Document Sample
					                                                       Volume 2, Issue 4                                       Fall 2006

                                                       North Carolina Alliance of Respiratory Educators

                                                       RESPIRATION STATION
                                                       Your One Stop for NCARE News
        A quarterly publication of the North Carolina Alliance of Respiratory Educators is free to all NCARE current memberships.

Inside this issue:                         The Engineer’s Depot
Healthy Hoops for SC          2     As healthcare professionals we are        using the ER and thought I was wast-     family on the use and indication.
                                    all too familiar with being on the        ing resources. I was assured that this   The whole experience got me think-
Spirometry Signals            3
                                    caring end of the medical spectrum.       is the type of emergency that war-       ing about our patients. Would they
Quit Tobacco Use              4-5   We can only imagine what it would         rants a visit. Next as a respiratory     know they were having an allergic
                                    be like to be on “the other side.”        therapist I was worried about my         reaction? Would they have gotten
Spotlight On ...              6
                                    Many of us go through great lengths       airway and concerned that intubation     care as quickly? Would they be
NCARE Registration            6     to avoid the other side even as far as    was soon to be an option. Luckily        overwhelmed with prescriptions and
                                    “doctoring ourselves” and thinking        my treatment consisted of an IV,         the use of an Epi-Pen? Would they
COPD Symposium                7
Registration                        we know what is best! I had the           EKG and Pulse Oximeter monitor,          have called their allergist or PCP the
                                    recent experience of being on “the        steroids, Epinephrine, Cimetidine,       next day? It is true a little bit of
Caboose                       8
                                    other side” and I can tell you first      fluids and not an artificial airway. I   knowledge can be a dangerous thing
                                    hand it was eye opening and contem-       was observed for four hours and          but in this case I don’t think I overre-
                                    plative.                                  allowed to go home. I was given a        acted. My quick thinking and fast
                                                                              prescription for three Epi-Pens, Ci-     action was very appropriate. I might
                                    Years ago I had an allergic reaction
                                                                              metidine, and a taper dose of Pred-      add that was the most expensive bag
                                    to walnuts and basically avoided all
                                                                              nisone. I have never been on oral        of nuts I ever ate costing me a $150
                                    nuts for years. I was re-allergy
                                                                              Prednisone and all I can say is what     Emergency Room co-pay!
                                    tested two years ago and although I
                                                                              an experience. It truly opened my
Respiration Station Staff           was positive for dust, dust mites,                                                 As respiratory educators we must be
                                                                              eyes up to what our patients go
                                    cockroaches, ragweed, trees, and                                                   vigilant with our patients and gently
Engineer (Editor):                                                            through! It made me feel edgy,
                                    grasses, I was negative for all foods,                                             prepare them for a “worst case sce-
•Rita Heath, RRT-NPS, AE-C                                                    irritable, and as if I could jump out
                                    including nuts. Fast forward from                                                  nario.” We also should remember
                                                                              of my own skin. I hope I never have
Contributing Editors:               those allergy test results a few years,                                            that no matter who is on the receiv-
                                                                              to be on it again. I was also very
•Jakki Rawlinson, MA, RRT, AE-C     and recently my PCP suggested I go                                                 ing end of our care or education
                                                                              fortunate to receive competent and
•Donna Dayer, BS, RRT, AE-C         on the South Beach Diet to decrease                                                despite their occupation, social
                                                                              professional care. Even though I
                                    a slightly elevated cholesterol. Be-                                               status, or advanced learning, they
                                                                              understood everything that was hap-
Publisher:                          ing the wonderfully compliant pa-                                                  demand our respect, compassion,
                                                                              pening it was comforting to know I
•Kelley Crowder, MBA                tient that I am, I dove in and soon                                                and understanding.
                                                                              wasn’t just being treated as a number           found myself eating walnuts, cash-
                                                                              or a diagnosis.                          Until next time,
                                    ews, almonds, and macadamias, as
Contact Information:
                                    recommended snack sources. On             The next day I called my allergist’s     UÜxtà{x ãxÄÄ? àxtv{ uxààxÜ4
•Respiration Station E-mail           July 5th of this year I found myself      office and spoke with his nurse. I
                                                                                                                       e|àt [xtà{? RRT-NPS, RPFT, AE-C
                                    having an anaphylactic reaction to a      was able to give her an account of
•NCARE Membership                   mix bag of nuts I had purchased at        what happened, and it was quickly        E-mail:
   Box 746
   Shelby, NC 28151                 work. Now thankfully I was at work        decided that I needed to be re-allergy
   Phone: 704.472.0022              and knew that I was having a reac-        tested and that I should stay away
                                    tion, within minutes I was in the         from all nuts and peanuts until then.
          or             emergency room. As a healthcare           I felt comfortable using the Epi-Pens
                                    professional I felt extremely foolish     if I needed to and instructed my
                 RESPIRATION STATION

