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©2013 UpToDate ® Print Email Delivery of asthma education by clinicians during patient care visits Assessment questions Information Skills Recommendations for initial visit Focus on: Teach in simple language: Teach or review and demonstrate: • Expectations of visit • What is asthma? Asthma is a chronic lung disease. The airways are very sensitive. They become inflamed and narrow; breathing becomes difficult. • Inhaler and spacer or valved holding chamber (VHC) use. Check performance. • Asthma control • The definition of asthma control: few daytime symptoms, no nighttime awakenings due to asthma, able to engage in normal activities, normal lung function. • Self-monitoring skills that are tied to a written action plan: • Patients' goals of treatment • Asthma treatments: two types of medicines are needed: - Recognize intensity and frequency of asthma symptoms. • Medications - Long-term control: medications that prevent symptoms, often by reducing inflammation. - Review the signs of deterioration and the need to reevaluate therapy: • Quality of life - Quick relief: short-acting bronchodilator relaxes muscles around airways. Waking at night or early morning with asthma "What worries you most about your asthma?" • Bring all medications to every appointment. Increased medication use "What do you want to accomplish at this visit?" • When to seek medical advice. Provide appropriate telephone number. Decreased activity tolerance "What do you want to be able to do that you can't do now because of your asthma?" • Use of a written asthma action plan that includes instructions for daily management and for recognizing and handling worsening asthma. "What do you expect from treatment?" "What medicines have you tried?" "What other questions do you have for me today?" "Are there things in your environment that make your asthma worse?" Recommendations for first followup visit (2 to 4 weeks or sooner as needed) Focus on: Teach in simple language: Teach or review and demonstrate: • Expectations of visit • Use of two types of medications. • Use of written asthma action plan. Review and adjust as needed. • Asthma control • Remind patient to bring all medications and the peak flow meter, if using, to every appointment for review. • Peak flow monitoring if indicated. • Patients' goals of treatment • Self-assessment of asthma control using symptoms and/or peak flow as a guide. • Correct inhaler and spacer or VHC technique. • Medications • Patient treatment preferences • Quality of life

• Remind patient to bring all medications and the peak flow meter, if using, to every appointment for review. • Peak flow monitoring if indicated. • Patients' goals of treatment • Self-assessment of asthma control using symptoms and/or peak flow as a guide. • Correct inhaler and spacer or VHC technique. • Medications • Patient treatment preferences • Quality of life Ask relevant questions from previous visit and also ask: "What medications are you taking?" "How and when are you taking them?" "What problems have you had using your medications?" "Please show me how you use your inhaled medications." Recommendations for second followup visit Focus on: Teach in simple language: Teach or review and demonstrate: • Expectations of visit • Self-assessment of asthma control, using symptoms and/or peak flow as a guide. • Inhaler/spacer or VHC technique. • Asthma control • Relevant environmental control/avoidance strategies: • Peak flow monitoring technique. • Patients' goals of treatment - How to identify home, work, or school exposures that can cause or worsen asthma • Use of written asthma action plan. Review and adjust as needed. • Medications - How to control house-dust mites, animal exposures if applicable • Confirm that patient knows what to do if asthma gets worse. • Quality of life - How to avoid cigarette smoke (active and passive) Ask relevant questions from previous visits and also ask: • Review all medications. "Have you noticed anything in your home, work, or school that makes your asthma worse?" "Describe for me how you know when to call your doctor or go to the hospital for asthma care." "What questions do you have about the asthma action plan?" "Can we make it easier?" "Are your medications causing you any problems?" "Have you noticed anything in your environment that makes your asthma worse?" "Have you missed any of your medications?" Recommendations for all subsequent visits Focus on: Teach in simple language: Teach or review and demonstrate: • Expectations of visit • Review and reinforce all: • Inhaler/spacer or VHC technique. • Asthma control - Educational messages • Peak flow monitoring technique, if appropriate. • Patients' goals of treatment - Environmental control strategies at home, work, or school • Use of written asthma action plan. Review and adjust as needed. • Medications - Medications • Confirm that patient knows what to do if asthma gets worse. • Quality of life - Self-assessment of asthma control, using symptoms and/or peak flow as a guide

• Patients' goals of treatment - Environmental control strategies at home, work, or school • Use of written asthma action plan. Review and adjust as needed. • Medications - Medications • Confirm that patient knows what to do if asthma gets worse. • Quality of life - Self-assessment of asthma control, using symptoms and/or peak flow as a guide Ask relevant questions from previous visits and also ask: "How have you tried to control things that make your asthma worse?" "Please show me how you use your inhaled medication." Reproduced from: National Heart, Blood, and Lung Institute Expert Panel Report 3 (EPR 3): Guidelines for the Diagnosis and Management of Asthma. NIH Publication no. 08-4051, 2007.