Take Action: 

Stop Asthma Today!

What You Can Do, NOW
Take Action: 

Stop Asthma Today!

What You Can Do, NOW

This action guide is brought to you by the National Asthma Control Initiative (NACI), a 

broad-scale initiative of the National Asthma Education and Prevention Program, coordinated 

by the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH),

Department of Health and Human Services.

NIH Publication 10-7542

September 2010
Who can make the difference between a life controlled by asthma, 

and a life where asthma is under control? 

YOU CAN, whoever you may be – 

a patient, health care provider, or other.

If you don’t have asthma, you might not think twice about walking up a flight of 

stairs or blowing out the candles on a birthday cake. 

But some 23 million Americans—one out of every 13 people—who have this serious 

and chronic, inflammatory disease of the airways not only have to think about simple 

actions like these—but are often unable to do them.

The good news is that with continuous, long-term care, most people can control 

their asthma and live their lives to the fullest. 

That’s where you can help, and this action guide can help you.

No matter who you are, what’s most important is your willingness to help. With 

everyone doing their part to follow the clinical guideline recommendations, we know 

we can bring about improvements in asthma control.

The National Heart, Lung, and Blood Institute of the National Institutes of Health 

has worked with our nation’s leading asthma experts to establish clinical guidelines 

for asthma care.

These guidelines include six priority action messages that WILL make a difference: 

1. Use inhaled corticosteroids as indicated by the guidelines.

2. Use written asthma action plans to guide patient self-management.

3. Assess asthma severity at the initial visit to determine initial treatment.

4. Assess and monitor asthma control and adjust treatment if needed.

5. Schedule follow-up visits at periodic intervals.

6. Act to control environmental exposures that worsen asthma.

You can use these messages to manage personal care (asthma patients); guide clinical 

decisions (health care professionals); improve asthma care knowledge and skills of 

constituents (professional associations, state health departments, local coalitions); 

or to craft specific policies, practices, and outreach activities that are relevant to your 

organization (administrators and staff at settings e.g., schools, work sites, health 

insurance agencies, etc).

Take Action: Stop 

Asthma Today!

2

FOR MORE INFORMATION ON THESE MESSAGES, GO TO: 

www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.htm. 
“I thought my asthma 

was under control... 

But I get winded after 

walking up a flight 

of stairs, so I have 

avoided taking the 

stairs for years. Now 

I know I need to go 

back to my doctor.”

Woman living with asthma

Table 1.

Graphic and Chart showing prevalence of asthma among different age groups and 

other data including annual number of emergency department visits, missed work 

days, missed school days, hospitalizations, physician office visits, and deaths.

3

 Asthma Prevalence by Age

 National Health Interview Survey, 2007

age group

percent

0

12

10

8

6

4

2

0-4 5-14 15-19 20-24 25-34 35-64 65+

6.8

9.4

10.8

7.8 7.4 6.9

7.5

Asthma’s Annual Toll

10.6 million

physician office visits 1.7million

emergency department

 visits 12.8 million

missed school days

10.1 million

missed work days

444,000

hospitalizations

3,613 deaths

$20.7

billion in direct 

and indirect costs 

If you are a patient, health care provider, or other, here are some actions that you can take:

What You Can Do, NOW
Take Action: Stop 

Asthma Today!

4

Patients and Families

• Visit your doctor regularly (at least every six months) if you have asthma, and work with 

him/her to develop a written asthma action plan that you can share with family members, 

school nurses, and other caregivers.

• Do what the doctor recommends, including taking medicines as prescribed; monitoring 

asthma on a regular basis; and avoiding known asthma triggers. Download or order 

NHLBI’s So You Have Asthma for a simple guide to keeping asthma under control at 

www.nhlbi.nih.gov/health/public/lung/asthma/have_asthma.htm.

For an asthma action plan and other useful tools and tips to help you manage asthma, visit the NACI Web site 

at naci.nhlbi.nih.gov and click on Patients, Families, and Caregivers
Health Care Professionals 5

• Make asthma self-management a priority for your patients, their families, and their caregivers. 

