The West Virginia Asthma Education and Prevention Program recognizes and applauds the hardwork, time and effort that healthcare providers expend everyday to improve the lives of their patients. This program is here to aid you in that battle by providing: a quick reference to the standards put forth by The National Heart Lung and Blood Institute (NHLBI), Guidelines for the Diagnosis and Treatment of Asthma Expert Panel Review 3 – 2007, for all age groups; educational materials available online and via mail for free; utilization of our partners in the collaborative group created to fight the burden of asthma known as the West Virginia Asthma Coalition, our partners in the WV Bureau for Public Health – Chronic Disease Division, and the Centers for Disease Control and Prevention, specifically the Environmental Health Division.
The success of any effort to manage asthma rests solely upon the effort and dedication of the patient with asthma in self-managing their condition. The impact of you, the healthcare provider, to convey information, teach skills – how to identify asthma triggers – recognizing signs & symptoms, giving inspiration to follow their Asthma Action Plan, and working with a health care team to make recommendations regarding treatment is paramount to success.
The average patient only spends 0.02% of their life with their healthcare provider, so the care and adherence of that patient rests solely on the shoulders of that person. Your effort influences how well patients and families form a team approach with healthcare providers and helps determine how well the individual with asthma assumes the ultimate responsibility for their own well-being and self-managed care. If you make asthma a health a concern, hopefully the patient with asthma will too!
Clinical Activities for Providing Quality Asthma Care:
- Establish asthma diagnosis and classify severity of asthma.
- Schedule routine follow-up care: at least 1-6 months and spirometry testing at least every year.
- Perform lung spirometry testing to assess lung function and airway reversibility using pre/post beta2-agonist testing. (to be performed at least once every two years)
- Assess need for referral to specialty care.
- Recommend measures to control asthma. Instruct patient (and/or child’s family) on recognizing triggers of asthma, and signs and symptoms of an asthma episode. Provide the patient or child’s family with easy to read materials such as the “Home Environment Asthma Checklist” (see below) to help identify and remove asthma triggers in the home.
- Treat and prevent comorbid conditions including providing annual influenza (flu) vaccination and pneumonia vaccination (if needed).
- Prescribe medications according to severity including appropriate medication delivery and monitoring devices.
- Monitor use of beta2-agonist drugs (bronchodilators) – re-evaluate patients using more than ONE metered dosed inhaler (MDI) canister per month.
- Develop a written Asthma Action Plan (Provide copies of the Asthma Action Plan to the child’s school, daycare center, caregivers, and family).
- Provide routine maintenance on patient self-management. Have patient bring in inhaled medications – including metered dosed inhalers, dry powdered inhalers, diskus, and nebulizer; other delivery devices to include spacer and valved holding chambers; and monitoring devices such as a peak flow meter with each visit to ensure proper use and function of device.
- Track and monitor patients with asthma via a “chronic disease patient registry system” or similar process to ensure improved care and adherence to medications and control. WVAEPP offers opportunities for rural health centers to achieve this goal. Contact us today to learn more – click here.
If the initial treatment fails to achieve adequate control of the patient’s asthma after it has been given for a certain period of time, e.g., one month, various further aspects should be considered:
- Checking the patient’s adherence to treatment (drug-taking compliance)
- Checking the patient’s inhalation technique through direct observation by the physician
- Re-evaluating the diagnosis: other differential diagnoses that may have to be considered include, for example, chronic obstructive pulmonary disease (COPD), airway narrowing by a tumor, vasculitis, and pulmonary embolism
- Persistent exposure to toxic substances and allergens
- Aggravating factors such as gastroesophageal reflux and chronic sinusitis.
Severity of Asthma changes slowly over time,
Control of Asthma changes quickly!!!
Asthma Coding, Billing, and Reimbursement
Medicare Guidelines – a reference guide to coding, billing, and reimbursement for services and education for patients
National Guidelines
National Heart Lung and Blood Institute EPR 3 – (NHLBI) Guidelines for the Diagnosis and Treatment of Asthma Expert Panel Report 2007
The GIP Report – A one page summary of what is most important in the National Guidelines on Asthma. For the full report – read below.
NHLBI Guidelines Implementation Panel Report for the Expert Panel Report for the Diagnosis and Management of Asthma – The Guidelines Implementation Panel (GIP) Report presents recommendations and strategies for overcoming barriers to the acceptance and utilization of the updated NHLBI clinical practice guidelines for asthma. At the heart of the GIP Report are six key messages to address those issues considered to be the most likely ones to result in significant impact on asthma care processes and outcomes.
NIOSH CERTIFICATION – spirometry training and interpretation, pulmonary function testing quality assurance measures, and other respiratory equipment and measures.