Healthy Hoops for Asthma in South Carolina
                                                                                               Jakki Rawlinson, MA, RRT, AE-C
As we all know, getting children with asthma and their parents the appropriate asthma education can be a challenge. But combining the education
with a popular sport such as basketball has proven to work, families participate.

Healthy Hoops does just that. Select Health of South Carolina, a Medicaid Health Plan, parent company, AmeriHealth Mercy in Pennsylvania,
first implemented Healthy Hoops three years ago in Philadelphia. The results were phenomenal. The number of people visiting the emergency
room for asthma-related problems dropped 78 percent, and there was also a significant reduction in asthma-related sleep disturbances.

The program which includes three components was brought to Columbia, South Carolina in July 2005. Increasing preventive medication use rather
than rescue medication, reducing emergency room use and hospitalization and increasing parental knowledge about their child’s asthma manage-
ment are among the program’s clinical objectives.

The kickoff engaged young children age 7 – 15 in basketball. The kickoff was held at the University of South Carolina. The sport was used as a
tool to teach them the importance of regular exercise and nutrition in managing obesity and cardiovascular disease along with asthma.

They participated in basketball drills and motivational talks with well-known basketball coaches including USC Men’s basketball Head Coach
Dave Odom and former Philadelphia 76er Sonny Hill. Thirty nine children from all over South Carolina participated. Twenty nine parents also
participated. During the kickoff the children and their parents rotated through sessions with four celebrity coaches and the asthma education por-
tion, which I conducted.

The second component of the program consisted of a free health exam and spirometry screening at a local health center. Controller medications
were prescribed if necessary. Fifty children were screened. Thirty one of the screened children attended the kickoff; the remainder joined the pro-
gram after the kickoff.

                                                                                           The third component, the Healthy Hoops Fall Challenge
                                                                                           was held in October at the University of South Caro-
                                                                                           lina’s basketball training gym. The Fall Challenge was a
                                                                                           full day basketball camp and an asthma education ses-
                                                                                           sion, which I conducted, for the parents. Seventy-two
                                                                                           children participated in the Fall Challenge. The children
                                                                                           had to be well controlled to participate. Forty four of
                                                                                           the participants had the health screening and spirometry.
                                                                                           The remaining twenty-eight children were siblings or
                                                                                           guest. Forty-two parents participated in the asthma edu-
                                                                                           cation sessions. Thirty children participated in all three

                                                                                           Pre and Post test clinical data are still being collected.
                                                                                           The parent evaluations are also being tabulated. The
                                                                                           participants will be asked to complete a questionnaire
                                                                                           periodically after completion of the camp. Considering
                                                                                           this is the first year, we feel participation following the
                                                                                           kickoff was successful.

                                                                                           Healthy Hoops was held October 7, 2006 at the USC
  Jakki Rawlinson, MA, RRT, AE-C, (front row, center) is the Asthma/COPD Basketball Practice Facility in Columbia, and will be
 Program Administrator for BlueChoice HealthPlan, a graduate of both Asthma held on October 28, 2006 at the Cleveland Street
                 and COPD Courses and an NRTC Trainer.
                                                                                           YMCA in Greenville.

     Page 2
                  Volume 2, Issue 4

This patient is a 27-year-old female with a
10-year pack history. She presents to the       Spirometry Signals
pulmonary function lab to role out asthma.
She has been complaining of increased
shortness of breath with exertion and fre-
quent coughing at night. She has an Al-
buterol Inhaler that she uses PRN. She
continues to smoke but reports cutting
back some. She has no apparent work
related exposures. Her weight clearly
shows she is over a normal BMI. Again
using the NRTC Training Method of spi-
rometry, let’s ask ourselves the following

How long was the test?