• Use written asthma action plans available at www.nhlbi.nih.gov/health/public/lung.

• Update your asthma encounter forms and flow sheets to reflect the six priority messages.

• Train staff on how to apply the asthma guidelines routinely in your practice setting. Many online 

training programs are available for all levels of medical professionals. One such program is the 

Physician Asthma Care Education (PACE) Program at www.nhlbi.nih.gov/health/prof/lung/asthma/

pace. This multimedia educational program trains physicians on how to use behavioral, educational 

and therapeutic techniques to reduce the effects of asthma on children and their families. It also 

includes tips on how to document and code asthma counseling for reimbursement. PACE has been 

shown to improve physician-patient communication and patient outcomes without extending time 

spent with the patient.

For more examples of actions you can take to improve asthma outcomes in your practice, visit the NACI Web 

site at naci.nhlbi.nih.gov and click on Health Care Professionals

What You Can Do, NOW
Take Action: Stop 

Asthma Today!

6

Health Care Professional 

Associations

• Introduce your members to the six priority messages for improved asthma care, control, and 

outcomes by adding information about them—and a link to the NACI—to your Web site; 

sending out information in your online and print publications; incorporating them into your 

professional education and training programs; and hosting sessions at your association 

meetings and conferences. 

• Engage your members in self-assessment and quality improvement activities that will sharpen 

their professional skills and improve their delivery of asthma care. Educational seminars such 

as the NHLBI’s Physician Asthma Care Education (PACE) Program are a great way to begin. 

PACE provides clinicians with educational strategies and tools for improving patients’ capacity 

for asthma self-management.

For more tools and tips to help you manage asthma, visit the NACI Web site at naci.nhlbi.nih.gov 
States, Communities, and Coalitions

• Know what is going on in your backyard: touch base with your health department to get local/state 

asthma statistics, monitor trends, assess which communities carry the greatest burden, and identify 

needs and areas for improvement. Use this information to reach out to legislators and others who 

influence public health policy.

• Schedule a strategy workshop with a broad spectrum of community members—include asthma 

experts; policy and other decision makers from the public and private sector; activists; people affected 

by the disease; and others. Draw on their expertise to align asthma management resources, policies, 

benefits packages, and care services with the six priority messages. 

• Learn which allergens and irritants can cause or worsen asthma, and then use that knowledge to 

improve the indoor and outdoor physical environments over which you have control, ranging from 

schools, offices, homes, places of worship and beyond.

To learn more about how to lift the asthma burden from your community, visit the NACI Web site at 

naci.nhlbi.nih.gov and click on States, Communities, and Coalitions

7

What You Can Do, NOW
Schools and Childcare Organizations

• Download and complete the NHLBI’s How Asthma-Friendly Is Your School? or How AsthmaFriendly Is Your Childcare Setting? checklist at www.nhlbi.nih.gov/health/prof/lung/index.htm

• Request a written asthma action plan for each child with asthma. Work with the child, family, 

health care provider, and other staff to help the child stick to the plan. A useful feedback tool 

is the NHLBI’s Is the Asthma Action Plan Working?—A Tool for School Nurse Assessment at 

www.nhlbi.nih.gov/health/prof/lung.

• Use the NHLBI’s Managing Asthma: A Guide for Schools to put together a comprehensive plan 

of your own to meet the needs of children with asthma, including training teachers and staff 

on how to recognize and respond to an asthma attack.

For more examples of actions and easy to use tools to improve asthma outcomes in your school, visit the NACI 

Web site at naci.nhlbi.nih.gov and click on Schools and Childcare Settings

Take Action: Stop 

Asthma Today!

8
Employers, Employees, and Work Sites 9

• Visit the Occupational Safety and Health Administration Web site for a wealth of information on 

asthma in the workplace, including potential hazards and how to avoid them and/or train workers 

to take precautions—such as using protective equipment—when they are unavoidable.

