6/4/20

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Allergy'&'Asthma'Network'Announcements

COVID&19:*The*New*Normal*for*Asthma,*Schools*&*Business*

Dr.*Purvi ParikhDr.*Jackie*Eghrari&Sabet

Tonya*Winders

6/4/20

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Our$Speakers

Dr.$Purvi ParikhClinical$Assistant$Professor$of$Medicine,$George$Washington$School$of$Medicine$&$Health$Sciences

Medical$Director,$Telehealth,$Allergy$&$Asthma$Network$

Dr.$Jackie$Eghrari1SabetClinical$Assistant$Professor$of$Medicine$NYU$Langone$School$of$Medicine &$Director,$Allergy$and$Asthma$Association,$Murray$Hill

National$Spokesperson,$$$$$$$$$$Allergy$&$Asthma$Network$

Tonya$WindersPresident$&$CEO,$Allergy$&$Asthma$NetworkPresident,$Global$Allergy$&$Airways$Patient$Platform

Outline

• Current*State*of*COVID219• Testing*&*Asthma*Concerns*in*the*“New*Normal”• The*“ABCs”*of*School*Reopening• Business*&*Economic*Impact*

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Current'State'of'COVID019

Tonya&Winders

6/4/20

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US#Data#Report#

Total&Confirmed&

Cases1,827,425

Total#New#Cases 24,955

Total#Deaths 106,202

Total#New#Deaths 1045

Data$as$of$6/4/20

In#the#News

• COVID.19#fell#from#the#headlines#this#week• Cases#are increasing#rapidly#in#parts#of#Latin#America.

• Dr.#Fauci:##• A#vaccine#by#the#end#of#the#year#is#“aspirational”#but#“doable”

• We#should#have#a#100#million#doses#by#years#end

• We#will#have#limited#data#on#the#new#vaccines#when#they#are#deployed

• May#have#to#balance#saving#lives#with#the#possibility#of#adverse#events

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COVID&19)Cases)in)US)by)Date)Reported

0

5000

10000

15000

20000

25000

30000

35000

40000

February28

March)6 March)13March)20March)27 Ap ril)3 Ap ril)10 Ap ril)17 Ap ril)24 May)1 May)8 May)15 May)22 May)29 June)2

New)Cases)by)Day

Cases

COVID&19)Information)Center)–Allergy)&)Asthma)Network)

• https://allergyasthmanetwork.org/health&a&z/covid&19/

• Webinar)recordings• Patient)program)with)ATS)recording

• Infographics• Fact)Sheets)and)Q)&)A’s• Managing)Pediatric)Asthma)during)COVID&19)

• What)coronavirus)looks)like• State)by)State)guidance)on)reopening

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Testing(&(Asthma(Concerns(in(the(“New(Normal”

Dr.$Purvi Parikh

Three%Main%Types%of%Tests%for%COVID519

• Detects%nucleic%acids• Lets%you%know%if%you%HAVE%the%virus

PCR%5 Polymerase%Chain%Reaction

• Looks%for%proteins• Lets%you%know%if%you%HAVE%the%virusAntigens

• Detects%Antibodies• Lets%you%know%if%you%HAD%the%virusAntibodies

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PCR$Testing

Diagnostics• Diagnoses$people$who$are$currently$sick

• Mucus$sample• Detects$nucleic$acids$– present$in$virus

Accuracy• Most$reliable$test• Detects$it$a$week$before$symptoms$start$until$a$few$weeks$after$symptoms$end$(range$of$approximately$4$weeks)

• Can$have$up$to$30%$false$negative

Timing• Sent$to$centralized$lab• Results$in$several$days• Testing$backlog$– can$cause$delays

• Rapid$PCR$Tests$–results$in$13$mins.

