Eleven ways to start educating patients, parents, and
physicians about asthma
Asthma has reached epidemic proportions in the United
States with 17 million people suffering from the condition.
While progress in alleviating the symptoms and treating the
disease pharmaceutically has progressed dramatically, patient
education has often been given inadequate attention. Speaking
at a recent Asthma Summit, sponsored by the American Lung
Association of Colorado, keynote speaker Jura Scharf of the
Chicago Asthma Consortium said, “Effective asthma management
is 10% medication and 90% education.” Hospitals and insurance
carriers are now learning that the cost of not providing
adequate asthma education can be staggering.
Specialized training and experience in treating asthmatics
on the front lines have made RCPs uniquely qualified to
provide asthma education at the bedside, at home, and in the
classroom. However, it is often incumbent on RCPs to
capitalize on opportunities that are available or to create
opportunities themselves. This how-to guide describes 11 ways
to get started educating patients about asthma.
Create a Bedside Asthma Education Kit
patient in room 3091 is being discharged from the hospital
within the hour. The physician has written an order for the
patient to be “instructed in the use of a spacer with
inhaler.” The patient has not yet received an inhaler from the
pharmacy, the parents are anxious to get home, and there are
two new treatments to start down the hall.
Does this sound familiar? Having the right tools prepared
ahead of time and located within easy reach can go a long way
toward providing your patient with well-prepared and
meaningful instruction even under the pressures typical of a
busy hospital setting.
A plastic shoe box is all it takes to start your bedside
education tool kit. Make a label to identify its purpose and
include a contents list so that it can be restocked as
A bedside asthma education kit might include:
• a sample spacer for demonstration;
• a sample peak flow meter;
• instructional flyers and
brochures that the patient can take home;
• flip charts
and visual aids;
• a list of local resources including any
asthma support groups that are available in your area;
• a referral form for your community’s asthma education
program, if available.
Always have the patient demonstrate the ability to use his
inhaler, spacer, and peak flow meter without assistance.
Pharmaceutical companies have excellent support materials
including instructional flyers, full-color flip charts, and
three-dimensional models that will dramatically improve your
ability to create an effective presentation. Pharmaceutical
sales representatives are typically very generous in providing
these materials for free.
A respiratory department in-service is an excellent
opportunity to introduce your asthma instruction kit to the
staff and to agree on a convenient location for storing and
stocking it. As respiratory therapists, we assume that all
staff are familiar with the correct use and cleaning routines
of inhalers, spacers, and peak flow meters, but that is not
always the case.1 And knowing how to use the
materials is only one of the skills necessary to provide an
effective teaching session for patients. A role-playing
session at a department meeting is a good opportunity to
practice so clinicians do not have to “wing it” at the
To provide an effective bedside teaching experience for the
patient, try to create an atmosphere conducive to teaching.
Let nurses know that you will be spending the next few minutes
instructing the patient, and hopefully they will try to
respect your time together. Turn off the television set and
partially close the door to minimize noise and distractions.
An outline or checklist can be a handy tool to make sure
you cover all the points and proceed in a logical manner.
Often the patient handout or brochure from your instruction
kit will serve this purpose.
It is never safe to assume that physicians have talked with
patients about the nature of their condition and their plan of
treatment in terms the patient can understand. These topics
should be discussed in addition to instructing the patient on
proper technique for using and cleaning the inhaler, spacer,
and peak flow meter. Never consider an inhaler instruction
session complete unless the patient can tell you the purpose
and frequency of use for each medication. Always ask the
family if they have any questions, and let them know where
they should call if they have questions later.
Support a Support Group
groups can be highly effective in bringing families with
asthma together with experts who can help them. It is
reasonable to have asthma specialists present talks aimed at
the layperson and addressing topics such as “Back to School
with Allergies” or to provide free pulmonary function testing
screens at local shopping malls.
Cindy Coopersmith, RRT, chairperson of PA/AC (Parents of
Allergic/Asthmatic Children), Fort Collins, Colo, says, “One
of our most popular events is called ‘Surviving the Holidays
With Allergies.’ Each member of our group prepares a different
allergen-free dish and a local health-food grocer provides a
turkey. This year we had two asthma and allergy specialists
present a brief lecture and answer questions. As a bonus, we
provided recipes for all the dishes we prepared. It was a lot
of work, but it was also a lot of fun and really made a
One of the unmet
challenges facing the health care community is bringing
service providers and patients together. Often there are
abundant resources that are underutilized because people (both
within and without the health care system) simply do not know
about them. One of the things you can do to make a difference
is to assemble a comprehensive listing of services available
in your community. This would include:
service organizations such as the American Lung Association;
• community support groups such as Allergy and Asthma
Network-Mothers of Asthmatics Inc (AAN-MA) or the Asthma and
Allergy Foundation of America;
• a listing of the asthma
specialists in your area; and
• asthma education programs
available in your community.
Be sure to include current addresses, phone numbers, and,
when possible, the name of the appropriate contact person for
each resource. Brochures or flyers can often be assembled
in-house very economically and can be distributed to every
asthma patient with whom you have contact. In many cases you
can simply gather existing promotional material from the
organizations that service your community and assemble them
into folders or packets.
Provide Asthma Treatment and
Working in a physician’s office with
pulmonary or asthma specialists is a real alternative to life
within the local hospital. The nationwide nursing shortage
combined with RCPs’ unique education, experience, and
skill-set makes employing RCPs in medical practices more
attractive than ever. Many physicians are finding that it is
often easier to train RCPs in the nursing skills needed at the
practice than it is to teach nurses the respiratory skills
required for performing pulmonary function tests and other
procedures in an optimal manner.