The answer isn’t visible with this tracing
but trust me it was 6 seconds.

How is the shape of the test?

We can definitely see an inspiratory and
expiratory side to our flow volume tracing.
The inner loop is the pre-medication flow-
volume loop and the outer loop is the post-
medication flow-volume loop.

What is the FEV1/FVC ratio?

Pre-medication it was 80% and post-
medication it was 87%. Both within nor-
mal limits. In our PFT Lab we administer
                                                What is the FEF25-75?                              She should also be counseled on smoking cessa-
2 puffs of Maxair and wait 10 - 15 minutes
                                                                                                   tion and determine how ready she is to quit.
as protocol for our pre/post spirometry.        The pre-medication FEF25-75 was 78% and
                                                                                                   Her weight also needs to be addressed and an
                                                the post-medication FEF25-75 was 115%, a
What is the FVC?                                                                                   exercise plan might also motivate this patient to
                                                48% increased with the bronchodilator!
                                                                                                   move towards a healthier lifestyle. If symptoms
The FVC pre-medication was 91% and
                                                What is your interpretation?                       continue a cardiac work-up should also be con-
post-medication was 101%. Both are
within normal limits and the patient ex-        Well, her spirometry was normal before the
perienced a 11% increase post change            bronchodilator challenge and post-medication
after the bronchodilator was given.             showed a very positive result from the Maxair.     ♦    Do you have an interesting case study that
                                                Would you call this asthma then? Might many             you would like to share?
What is the FEV1?
                                                of us have a positive reaction to taking a bron-
The pre-medication FEV1 was 87% and             chodilator? Is her asthma under control and        ♦    Please remember to remove all patient
the post-medication FEV1 was 104%, both         this PFT just further verifies that? What about         personal information before sharing case
within normal limits, but the bronchodila-      her symptoms? There is always a very fine line     ♦    Please send case studies or questions to:
tor challenge showed a 20% post change          between deciding whether someone is decondi-
increase, which is statistically significant.   tioned or perhaps the symptoms are more wor-
We normally look for a positive result of       risome. This patient might benefit from keeping
12-15% improvement in the FEV1 post-            an asthma diary of symptoms and complete
medication to help us make the diagnosis        peak flow monitoring for a period of two weeks.
of asthma.
     Page 3
                  Respiration Station

                                    Helping Your Patients Quit Tobacco Use
                                                                                                        Donna Dayer,BS,RRT,AE-C

                                    You are a busy health care professional whether you are a nurse, a pharmacist, an RT, NP or PA. You care
                                    about patients, especially those who have lifestyle behaviors and addictions that negatively affect their
                                    health, like tobacco use. You want to help, and as a member of NCARE you’ve made a commitment to
                                    educate your patients. How can you best help your patients in a limited amount of time? The North Caro-
                                    lina Tobacco Use Quitline is a free, confidential evidence-based cessation program available to all North
                                    Carolinians that can complement your cessation efforts by providing evidence-based tobacco use quitting
                                    assistance for your patients who want to quit. Finding time to fully implement the 5As (Ask, Advise, As-
                                    sess, Assist, and Arrange) of evidence-based cessation assistance is difficult for many of us. Fortunately,
                                    taking 3 to 5 minutes to Ask, Advise, and Refer your patients to the NC Tobacco Use Quitline is a proven
                                    way to provide effective cessation help for your patients.

                                    You can begin by asking every patient about tobacco use. Including this step as a 5th vital sign in the medi-
  “Finding time to fully            cal record has been proven to increase the rate of asking patients about tobacco use status. The next step is
implement the 5As (Ask,             to give strong, personalized advice to quit. Remember to discuss the health benefits of quitting and include
 Advise, Assess, Assist,            the short term benefits (clothing no longer smells like smoke, fresher breath) as well as the long term bene-
     and Arrange) of                fits of reduced negative health effects. Remember to give your patient the opportunity to tell you their
                                    thoughts and feelings about quitting. The third step is to assess the patient’s willingness to quit. The im-
                                    portant aspect of this step is to determine if your patient feels that he/she needs to quit or if he/she wants to
 cessation assistance is            make a serious quit attempt. Those who want to make serious quit attempt are often those for whom
 difficult for many of us.          prompt interventions such as counseling or referral to the NC Quitline can be most helpful. For those who
                                    are not yet ready to make a serious quit attempt, ongoing advice to quit can be useful to help them decide to
                                    attempt cessation.

