RT Book, Section
A1 Sorkness, Christine A.
A1 Blake, Kathryn V.
A2 DiPiro, Joseph T.
A2 Talbert, Robert L.
A2 Yee, Gary C.
A2 Matzke, Gary R.
A2 Wells, Barbara G.
A2 Posey, L. Michael
SR Print(0)
ID 1148572282
T1 Asthma
T2 Pharmacotherapy: A Pathophysiologic Approach, 10e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9781259587481
LK accesspharmacy.mhmedical.com/content.aspx?aid=1148572282
RD 2024/04/18
AB Patient  Care  Process  for  the  Management  of  Persistent  AsthmaCollectPatient  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  awakeningsAlbuterol  use  frequency  for  symptom  controlActivity  limitationExacerbation  frequencyPeak  expiratory  flow  readingsAssessCo-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  exacerbationsInhaler  technique  (see  Figure  26-5)  and  adherence;  potential  barriers  Socioeconomic  barriers  to  obtain  medicationsAdherence  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  resultsReferrals  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  adherenceSchedule  follow-up  based  on  symptoms  and  medication  changesFollow-up:  Monitor  and  EvaluateDetermine  symptom  control  and  exacerbation  outcomesPresence  of  adverse  effectsPatient  adherence  to  treatment  plan  using  multiple  sources  of  information*Collaborate  with  patient,  caregivers,  and  other  health  professionals