The following information should ideally be covered while
educating patients/caregivers on asthma-especially new patients. At
each visit, it is important to determine how often the patient is
taking rescue medications, the technique of taking current
medications, and to review how to move through the zones. It is
best not to ask yes or no questions in order to better determine if
patient/caregiver understand the plan.
Classify asthma severity: according to the NIH
guidelines, patients symptoms should fit into a category which
allows the provider to pick from one of the categories:
mild/intermittent, mild persistent, moderate persistent, and severe
persistent. IF not sure what category to classify, best to start
with the most severe symptom
Action Plan: this will be what the patient is sent
home with for self management of their asthma. It will explain how
to step up/step down therapy depending on patients
Locate any previously written asthma action plan by reviewing
inpatient/outpatient and practitioner reports.
Assess for adequate step-up in medicines.Make sure the patient
has a increased medication dose in the yellow zone and a red zone
Complete asthma action cards/plan and /or school plan per
written orders after reviewing patient information and
Defining asthma: once asthma is
diagnosed, it is important the patient/caregiver understand the
disease process. The asthma action cards can be used here to cover
this information or refer to the NIH guidelines
Instruct caregiver and patient on "What is Asthma ?"-important
to define what chronic and inflammation mean to this process.
Describe asthma severity.
Review the patient goals of asthma treatment.
Know reference sources to provide written information or for
Asthma triggers identified and
Review common triggers with caregiver and patient to assess
for additional known irritants.
Instruct caregiver and patient on prevention or remediation
procedures based on identified triggers or universal asthma
Asthma Medications: any medications prescribed for the
patient should be explained so the patient understands why and when
Explain controller/preventive vs. quick-reliever/rescue
Review medicines prescribed per written order.
Review written AA Plan; identify controller vs. quick reliever
based on patient's individual plan.
Instruct caregiver/patient on use of medicines including dose,
frequency, and medicine specific devices.
Zone treatment (green, yellow, and red): zone
management best describes how to move through the zones depending
on asthma symptoms. Patients may need to begin taking medications
or step up their current medications in the different
Explain system of managing asthma according to treatment
Review symptoms associated with /identification of
Instruct caregiver/patient on use of AAP to identify zones and
medicines to use in each zone.
Explain the test dose to help identify whether to move to
yellow or red zone.
Explain the theory of step-up and the importance of using the
medicines from the previous zones.
Instruct caregiver/patient to call provider if repeatedly
moving to the yellow zone.
Instruct caregiver/patient to notify provider if beginning the
red zone medications.
Review use of 911 vs. ambulance vs. private transport when in
Demonstration of devices: important to review every
visit how to give/take asthma medications. It is essential that
each patient has a thorough instruction and proper technique. What
works for one patient, may not work for the rest.
Nebulizer: may be used to administer the
quick reliever or inhaled corticosteroid. Patients under the age of
5-6 should use a face mask. When able to inhale with a mouthpiece
may be switched to that route. Blow by should not be used to
administer the medication.
Spacers/holding chamber: this device can increase the
medication delivered to the lung and reduce
the deposition of medicine into the throat and upper
airway. Instruct patient/caregiver on use of appropriate
spacer (mouthpiece vs. facemask) depending on age and ability to
Diskus/ Dry powder inhaler: DPI
delivers medication to the lungs as the patient inhales through the
device. The DPI does not contain propellants or any other
Peak flow meters (PFM): this is a tool used to monitor
asthma, not make a diagnosis. The NIH guidelines encourage peak
flow monitoring for all moderate-severe persistent patients with
asthma. Patient technique is very important with this tool for
Medication refills: review with
patient when medication should be refilled and how many they have
left. This needs to be done on each level-providers, educator,
pharmacy-Many patients do not understand they have refills and may
call back for more medication when they do not need to do
(References: CMH asthma action cards and NIH/NHLBI guidelines.)
These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time.
It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.