                                    Once you have asked about tobacco use, advised your patient to quit, and assessed whether they are ready
                                    to make a serious quit attempt, you are ready to assist them in their quit attempt. An easy acronym to re-
                                    mind you of the basic components of assisting in cessation is S.T.A.R.: Set a quit date, Tell family and
                                    friends the plan, Anticipate challenges, and Remove tobacco products. Patients may also need help with
                                    social support, triggers, developing coping skills, and advice and education concerning nicotine replacement
                                    therapy (NRT), bupropion, and varenicline (Chantix). The assist aspect of tobacco use cessation interven-
                                    tions is one of the components that the NC Tobacco Use Quitline can fulfill for your patients.

                                    If you are unable to spend the amount the time required to assist your patient in quitting tobacco use, refer-
                                    ral to existing evidence-based tobacco cessation programs is appropriate. One great option is to refer inter-
                                    ested patients to the NC Tobacco Use Quitline. The quitline is a free, confidential evidence-based service
                                    available to all North Carolinians, youth and adult. It is staffed by quit coaches who are trained to assist
                                    tobacco users through the entire quitting process. Once in contact with the quitline, tobacco users may
                                    choose to enroll in the one-call program in which they receive one cessation coaching session, or they may
Patients need to Anticipate         choose the proactive 4-call program in which the quit coach will call the tobacco user back at mutually
challenges along the way.           agreed upon times to check on quitting progress. (Story continued on next page ….)

     Page 4
                 Volume 2, Issue 4

Helping Your Patients Quit Tobacco Use (cont.)
Patients may either call the quitline at 1-800-QUIT-NOW (1-800-784-8669) or you may send in a fax refer-
ral. Anyone working with a tobacco user may refer them to the quitline via fax. Simply download the fax
referral form from or, fill it out, have your patient sign the form
giving the quitline permission to call them and fax it to the quitline. When the Quitline receives the fax, a
tobacco cessation quit coach can make the first call to assist the patient with all the components of quitting.
Also available for patients are quitline business cards that you may hand out that contain the quitline number
and other information about quitline services.

                                                                                                                     Patients May Call:
To help you get started with this comprehensive counseling program, the NC Tobacco Prevention and Control
                                                                                                                       1-800 QUIT-NOW
Branch can provide pocket cards that contain an outline of the 5As as well as information about the quitline
and other cessation resources.                                                                                          1-800-784-8669
Other important points to keep in mind are:
                                                                                                                    Clinician May 0btain
          ⇒ Many patients want to quit but they may not want to make that first call
                                                                                                                    Fax Referral Form:
          ⇒ The NC Tobacco Use Quitline provides cessation help in English, Spanish,                       or
               and other languages.
          ⇒ Anyone may call the quitline, even non-tobacco users who may have questions
               or desire information for a friend or family member.

          ⇒ Cessation specialists are trained to work with youth and adults.

          ⇒ Patients double their chances of quitting by using NRT coupled with
               cessation coaching.

If you would like more information about using the 5A’s in your practice and about referring patients to the
NC Tobacco Use Quitline, visit the website:, or

Or you may contact NCARE member: Donna Dayer, Tobacco Control Specialist

                                        Tobacco Prevention & Control Branch, NC Division of Public Health

                                        919-707-5415                              Patients double their chances of
The NC Tobacco Use Quitline is funded by the NC Division of Public Health, the NC Health and Wellness             quitting by using NRT coupled
Trust Fund and Blue Cross Blue Shield of NC.                                                                          with cessation coaching.