Antibody)Test

Diagnostics• Identify)people)who)have)been)previously)infected,)not)currently)infected

• Blood)sample• Tracks)the)virus)through)the)population

Accuracy• Are)not)as)reliable• Detects)it)1)– 3)weeks)after)infection

• Does)not)indicate)whether)you)are)protected)from)getting)virus)again

Timing• Results)in)a)few)minutes

• Elisa)test)more)accurate,)not)as)widely)available

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Antigen'Test

Diagnostics

• Identify'people'who'are'currently'infected

• Nose'&'throat'secretions

• Looks'for'proteins'in'the'virus

Accuracy

• New'type'of'test• Not'expected'to'be'as'accurate'as'PCR'test

Timing

• Results'in'a'few'minutes

• Could'be'valuable'screening'tool

New$York$City$Update

• Cases$continue$to$decline

• Projected$Phase$One$opening$is$June$8th

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Pediatric)Multisystem)Inflammatory)Syndrome

• Multisystem)Inflammatory)Syndrome)in)Children)(MIS8C))is)a)condition)where)different)body)parts)can)become)inflamed,)including)the)heart,)lungs,)kidneys,)brain,)skin,)eyes,)or)gastrointestinal)organs

• Don’t)know)the)cause• Many)children)with)MIS8C)had)the)virus)that)causes COVID819,)or)had)been)around)someone)with)COVID819

• Fever• Abdominal)pain• Vomiting• Diarrhea• Neck)pain• Rash• Bloodshot)eyes• Feeling)extra)tired• Not)all)children)have)all)the)same)symptoms

• Trouble)breathing• Pain)or)pressure)in)chest)that)doesn’t)go)away

• New)confusion• Inability)to)wake)or)stay)awake• Bluish)lips)or)face• Severe)abdominal)pain

What)is)it? Seek)Emergency)Care)For:Symptoms

Looking'Ahead'– So'Much'We'Still'Aren’t'Sure'About'8

Will'testing'bring'us'back'to'“normal”?• If'you'have'the'antibodies,'you'have'been'exposed'to'the'virus• You'can'conclude'that'you'are'immune'– but'immunity'can'wane• Critical'question:''After'6'months'to'a'year,'does'immunity'wane?• Need'answers'that'will'come'over'time• Testing'is'likely'here'to'stay'for'a'while

Will'antibody'tests'affect'who'will'get'the'vaccine'first?

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Asthma'Guidance'from'CDC'during'COVID819

General'Information

People'with'moderate'to'severe'asthma'may'be'at'higher'risk'of'getting'very'sick'from'COVID819

COVID819'can'affect'your'respiratory'tract'(nose,'throat,'lungs),'cause'an'asthma'attack,'and'possibly'lead'to'pneumonia'and'acute'respiratory'disease

There'is'currently'no'specific'treatment'for'or'vaccine'to'prevent'COVID819. The'best'way'to'prevent'illness'is'to'avoid'being'exposed'to'this'virus.

Inhalers,*Triggers*and*Stress

• Know*how*to*use*your*inhaler• Avoid*your*asthma*triggers• People*are*feeling*concerned*and*stressed*–strong*emotions*can*trigger*an*asthma*attack*–take*steps*to*cope*with*stress*&*anxiety

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Current'State'of'Asthma

• Asthma'is'getting'more'attention,'patients'are'increasingly'aware'of'the'importance'of'adherence'to'health'plan• Adherence'to'controller'medications'appears'to'have'increased'among'patients'with'asthma'&'COPD• Telehealth'visits'are'becoming'more'common'– patients'that'are'symptomatic'are'not'exposed'to'triggers'just'to'see'their'doctor• Racial'disparities'exist'and'have'been'brought'to'light'during'this'viral'outbreak

The$Future$of$Asthma$Care$(A$Bit$of$a$Wish$List)

• Improved$adherence• Patients$more$willing$to$use$controller$meds$to$stay$healthy

• Digital$Tools$provide$insight$into$patient$wellBbeing$between$office$visits

• Reliable$online$tools$more$commonly$sought$out$&$used

• General$health$hygiene$improves$– handwashing,$social$distancing$become$ingrained$habits$– keeping$people$with$asthma$in$better$general$health

