Asthma Action Plan
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Transcript of Asthma Action Plan
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ASTHMA ACTION PLAN
Presented by:RuthAnn Begay Goradia,
MSN, MPH, RN, AE-C
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EPR-3 Clinical Practice Guidelines
1. Use inhaled corticosteroids to control asthma.2. Use written asthma action plans to guide
patient self-management3. Assess asthma severity 4. Assess and monitor asthma control 5. Schedule follow-up visits6. Control environmental exposures
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Asthma patients who spend as little as 30 minutes with a health care professional to develop a personalized self-management plan show improved adherence to medications and better disease control.
Why Use Asthma Action Plans?
Study findings were published in the April 2009 issue of “The Journal of Allergy and Clinical Immunology.”
Co-authors of the study are Kelly Wong McGrath, BA; Jack K. Covington, BA; Su-Chun Cheng, DSc; and Homer A. Boushey, MD
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• Recommended in EPR-3 as part of an Educational Program
• Studies have found:– Reduced urgent care visits, emergency department
visits, hospitalizations, work absences, and nocturnal asthma
– Improved control
Why Use Asthma Action Plans?
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I. Reducing impairmentII. Reducing risk
Goal Of Therapy
Goal of Therapy: To Control Asthma
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• Prevent symptoms• Infrequent use of reliever(s)• (Near) normal pulmonary function• Normal activity levels• Patients’ and families’ satisfaction with care
Goal Of Therapy
EPR 3 p. 277
Reducing Impairment
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• Prevent recurrent exacerbations; minimize ED visits and hospitalizations
• Prevent progressive lung function or loss of lung growth
• Optimal pharmacotherapy with minimal or no adverse effects
Goal Of Therapy
EPR 3 p. 277
Reducing Risk
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Four components of asthma management
Asthma Management
Measures of assessment
and monitoring
Education for a partnership
in asthma care
Control of environmental
conditions and comorbid
conditions
Pharmacologic therapy
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A plan, or roadmap to implement the goals of asthma therapy that uses all four components of asthma management.
Asthma Action Plans
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What Is An Asthma Action Plan?
EPR 3 p. 94
• Created in partnership with the patient for guided self-management
• Addresses daily management to maintain control
• Identifies what to do for exacerbations by recognizing and handling worsening asthma
A Written Plan
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What Is An Asthma Action Plan?
• Empowers the user to manage their asthma
• Following a daily management plan should lead to control of asthma
• Used as an education and communication tool between the provider & patient, other caregivers (e.g., schools, childcare)
The Purpose
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What Is An Asthma Action Plan?
Asthma Action Plans are patient-
centered
Meets patient’s
goals
Consider level of
control and severity
Understandable
Culturally appropriate
Affordable
Doable
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What are the goals of the patient?
Created In Partnership With The Patient
Patient’s Goals
Play basketball
Not use inhaler at
work
Afford medications
Sleep through the
night
• What sports would you play if your asthma was in good control?
• What’s your biggest concern about using your inhaler?
• When do you feel the most asthma symptoms?
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Motivational Interviewing
What’s important to the patient?
• Soccer• Working out
What would life look like if your asthma
was well controlled?
• Breathe better while exercising
• Take less medicine
Action steps to get there.
• Pre-medicate• Quit smoking
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Level of control and severity
Created In Partnership With The Patient
What IS good control? What does good control feel like?
Recognize yellow-zone symptoms and act to avoid worsening of symptoms.
Understand the severity of red-zone symptoms and seek medical attention quickly.
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Is it understandable and culturally appropriate?
Created In Partnership With The Patient
FORMAT• Can range from simple design to more
detailed design • Age appropriate, child/adult versions• Increased font size for elderly• Includes visual elements that are
LANGUAGE• Use language that is understandable to the
patient (i.e., Advair, “flat, purple inhaler”; Proventil, “yellow pump”)
• Use culturally appropriate imagery
SYMPTOM-BASED VS. PFM-BASED• Symptoms only• Symptoms + peak flow
ACCESSIBILITY• Consider who should have a copy, such as a
parents, caregivers, teachers, coaches, and other childcare providers
• Available in print format, triplicate form, web-based, or mobile-friendly
Tailor the plan to the patient
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Work with the patient’s health insurance plan
• Health insurance plan may change over time• Consider options to lower costs
• Refer to formularies; may need to find the best medications at the lowest price/co-pay
• 90-day mail order• Prescription assistance programs
Created in Partnership with the Patient
Is it affordable?
