Respiratory Therapists: Patient Asthma Management

Many people with asthma receive care from a respiratory therapist. Respiratory therapists assist physicians in determining the proper diagnosis and treatment for patients. Respiratory therapists can demonstrate the correct use of medical devices such as peak-flow meters, help patients identify and reduce exposure their asthma triggers, and give asthma education and guidance. Respiratory therapists need to periodically monitor asthma patients to prevent asthma exacerbations.

• 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 and update annually. 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.
  

• 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.
  

• 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 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 of asthma triggers and fact sheets for each of them. 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.
  

• 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.