• Racial$issues$in$healthcare$are$more$visible,$interventions$put$in$place$to$reduce$disparate$care

• Telehealth$– for$visits$&$asthma$education$– deliver$needed$care$without$disruption$to$schedule

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The$“ABCs”$of$School$Reopening

Dr.$Jackie$Eghrari.Sabet

Risk%Levels%for%Schools%0 CDC

Lowest'Risk:'''''''''''''Virtual0only%classes,%activities%&%event%

More'Risk:'''''''''''''''''''Small,%in0person%classes,%

activities%&%events

Highest'Risk:Full%sized,%in0person%

classes,%activities%&%events

Students%stay%6%feet%apart,%don’t%share%objects.%%Have%same%teacher,%groups%don’t%mix.%%Hybrid%virtual%&%in0person%classes,%rotate%

schedule

Students%are%not%spaced%apart,%share%classroom%materials/%supplies,%mix%

between%classes%&%activities

A B C

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Promoting)Behaviors)that)Reduce)Spread)6 CDC

STAY%HOME%WHEN%APPROPRIATE

Hand)Hygiene

Respiratory)Etiquette)– Cover)coughs,)sneezesWash)hands,)hand)sanitizer

Cloth)Face)Coverings

Students)&)staffDon’t)touch)face,)proper)use,)removal

Adequate)Supplies

Have)enough)soap,)hand)sanitizerTissues,)paper)towels

Signs)&)Messages

Promote)protective)measures,)announcements,)signsDescribe)how)to)stop)the)spread

School&Nurse&Leadership&Issues

Be&part&of&the&planning• You&are&the&expert&on&the&FRONT&LINE!• The&Network&is&here&to&help

Overseeing&disinfecting• Are&disinfectants&appropriate&around&children?&Asthma&triggers?

Ventilation• Asthma&triggers&with&open&windows?

Group&settings• Markings&in&hallways&to&promote&distancing?&&Stagger&use?

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School&Nurse&Leadership&Issues

Food&Service•Bring&own&meals&when&feasible,&Pre=packaged&food&whenever&possible•CDC&guidance&is&to&eat&in&classrooms•Make&accommodations&for&students&with&food&allergies• Provide&those&that&supervise&lunch&with&food&allergy&symptoms&so&they&can&respond&quickly&if&needed• Reinforce&to&staff&to&build&bridges&in&talking&to&parents&– provide&safety&measures&for&students• Clean&placemat&for&eating&– cleaned&first&or&with&separate&cloth&to&avoid&cross=contact•Be&sure&epinephrine&auto=injector&is&easily&accessible&near&where&child&is&eating

Health'Office'Considerations

• Have'plenty'of'PPE'for'yourself,'staff'and'students'that'need'it• Use'vinyl'or'nitrile'gloves'– do#not#substitute'latex'gloves'

• Limit'number'of'students'in'Health'Office'at'one'time'• Get'administrative'support'&'assistance'as'needed'to'supervise'students'who'are'waiting'to'enter

• Stagger'medication'administration'times'to'reduce'number'of'children'in'Health'Office'at'a'time• Have'isolation'space'available'for'students'with'viral'symptoms'– be'sure'to'have'enough'supervisory'assistance• Develop'protocol'on'when'to'isolate'&'dismiss'students

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Assessing'students'with'viral'symptoms'–is'it'a'COVID;19'or'

asthma?

Algorithm*Notes

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Asthma'Treatment'Notes

• Asthma'care'is'not'what'it'was'10'years'ago!

• Nebulizers• Peak'Flow'Meters• Pulse'Oximeters

= Asthma = COPD = Generic Available

MEDICATIONSAvailable in sterile, unit dose vials – no measuring or mixing necessary.

