What you tell an asthma patient could save a life

Teach patients correct use of medications

An asthmatic patient comes to your ED gasping for breath. A few minutes later, the patient's breathing has improved dramatically. That patient is less likely to come to your ED again, if education is given during or after the ED visit, according to a recent publication.

Twelve studies involving 1,954 patients were analyzed, all involving ED visits for a severe asthma attack. Patients who received asthma education in the ED were 30% less likely to return to the ED and 50% less likely be hospitalized.1

"Clearly, asthma education has been shown to be an important component of asthma control," says Brian H. Rowe, MD, MSc, CCFP(EM), FCCP, the study's co-author and an ED physician at the University of Alberta Hospital in Edmonton, Canada. "We have limited time in the ED, but key educational issues should be discussed whenever time permits," he says. "It is encouraging that a simple educational intervention has the potential to reduce ED utilization and improve the quality of life for our patients."

Education in the ED

At Utah Valley Regional Medical Center in Provo, an educational program was implemented in the ED for asthma patients, with nurses showing patients how to use their inhalers and medications appropriately when the first signs of an asthma attack surfaces, says Barbara Stuart, ED clinical educator. "Since that time, the visits of asthma patients in the ED have decreased because they are able to manage their condition at home," she says. "When patients do come in, it is because all their treatments have not helped."

When patients comes to your ED with a severe asthma attack, you have an opportunity to change the way they manage their condition, says Susan Janson, DNSc, RN, NP, FAAN, a member of the expert panel that wrote the Guidelines for the Diagnosis and Management of Asthma developed by the National Asthma Education and Prevention Program. Do the following before the patient is discharged, says Janson:

— Assess the patient's ability to use an inhaler correctly, and correct errors in technique.

— Provide all patients with a written action plan based on the patients' symptoms or peak flow, to be followed when the next exacerbation occurs.

— Teach patients the signs of worsening asthma and the immediate rescue steps to take.

— Make sure the patients understand the prescriptions and medications they are to take and how long to take them before discharge.

"Warn them not to stop the oral steroids until the full course prescribed is finished," says Janson. "Explore whether allergens or irritants precipitated this exacerbation, and recommend removal."

Make a follow-up appointment with a specialist or primary care physician and provide the information in writing to the patient, recommends Janson. "Emphasize that asthma is a chronic disease, exacerbations can be prevented, and asthma can be controlled, but that this requires ongoing care from a physician or nurse practitioner," she says.

Reference

1. Tapp S, Lasserson TJ, Rowe BH. Education interventions for adults who attend the emergency room for acute asthma (Review). Cochrane Database Syst Rev 2007; Issue 3.

Sources

For more information on asthma patients, contact:

  • Susan Janson, DNSc, RN, NP, FAAN, Professor and Mary Harms/Alumni Endowed Chair, University of California — San Francisco, San Francisco, CA 94143-0608. Phone: (415) 476-5282. Fax: (415) 476-6042. Phone: susan.janson@nursing.ucsf.edu.
  • Brian H. Rowe, MD, MSc, CCFP(EM), FCCP, Professor and Research Director, Department of Emergency Medicine, University of Alberta, Room 1G1.43 WMC, University of Alberta Hospital, 8440-112th St., Edmonton, Alberta, Canada T6G 2B7. Phone: (780) 407-6707. Fax: (780) 407-3982. E-mail: brian.rowe@ualberta.ca.
  • Barbara Stuart, RN, BSN, CEN, Service Line Clinical Educator, Emergency Services, Utah Valley Regional Medical Center, 1034 N. 500 West, Provo, UT 84604-3337. Phone: (801) 357-2136. E-mail: barbara.stuart@ihc.com.