Asthma Education

1. See Also
   1. Asthma Management
2. Management: Explain Pathophysiology
   1. Contrast between Asthmatic and normal lungs
   2. Describe what happens to airways in Asthma attack
   3. Explain Asthma as a chronic disease
      1. No Cure (although may resolve on its own)
      2. Management directed at achieving Asthma control
3. Management: Describe Medication Roles
   1. Emphasize Long-term medications as key to control
   2. How Medications work
      1. Long-term medications reduce inflammation (e.g. Inhaled Corticosteroid)
      2. Short-term medications rescue from bronchospasm (e.g. Short acting beta agonist)
4. Management: Inhaler Use
   1. Metered Dose Inhalers (e.g. ProAir, Qvar) - HFA propellant
      1. Shake before each puff (to mix the suspension)
      2. Use with Inhaler Spacer
      3. Exhale, then press down on Inhaler while breathing in slowly and deeply and then hold breath for 10 seconds
   2. Soft Mist Inhaler (e.g. Combivent Respimat) - spring-loaded device without propellant
      1. No shaking of suspension required
      2. Exhale, then press down on Inhaler while breathing in slowly and deeply and then hold breath for 10 seconds
   3. Dry Powder Inhaler (e.g. Advair, Spiriva)
      1. Hold device level and do not shake
      2. Device punctures medication casing exposing the powder
         1. Patient exhales and then ruptures capsule, inhales quickly and deeply
      3. Device types
         1. Single-dose device (e.g. aerolizer, handihaler)
            1. One dose capsule inserted into device, punctured and inhaled once or twice
         2. Multi-dose device (e.g. Discus, Flexhaler, Twisthaler)
            1. Dose is advanced (specific to device) and then capsule punctured and inhaled
   4. References
      1. (2014) Presc Lett 21(2): 9
5. Management: Skill Training
   1. See Metered Dose Inhaler
   2. See Inhalers above
   3. Inhaler technique teaching is billable (CPT 94664)
   4. Spacer and holding chamber use
      1. See Spacer Devices for Asthma Inhalers
   5. Monitoring methods
      1. Symptom monitoring
      2. Peak Flow meter
      3. Early recognition of exacerbation
   6. Written action plan
      1. Stepwise plan for exacerbations
      2. When and how to take Rescue medications
6. Management: Control Measures for Environmental Allergens
   1. See Environmental Allergen
   2. Animal Dander
      1. Remove animal from house
      2. Keep animal out of patient's bedroom
      3. Install Filter on bedroom air duct
   3. House-Dust mites
      1. Encase mattress and pillow in impermeable cover
      2. Wash bedding weekly in hot water
      3. Reduce indoor humidity <50%
      4. Remove dust "collectors" from room
   4. Cockroaches
      1. Set traps
      2. Preventative measures
   5. Pollens
      1. Keep windows closed during the season
   6. Indoor Mold
      1. Fix leaks and other water sources of mold growth
      2. Reduce indoor humidity to <50%
      3. Clean