Guidelines for the Diagnosis and Management of Asthma

Develop an active partnership with the patient and
family by:
■ Establishing open communications that consider
cultural and ethnic factors, as well as language and
health care literacy needs, of each patient and family.
■ Identifying and addressing patient and family
concerns about asthma and asthma treatment.
■ Developing treatment goals and selecting
medications together with the patient and family,
allowing full participation in treatment decision
making.
■ Encouraging self-monitoring and self-management
by reviewing at each opportunity the patient’s
reports of asthma symptoms and response to
treatment.
Provide to all patients a written asthma action
plan that includes instructions for both daily
management (long-term control medication, if
appropriate, and environmental control measures)
and actions to manage worsening asthma (what signs,
symptoms, and PEF measurements (if used) indicate
worsening asthma; what medications to take in
response; what signs and symptoms indicate the need
for immediate medical care). Written asthma action
plans are particularly recommended for patients who
have moderate or severe persistent asthma (i.e.,
requiring treatment at step 4, 5, or 6), a history of
severe exacerbations, or poorly controlled asthma.
See figures 5 and 6 for samples of written asthma
action plans.
Integrate asthma self-management education into
all aspects of asthma care. Asthma self management
requires repetition and reinforcement. It should:
■ Begin at the time of diagnosis and continue through
followup care. See figure 7, “Delivery of Asthma
Education by Clinicians During Patient Care Visits,”
for a sample of how to incorporate teaching into
routine clinic visits.
■ Involve all members of the health care team, including
physicians, nurses, pharmacists, respiratory
therapists, and asthma educators, as well as other
health professionals who come in contact with
asthma patients and their families.
■ Occur at all points of care where health care professionals
interact with patients who have asthma.
The strongest evidence supports self-management
education in the clinic setting. Evidence also
supports education provided in patients' homes,
pharmacies, targeted education in EDs and hospitals,
and selected programs in schools and other
community sites. Proven community programs
should be considered because of their potential to
reach large numbers of people who have asthma
and encourage “asthma-friendly” support from
their families and community environments.
■ Use a variety of educational strategies to reach
people who have varying levels of health literacy
or learning styles. Individual instruction, group
programs, written materials (at a 5th grade reading
level or below), video- or audiotapes, and computer
and Internet programs all provide effective
educational opportunities. See figure 8, “Asthma
Education Resources,” for a sample of available
resources.
■ Incorporate individualized case/care management
by trained health care professionals for patients
who have poorly controlled asthma and have
recurrent visits to the emergency department
or hospital. This will provide tailored
self-management education and skills training.
Encourage patients' adherence to the written
asthma action plan by:
■ Choosing treatment that achieves outcomes and
addresses preferences that are important to the
patient, and reminding patients that adherence
will help them achieve the outcomes they want.
■ Reviewing with the patient at each visit the success
of the treatment plan to achieve asthma control
and make adjustments as needed.
■ Reviewing patients' concerns about their asthma
or treatment at every visit. Inquire about any
difficulties encountered in adhering to the written
asthma action plan.
■ Assessing the patient's and family's level of social
support, and encouraging family involvement.
■ Tailoring the self-management approach to the
needs and literacy levels of the patient, and
maintaining sensitivity to cultural beliefs and
ethnocultural practices.
Encourage health care provider and health care
system support of the therapeutic partnership by:
■ Incorporating effective clinician education strategies,
Managing Asthma Long Term
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