Outcome Evaluation Chronic Asthma

• Assess the patient s inhaler technique frequently and always assess technique before stepping up therapy. Reeducate the patient on appropriate inhaler technique at every visit.

• Monitor symptoms such as wheezing, shortness of breath, chest tightness, cough, and nocturnal awakenings. Daytime symptoms should occur no more than twice a week, and nocturnal symptoms should occur no more than twice a month in adolescents and adults and no more than once a month in children younger than 12 years of age. Patients with more frequent symptoms should have their long-term control medications increased.

• In persons 12 years of age and older, monitor lung function. FEV1 or PEF should remain above 80% of predicted or personal best. Patients with PEF rates consistently greater than 80% over several months should be evaluated for a stepdown in long-term control therapy. Patients with a PEF less than 80% of personal best should begin to monitor PEF twice daily and consult their asthma action plan. Patients with a PEF less than 50% of personal best should immediately use their SABA and consult their asthma action plan.

• Monitor patient activity levels. Inability of a patient to perform routine physical activities indicates inappropriate therapy, and long-term control medications should be increased.

• In individuals 12 years of age and older, monitor asthma impairment using a validated questionnaire to ensure asthma is well controlled.

• Monitor frequency of patient exacerbations. Frequent exacerbations, unscheduled clinic visits, emergency department visits, and hospitalizations due to asthma may indicate a nonadherent patient or the need to step up long-term control medications.

• Monitor use of long-term control medications to ensure adherence. Reeducate nonadherent patients on the importance of these medications for asthma control.

• Monitor use of inhaled SABAs. Their use more than twice a week in intermittent asthma may indicate the need to initiate long-term control therapy. Use of more than one canister per month indicates the need to step up long-term control therapy.

• Monitor for adverse events from medications, including candidiasis and dysphonia from ICS.

• Monitor the patient's immunization status and provide an annual influenza vaccination if warranted.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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