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Created In Partnership With The Patient
• Taking medications twice a day is doable, right?
Standard Question
• What are your work hours?• Where are you at 7 am and 7 pm? • What are you doing at 7 am and 7 pm?
Better Question
Is it doable/convenient/manageable?
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Link To Understanding Asthma
Maintain Good Control
Understand the nature of
asthma
Inflammatory Chronic
Connect symptoms
with variability
Associate symptoms
with triggers
Recognize symptoms and
follow the plan
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Asthma Action Plans
www.lung.org/asthma• Available in English & Spanish• Large or regular font
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• NHLBI Asthma Action Plan:• http
://www.nhlbi.nih.gov/health/prof/lung/asthma/naci/discover/action-plans.htm
Asthma Action Plans
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Asthma Action Plans
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Asthma Action Plans
• CDC:• http://www.cdc.gov/asthma/tools_for_control.htm
• Print and Fill forms• Electronic forms• Computer-based, interactive plan
• New Mexico Asthma Action Plan for Schools• http://nmhealth.org/eheb/asthma_schoolhealth.shtml
Other Asthma Action Plans:
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• Name, important contacts• Healthcare provider signature• Severity classification• Triggers• Premedication and exercise instructions
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Asthma Zone – green means go! • Signs you are doing well• No symptoms• Peak flow meter reading of more than 80% of
personal best or number• Control medications – name, dosage, when to
take, descriptions • May include allergy medications
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Asthma Zone Yellow: Caution! • Worsening symptoms• Peak Flow Meter reading between
50% - 80% of personal best, or number range• Quick-relief medications – name, dosage, when to
take
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Asthma Zone Yellow: Caution! • What to do when symptoms and
peak flow meter reading improves • What to do if symptoms and peak flow meter
reading to do not improve
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Asthma Zone Red: STOP!• Worsening symptoms• Peak Flow Meter less than 50% of personal best,
or number range• Quick-relief medications – name, dosage, when to
take
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Asthma Zone Red: STOP!• What to do if symptoms and peak flow meter
reading does not improve in 15 minutes after using rescue medications
• When to call an ambulance immediately
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• Meds, relaxation, breathing techniques for COPD
• Antihistamines, nasal steroids, hypertonic saline irrigation for rhinosinusitis
• Meds, dietary changes, elevation of bed for GERD
• Speech path, relaxation techniques for VCD
Include Treatment for Comorbid Conditions
If patients has other conditions, it’s also important to include. . .
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Practical Tips for Medications: A
Emphasize difference between controllers and relievers at each encounter.
Success means control, especially of inflammation.
Relief also must be adequate.
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Practical Tips for Medications: B
Repeat demonstration/counter-
demonstration of inhaler and peak flow
technique at each visit.
Keep regimen simple, affordable, doable.
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• Patient and family• All caregivers – at school, after school, coaches• All professional caregivers – healthcare provider,
school nurse, etc.• Copies of Asthma Action Plan for all
Coordinate All the Players on the Team
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Assess
Follow-Up
Reassess
Revise
Revising Asthma Action Plans
• Control – adjust until optimal
• Ongoing assessment, communication
• Trial and error, always subject to revision
• Frequency based on severity and acuity, how new
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Follow-Up
Frequency of follow-upInitial, intermittent, final
Document in patient recordPaper Electronic charting
Type of follow-upPhone Face-to-face
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Daily Self-Management Activities
Asthma diary
Symptom monitoring
To peak flow or not to peak flow?
Environmental control
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• Use of controllers• Use of relievers• Daily symptoms• Peak flows • Nocturnal episodes• Triggers• Effects on activities
What Is an Asthma Diary?
A log to help a patient monitor their asthma
From: Seattle Children’s Hospital, http://www.seattlechildrens.org/kids-health/page.aspx?id=62128
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Self-Monitoring: Asthma Diary
Controllers: AM PM
Puffs Albuterol last 24 hours:
Activities limited? Yes No
Nocturnal symptoms? Yes No
Triggers:
Peak flows:
Zone: Green Yellow Red
Notes:
Available in print, web-based, or mobile-friendly
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• PEF provides a simple, quantitative and reproducible measure of the existence and severity of airflow obstruction.
