our children to function normally. The goal is that their lives not be adjusted around asthma; asthma is something that they need to live with everyday, but when totally controlled, children with asthma should be able to function just like any other happy, healthy child.

Education on asthma, medications, and the lungs is also very important. As this video shows…

The Breathmobile makes sure that parents and children dont lose sleep, children go to school, parents go to work, and children don’t go the ER. No stress, no mess…just follow the asthma plan, come to your appointments, listen carefully to what the doctor says…your asthma will be controlled…and you’ll be good to go!

Here is a video of all the steps that were described on this page all at once:

We hope this page gave you a good idea of everything that happens on the Northern CA Breathmobile. We would love to hear your feedback, suggestions, or questions. Please leave a comment and we will do our best to get back to you as soon as possible.