Covering the basics of asthma education

Know triggers, symptoms, signs of good control

A patient should be educated with several topics when diagnosed with asthma, says Marc Riedl, MD, assistant professor of medicine, Division of Clinical Immunology and Allergy at Ronald Reagan UCLA Medical Center in Los Angeles. They include the following:

• Patients should have an understanding that asthma is an inflammatory condition and should know what causes symptoms that include coughing, wheezing, and chest tightness.

There can be many factors that trigger asthma. People can be allergic to certain airborne substances or pollutants such as cigarette smoke or vehicle exhaust. Dramatic temperature changes can trigger asthma attacks as well, says Riedl.

Often asthma triggers are obvious. For example, a person might experience tightness in their chest from exhaust after standing at a bus stop for 15 minutes or start wheezing when exposed to cigarette smoke. To determine subtle triggers, allergy testing might be needed, says Riedl.

Allergy tests might show that a person is allergic to house dust mites, which they are exposed to nightly in their bed or pillow. "There are definitely more subtle triggers that need to be worked out over time or through observation or testing,' says Riedl.

When a person is aware of his or her asthma triggers, such as cigarette smoke, these irritants can be avoided. Often infections, such as a cold, can worsen asthma, so good hygiene such as hand washing can help control asthma, he adds.

• Another area of education is knowledge of what good asthma control looks like.

This information is covered with families enrolled in the Asthma Management Program at the Children's Medical Center in Dallas.

"Many times people feel like their child's asthma is in good control when it is not," says Robin Brown, RN, BSN, AE/C, program manager.

Asthma is not in good control if a patient has daily symptoms more than two times a week and night symptoms more than twice a month, or if the patient needs to refill their quick reliever inhaler two times or more a year, explains Brown.

• The proper use of anti-inflammatory medicines to keep the airway from becoming obstructed or blocked by asthma is the primary way to prevent asthma attacks and must be included in education.

"Medications have to be taken on a regular basis to keep the inflammation under control," says Riedl.

People with asthma need to be educated about their medications, how they are used, and why they are used in that manner, says Riedl. Asthma patients are prescribed long term controller medicines and also short term acute or rescue medicines. Spend time with patients helping them to know the difference in medications and the correct way to administer them.

Brown says families enrolled in the Asthma Management Program often are confused about their medications and are using the controller medication as the reliever and vise versa. Also they frequently are not administering the medications correctly. To help remedy this problem, a holding chamber is given to the family. This is a tube that is placed on the inhaler to keep the medication from squirting directly into the mouth. The medicine needs to be trapped in the holding chamber, and with deep breaths, pulled into the lungs, says Brown.

• An asthma management plan is also a key piece of education.

Referred to as an asthma action plan, this document provides instructions on how to best monitor asthma symptoms on a daily basis and provides information on what actions to take when an asthma attack occurs.

The asthma action plan is a living document and might change based on new medications available, a patient's response to medicines, and whether the condition becomes more severe, says Riedl.