                                                                            Position Available
                                                                   Certified Asthma Educator
                                                                   Wake-Med Asthma Program
                                                              Contact: Debbie Langdon, Coordinator
                                                                   Wake-Med Asthma Program
                                                                        Tel: 919-350-8859

     Page 5
                   RESPIRATION STATION

                                   PASSENGER                                SIGN-UP NOW!
                                   SPOTLIGHT ….
                                                                                  Renewals Needed STAT!
                                              Pamela Biggs, RN, AE-C
                                                          Nurse Manager
                                                                          Membership requirements:
                                                                           • Successful completion of NRTC Course:
                                    Duke Asthma Allergy & Airway Center
                                                                              i.e. Asthma or COPD
                                                   Board Member, NCARE
                                                                          Membership fee: $25.00 yearly
What is the best aspect of your job?
                                                                          Membership benefits:
Helping patients that come from near and far with complex                  • NCARE Newsletter
airway problems                                                               “The Respiration Station”
                                                                           • Membership discounts with the purchase of
What is your most significant achievement?                                    NRTC educational materials and all NCARE
Opening the Duke Asthma, Allergy and Airway Center
                                                                                   First Name             MI            Last Name
Hardest lesson learned?                                                    ___________________________________
Time passes way too quickly, “Seize the moment!”                              Place of Employment               Professional Affiliation
                                                                                           Address       Work or     Home
     “I only wish my patients would not have to live the                   ___________________________________
         rest of their lives not being able to breathe.”                            City        State    Zip Code
                                                                           (____) ______________ (____) ___________
                                                                                  Phone   Work or Home Fax Number

What kind of car do you drive?
                                                                                                     Email Address
Subaru Forrester                                                                                             $25.00
                                                                                             Membership fees $25.0 0:

                                                                                       New Member
What is your favorite food?

Seafood                                                                               Renewal

What is your ideal leisure activity?                                                       Asthma Date Completed ________
                                                                                           COPD Date Completed ________
                                                                          Mail your membership form and payment to:
What would you like people to know about you?                                          NCARE
I am extremely dedicated to my work.
                                                                                       PO Box 746
                                                                                       Shelby,    28151-0746
                                                                                       Shelby, NC 28151 - 0746

What is your favorite possession?                                          For more information regarding NCARE please call:
An antique velvet fainting couch                                                               NCARE
                                                                                           704.472.002 2
A surprising fact people don’t know about you…                                         www.nrtc-
My hair really is red!

Page 6
         Volume 2, Issue 4

Page 7
                    North Carolina Alliance of Respiratory Educators

                                                           The North Carolina Alliance of Respiratory Educators (NCARE) is a
 For More Information:                                           501(c)3 not-for-profit organization of NRTC graduates.                                   NCARE’s mission is to offer “excellence in asthma and COPD education
 NCARE is not in the practice of dictating medical        to medical professionals as well as to their patients, families, and the
 management. This newsletter should not replace
            sound medical advice.                                                 greater community.”

                         THE CABOOSE
     NEXT ISSUE: (Estimated Time of Arrival—Winter 2007)
     ♦     Spirometry Signals
             - Test your knowledge on spirometry with our Case Study & Tracing
     ♦     Hot Off The Tracks
             - The latest & greatest in respiratory care news
     ♦     Practice Crossroads
             - Innovative ideas from your fellow NCARE Colleagues

                       Note Date Change!
                                   Third Annual
                          North Carolina Respiratory Forum
                                        NCARE/Charlotte AHEC
                                               Charlotte, NC
                                 Thursday and Friday, April 26 & 27, 2007

NCARE Board of Directors:                                                   Members-at-Large:
Rita Heath, RRT-NPS, AE-C                     Jeanne LaFrancis, RN          Pamela B. Biggs, RN, AE-C        Vickie Moore, FNP-C, AE-C
President                                     Treasurer
                                                                            Edana Christy ANP-C, AE-C        Jakki Rawlinson, MA, RRT, AE-C
Pam Ellwood, FNP-C, AE-C                      Cynthia Conner, BSN, RN
                                                                            Kelley Crowder, MBA              Melinda Schuler, RRT, AE-C
Immediate Past President                      Secretary
                                                                            Sheila Driver, MSN, CPNP, AE-C   Mary Webster, BSN, RN, CCM, AE-C
Vice-President                                                              Catherine Hathcock, RRT, AE-C

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