Short-acting beta2-agonists (SABA)Relaxes tight muscles in airways and offers quick relief of asthma symptoms such as coughing, wheezing and shortness of breath for 3-6 hours

• AccuNeb® (albuterol sulfate) Inhalation Solution

• Xopenex® (levalbuterol hydrochloride) Inhalation Solution

Long-acting beta2-agonists (LABA)Relaxes tight muscles in airways and offers lasting relief of symptoms such as coughing, wheezing and shortness of breath for at least 12 hours

• Brovana® (arfomoterol tartrate) Inhalation Solution

• Perforomist® (formoterol fumarate) Inhalation Solution

CorticosteroidsReduces and prevents inflammation of airway tissue; does not relieve sudden symptoms of coughing, wheezing or shortness of breath

• Pulmicort Respules® (budesonide inhalation suspension)

Short-acting muscarinic antagonists (anticholinergics)Relieves cough, sputum production, wheeze and chest tightness associated with COPD for 4-6 hours

• Ipratropium Bromide Inhalation Solution Sold only as a generic

Long-acting muscarinic antagonists (anticholinergics)Relieves cough, sputum production, wheeze and chest tightness associated with COPD for at least 24 hours

• Lonhala® Magnair® (glycopyrrolate) Inhalation Solution Lonhala is the medicine; Magnair is the nebulizer system

• Yupelri® (revefenacin) Inhalation Solution

Combination medicationsContains both short-acting beta2-agonist (SABA) and short-acting muscarinic antagonist

• DuoNeb® (ipratropium bromide and albuterol sulfate) Inhalation Solution

Mast cell stabilizerPrevents coughing, wheezing and shortness of breath caused by exercise, cold and dry air, or inhaled substances such as pet dander, pollen, dust mites or chemicals

• Cromolyn Sodium Inhalation Solution Sold only as a generic

Respiratory ToolsAllergy & Asthma Network is a national nonprofit organization dedicated to ending needless death and suffering due to asthma, allergies and related conditions through outreach, education, advocacy and research.

AllergyAsthmaNetwork.org • 800.878.4403

VALVED HOLDING CHAMBERS AND SPACERSA device attached to metered-dose inhalers that extend the mouthpiece of the inhaler, trap and suspend particles of medication long enough to be inhaled, and help direct the medication into the lungs where it provides maximum benefit. Available with masks.

IN-CHECK DIAL INSPIRATORY FLOW METERA handheld device to assess inspiratory flow and help determine whether a patient is using correct inhaler technique by comparing the result and optimum result.

PEAK FLOW METERA handheld device to measure a patient’s Peak Expiratory Flow Rate (PEFR), the maximum speed you can force air out of your lung’s large airways; PEFR may indicate how well lungs are working and signal early signs of an asthma flare.

SPIROMETERA device (used primarily in a doctor office) to measure the volume and speed that air is pushed in and out of the lungs; the results assist in diagnosis and measure progress in treatment.

All ofthe time

2

More thanonce a day

2

4 or morenights a week

2

3 or moretimes per day

2

Not controlled at all

1

1

1

1

1

Most ofthe time

Once a day

2 or 3 nightsa week

1 or 2 timesper day

Poorlycontrolled

2

Some ofthe time

3 to 6 timesa week

Once a week

2 or 3 timesper week

Somewhatcontrolled

3

3

3

3

3

A little ofthe time

Once or twicea week

Once or twice

Once a weekor less

Wellcontrolled

4

4

4

4

4

None of the time

Not at all

Not at all

Not at all

Completelycontrolled

TOTAL

SCORE

5

5

5

5

5

2. During the past 4 weeks, how often have you had shortness of breath?

3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness

or pain) wake you up at night or earlier than usual in the morning?

4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)?

5. How would you rate your asthma control during the past 4 weeks?

1. In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home?

If your score is 19 or less, your asthma may not be under control. Be sure to talk with your

doctor about your results. The answers below should not be added to your total score.

These answers should be discussed with your doctor.

In the past 12 months, how many emergency department visits have you had due to asthma

(that did not result in a hospitalization)? ________

In the past 12 months, how many inpatient hospitalizations have you had due to asthma? ________

Asthma Control Test™ Is:

A quick test that provides a numerical score to assess asthma control.

