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.

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