1. The target population for this asthma education and self-management program is low-income inner-city patients with uncontrolled mild persistent to severe persistent asthma.
2. An initial assessment would be done to verify the referring physician made an accurate diagnosis of asthma and to establish the severity of the disease. During this assessment, the patient will undergo PFTs pre and post bronchodilators and peak flow monitoring. Additional information would be obtained from the patient including the following:
History of asthma exacerbations and hospitalizations
Current medications, dosages, and frequencies
Adherence to current therapy
Frequency of rescue inhaler use
History of adverse reactions to asthma medications
History of absenteeism from work or school
Ability to recognize asthma triggers and symptoms
History of smoking
Knowledge of environmental allergy sensitivities and/or previous allergy testing
Current methods of asthma self-management
Knowledge and use of home peak flow monitoring
Knowledge and use of an asthma action plan
Current perception of quality of life and functional status
Anticipated outcomes of this program
3. To qualify for program entry, patients must be referred by a physician and have been diagnosed with mild persistent, moderate intermittent to persistent, or severe intermittent to persistent asthma. Patients must have a history of exacerbations refractory to daily use of inhaled corticosteroids and frequent use of short-acting beta agonists (frequent use is defined by use > 2 days per week). Patients excluded from program enrollment would be those with concomitant irreversible lung disease such as cystic fibrosis, pulmonary fibrosis, and pulmonary alveolar proteinosis. Other exclusions would include active pulmonary infection, untreated lung cancer, end-stage emphysema, and psychosocial disorders interfering with the patient’s ability to adhere to the program.
4. This program would be offered in an outpatient setting. To participate in this type of program the patient’s asthma would need to be relatively stable. The patient must be able to undergo testing as described above with the initial assessment and with subsequent monitoring. This would not be possible in an inpatient setting in which the patient is having an acute asthma exacerbation. Additionally, to achieve the best asthma control and medication adherence, patients need to be managed in a setting that is conducive to long term monitoring. The outpatient setting will allow patients to develop a report with their caregivers. This will enable us to tailor interventions to patient-specific risks and give patients confidence in our approach to managing their disease. Lastly, given this is a physician-referred outpatient program, the objective is receive a body of patients that have been prescreened and can potentially produce outcomes that are aligned with the goals of the program.
5. Interventions used in the program would include the following:
Home asthma management and symptom monitoring
a. Proper use of peak flow meter and interpretation of the results.
b. Trigger and symptom recognition.
c. Use of an asthma action plan.
d. Environmental control for trigger and symptom reduction.
e. Use of a daily journal to track peak flows, use of rescue inhalers, and symptom triggers.
Patient-specific medication administration
a. Administer or adjust inhaled corticosteroids
b. Administer or adjust long term beta agonists
c. Consideration of inhaled leukotriene receptor antagonist and/or anticholinergics.
d. Consideration of oral systemic corticosteroids.
e. Reduced use of sort acting beta agonists/ rescue inhalers.
Management of comorbidities (if necessary)
a. Provide smoking cessation information.
b. Refer for weight management services.
c. Refer to
