METHODOLOGY OF ORGANIZING LESSONS
Health school for patients with bronchial asthma is a regular form of training with patients who study a number of topics over a certain period of time.
Schools are held :
- for outpatients and inpatients;
- both doctors and specially trained paramedical personnel;
- for all patients with bronchial asthma – the only requirement is preserved intelligence and memory (the patient must learn the information received); The group includes patients of different age and with different experience of the disease.
- for patients with severe bronchial asthma, it is necessary to supplement group classes with individual training.
Recruitment to the School of Health for Patients with Bronchial Asthma is carried out:
- in a hospital : all doctors are notified of the opening of the School of Health, who compile a list of patients who need training and send them to classes.
- at an outpatient appointment: district doctors inform patients of the expected date for the start of classes, then the patients are notified by contact phone about the start of classes.
The health school is organized by order of the head of the medical institution. The order states:
- responsible persons for the performance of this type of medical services;
- instructions, procedure and forms for referring patients to study at the School;
- statistical forms of registration and accounting;
- work plan and schedule;
- fixing the premises for classes, a list of equipment.
A mandatory requirement is the “non-admission” to subsequent classes of those patients who did not attend the first lesson, i.e. The school should be a “closed team” and no new patients joined during the cycle of classes. If this rule is not observed, then new patients begin to ask questions that have already been discussed in previous sessions and pull the group back. The group goes through a full cycle of classes, and then a new group is recruited.
The number of patients in the group should not be more than 8-10 people. It is preferable to educate patients in conjunction with their family members, who have the opportunity to determine the patient’s lifestyle.
For classes, it is better to have a classroom or other room where there are tables so that it is more convenient for patients to take notes.
For each lesson, you must have demonstration material: posters, booklets, medicines, a video film, etc.
The cycle of classes can be limited to 5 lessons lasting no more than 1.5 hours. The total duration of the cycle should be no more than 7-10 days. Classes are preferably carried out daily or, in extreme cases, with an interval of 1-2 days. During the year, 7-9 cycles of classes are usually held, depending on the need, there may be more. There is no training during the summer months.
At the first lesson, patients should be warned that they should ask questions as they arise, without waiting for the end of the lesson. Thus, the doctor’s monologue is interrupted by the patients’ questions and remarks, and the lesson turns from a lecture into a conversation.
The educational program includes the following topics:
- What is bronchial asthma?
- Why does an asthma attack occur? Allergy and bronchial asthma.
- Chronic inflammation and bronchial asthma. Mechanisms of obstruction in bronchial asthma.
- Non-allergic causes of bronchial asthma.
- Peakflowmetry. bronchodilator test. Rules for plotting peak flowmetry. Individual control zones.
- Inhalation therapy of bronchial asthma. Symptomatic treatment of bronchial asthma.
- Treatment of chronic inflammation in bronchial asthma.
- Glucocorticosteroid therapy in bronchial asthma.
- Treatment of exacerbation of bronchial asthma.
- Treatment and prevention of viral and bacterial infections.
- What is the School of Health for Patients with Bronchial Asthma?
- Definition of bronchial asthma.
- Bronchial asthma is a chronic inflammation.
- The structure of the respiratory tract.
- What happens during an asthma attack?
- Allergic and non-allergic causes of bronchial asthma.
Props : poster “The structure of the respiratory tract”, “Bronchi outside the attack and during an asthma attack.”
At the first lesson, patients get to know each other and the teacher. The lesson begins with the fact that the teacher introduces himself to the audience and writes down those present. Then he briefly talks about what the School of Health is and how the training program will be organized; after which he moves on to the topic of the first lesson – “What is bronchial asthma.”
Bronchial asthma is a chronic inflammatory disease of the bronchi, which periodically occurs reversible narrowing of the airways – bronchospasm.
Patients should be explained that bronchial asthma , as well as diabetes, hypertension is a chronic disease . In children, bronchial asthma may disappear, but in adults we can talk about a long-term remission, and not about a complete cure. Therefore, the main task of the patient is to learn to control his disease, to prevent exacerbations.