• When it comes to asthma triggers, a little common sense goes a long way: clean regularly to get rid 

of accumulated dust in carpeting and stored papers; ventilate to dilute indoor-air pollution that 

can build up from building materials and furnishings, cleaning agents, and copy machines; enforce 

smoke-free policies; and ask employees to avoid using perfumes and colognes if a coworker has asthma.

• If you are an employer, work with your human resources director to schedule an asthma presentation 

or training session at a staff meeting, brown bag lunch, or workplace health fair. 

Make your workplace a more productive place by leaving asthma at the doorstep using tips and tools on the 

NACI Web site at naci.nhlbi.nih.gov. Click on Employers, Employees, and Work Sites

What You Can Do, NOW
Take Action: Stop 

Asthma Today!

10

Public and Private Purchasers 

and Insurers

• Help your members, especially those at higher risk for poor asthma outcomes, improve 

control of their asthma symptoms and reduce asthma attacks through disease management 

programs that adhere to the six priority messages.

• Create mechanisms for ongoing monitoring and feedback of asthma care processes, quality, 

and outcomes, such as health plan report cards, consumer satisfaction surveys, provider 

performance profiles, and regular updates from asthma patient registries.

• Use clinical information systems, including electronic medical records and decision support 

programs, to enhance adherence to clinical practice guidelines.

Find additional guidance about how to reduce the financial burden of asthma on the NACI Web site 

at naci.nhlbi.nih.gov. Click on Public and Private Purchasers and Insurers
11

Summary of Priority Messages and the Underlying 

Clinical Recommendations

Message: Use Inhaled Corticosteroids

Inhaled corticosteriods are the most effective medications 

for long-term management of persistent asthma, 

and should be used by patients and clinicians as 

recommended in the guidelines for control of asthma.

Recommendation: The Expert Panel recommends that 

long-term control medications be taken on a long-term 

basis to achieve and maintain control of persistent 

asthma, and that inhaled corticosteroids are the most 

potent and consistently effective long-term control 

medication for asthma (Evidence A).

Message: Use Asthma Action Plans 

All people who have asthma should receive a written 

asthma action plan to guide their self-management 

efforts.

Recommendation: The Expert Panel recommends 

that all patients who have asthma be provided a 

written asthma action plan that includes instructions 

for: (1) daily treatment (including medications and 

environmental controls), and (2) how to recognize 

and handle worsening asthma (Evidence B).

Message: Assess Asthma Severity 

All patients should have an initial severity assessment 

based on measures of current impairment and future 

risk in order to determine type and level of initial 

therapy needed.

Recommendation: The Expert Panel recommends that 

once a diagnosis of asthma is made, clinicians classify 

asthma severity using the domains of current impairment 

(Evidence B) and future risk (Evidence C, D) for guiding 

decisions in selecting initial therapy.

Note: While there is not strong evidence from clinical 

trials for determining therapy based on the domain of 

future risk, the Expert Panel considers that this is an 

important domain for clinicians to consider due to the 

strong association between history of exacerbations 

and the risk for future exacerbations.

Message: Assess and Monitor Asthma Control 

At planned follow-up visits, asthma patients should

review their level of control with their health care provider 

based on multiple measures of current impairment and 

future risk in order to guide clinician decisions to either 

maintain or adjust therapy.

Recommendation: The Expert Panel recommends that 

every patient who has asthma be taught to recognize 

symptom patterns and/or Peak Expiratory Flow measures that indicate inadequate asthma control and the 

need for additional therapy (Evidence A), and that control 

be routinely monitored to assess whether the goals of 

therapy are being met–that is, whether impairment and 

risk are reduced (Evidence B).

Message: Schedule Follow-up Visits 

Patients who have asthma should be scheduled for 

planned follow-up visits at periodic intervals in order 

to assess their asthma control and modify treatment 

if needed.

