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PATIENT CARE PROCESS

Patient Care Process for the Management of Persistent Asthma

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Collect

  • 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

Assess

  • 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)

Plan*

  • 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)

Implement*

  • 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

CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

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

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. 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 not available. 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 not available. 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 not available. The inflammatory process in asthma is ...

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