In order to control their disease, each patient must have a good understanding of the anatomy of the bronchial tree and the mechanisms that underlie an attack of bronchial asthma.
A doctor or paramedical worker tells the audience:
- about the external structure of the respiratory tract, about the relationship between diseases of the upper and lower respiratory tract, about the branching of the bronchi and the concept of the bronchial tree, about the respiratory act and the role of the diaphragm in the respiratory act.
- about the internal structure of the respiratory tract, about the mechanisms of self-purification of the bronchial tree, about mucociliary clearance, about the detrimental effect of smoking on the protective processes in the respiratory tract, about bronchial secretion – its composition and protective properties.
- about the mechanisms of the development of an attack of bronchial asthma: about the concept of bronchospasm, about mucosal edema, about sputum hypersecretion; demonstrates the difference between the bronchi during and outside of an asthma attack.
- about allergic causes of bronchial asthma.
Allergy is an increased sensitivity of the body to the effects of certain environmental factors: chemicals, microorganisms and their metabolic products, foods, drugs, physical phenomena; This is a condition that has a hereditary predisposition, in which the body, in response to exposure to allergens, produces a whole group of specific substances (including immunoglobulins). The most common manifestations of allergies, such as bronchial asthma, hay fever (allergy to plant pollen) , urticaria.
The most common allergens are household dust, animal dander, plant pollen, house ticks, medicines, household chemicals, and food products. This also includes various bacteria, viruses and fungi, their metabolic products. Sometimes the allergen is daphnia, which is used as fish food. Among the factors contributing to the increase in the number of allergic diseases, a significant place is occupied by the deterioration of the environmental situation, in particular, air pollution from car exhaust gases.
It is very important to focus patients’ attention on the prevention of household allergies , which includes: regular wet cleaning, airing the apartment, getting rid of things that accumulate dust – upholstered furniture, carpets, heavy curtains; glazing bookshelves, etc.
It is necessary to talk in detail about house dust, which contains many organic and inorganic components, in particular, insect remains, animal dander, food debris, bacteria, fungi. Another component of house dust is the house mite (Dermatophagoides pteronissimus), which feeds on dandruff and food debris. Often the house tick is the main allergen. Carpets, upholstered furniture, woolen things, feather pillows contain a huge amount of mites. Lying down to sleep on a feather pillow and covering himself with a woolen blanket, a patient with bronchial asthma is exposed to massive allergen exposure.
As a result, special requirements have been developed for the room in which a patient with bronchial asthma lives (particularly strict rules must be observed in relation to the bedroom):
- The bedroom should have a minimum of furniture. Decorations on the walls (including paintings) and carpets are dust collectors, it is advisable to get rid of them. Curtains should be lightweight and washable. The bedroom should not have bookshelves.
- The closet should be washed and only seasonal clothes should be kept in it. Clothes should be put away in the closet, and not hung on chairs and lying on the bed. Cabinet doors must be tightly closed.
- It is necessary to carry out wet cleaning at least 3-4 times a week. It is desirable that relatives do the cleaning, and not the asthma patient himself. Cleaning of the premises must be carried out with a special vacuum cleaner with a water filter and a separator, which isolates all dust in the aquatic environment and prevents its increase in the air after cleaning with a conventional vacuum cleaner.
- Mattresses must be covered with special dust-proof covers. Do not store old newspapers and books under the bed.
- Feather and down pillows should be replaced with cotton or polyester pillows. Pillows should also have dust-proof covers.
- The bedspread should be on the bed so that dust does not accumulate on the bed during the day.
- Children with asthma should not sleep with soft toys.
- It is forbidden to have pets. It should be clarified that if an asthma patient is allergic to a cat, then it is also impossible to get a dog. With bronchial asthma, the spectrum of allergens expands. Patients should know that there are no “hypoallergenic animals”.
