Effective care of asthma requires comprehensive assessment, appropriate diagnosis using current criteria, development and implementation of a written plan of care, and evaluation of the client’s response to treatment.
As asthma increases in prevalence—and there are multiple factors including genetics, environmental triggers, and allergens that contribute to symptom severity—clinicians must maintain a high level of awareness in order to detect asthma and initiate treatment early to preserve client’s overall quality of life while preventing morbidity and mortality.
Knowing that asthma is an episodic disease, and that physical symptoms may vary dramatically with time, all members of the client’s healthcare team must remain alert to the possibility that mild but chronic symptoms that are being treated as viral, bacterial, or another type of illness may be masking what is, in fact, asthma.
In considering the diagnosis of asthma, it is important that the medical history include standard questions designed to identify factors that seem to exacerbate symptoms. When modifiable elements of the disease are found, the client needs appropriate education in order to decrease exposures that contribute to a decline in functional status. Even with the best management, however, exacerbations may occur. Early treatment remains the best management, with the client as an active participant. Written asthma action plans guide clients in decision making so that they become more confident and proficient in self-management strategies.
Asthma self-management begins at the time of diagnosis and continues through followup, involving all members of the healthcare team (eg, primary clinicians, office and inpatient nursing staff, respiratory therapists, pharmacists). The team approach in managing asthma should be uppermost whenever the asthmatic client is seen by any provider, should reinforce basic components of care, including medication, and should refer for followup care when needed.
Factors that promote partnership include establishment of open communication with the client and family and consideration of client or caretaker preferences in a comprehensive plan of care. Effective teaching strategies are tailored to meet cultural, ethnic, and health literacy variations that impact clients’ level of understanding. Using a comprehensive approach in detecting and managing asthma, with care delivered in the context of a therapeutic relationship, asthma can be managed in a way that improves symptom control and quality of life.
As advances in science lead to increased understanding of asthma, healthcare providers must bridge the gap between knowledge and practice. Clinicians who take personal responsibility for maintaining currency in their own level of expertise are well positioned to combat poor outcomes associated with this disease.