Nurses & Licensed Practical Nurses: Patient Asthma Management

Physicians must rely on their support staff for many reasons, from educating patients about their disease to demonstrating how to use a peak flow-meter. Asthma management is multifaceted. While proper diagnosis and adherence to prescribed medications is important, it is not enough to prevent exacerbations. Nurses and licensed practical nurses have the opportunity explain the importance of identifying and reducing the patient’s exposure to their asthma triggers . Patient education is an essential part of asthma management.

• Develop an asthma action plan for each patient with asthma. Every plan should contain emergency contact numbers, peak flow readings, rescue medications, warning signs of an episode, action steps to take during an episode, and environmental triggers. IDEM has created an Asthma Action Plan that includes all of these elements. Be sure patients and their caregivers know how to read the plan. The patient’s physician should sign and date the plan. Update annually. There are many different forms of asthma action plans.
  

• Identify the patient’s asthma triggers. Studies have shown that for a long-term asthma management plan to be successful, it is vital to control all factors that have been shown to increase asthma symptoms and/or cause exacerbations. What type of asthma does the patient have: allergic, non-allergic, exercised-induced, or occupational? Do symptoms only occur at night? Talk with the patient about when and where they experience asthma symptoms. What was the patient doing when symptoms began? It is important to determine a patient’s sensitivity to indoor allergens. Question the patient on the four most common indoor allergen exposures; dust mites, cockroaches, pets, and molds. IDEM has developed a list of Questions to Identify Patient Environmental Asthma Triggers that can be used. Be sure each patient with asthma has received an allergy skin test to identify sensitivities to allergens. After exposure to an asthma trigger, the patient may not experience any symptoms for hours, even days. Recommend the patient keep a daily journal.
  

• Provide patients with asthma trigger information. Once the patient’s asthma triggers have been identified, provide information about each of their known triggers. IDEM has created an evidence-based list Environmental Asthma Triggers. For a quick-reference, provide IDEM’s Top 10 Ways to Reduce Asthma Triggers at Home. Environmental alterations must occur for each of the patient’s triggers.
  

• Recommend that patients with asthma receive an influenza vaccine. Respiratory illnesses (e.g., respiratory syncytial virus, influenza virus, and rhinovirus) put added burden on the lungs of asthma patients.
  

• Demonstrate new medical devices and new medications. Explain the difference in long-term controller medications and quick-relief medications. Be sure the patient understands the importance of continuing to take the long-term controller medication, even when they have gone long periods without asthma symptoms. Show the patient how to measure their lung function with a peak-flow meter. Be sure the patient is familiar with using a spacer for inhaled medications if necessary.
  

• Provide smoking cessation education for patients when necessary. Active/passive smoking is the most important irritant trigger. Encourage patients not to smoke. Visit the Indiana Tobacco Prevention and Cessation for information.
  

• Refer patients to the asthma coordinator or educator to provide patients with asthma education and tools to better manage their disease. Medical professionals in Indiana have developed a website for Medicaid patients, one section deals with asthma. The Indiana Chronic Disease Management Program has printable medical information for medical providers and asthma patients. Breatheasyville contains a list of evidence-based asthma triggers and printable educational fact sheets about each asthma trigger and how to reduce exposure to that trigger.