Guidelines for Asthma Diagnosis, Management

Diagnose asthma and initiate partnership with the patient:

o Diagnose asthma by establishing:

— a history of recurrent symptoms;

— reversible airflow obstruction using spirometry;

— the exclusion of alternative diagnoses.

o Establish a patient-clinician partnership:

— Address patient’s concerns.

— Agree upon the goals of asthma therapy.

— Agree upon a written action plan for patient self-management.

o Reduce inflammation, symptoms, and exacerbations:

— Prescribe anti-inflammatory medications to patients with mild, moderate, and severe persistent asthma (i.e., inhaled steroids, cromolyn, or nedocromil).

— Reduce exposures to precipitants to asthma symptoms.

— Assess patient’s exposure and sensitivity to individual precipitants (e.g., allergens, irritants).

— Provide written and verbal instructions on how to avoid or reduce factors that make the patient’s asthma worse.

o Monitor and manage asthma over time:

— Train all patients to monitor their asthma.

— All patients should monitor symptoms.

— Patients with moderate-to-severe persistent asthma should also monitor their peak flow.

o See patients at least every one to six months:

— Assess attainment of goals of asthma therapy and patient concerns.

— Adjust treatment, if needed.

— Review the action plan with the patient.

— Check patient’s inhaler and peak flow technique.

o Treat asthma episodes promptly:

— Prompt use of short-acting inhaled beta- agonists; and, if episode is moderate to severe, a three- to 10-day course of oral steroids.

— Prompt communication and follow-up with clinician.

Patient education after diagnosis:

Identify the concerns the patient has about being diagnosed with asthma by asking: "What worries you most about having asthma? What concerns do you have about your asthma?"

Address the patient’s concerns and make at least these key points:

o Asthma can be managed and the patient can live a normal life.

o Asthma can be controlled when the patient works together with the medical staff. The patient plays a big role in monitoring asthma, taking medications and avoiding things that cause asthma episodes.

o Asthma is a chronic lung disease characterized by inflammation of the airways. There may be periods when there are no symptoms, but the airways are swollen and sensitive to some degree all of the time. Long-term anti-inflammatory medications are important to control airway inflammation.

o Many things in the home, school, work or elsewhere can cause asthma attacks (e.g., second-hand tobacco smoke, allergens, irritants). An asthma attack (also called episode, flare-up, or exacerbation) occurs when the airways narrow, making it harder to breathe.

o Asthma requires long-term care and monitoring. Asthma cannot be cured, but it can be controlled. Asthma can get better or worse over time and requires treatment changes.

o Patient education should begin at the time of diagnosis and continue at every visit.

Source: National Heart, Lung and Blood Institute, Bethesda, MD.