Professional Documents
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Medical Director
Laguna Beach Community Clinic
Declaration of Interest
Dr. Bent declares that he is not a member
of an advisory board or speakers’ panel for
any pharmaceutical company.
Learning Objectives
• Understand the 10 Key Clinical Activities
for Quality Asthma Care
• Manage Asthma with a step-wise
approach
• Educate patients in self-monitoring and
self-management
Burden of Suffering
• 15 Million Americans with Asthma
• 5000 Deaths per year
• 500,000 Hospitalizations per year
• 2,000,000 ER visits per year
• Cost of Care: $6 Billion
Definition of Asthma
• Chronic inflammatory disorder of the airways in
which many cells and cellular elements play a role,
in particular, mast cells, eosinophils, T lymphocytes,
neutrophils,and epithelial cells.
• Recurrent episodes of wheezing, breathlessness, chest
tightness, and cough.
• Reversible airflow obstruction, either spontaneously
or with treatment.
• Increased bronchial hyperresponsiveness to a
variety of stimuli.
Information Taken From
National Asthma Education and Prevention Program (NAEPP). Expert Panel Report
2: Guidelines for the Diagnosis and Management of Asthma. National Heart, Lung,
and Blood Institute (NHLBI), National Institutes of Health (NIH). April 1997.
Components of Asthma
• Reversible Airway Obstruction
• Airway Hyper reactivity
• Airway Inflammation
Airway Pathology in Asthma
Permissions for this slide not granted.
Role of Inflammation and
Bronchoconstriction in Asthma
Permissions for this slide not granted.
Key Clinical Activity 1:
Establish Asthma Diagnosis
• History
• Physical Exam
• Spirometry
Or
Name_________________________________Chart #__________DOB____/____/____
Diagnoses 1___________________2__________________3__________________
Date / / / / / / / / / /
Peak Flow
Rescue MDI&Freq
Albuterol
Asthma Severity
COPD/History
PreventiveMDI/MEDS
ICS
LA BetaAg
Leukot. Inhib
MC Stabilizers
SA BetaAg
Oral Steroids
Theophylline
Antihistamines
Flu Vaccine
PT Monitor Peak Flow
Tobacco ETS
Tobacco Use/Smoke
Best PEFR
Lost Days (30)
SymptomFreeDays (14)
Acute Asthma Educ
Asthma Plan
Self Management Goal
Triggers
Asthmatic Educ. Appt.
Smoking Avoidance
Counseling
PT. Demonstrated
Proper Use of MDI
TX Plan Reviewed
Environmental
Guideline Given
Asthma Mild Intermit SX<2X/WK________ Mild Persistent SX>2X/WK BUT NOT EVERY DAY_________
Severity Mod Persistent DAILY SX________ Sever Persistent CONTINUAL SYMP / FEV < 60%____________
Criteria
ED Visits Within 6 months ____ ____ ____ ____ Hospitalization_____ _____ Intubation______
Pneumonia Vaccine ____ ____ ____ ____ Initial CXR______2nd______ Initial PPD____
Summary
• Step wise approach is meant to assist, not
replace, clinical decision making required to
meet individual patient needs
• Classify severity
• Gain control quickly
• Minimize use of short acting beta agonists
• Provide education on self management and
environmental control
Thank You!