It is important for a patient with asthma who has a pollen allergy to know the flowering calendar of plants in the area and take measures to avoid contact with allergens: do not go to the forest, to the meadow, adhere to an urban lifestyle in certain months, if possible, in the month of flowering of the allergen plant go on vacation, etc. With allergies to food – the creation of individual diets.
Briefly, it is necessary to dwell on which drugs should not be taken by patients with aspirin bronchial asthma, as well as what kind of diet they should follow.
In addition, it is necessary to talk about the method of specific immunotherapy, indications and contraindications for this method – the type of allergy, the stage of the disease, the age of the patient, etc.
- non-allergic causes of asthma
Non-allergic causes that cause an asthma attack in patients with bronchial asthma include: emotional stress, sudden change in weather, exposure to cold air, viral infection, physical activity, strong odors, high humidity, etc. One of the characteristic signs of bronchial asthma is the increased sensitivity of bronchial the tree responds by narrowing the lumen of the bronchi to the impact of various non-allergic stimuli, and an asthma attack occurs. Airway hyperreactivity is very difficult to deal with, and the main method of treatment is to try to avoid situations in which an asthma attack occurs.
It is known that nervous stress can cause a prolonged attack of suffocation, and in some patients only emotions support the disease. You can give advice of a general order: try to avoid stressful situations, engage in physical education, harden. There are also a number of patients who should be confidentially advised to consult a psychotherapist or medical psychologist.
Patients who have an asthma attack when going out into the cold are recommended to inhale salbutamol in 20-30 minutes. The same recommendation applies to the prevention of exercise-induced choking. Patients need to be explained that they can play sports with asthma. Bronchial asthma is not a contraindication for sports, on the contrary, physical activity improves the course of the disease. Swimming is especially beneficial for asthma patients.
- What is a peak flow meter? Goals and objectives of peak flowmetry.
- The method of using a peak flowmeter.
- Method of self-monitoring of bronchial asthma using a peak flowmeter.
- Rules for the use of a metered dose inhaler.
- Rules for using the spacer.
- Rules for conducting a bronchodilator test.
Objectives of the second session :
- teach trainees how to use the peak flow meter, metered dose inhaler and spacer;
- to teach to carry out full control of bronchial asthma, using the graph of peak flowmetry.
Props : inhalers, peak flow meter, spacer, posters with options for plotting peak flow measurements, self-control diary.
At the beginning of the second lesson, it is necessary to briefly repeat the questions that were discussed in the previous one. It is advisable to invite the group to answer questions regarding the definition of bronchial asthma and the causes and mechanisms of the development of an attack of bronchial asthma.
A peak flowmeter is a device for measuring the maximum (peak) expiratory flow rate (PSV). All over the world, patients with bronchial asthma measure this indicator in the morning and in the evening, controlling their health. The peak flow rate directly depends on how narrowed the bronchi are.
Peak expiratory flow measurement technique:
- Exhalation is carried out in a standing position, so that during exhalation the diaphragm actively works.
- You need to take a deep breath.
- Close the mouthpiece of the device tightly with your lips.
- Make a full and sharp exhalation.
- Record the instrument readings.
- Repeat measurements two more times and choose the best one.
- Record it in a diary, compare with previous indicators.
Patients need to be taught the technique of self-monitoring of bronchial asthma using a peak flow meter. To do this, you need to teach how to keep a daily and weekly peak flow diary.
Goals and objectives of the diary of peak flowmetry :
- With the help of dynamic peak flowmetry, the causative allergen can be identified (by the fall in PSV during the day).
- Determine the degree of bronchial obstruction (comparing the PSV index with the norm established for this patient).
- Determine daily fluctuations in airway patency.
- Recognize the beginning exacerbation of bronchial asthma.
- Assess the effectiveness of the treatment.
At the lesson, patients are given the concept of delimiting the control zones on the peak flow chart, which is extremely important for the timely recognition of an exacerbation of the disease. An approximate scheme of the patient’s behavior during an exacerbation of asthma is discussed in the lesson and recorded by each student individually, after serial measurements of PSV.