Priority Topic: Asthma

Key Feature 5: For the ongoing (chronic) treatment of an asthmatic, propose a stepwise management plan including:

1. Self-monitoring
2. Self-adjustment of medication
3. When to consult back

Patient education is the backbone of providing care to patients with asthma (or their caregivers). So what is it exactly that needs to be learned/understood? UpToDate has an article on this very topic, entitled, "What do patients need to know about their asthma?" In it, they outline the 3 main messages in asthma education for improved control, which are:

1. The pathophysiology of asthma
2. The function of medications and how to use them appropriately
3. How to prevent and treat symptoms

The pathophysiology of asthma
The 3 things UpToDate suggests patient ought to know about regarding the disease process are:

1. Asthma is a result of airway inflammation
2. This inflammation is due to a hypersensitivity to a number of triggers
3. The inflammation leads to temporary airflow obstruction (smooth muscle constriction and mucus production)

The function of medications and how to use them appropriately
There are two different types of inhalers used to manage asthma (sometimes other medications are used as well, depending on individual patient factors):

1. Long-acting controller medications (prevent symptoms, often by reducing inflammation)
2. Short-acting rescue medications (relax smooth muscle around airways)

*It is important to understand how to use the various forms of inhalers to be able to teach patients how to administer them properly as well. Note that many pharmacists can provide excellent education on how to use asthma inhalers correctly, and in the past I have referred patients to receive this teaching by the pharmacist with excellent results.

How to prevent and treat symptoms
It is important to review with the patient what their individual triggers are, and to create strategies to avoid them when feasible. If a patient is expecting to encounter a trigger, they can take their short-acting medication prophylactically 15 minutes before the exposure, such as before exercise, which is a common precipitant. Some patients may benefit from referral to an allergy specialist for allergen immunotherapy. 

It is also important that patients pay attention to signs and symptoms suggesting an asthma exacerbation so they can begin to treat this as early as possible, as I discussed in part in my last blog post. Asthma Action Plans provide guidance for this, and are part of the framework of care for every patient with asthma. See below for an example of this, as well as for a framework by UpToDate for patient education recommendations at initial and followup visits for patients with asthma.