Recognized by the National Institutes of Health (NIH) in its 2007 asthma guidelines.1

Clinically validated against spirometry and specialist assessment.2

References: 1. US Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. Expert Panel Report 3: Guidelines for the Diagnosis and

Management of Asthma (EPR-3 2007). NIH Item 08-4051. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm. Accessed September 10, 2007. 2. Nathan RA et al. J Allergy Clin Immunol.

2004;113:59-65.

For Patients 12 Years and Older: 1. Answer each question and write the answer number in the box to the right

of each question.

2. Add your answers and write your total score in the TOTAL box shown below.

3. Discuss your results with your doctor.

Copyright 2002, by QualityMetric Incorporated.

Asthma Control Test is a trademark of QualityMetric Incorporated.

The Asthma Control Test is for people with asthma 12 years and older.

HM2630R0 May 2010

InspiraChamber®

Vortex®AeroVent Plus® MicroChamber®

Asthma Action Plan for Home & School

Name:

Birthdate:

Asthma Severity: Intermittent Mild Persistent Moderate Persistent Severe Persistent

He/she has had many or severe asthma attacks/exacerbations

School Staff: Follow the Yellow and Red Zone plans for rescue medicines according to asthma symptoms.

Unless otherwise noted, the only controllers to be administered in school are those listed as “given in school” in the green zone.

Both the asthma provider and the parent feel that the child may carry and self-administer their inhalers

School nurse agrees with student self-administering the inhalers

Asthma Provider Printed Name and Contact Information:Asthma Provider Signature:

Date:

Parent/Guardian: I give written authorization for the medications listed in the action plan to be administered in school by the nurse or other school

members as appropriate. I consent to communication between the prescribing health care provider/clinic, the school nurse, the school medical advisor

and school-based health clinic providers necessary for asthma management and administration of this medication.

Parent/guardian signature:

Date:

School Nurse Reviewed:

Date:

AAAAI-0416-085 Alpha

Asthma Triggers: (List)

Please send a signed copy back to the provider listed above.

JGreen Zone Have the child take these medicines every day, even when the child feels well.

Always use a spacer with inhalers as directed.

Controller Medicine(s):

Controller Medicine(s) Given in School:

Rescue Medicine: Albuterol/Levalbuterol puffs every four hours as needed

Exercise Medicine: Albuterol/Levalbuterol puffs 15 minutes before activity as needed

Yellow Zone Begin the sick treatment plan if the child has a cough, wheeze, shortness of breath, or tight chest. Have the

child take all of these medicines when sick.

Rescue Medicine: Albuterol/Levalbuterol puffs every 4 hours as needed

Controller Medicine(s):

Continue Green Zone medicines:

Add:

Change:

If the child is in the yellow zone more than 24 hours or is getting worse, follow red zone and call the doctor right away!

Red Zone If breathing is hard and fast, ribs sticking out, trouble walking, talking, or sleeping.

Get Help Now

Take rescue medicine(s) now

Rescue Medicine: Albuterol/Levalbuterol puffs every

Take:

If the child is not better right away, call 911

Please call the doctor any time the child is in the red zone.

NEBULIZERSNebulizers turn liquid asthma and COPD medicine into a fine aerosol that can be inhaled deep into the airways. They are powered by a compressed air machine and can be battery operated or plugged into an electrical outlet.

Many types of nebulizers are available – some are small enough for travel and most are quiet enough for silent nights. Available with masks.

Aerochamber Plus® Flow-Vu® and Aerochamber Plus® Z STAT®

ASTHMA CONTROL TEST ™

A quick test that provides a numerical score to assess a patient’s asthma control; discuss results with a doctor. An Asthma Control Test for children is also available.

ASTHMA ACTION PLANSA personalized document put together by doctor and patient spelling out how to manage symptoms daily and what to do when they worsen. Action plans are also available for COPD.