Recommendation: The Expert Panel recommends that 

monitoring and follow-up is essential (Evidence B), 

and that the stepwise approach to therapy–in which 

the dose and number of medications and frequency 

of administration are increased as necessary (Evidence A) 

and decreased when possible (Evidence C, D)–be used 

to achieve and maintain asthma control.

Message: Control Environmental Exposures

Clinicians should review each patient’s exposure to 

allergens and irritants and provide a multipronged strategy to reduce exposure to those allergens and irritants 

to which a patient is sensitive and exposed, i.e., that make 

the patient’s asthma worse.

Recommendation: The Expert Panel recommends that 

patients who have asthma at any level of severity 

be queried about exposure to inhalant allergens, 

particularly indoor inhalant allergens (Evidence A) and 

tobacco smoke and other irritants (Evidence C), and 

be advised as to their potential effect on the patient’s 

asthma. The Expert Panel recommends that allergen 

avoidance requires a multifaceted, comprehensive 

approach that focuses on the allergens and irritants to 

which the patient is senstitive and exposed–individual 

steps alone are generally ineffective (Evidence A).

RESOURCES:

Expert Panel Report 3—Guidelines for the Diagnosis and Management of Asthma: www.nhlbi.nih.gov/guidelines/asthma

Guidelines Implementation Panel Report: www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.htm

Asthma public education materials: www.nhlbi.nih.gov/health/public/lung/index.htm

What You Can Do, NOW
Help make life livable for someone with asthma—

Take action TODAY!

The National Asthma Control Initiative (NACI) is working to improve asthma control and to reduce 

health-related asthma disparities by putting science-based asthma guidelines into action—at 

home, at work, and in the community. To do this, the NACI is bringing together organizations from 

local, state, regional, and national levels so that they can share best practices, pool and direct 

resources, and identify new directions and learning opportunities. 

TO READ ABOUT THE INITIATIVE VISIT: naci.nhlbi.nih.gov

Also, while on the NACI Web site, make sure to sign up for the NACI In the Know eNewsletter for 

quarterly updates on the latest asthma-related news and resources.

Take Action: Stop 

Asthma Today!

12

“The goal of asthma therapy is to control 

asthma so that patients can live active, full 

lives while minimizing their risk of asthma 

exacerbations and other problems.” 

WILLIAM W. BUSSE, M.D. 

Chair, Third Expert Panel on the Diagnosis 

and Management of Asthma

University of Wisconsin Medical School
NAEPP Coordinating Committee Members

Agency for Healthcare Research and Quality

Allergy & Asthma Network Mothers 

of Asthmatics

American Academy of Allergy, Asthma, 

and Immunology

American Academy of Family Physicians

American Academy of Pediatrics

American Academy of Physician Assistants

American Association for Respiratory Care

American College of Allergy, Asthma, 

and Immunology

American College of Chest Physicians

American College of Emergency Physicians

American College of Physicians

American Lung Association

American Medical Association

American Pharmacists Association

American Public Health Association

American School Health Association

American Society of Health-System Pharmacists

American Thoracic Society

Asthma and Allergy Foundation of America

Council of State and Territorial Epidemiologists

National Association of Pediatric Nurse 

Practitioners

National Association of School Nurses

National Center for Chronic Disease 

Prevention and Health Promotion, CDC

National Center for Environmental Health, CDC

National Center for Health Statistics, CDC

National Environmental Education Foundation

National Heart, Lung, and Blood Institute, NIH

National Heart, Lung, and Blood Institute, 

Ad Hoc Committee on Minority Populations, NIH

National Institute for Occupational Safety 

and Health, CDC

National Institute of Allergy and Infectious 

Diseases, NIH

National Institute of Environmental Health 

Sciences, NIH

National Institute of Nursing Research, NIH

National Medical Association

National Respiratory Training Center

Society for Academic Emergency Medicine

Society for Public Health Education

U.S. Department of Education

U.S. Environmental Protection Agency, HHS

U.S. Food and Drug Administration, HHS

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Publication Number 10-7542

September 2010