Delivery of Asthma Education During Patient Visits

Recommendations for Initial Visit

Focus on: Concerns Quality of Life Expectations Goals of Treatment What is Realistic Role of patient in Self-Management	Teach or review in simple language	Teach or review and demonstrate
Assessment questions	Information	Skills
"What worries you most about your asthma?" "What do you want to get done at this visit?" "What activities does your asthma keep you from doing?" "What do you expect from treatment?" "What medicines have you tried?" "Do you take your quick-relief inhaler more than two times a week?" "Do you awaken at night with asthma symptoms more than two times a month?" "Do you refill your quick-relief inhaler more than two times a year?" "What other questions do you have for me today?" Complete Asthma Control Test (ACT) at each visit. www.asthmacontrol.com The Rules of Two is a registered trademark of the Baylor Health Care System.	What is asthma? A chronic lung disease. The airways are very sensitive. They become inflamed and narrow, making breathing difficult. Asthma treatments: two types of medicines may be needed: Long-term control: medicines that prevent symptoms, often by reducing inflammation Quick relief: Fast-acting medicine to stop attacks, making breathing easier Bring all medicines and devices to every appointment When to seek medical advice. Provide appropriate telephone number. The Asthma Control Test (ACT) is a validated objective measurement of the level of asthma control: A score of 20 and above is consistent with well-controlled asthma. A score of 16-19 is consistent with not well controlled asthma. A score of 15 and below is consistent with very poorly controlled asthma	Inhaler and spacer use. Check performance every visit (ask patient to bring medication and devices to every visit) Self-monitoring skills that are part of an Asthma Action Plan: Recognize intensity and requency of asthma symptoms Review the signs of deterioration and the need to reevaluate therapy: -Waking at night with asthma - Increased medicine use - Decreased activity tolerance Use of a simple, written Asthma Action Plan.

Recommendations for First Follow-Up Visit (2-4 Weeks or Sooner as Needed)

Focus on: Concerns Quality of Life Expectations Goals of Treatment What is Realistic Role of patient in Self-Management	Teach or review in simple language	Teach or review and demonstrate
Assessment questions	Information	Skills
Ask relevant questions from previous visits and also ask: "What medicines are you taking?" "How and when are you taking them?" "Show me how you use your inhaler(s) and devices." "What problems have you had using your medicines?" "Please show me how you use your inhaler or nebulizer."	Use of two types of medicines. Remind patient to bring all medicines and the peak flow meter to every appointment for review. Self-evaluation of progress in asthma control using symptoms and peak flow as a guide.	Use of a daily Asthma Action Plan. Review and adjust as needed. Peak flow monitoring and daily diary recording. Correct inhaler and spacer technique.

Recommendations for Second Follow-Up

Focus on: Concerns Quality of Life Expectations Goals of Treatment What is Realistic Role of patient in Self-Management	Teach or review in simple language	Teach or review and demonstrate
Assessment questions	Information	Skills
Ask relevant questions from previous visits and also ask: "Have you noticed anything in your home, work, or school that makes your asthma worse?" "Tell me how you know when to call your doctor or go to the hospital for asthma care." "What questions do you have about your Action Plan? Can we make it easier?" "Are your medicines causing you any problems?"	Relevant environmental control/avoidance strategies. How to identify home, work, or school exposures that can cause or worsen asthma. How to control house-dust mites, animal exposures if applicable. How to avoid cigarette smoke (active or passive). Review all medicines. Review and interpret peak flow measures and symptom scores from daily diary.	Inhaler/spacer/holding chamber technique. Peak flow technique. Use of the Action Plan. Confirm that patient knows what to do if asthma gets worse

Recommendations for Subsequent Visits

Focus on: Concerns Quality of Life Expectations Goals of Treatment What is Realistic Role of patient in Self-Management	Teach or review in simple language	Teach or review and demonstrate
Assessment questions	Information	Skills
Ask relevant questions from previous visits and also ask: "How have you tried to control things that make your asthma worse?" "Please show me how you use your inhaler or nebulizer."	Review and reinforce all: Educational messages Environmental control strategies at home, work, or school Medications Review and interpret from diary: Peak flow Symptom scores	Inhaler/spacer technique Peak flow technique Use of daily self-management plan Review and adjust as needed Use of the Action Plan. Confirm that patient knows what to do if asthma gets worse. Periodically review and adjust the written Action Plan.