Asthma is a condition that may go into remission or present differently throughout the stages of life. The presence of airway inflammation remains a consistent feature.
Symptoms of asthma are preventable and manageable with lifestyle modification and, when needed, pharmacotherapy.
To achieve optimal outcomes, the medication therapy management (MTM) consult process must include patient education on trigger avoidance and self-management techniques.
MTM providers should assess inhaler and/or device technique at each visit to help ensure maximal efficacy of asthma pharmacotherapy.
INTRODUCTION TO ASTHMA
Asthma is a disease that is characterized by airway inflammation and airway obstruction. In individuals with a genetic predisposition, the airways become inflamed and hyperresponsive when exposed to various environmental triggers, resulting in bronchoconstriction, formation of mucus plugs, and airway obstruction. Common symptoms of asthma are cough, dyspnea, wheeze, and/or chest tightness. Asthma is a serious lung condition affecting all age groups in many countries.1,2 Although a common health condition, the clinical presentation is highly variable because of the intrinsic nature of the disease. Thus, global measures were created to assist clinicians in disease state management (Table 13-1).
++ Table Graphic Jump Location TABLE 13-1Overview of Global Measures of Asthma Assessment ||Download (.pdf) TABLE 13-1 Overview of Global Measures of Asthma Assessment
|Assessment and monitoring are linked to the concepts of severity, control, and responsiveness to treatment |
| Severitya refers to the individual’s intrinsic intensity of the disease process |
| Control refers to symptom control and the future risk of an adverse outcome |
| Responsiveness indicates the ease with which asthma symptoms are controlled by pharmacologic therapy |
|Both severity and control include the domains of “impairment” and “risk”b |
| Impairment describes the frequency of symptoms and subsequent functional limitations that the patient is experiencing or has recently experienced |
| Risk describes the likelihood of asthma exacerbations, progressive decline in lung function, or risk of an adverse effect from medication |
Severity of asthma symptoms in patients who are not currently taking a long-term controller medication (also known as maintenance medication) is assessed using the impairment and risk domains illustrated in Table 13-2. To determine whether a patient is presenting with intermittent, mild, moderate, or severe asthma impairment, the following symptoms are assessed: nighttime awakenings, use of short-acting bronchodilator for quick relief of acute symptoms, workdays missed, patient ability to engage in normal daily activities, and quality of life. In general, patients are considered at higher risk for uncontrolled asthma if they have a history ...