Asthma Action Plan—Adult 20 Figure 6. Sample Asthma Action Plan—Child 21 Figure 7. … Thomas J. Kallstrom, R.R.T., F.A.A.R.C., AE-C American College of Allergy, Asthma, and Immunology … List of Boxes and Figures Figure 1. Summary ofRecommended Key Clinical Activities for the Diagnosis and Management ofAsthma 4 Figure 2. The Interplay and Interaction Between Airway Inflammation and the Clinical Symptoms and Pathophysiology ofAsthma 9 Figure 3. Suggested Items for Medical History* 13 Figure 4. Sample Patient Self-Assessment Sheet …

3 Introduction New emphasis on multifaceted approaches to patient education and to the control of environmental factors or comorbid conditions that affect asthma. ? Patient education for a partnership is encouraged in expanded settings. —Patient education should occur at all points of care: clinic settings (offering separate self-management programs as well as integrating education into every patient visit), Emergency Departments (EDs) and hospitals, pharmacies, schools and other community settings, and patients’ homes. —Provider education should encourage clinician and health care systems support of the partnership (e.g., through interactive continuing medical education, communication skills training, clinical pathways, and information system supports for clinical decisionmaking. ? Environmental control includes several strategies: —Multifaceted approaches to reduce exposures are necessary; single interventions are generally ineffective. —Consideration of subcutaneous immunotherapy for patients who have allergies at steps 2-4 of care (mild or moderate persistent asthma) when there is a clear relationship between symptoms and exposure to an allergen to which the patient is sensitive. Clinicians should be prepared to treat anaphylaxis that may occur. —Potential benefits to asthma control by treating comorbid conditions that affect asthma. Modifications to treatment strategies for managing asthma exacerbations. These changes: ? Simplify the classification of severity of exacerbations. For the urgent or emergency care setting: <40 percent predicted forced expiratoryvolume in 1 second (FEV 1 ) or peak expiratoryflow (PEF) indicates severe exacerbation and potential benefit from use of adjunctive therapies; ?70 percent predicted FEV 1 or PEF is a goal for discharge from the emergency care setting. ? Encourage development of prehospital protocols for emergency medical services to allow administration of albuterol, oxygen, and, with medical oversight, anticholinergics and oral systemic corticosteroids. ? Modify recommendations on medications: —Add levalbuterol. —Add magnesium sulfate or heliox for severe exacerbations unresponsive to initial treatments. —Emphasize use of oral corticosteroids. Doubling the dose of ICS for home management is not effective. —Emphasize that anticholinergics are used in emergency care, not hospital care. —Add consideration of initiating ICS at discharge.

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