Healthcare Professional Consideration : There are numerous issues when a patient is either undiagnosed or overdiagnosed with asthma. For the person with undiagnosed asthma, symptoms go unaddressed and untreated, impacting their quality of life. Time is lost from work or school because of difficulty breathing or poor sleep from nocturnal asthma. This poses economic hardship from lost wages from work, because of the person’s own illness or that of their child. Permanent pathological changes can occur within the respiratory system, leading to disability. Emergency room visits and hospitalizations are more likely to occur from untreated asthma, greatly impacting quality of life and resulting in economic burden. For the person misdiagnosed with asthma, the excess expense of unneeded medications and healthcare visits can impose a heavy burden. It is essential that objective testing be conducted to confirm the diagnosis of asthma; the healthcare provider should not rely on patient symptom history alone for treatment decisions. Appropriate follow-up care is needed to confirm or reject the diagnosis and to ascertain the best treatment intervention to alleviate the symptoms presented by the person Asthma guidelines The National Asthma Education and Prevention Program (NAEPP) of the NHLBI, which developed the Expert Panel Report 3 (EPR3); the subsequent 2020 Focused Updates to the Asthma Management Guidelines (also developed by the NHLBI); and the GINA are three of the most commonly cited guidelines used by healthcare providers and researchers to achieve best practices. The GINA Scientific Committee prepares updates to their guidelines each year, which are available on the GINA website Asthma management goals The goals for asthma management for both NAEPP and GINA are to achieve good symptom control and reduce impairment and risk (GINA, 2021; NHLBI, 2007). Specific recommendations are based on age groups that vary slightly depending upon the two guidelines. GINA (2021) differentiates treatment for adults/adolescents, children ages 6 to 11 years, and children 5 years and younger; the latest updates to the EPR3 (NHLBI, 2021) delineate the age groups as 12 years and older, 5 to 11 years, and 0 to 4 years. Impairment refers to the intensity and frequency of asthma symptoms and the limitations imposed by these symptoms. Risk encompasses the adverse outcomes associated with asthma and its treatments. Specific goals for reducing impairment include freedom from asthma symptoms Asthma assessment Frequency of asthma assessment depends upon the patient’s initial level of asthma control, their response to treatment, and their level of engagement with self-management. Patients should be seen 1 to 3 months after the start of treatment and every 3 to 12 months thereafter. If an exacerbation occurs, a review visit with the healthcare provider should be scheduled within 1 week (GINA, 2021). Asthma assessment should also be conducted with each encounter with the healthcare system, even if asthma is not the focus of the visit. Spirometry should be done in the office, if available. Peak flow monitoring should be done if spirometry is not available. The person with asthma should monitor peak flows at home, if appropriate. GINA (2021) emphasizes a continuous cycle of assessment (diagnosis, symptom control, risk factors, comorbidities, inhaler technique and adherence, patient preference and goals), adjusting treatment (asthma medications, nonpharmacologic strategies, treatment of modifiable risk factors), and reviewing response (symptoms, exacerbations, side effects, patient satisfaction, lung function) to achieve asthma control. The following questions should be asked (Fanta, 2020): 1. How often has your asthma awakened you at night or in the early morning? 2. How often have you needed to use rescue (quick-relief) medication for cough, shortness of breath, or chest tightness?
as they are completed. The Committee reviews the world’s literature with regard to asthma management and updates the GINA documents to reflect any new evidence-based information (GINA, 2021). NHLBI, based on systematic reviews conducted by the Agency for Healthcare Research and Quality, with input from NAEPP participant organizations, medical experts, and the public, released updates to the EPR3 in 2020 (NHLBI, 2021). (cough, chest tightness, wheezing, shortness of breath), use of rescue medication no more than 2 days per week, no more than two nighttime awakenings per month, optimization of lung function, no activity limitations, and satisfaction with asthma care provided. Specific goals for reducing risk include prevention of recurrent exacerbations and the need for emergency department or hospital care, prevention of lung function loss, and optimization of pharmacotherapy with minimal or no adverse effects (Fanta, 2020). Again, it is essential that the patient’s goals for treatment be considered and incorporated into the management plan, and also a personalized plan addressing modifiable risk factors that have the potential to reduce the occurrence of asthma exacerbations (GINA, 2021). 3. Have you needed any unscheduled care for your asthma, including calling in to the healthcare provider, an office visit, or emergency room visit? 4. Have you been able to participate in school/work and recreational activities as desired? 5. If peak flow measurements are done, have your peak flow readings been lower than your personal best? 6. Have you taken oral steroids for your asthma within the past year? 7. Have you been hospitalized for your asthma? How many times in the past year? 8. Have you been admitted to the intensive care unit or intubated because of your asthma within the past 5 years? 9. Do you or anyone in your household currently vape or smoke cigarettes? If yes, how many each day? 10. Have you noticed an increase in asthma symptoms after taking aspirin or a nonsteroidal anti-inflammatory agent (NSAID)? Asthma management Both the EPR3 (NHLBI, 2007) and GINA (2021) recommendations include a “step-up” or “step-down” methodology, increasing or decreasing medications and/or dosages, based on the needs of the person with asthma. Initial treatment plans are based on an assessment of asthma severity with adjustments made to the plan based on assessing the level of control. Both look at
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Book Code: ANCCUS2423
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