Physicians, Physician Assistants, Nurse Practitioners: Patient Asthma Management

A patient’s most important source of information and asthma education needs to come from their medical professional. They trust and depend on their physician for guidance on managing their asthma. They depend on their physician and related staff for proper diagnosis, medications, asthma trigger identification and how to reduce exposure to their specific asthma triggers.

Asthma management is multifaceted. Proper diagnosis and adherence to medications is critical, but not enough. Physicians must recognize each patient’s culture, basic needs, psychosocial factors, and their daily environmental conditions. When each of these is considered, healthcare delivery will initiate the patient’s desire to adhere to asthma management plans.

Experts in the medical community agree that patients with asthma must identify what exacerbates their asthma. A recent study featured in the New England Journal of Medicine, Results of a Home-Based Environmental Intervention among Urban Children with Asthma, Morgan et al. found that environmental alteration for all of the allergens the patient is sensitized to and patient education can significantly reduce asthma exacerbations. Other groups such as the National Heart, Lung, and Blood Institute’s National Asthma Education and Prevention Program (NAEPP) Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma (1991 and 1997 update) and the National Research Council’s Committee on the Assessment of Asthma and Indoor Air Clearing the Air: Asthma and Indoor Air Exposures agree that environmental alterations are central to improving asthma outcomes.

• Determine if the patient has become sensitized to any allergens. There are advantages to both an allergy skin test and in-vitro tests. Question the patient on the four most common indoor allergen exposures; dust mites, cockroaches, pets, and molds. Together these profiles will help determine allergen avoidance measures. Environmental alterations must occur for each of the patient’s allergens. IDEM has developed a list of Questions to Identify Patient Environmental Asthma Triggers and fact sheets about the trigger and how to reduce exposure for each Environmental Asthma Triggers identified.
  

• Determine if the patient is exposed to any irritants. Active/passive smoking is the most important irritant trigger. Obviously, there is no test that can show what the patient’s irritant triggers are. Instead, a process of elimination in necessary. Do asthma symptoms occur when the patient is dusting, cleaning with chemicals that have strong odors, cooking (particularly frying), smells/uses strong perfumes/colognes, etc. Provide educational materials for each the patients Environmental Asthma Triggers.
  

• Determine if the patient has exercise-induced asthma. Roughly 80 percent of asthma patients have this type of asthma, often coupled with extrinsic or intrinsic asthma. Do asthma symptoms occur during/shortly after exercise, with a viral infection or when breathing cold/dry air, or when air pollutant or pollen levels are high?
  

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

• 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 know how to read the plan. Sign and date the plan. Update annually. There are many different forms of asthma action plans. Although studies have shown that these plans do not prevent exacerbations, it is essential in the event of a serious “attack” the patient (and others around them, such as the school nurse or teachers) knows how to handle it and when to call for help.
  

• 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.