Transcript Quick Fixes for Poor Asthma Control

Quick Fixes for Poor Asthma
Control
Barbara Carroll Langham RN,BSN
Pediatric Asthma Care Manager
Kaiser Permanente
Simple mistakes can sabotage
asthma management.
Little details matter.
• Seems like a good asthma plan so why is
it not working?
• Investigate reasons for poor asthma
control prior to increasing dose of a
medication or adding another drug.
Three Groups of Patients with Poor
Asthma Control
• Patient/parent believes they are following
•
•
instructions for asthma management correctly
but they are not.
Patient/parent choosing nonadherance with
asthma medications and/or are not following
other medical advice. Refill history can help
identify this group.
Asthma in poor control despite good adherence
Working Toward Better
Asthma Control
• Accurate history and assessment
• Targeted education to rectify errors in
management
• Develop written asthma plan with input
from patient/parent
• Regular follow up
• Revise plan as needed
Obtaining Accurate Information
• Obtain refill history prior to appointment
if possible
• Try to mimic home conditions
• Instruct pt to bring in all meds,
equipment
• Provide atmosphere where pt is
comfortable telling the truth
Obtaining Accurate Information
• Accurate current list of medications
• Ask questions correctly: “How often do
you forget to take you meds?”
• Have patient/parent demonstrate how to
use medications/spacer
• Exposure to irritants?
• Address patient/parent concerns
Common Problems with Asthma
Management
• Confusion about medicines: controller
and symptom reliever
• Unsure when to start/stop,
increase/decrease medications
• Using clogged inhaler or one with
little/no medication
• Inadequate inhaler or spacer
technique or not using spacer
More Problems With Asthma
Management
• Used to poor asthma control, don’t
know symptoms can be prevented
• Failure to identify early asthma
symptoms and treat promptly
• Exposure to irritants
• Allergy symptoms are not being
treated
Solution:
• Identification of problems
• Targeted education
• Solutions to problems
• Ensure spacer, proper technique
• Written Asthma Action Plan
Patient/Parent Should Know:
• Onset of action and role of each
medicine; symptom reliever/controller
• Dose and frequency of drugs
• When to start/stop and step up/step
down meds
• When should inhaler be replaced?
• How to clean inhaler
Problems with HFA and DPI Meds
• Different meds have different priming
needs
• MDI can clog easily (ProAir)
• Need proper cleaning
• Need to be aware of and look at counter
• Need to count puffs: Qvar, ProAir,
Proventil
Spacer Use
• Not just for children
• Does patient have one?
• Appropriate spacer?
• Effective technique?
• Demonstration worth a thousand
words
Asthma Action Plan
• Road map for asthma management:
Keep it simple and personalize
• Explains: when and how to use meds:
step up/down; start /taper off meds
• Emphasizes early identification and
treatment of symptoms
• When to call for advice/help
• May be filled out in a few minutes
• Good teaching tool, good review
Websites for Asthma Action Plans
• http://www.calasthma.org/resources/show
_resource/1082/
• www.kp.org/asthma : Select Northern
California
Environmental Triggers: Irritants
• Smoking
• Second hand smoke
• Fireplace/woodstove use
• Incense
• Air fresheners /plug ins
• Strong smelling cleaning products:
ammonia is an asmagen
Keeping Asthma in Good Control
• Monitor albuterol and anti-inflammatory
medications refills
• Regular Follow Up
• Check technique at office visit
• Revise asthma plan as needed
Monitoring Albuterol Use
• Mind the albuterol and your are half
way there
• Most patients can get by with 2 to 4
canisters per year
• Check previous refill history
• Check refills of controller drugs
• Increased albuterol use= increased
chance of hospitalization/ER visit
Patient Reasons for Noncompliance
with Medication
• Doubt asthma diagnosis
• Cost of medications
• Safety concerns; steroid phobic
• Medication doesn’t work
• Believes medication only needed for
serious symptoms
The little details are important for
good asthma management.