©2020 Allergy & Asthma Network

Business'&'Economic'Impact'

Tonya&Winders

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Current'Economics'Compared'to'1929

1929'– “Great'Depression”

• Took'several'quarters'for'unemployment'to'reach'25%

• Warning'signs'– no'specific'event

• Stock'market'fell'43.7%

• Stock'market'moves'in'waves'–

crash'followed'by'correction

• Most'systems'on'gold'standard

• High'debt'levels

2020

• Took'several'weeks'for'unemployment'to'reach'25%

• Warning'signs'– pandemic'event

• Stock'market'– 36%'decline'

followed'by'36%'correction'–

series'of'declines'&'corrections

• Not'on'gold'standard• High'debt'levels,'less'limitations

How$will$the$Stock$Markets$Recover?

• Complex$Systems$– embedded$within$social$system

• Events$never$affect$the$stock$market$in$isolation• Probably$won’t$be$over$in$several$months• Almost$40$million$people$unemployed

• Lower$disposable$income• Lower$revenue$and$profit$for$companies• Bankruptcies?$$Bank$runs?

• The$stock$market$is$forward$looking,$economy$reflects$the$here$&$now

• Stock$market$will$recover$before$family$life$will$feel$a$positive$impact

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Return'is'not'a'phase;'it’s'a'way'of'operating.'A'nerve'center'can'help'build'the'capabilities'that'businesses'need'in'the'“next'normal.”

New'Ways'to'Think• Businesses'around'the'world'have'faced'disruptions'at'a'speed'and'scale'unprecedented'in'the'modern'era

• Companies'everywhere'are'now'wrestling'with'the'question'of'how'to'reach'the'next'normal'safely

• The'best'possible'plan'today'is'merely'a'strawman'that'will'need'nearFcontinuous'recalibration'and'change.

Unknowns1. Hard'to'write'plans'

• Doubts'about'resurgences,'vaccines'&'immunity

2. Future'of'remote'work• Does'it'really'work'over'time?

3. Customer'behavior• Will'customers'still'embrace'online'shopping'or'return'to'their'old'ways?

From:''Return:(A(new(muscle,(not(just(a(plan.(((By Mihir'Mysore, Bob'Sternfels,'and'Matt'Wilson

The$“Next$Normal”

• Pandemic$has$shifted$demand$online

• Shopping,$Banking

• Consumption$has$fallen,$Economic$uncertainty

Shift$in$Demand

• Tens$of$millions$of$jobs$lost

• 1/3$of$workforce$–pay$cuts,$$furloughs,$layoffs

• Low$income$workers$hold$80%$of$those$jobs

Rapid$Changes$in$Workforce

• US$banned$gatherings,$Variation$in$states

• Consistency$is$difficult$when$businesses$span$multiple$

geographies

Shifts$in$Regulation

• Asymptomatic$workers

• Focus$on$seasonality,$resurgence$

• How$can$the$workplace$be$deemed$safe?

Increasing$information$about$

protocols$for$safety

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Guidance)for)Businesses)– CDC)&)White)House

• Continue)to)encourage)telework• Conduct)daily)health)checks• Conduct)a)hazard)assessment)of)the)workplace)– close)common)areas• Encourage)employees)to)wear)cloth)face)coverings)in)the)workplace,)if)appropriate• Implement)policies)and)practices)for)social)distancing)in)the)workplace• Strongly)consider)special)accommodations)for)vulnerable)populations

• Improve)the)building)ventilation)system

Questions?

Please&record&your&questions&in&the&Question&box&on&your&webinar&control&panel

We&will&address&as&many&questions&as&we&can

6/4/20

20

COVID&19)&)Asthma:)The)Time)for)Equity)in)Healthcare)is)NOW

Join)us)on)June)24th at)3:00)PM)Eastern)for)the)7thwebinar)in)our)COVID&19)Webinar)Series)&

COVID&19:*The*New*Normal*for*Asthma,*Schools*&*Business*

Thank&you&for&listening!Get&guidelines5based&information&at&

allergyasthmanetwork.org