Where there’s dust, there may be asthma
A simple assessment for asthma triggers
It’s more important than ever that home care nurses learn how to conduct a thorough home environment assessment for asthma triggers, a pediatric asthma expert says.
Two trends have made an assessment crucial:
• First, recent studies are showing that the home environment not only contributes to asthma problems in children but also might be the main cause of childhood asthma.
Earlier this year, the National Institute of Allergy and Infectious Diseases (NIAID) of Bethesda, MD, announced its findings in the first phase of a five-year study of 1,500 inner-city children, ages 4-11, with asthma. Researchers for the National Cooperative Inner-City Asthma Study found that the children’s asthma was related to indoor allergens, passive cigarette smoke, and psychological problems among the children and their caregivers.
Asthma worse when difficult to get care
Also, the children’s asthma was more severe among those who reported significant problems with obtaining medical care.
• Second, most children with asthma these days are given maintenance medication that is administered by their families, and home care nurses will only be able to see them at the very beginning of their treatment or after an asthma episode.
Beth Younger, PHD, RN, pediatric case manager at Medical Innovations of Fredericksburg, VA, suggests nurses approach the assessment by telling parents that the physician is trying to figure out why the child is getting sick all the time. This should alleviate any fears they might have about their privacy being invaded.
"You have to do a complete environmental survey to see if there’s dust in the home and pets in the home," Younger says. The Fredericksburg office is one of four Medical Innovations offices in Virginia. The parent company is Horizon CMS based in Albuquerque, NM.
The environmental assessment could take one to two hours, and a follow-up assessment could last for 1¼2-to one hour.
Conducting asthma assessment
Education managers who would like to teach nurses how to conduct an asthma assessment can follow these guidelines:
1. ote all environmental triggers.
Younger suggests nurses see whether the house is excessively dusty, whether the parents smoke, or whether there are cats or dogs that could be shedding hair that triggers a child’s asthma episode.
Other common triggers are as follows:
• skin dander, hair, feathers;
• house dust mites;
• indoor and outdoor molds;
• cockroaches;
• grass, tree pollen;
• paint, strong smells, or fumes.
2. When does the child wheeze?
"There has to be a respiratory assessment of what the child’s baseline is," Younger says.
Nurses might ask the parents these questions:
• Does the child wheeze all of the time or at certain times of the day?
• Does the child have problems when he/she exercises?
• Does the child wheeze after showing strong feelings, such as crying or laughing?
• Did the child have a cold or upper respiratory infection prior to recent asthma attacks?
3. Check for food allergies.
Allergic reactions to food could trigger an asthma attack, Younger says.
Common food allergies might include chocolate, eggs, or tomatoes, she adds.
Also, research has shown that asthmatics can be sensitive to sulfites in foods. Sulfites are widely used in foods as a preservative and must be named on food labels.
Earlier this year, the U. S. processors of canned tuna announced that some canned tuna contains sulfites that are not declared as an ingredient on the label. But the tuna processors stopped shipping cans without the proper labels soon after the announcement, according to national news accounts.
4. What about weather?
"Asthma also has a seasonal component as well," Younger says. "The change-over from fall to winter can be very bad because the ground gets moldy and leaves decay on the ground."
In the summer, hot and humid weather can be difficult for people with asthma, as well as for people with other respiratory problems, she adds.
5. Medication compliance.
"It used to be we treated asthma on an as-needed basis, but now most children are on maintenance medications that they take all of the time," Younger says.
She suggests nurses ask families if they are giving the child the medications and whether the child is taking the medications on a regular basis.
"There are a lot of families who will say, He’s fine, and we don’t give him his meds.’"
So the nurse will have to explain that if the physician has prescribed maintenance medications, then the treatment is exactly that: It must be taken each day to maintain the child’s health.
6. Counsel families.
There are a number of organizations and publications that provide information about asthma for families and health professionals, and these could be used to supplement the nurse’s instruction. (See asthma resources, p. 162.)
"The nurse has to teach the family how to eliminate environmental triggers, and that’s hard to do; and it has to be said tactfully," Younger says.
She recommends these types of comments:
• "I wonder if dust is a problem for Johnny."
• "How often do you dust Johnny’s room, and how do you dust it?"
Helping someone change housekeeping behavior is difficult because people frequently do what they learned from their parents. "If your mom didn’t clean the kitchen floors, then you don’t," Younger says. "The best thing you can do is make recommendations and demonstrate the proper way to clean."
For example, the nurse could watch the parent dust. "Some people just flip a cloth over the surface and put more dust in the air," Younger says.
Nurses teach proper dusting method
Then a nurse could show the parents how to use a damp cloth to carefully pick up all of the dust on a surface. And the dusting should take place after vacuuming because vacuuming also spews dust into the air, she explains.
Also, nurses could tell parents about various allergy-free air filters and how these could help the child.
The most difficult thing to discuss is the parent’s smoking habits, Younger says. "I’ve counseled hundreds of families about how they have to quit smoking, and of those, maybe 50 have stopped smoking."
Younger says she frequently hears their comments that they only smoke outside. "But the smoke is still on their clothes and in the house."
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