# Presentation: 107137

## Managing Asthma:Asthma Management Goals

**Control symptoms**
**Prevent exacerbation**
**Maintain lung function as close to normal as possible**
**Avoid adverse effects from medications**
**Prevent irreversible airway obstruction**
**Prevent asthma mortality**

**Notes:**
Treating some diseases by taking a pill once a day may be sufficient.  Asthma is much more complex to treat.  Asthma must be managed in a comprehensive fashion.  The goals of a successful asthma management program are to:
Achieve and maintain control of symptoms
Prevent asthma exacerbation
Maintain pulmonary function as close to normal levels as
 possible
Avoid adverse effects from asthma medications
Prevent irreversible airway obstruction, and
Prevent death from asthma.
Proper case management should avert many emergency visits and hospital stays as well as much of  the anxiety associated with asthma.  Education is the key, not only for people with asthma, but also for their families and care givers and for physicians and researchers. 	

## Managing Asthma:Asthma Management Plan

** ****Develop with a physician**
** ****Tailor to meet individual needs**
** ****Educate patients and families on all ****	****aspects of the plan**
**	****Recognizing symptoms**
**	****Medication benefits and side ****	****	****	****	****	****	****effects**
**	****Proper use of inhalers and peak ****	****	****	****	****expiratory flow (PEF) meters**

**Notes:**
Individual management plans should be developed with a physician.  Different people have different requirements and specific triggers that initiate their attacks and need to be avoided.  The management plan should be guided by the severity of the person’s asthma, the benefits and risks of each treatment, and the availability of the various forms of treatment. Routine follow-up care is an integral part of good management.  As people with asthma grow and change, their asthma also changes, and their management plan needs to address those changes.  An asthma management plan should serve as a communications tool between the physician, the person with asthma, and his or her family.

Educating people with asthma is crucial to the success of any management plan.  Patients may be reluctant to continue taking prescribed medicines simply because they do not understand that the medications are not addictive---a common fear that often is not addressed.  People with asthma also need to understand the correct way to inhale their medications and to monitor lung function with peak flow meters.  In addition, these individuals and their families need to know what actions to take if they are faced with an asthma emergency.  A well-thought-out management plan, discussed during routine health-care visits, will address these concerns.

## Managing Asthma:Sample Asthma Management Plan

- National Heart, Lung, and Blood Institute

**Describes what medicines to use and actions to take**

**Notes:**
An asthma management plan like the one shown here helps people with asthma determine what medicines to use and what actions to take in particular situations.   If they are breathing well, have no cough or wheeze, and have no trouble at work or play, they are in the green zone.  Green means go and to continue to use preventive medicines.  If they experience a cough, wheeze, or tight chest or wake up at night, they are in the yellow zone and should take caution and administer the quick-relief medication.  If the medicine has no effect or they are experiencing trouble breathing, they are in the red, danger zone and should get medical assistance. 

A key indicator as to a person’s overall respiratory wellness is his or her peak flow number.  This is determined by using a peak expiratory flow(PEF) meter, a device which measures how well air moves out of the lungs.

## Managing Asthma:Peak Expiratory Flow (PEF) Meters

**Allows the patient to assess the status of his or her asthma**

- Use of trade names does not reflect
- endorsement of these products

**Notes:**
These are peak expiratory flow meters.  PEF meters come in different styles, but they all measure the amount of air a person can blow out in liters per minute. You set the indicator to zero, take a deep breath, put your lips around the mouthpiece and exhale as hard and fast as you can.  Then you read the number on the scale.

The proper use of PEF meters can help predict asthma episodes and monitor response to therapy.  The goal is to monitor the airflow consistently to recognize any changes from normal.  People with asthma need to know how and when to use the PEF meter and how to record the results.

## Managing Asthma:Peak Flow Chart

**People with moderate or severe asthma should take readings****—**
** ****Every morning ****	****and evening**
** ****After an ****	****exacerbation**
** ****Before inhaling ****	****certain ****	****medications**

- Source: “What You and Your Family Can Do About Asthma” by the Global Initiative For Asthma
- Created and funded by NIH/NHLBI

**Notes:**
This is an example of a peak flow chart.  The chart can help display a person’s personal control zone, caution zone, and danger zone.  People with moderate persistent or severe persistent asthma should take peak flow readings and record them every morning and evening and before inhaling certain medications.  A person also should take a peak flow reading when he or she has symptoms to determine the severity of the episode and monitor the response to therapy.

## Managing Asthma:Indications of a Severe Attack

**Breathless at rest**
**Hunched forward**
**Talking in words rather than sentences**
**Agitated**
**Peak flow rate is less than 60% of normal**

**Notes:**
An attack can worsen over minutes, hours, or even days.  Recognition and proper treatment of an attack can prevent discomfort, and in some cases, emergency care and hospitalization.  In an attack, symptoms should be listed and the peak expiratory flow (PEF) rate determined.  If a person’s PEF is below his or her green zone despite increased medication, the attack may be worsening.  The attack also may be worsening if the person needs more quick-relief medication or feels that the medication is not helping as much as it usually does.
A mild attack usually can be treated at home with quick-relief bronchodilator medication.  A patient’s individual management plan should provide the physician and patient with a guideline to follow, including prescription medication that may require consistent use for several days to improve the symptoms of the attack.  A moderate attack may require a physician visit or hospital care.  Patients who do not respond promptly to the medication or who have the symptoms listed here need emergency care.  

## Managing Asthma:Things You Can Do

**Have an individual management plan**
**Educate yourself and others about****—**
**Asthma management plans**
**Environmental interventions**
**Seek help from asthma resources**
**Join an asthma support group**

**Notes:**
An effective management plan for asthma requires avoiding the things that cause attacks and taking the appropriate medications to prevent symptoms.  A physician-patient partnership in which asthma is continually controlled and monitored is essential to a successful plan.  

Educating people with asthma and parents of children with asthma is a major part of controlling the disease.  Many people already are aware of the benefit of asthma management; they just need to know how to better participate in their own care.  Many things can be done to promote better care for people with asthma.  For example, existing asthma resources can be used to help teach the benefits of proper asthma management.  Forming asthma support groups at local schools is a good way to reach children with asthma.  Groups such as the Asthma and Allergy Foundation of America; Allergy and Asthma Network, Mothers of Asthmatics; and the American Lung Association are willing to share their experience and information with those interested in starting an asthma support group.