Physician Asthma Care Education – NHLBI’s PACE program is a two-part interactive, multi-media educational seminar to improve physician awareness, ability, and use of communication and therapeutic techniques for reducing the effects of asthma on children and their families. It also provides instruction on how to document, code, and improve asthma counseling reimbursement.
National Asthma Control Initiative (NACI) – The NACI is a multi-component, mobilizing, and action-oriented initiative to engage diverse stakeholders who are concerned about or involved in improving asthma control. For fact sheet click here.
Asthma Treatment for Children is not “one size fits all” – the NIH article on BADGER THERAPY (Best Add on therapy Giving Effective Responses)
Improving the Health Outcomes of Your Patients
Asthma Return-on-Investment Calculator – Here is a tool for exploring the potential returns from quality improvement and disease management programs for populations diagnosed with asthma. This Asthma ROI Calculator provides estimates based on an analysis of 52 research studies on improving asthma care and what those studies imply for cost savings.
Asthma Education Resources
Asthma Medications, Dosages, Usage, and NHLBI Guidelines EPR3 Referencing – Quick Reference Sheet
Asthma and other Respiratory Disease Medications
Inhaler Medications being discontinued by the FDA – quick reference list of the inhalers that are being phased out 2010-2013
Basic Steps on How to Perform Spirometry on a patient
Managing Asthma while Pregnant – Is asthma being masked during pregnancy?
NIOSH Spirometry Graph – what constitutes a good spirometry result? this descriptive poster explains the results
Pathophysiology of Asthma Graph – an outline of the relationship between airway inflammation, airway hyperresponsiveness, airway obstruction, and asthma symptoms.
Toolkit for Making Written Material Clear and Effective – The Toolkit is a health literacy resource from the Centers for Medicare and Medicaid Services (CMS). The 11-part Toolkit provides a detailed and comprehensive set of tools to help you make written material in printed formats easier for people to read, understand, and use.
Educate the Patient and the Family
Home Environment Asthma Checklist – Is your patient’s home “asthma friendly”? Here is an easy to follow list and suggestions to improve the air quality of the home.
Things a family can do to get ready for an “asthma” lung doctor visit – what questions to ask at the next visit
Learn about asthma – what is asthma? what are triggers? what can I do to prevent asthma episodes or attacks?
Patient Aerosol Guide – this how-to education guide explains the use of all types of inhalers and nebulized medications
Safe Cleaning for People with Asthma – educate your patients to learn safer ways to clean the home and office; easy cleaning and tips
Environmental Health Issues – Resources
Pediatric Environmental Specialty Units – a network of experts in the field of children’s environmental health. Online tutorials, presentations, and training opportunities available.
Asthma Informational Pamphlets and Posters
The items in this section are available in printed color versions for free. Just contact AEPP for your copies today by calling 304.365-4193.
Fact Sheets on Asthma in West Virginia – certain populations of people are more adversely affected by asthma in the state versus nationwide, specifically children, women, seniors, and individuals of low socioeconomic status.
Smoking and Your Health – for those with Asthma and Diabetes in WV
Tobacco Use & Asthma Trifold – Know the Risks! in West Virginia
ASTHMA Guidelines Trifold – Quick reference guide of the 2007 NHLBI Guidelines for the Diagnosis and Treatment of Asthma
Asthma Trigger Banner
Together We Can Control Asthma Poster
Secondhand Smoke, SIDS, and Asthma Flier
Online Training and Continuing Educational Units
takeACTION! interactive program – asthma and diabetes education for school personnel and others in wv. Available online and via CD-ROM. CEUs available.
Association of Clinicians for the Underserved – website with multiple resources for the provider and patient
Asthma Education for the Healthcare Provider – CEUs and CMEs available for respiratory therapists, nurses, and physicians.
Health Literacy Training for Health Professionals: Free Continuing Education Limited health literacy affects nine out of ten adults and impacts their capacity to fully manage their health. To help public health professionals respond to limited health literacy, the Centers for Disease Control and Prevention (CDC) has launched a FREE, online training program: Health Literacy for Public Health Professionals.
Pediatric Environmental Home Assessment – From the National Center for Healthy Housing. This program is for Public Health and Home Visiting Nurses. This course prepares nurses to:
- Complete a pediatric environmental health history and recognize potential environmental hazards and sentinel illnesses as part of a primary prevention approach.
- Recommend a course of preventative action or make appropriate referrals for conditions with probable environmental etiologies as appropriate for their discipline.
Asthma Articles and Topic Links
A Call to Action Against Asthma – Journal of the National Medical Association
Asthma Action Plan (PDF) – template