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Patient Care Process for the Management of Persistent Asthma



  • Patient characteristics (e.g., age, race/ethnicity, sex, pregnant)

  • Patient history (past medical, known triggers, psychosocial history, gastroesophageal reflux disease)

  • Family history (asthma, allergy, atopic dermatitis)

  • Home/work environment (environmental, occupational, tobacco smoke, carpet/bedding, pets) (see Table 26-1)

  • Current medications and prior response to controller therapies (e.g. ICS+/-LABA; montelukast; LAMA; biologic therapies)

  • Subjective and objective data (see Table 26-2)

    • Symptoms (description and frequency)

    • Nocturnal awakenings

    • Albuterol use frequency for symptom control

    • Activity limitation

    • Exacerbation frequency

    • Peak expiratory flow readings


  • Co-morbid conditions (atopy, rhinosinusitis, obesity, obstructive sleep apnea, gastroesophageal reflux, smoking)

  • Symptom frequency, including exercise tolerance (see Tables 26-2 and 26-10)

  • Exacerbation history (oral corticosteroid use, emergency department visit, hospitalization)

  • Current medications that may contribute to or worsen asthma (NSAID, aspirin)

  • Appropriateness and effectiveness of current medications in controlling symptoms and preventing exacerbations

  • Inhaler technique (see Figure 26-5) and adherence; potential barriers

  • Socioeconomic barriers to obtain medications

  • Adherence to nonpharmacologic recommendations (allergen avoidance, environmental control)


  • Tailored environmental modifications (e.g., pet removal, carpet removal, pillow and mattress covers, exercise pre-treatment, occupational exposures) (see Table 26-1)

  • Medication therapy regimen: dose, route, frequency, duration, and MDI spacer; specify the continuation and discontinuation of existing therapies (see Tables 26-4, 26-7, 26-10, 26-11, 26-12; Figure 26-5)

  • Monitoring parameters including daily symptoms, nocturnal awakenings, albuterol use, exercise tolerance, peak expiratory flow (in selected patients), and timeframe (see Table 26-11)

  • Patient/family education (e.g., purpose of treatment, environmental modifications, drug therapies, inhaler technique)

  • Self-monitoring of symptoms, albuterol use, peak expiratory flow (in selected patients)—where and how to record results

  • Referrals to other providers when appropriate (e.g., specialist physician)


  • Provide patient/family education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up based on symptoms and medication changes

Follow-up: Monitor and Evaluate

  • Determine symptom control and exacerbation outcomes

  • Presence of adverse effects

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other health professionals


For the chapter in the Wells Handbook, please go to Chapter 77. Asthma.



  • image Asthma is a disease of increasing prevalence that is a result of genetic predisposition and environmental interactions; it is one of the most common chronic diseases of childhood.

  • image Asthma is primarily a chronic inflammatory disease of the airways of the lung for which there is no known cure or primary prevention; the immunohistopathologic features include cell infiltration by neutrophils, eosinophils, T-helper type 2 lymphocytes, mast cells, and epithelial cells.

  • image Asthma is characterized by either the intermittent or persistent presence of highly variable degrees of airflow obstruction from airway wall inflammation and bronchial smooth muscle constriction; in some patients, persistent changes in airway structure occur.

  • image The inflammatory process ...

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