NAPNAP Revises Position Statement on Integration of Mental Health Care in Primary Care Settings
October 21, 2020 04:45pm
By Jill Murphy, Assistant Editor
Providing them with advice can improve control of the disease and reduce hospitalizations, morbidity, and unscheduled health care visits.
Asthma is a chronic disease that is commonly diagnosed and managed in primary-care settings. Yet, health care providers can develop partnerships with patients to provide education and skills for asthma self-management. This education includes an asthma action plan; monitoring of asthma symptoms and peak flow; a regular review of asthma control, medication use, and symptoms and skills training on the use of inhalers.1
Patients can learn to self-monitor asthma symptoms, such as cough, nocturnal awakenings, shortness of breath, wheezing, and triggers for asthma exacerbations. Asthma self-management can improve asthma control and reduce morbidity, hospitalizations, and unscheduled health care visits.1It also can provide patients with a better understanding of their asthma and empower them to control the disease.2
Common asthma triggers include cold weather, dust mites, high humidity, indoor allergens, tobacco smoke, and viral infections.2Daily asthma diaries can help patients identify and record core symptoms, limitations in activities because of asthma symptoms, peak flow measurements, triggers, and the use of asthma medications. The American Lung Association provides a brief description and video on how to use a peak flow meter.3Patients who use peak flow meters should compare all readings with their personal bests to help determine the severity of an asthma attack and the plan for management.
A written asthma action plan shows patients how to manage worsening asthma symptoms and diminished peak flow measurements. These plans also include how and when to access medical care, such as in a hospital or office setting. Many asthma action plans are color coded using green, red, and yellow, based on the level of symptom severity, peak flow, and response to relief medications. Several asthma action plan templates are available for patients with varying levels of health literacy. The CDC, for example, provides options for electronic, interactive, and printable versions of asthma action plans.4
An action plan for patients with exacerbations should include increasing the use of acute relief medications, such as short-acting beta2agonists, or daily controller medications, such as inhaled corticosteroids, as well as self-assessing response to relief medications. For patients with more severe attacks and symptoms that persist after the use of acute relief medications, the asthma action plan should include the addition of oral corticosteroids (ie, amount, duration, frequency) and immediate contact with their health care providers. In general, patients should follow up with their health care providers within 1 to 2 weeks after an asthma exacerbation.
Another component of asthma self-management is regular review with a health care provider. The reviews should address patient concerns and questions about inhaler techniques, medication use, and frequency. Identifying issues with medication costs and clarification to distinguish relief medications from controller medication use are essential. Adherence may be enhanced by simplifying the medication regimen (combination inhalers, oncedaily dosing), using cost-effective medications, and correcting or teaching inhaler techniques.5Patients can demonstrate how they use their inhalers to providers, which may identify and correct potential issues with techniques. The CDC provides written instructions and videos that demonstrate correct inhaler technique.6
Health care providers also can review a patient’s self-assessment of the frequency and severity of asthma symptoms and peak flow measurements and help identify triggers that may be avoidable. Patients’ reports of the frequency of relief medication use can identify a lack of asthma control and the need forcontroller medications. Review consultations should include updates of asthma action plans, including additions or changes to current medications.
Three core components of asthma self-management center on patient education and engagement. Patients can self-monitor asthma using daily symptom diaries to assess the level of asthma control. Asthma self-monitoring action plans provide guidance for patients to assess and respond to exacerbations. These plans are reviewed at regular health care provider visits. Medication use, including adherence, increasing use of relief medications, and technique, are also core components of follow-up visits. Effective and guided asthma self-management improves asthma control and reduces asthma-related morbidity.
Jennifer L. Hofmann, MS, PA-C, is a clinical associate professor and full-time faculty and pharmacology courses instructor at Pace University-Lenox Hill Hospital PA Program in New York, New York. She is also a PA Program adjunct professor for the Touro College School of Health Sciences in Bayshore, New York, and Nassau University Medical Center in East Meadow, New York. In addition, she is a Stony Brook University PA Program postprofessional clinical pharmacology seminar adjunct professor in New York.