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Asthma - Extended version

Objectives:

  1. Develop an understanding of the pathogenesis and diagnosis of asthma
  2. Develop a differential diagnosis for wheeze and cough in early childhood. Understand the relationship between early childhood wheezing, chronic cough and asthma
  3. Understand the National Asthma Education and Prevention Program (NAEPP) and Global Initiative for Asthma (GINA) guidelines and review recent updates in clinical management
  4. Understand treatment options including anti-inflammatory “controller” medications and rescue medications, including methods of medication delivery and treatment side effects
  5. Recognize common asthma triggers and learn how to manage environmental factors
  6. Review management of asthma exacerbations and the rationale for institutional protocols
  7. Recognize different asthma phenotypes in childhood
  8. Know how to evaluate sports performance and the management of exercise-induced bronchoconstriction
  9. Understand how biologic therapies are included in the pathway of treatment
  10. Review the current understanding of how COVID-19 infection affects asthma
  11. Recognize the determinants of health in patients with asthma

Articles:

Additional Resources:

  • Handy Asthma Care Guide developed by Dr. Dy and updated intermittently by our pulm team
  • The GINA Pocket guide provides an in-depth view into the diagnosis and management of asthma. It is a very useful read to understand the rationale for treatment options, including a discussion on new asthma guidelines recommending ICS-formoterol as Step 1 therapy.  The guide also includes a glossary of all medication classes, when to consider using each and the potential adverse effects.  These guidelines differ somewhat from the NAEPP guidelines, mainly in terms of the use of ICS-LABAs for patients with mild disease.  [Objectives 3,4]
  • NAEPP asthma guidelines provide excellent tables on classifying asthma severity. Also included is a useful table with common outpatient medications and appropriate dosages by age. These guidelines differ somewhat from the GINA guidelines, mainly in terms of the use of ICS-LABAs for patients with mild disease.  [Objectives 3,4]
  • Clinical pathways improve outcomes for patients who need to be managed acutely for asthma exacerbations. A clinical pathway is a treatment protocol that aims to ensure that all patients receive standard, guidelines-based treatment, improve outcomes, and reduce costs.  Here is an example of a Pediatric ED clinical pathway for an asthma exacerbation and an inpatient clinical pathway.  [Objective 6]
  • An asthma action plan provides patients with clear information about the use of their medicines, the actions they are to take at home for asthma attacks, and either the degree of symptoms and/or the actual peak flow measurements that they should use as a guide. Please be sure to make them in Epic for our patients![Objective 4]
  • Videos demonstrating how to use asthma devices: [Objective 4]
  • The American Thoracic Society has published guidelines on the management of persistent or recurrent wheezing in infants. The paper poses a series of questions representing common clinical scenarios with responses to each question.  [Objective 2]
  • Basic book chapter written by Dr. Miles Weinberger which is helpful for understanding the epidemiology and natural history of asthma in preschool children. The chapter also addresses other causes of wheezing and cough in early childhood and how to differentiate them from asthma.  [Objectives 1,2]
  • Pictorial of all inhalers from the Allergy & Asthma Network – Mother of Asthmatics from 2013 [Objective 4]
  • Commentary on the pros and cons of breath-actuated inhalers [Objective 4]
  • The IMPACT DC (Improving Pediatric Asthma Care in the District of Columbia) program has a number of family friendly educational videos. [Objective 4]
  • Link to additional family education resources developed by Boston Children’s Hospital [Objective 4]