• PEF can be measured with inexpensive, portable peak-flow meters.
• PEF is effort- and technique-dependent; patients need frequent instruction, demonstration and review of technique.
Peak Expiratory Flow Monitoring (PEF)
Peak Flow Monitoring
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When To Use Peak-Flow Monitoring
EPR 3 p. 59
Discretion of patient and
provider
Evaluate responses to
treatment
Occupational or environmental
exposuresPoor perceivers
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“When self-management is the chosen method for maintaining asthma control, peak-flow-based self-management is equivalent to symptom-based self-management as long as either method also includes a written asthma action plan with instructions on how to recognize and handle worsening asthma, including self-adjustment of medications.”
NAEPP-3 on Peak-Flow Monitoring
EPR 3 p. 60-61
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Peak Flow vs. Signs & Symptoms
Peak Flow vs. Signs & Symptoms
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Questions and Answers
Clicker Time!!!
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Which of the following statements BEST describes the concept of an “active partnership in asthma care” between the health care provider and the person with asthma and/or the family?
A. The person with asthma and/or the family is fully compliant, carrying out all aspects of the plan of care on a regular basis.
B. All asthma management decisions must be approved by both the health care provider and the person with asthma and/or the family.
C. The health care provider designs an asthma care plan that is acceptable to and realistic for the person with asthma and/or the family
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Best Answer:
C. The health care provider designs an asthma care plan that is acceptable to and realistic for the person with asthma and/or the family
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True or False: An Asthma Action Plan should be written according to the judgment and experience of the provider and then carefully explained to the patient.
A. TrueB. False
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Best Answer:
B. False
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John’s peak flow reading in the office is between 50-80% of his personal best. This reading indicates:
A. An expected level for individuals with asthma.B. A need for observation but no increase in the level of
medication.C. A need for observation and an increase in the level of
medication.D. A severe asthma episode.
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Best Answer:
C. A need for observation and an increase in the level of medication.
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Which of the following signs/symptoms indicates a deteriorating or worsening asthma status that requires immediate medical intervention?
A. No improvement in asthma symptoms within 5 minutes of use of a quick relief inhaler.
B. Difficulty walking and talking due to shortness of breath.C. Inspiratory wheezing and persistent cough.D. A and B.E. B and C.
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Best Answer:
D. A and B.– A. No improvement in asthma symptoms within 5
minutes of use of a quick relief inhaler.– B. Difficulty walking and talking due to shortness of
breath.
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Peak flow monitoring can be used for all of the following EXCEPT:
A. Short term monitoring.B. Managing exacerbations.C. Daily long-term monitoring.D. Diagnosing asthma.
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Best Answer:
D. Diagnosing asthma.
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Asthma Action Plans should be revised:
A. Whenever therapy is stepped up or down on a long-term basis.
B. When a patient who has adhered well to the plan has an exacerbation requiring oral steroids.
C. When a patient’s PEF/Personal Best is re-established.D. When a patient has not needed to use a short-acting
beta agonist reliever for 2 consecutive months.E. Both A and C.
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Best Answer:
E. Both A and C.– A. Whenever therapy is stepped up or down on a
long-term basis.– C. When a patient’s PEF/Personal Best is re-
established.
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A person with asthma has a predicted peak flow reading of 400L/min. Today the peak flow reading is 450L/min. Based on the predicted reading, what is the BEST interpretation of today’s peak flow?
A. Red zone.B. Yellow zone.C. Green zone.D. Personal best zone.
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Best Answer:
C. Green zone
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Case Study: Pedro, 23 y.o. male1. Break into groups and discuss Pedro case
study 2. Think about the Asthma Action Plan for Pedro,
and discuss: Controllers Relievers Environmental changes Monitoring Other
Case Study
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• RuthAnn Goradia, MSN, MPH, RN, AE-CAPS Chronic Health Needs Resource Nurse
• Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma – Pages 115-121– Pages 124-125– Pages 277-288
Acknowledgements
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We will breathe easier when the air in everyAmerican community is clean and healthy.
We will breathe easier when people are free from the addictivegrip of cigarettes and the debilitating effects of lung disease.
We will breathe easier when the air in our public spaces andworkplaces is clear of secondhand smoke.
We will breathe easier when children no longerbattle airborne poisons or fear an asthma attack.
Until then, we are fighting for air.