Because RCPs are working directly under the supervision of
the medical practice, it is possible for them to perform
procedures (such as starting IVs) that are commonly performed
by nurses in the hospital setting.
The physician’s office presents a unique opportunity to
impact the patient with direct physician support and
leadership. RCPs can provide their asthma patients with
comprehensive educational materials, take the time to answer
their questions, and work as a team with the physician’s
guidance and support.
RCPs have been an essential
component of effective home management of respiratory disease
for decades, but their function is often poorly understood by
insurance carriers who see home care as an equipment-driven
rather than a service-driven business. Insurance groups still
fail to reimburse for the RCPs’ services and time.
Because of the competitive nature of the home care
business, home oxygen and respiratory equipment providers have
been motivated to provide the kind of education and
troubleshooting assistance that only an RCP can deliver.
Hopefully, referral sources will continue to favor home
respiratory equipment providers who utilize RCPs to provide
direct service to patients. Economic pressures in the industry
have encouraged many companies to use RCPs primarily for
marketing and management. Day-to-day patient visits are
increasingly delegated to underqualified individuals with no
formal training in respiratory care.
If you are in a position to assist patients in choosing a
home care company, always consider the advantages of relying
on a company that utilizes RCPs to provide patients with
direct clinical support. A home care therapist can provide
patients with competent instructions about both their
equipment and their condition. An RCP can answer individual
questions and will know when to notify a physician when a
patient is not compliant or responsive to home treatment.
Many home care companies have developed their own asthma
education protocols and support materials. Home care RCPs can
take the time to properly instruct patients in the use of
nebulizers, inhalers, spacers, and peak flow meters. RCPs in
the home care setting are also in a unique position to observe
the patient’s environment. They can work with the family to
become aware of aggravating triggers such as environmental
tobacco smoke, pets, and dirty carpets. Obviously, discretion
and judgment are required when addressing these issues, but an
experienced home care RCP is in an optimal position to
directly and positively affect the asthmatic patient in his
Hospital systems and
insurance carriers have been slow to respond to the need for
comprehensive asthma education, perhaps because our system of
reimbursement is driven by equipment and procedures. However,
they are learning that failing to provide asthma education is
costly and they can ill afford not to offer the service.
Consequently, asthma education programs and asthma clinics are
beginning to come into vogue and are proving their worth by
reducing asthma-related emergency department (ED) visits and
Childrens Hospital, Denver, recently launched an asthma
education clinic that is offered to outpatients 3 days per
week. It is staffed by an RCP, a nurse practitioner, and a
pulmonologist or allergist. “We interact with patients
one-on-one,” says Shirley McKinzie, PNP, “and the program is
customized to the individual patient’s needs.” RCPs play a key
role in providing the patient with instruction in the correct
use of spacers and peak flow meters, and explaining the
patient’s individual action plan. Environmental factors and
behavior modification issues are also emphasized.
Asthma education programs are often funded by the hospital
or insurance carriers who have done the math and learned that
failing to provide adequate asthma education is a costly
Put out the Fire
RCPs are well aware of
the connection between smoking and asthma. “In 1997, the
American Academy of Pediatrics issued the policy statement on
Environmental Tobacco Smoke (ETS): A Hazard to Children. The
paper points to strong evidence that exposure of children to
environmental tobacco smoke is associated with increased rates
of lower respiratory illness, asthma, and sudden infant death
syndrome, and may also be associated with development of
cancer in adulthood.”6
It is important not to let the magnitude of the problem
foster complacence. It is easy to assume that patients
understand the connection between smoking and asthma, but that
is never a safe assumption.
Sally Wenzel, MD, codirector of the Clinical Research Unit
at National Jewish Medical and Research Center, Denver, says
“Tobacco smoke, especially in the first 2 years of life and in
utero, is a significant causative factor for asthma and
decreased exposure to environmental tobacco smoke decreases
asthma symptoms.” She adds that “limiting exposure to ETS is
probably one of the most important things we can do.”
Asthma patients and their families need to hear this
message from RCPs. And if they continue to expose asthmatics
to ETS, they need to hear the message again and again. RCPs
can address the issue in the ED, at the bedside, in the
physician office, and in the home care setting.
Beyond the Ed
The ED rarely provides an
optimal environment for asthma education, but it sometimes
offers the only opportunity we will have to impact the
patient. RCPs can take the next step toward upgrading the
service patients receive in the ED by creating an asthma
information folder to be given to each asthma patient when
admitted. It can include:
• a brochure or flyer that
connects the patient to community resources; and
instructions for using spacers and peak flow meters.
It is important for patients to know how to use a peak flow
meter before leaving the ED. Most patients admitted to the ED
most likely do not have an action plan. RCPs should be
proactively working with their hospital’s administration to
develop an opportunity for ED patients to get the follow-up
they need to develop a customized action plan. If we merely
provide patients with pharmaceutical intervention during an
acute exacerbation, we have failed to treat the root of the
problem—the patient’s lack of knowledge and ability to manage
asthma as a chronic condition.
Go to School
Public schools welcome the
time and expertise about asthma education that RCPs can
provide as a community resource to:
• act as a guest
speaker in a health or science class, teaching students about
asthma, smoking, and other respiratory-related topics. RCPs
can increase the visibility of our profession while providing
a valuable service and inspiration to our public school
• work with your local asthma support group to
bring asthma awareness and education materials to school
teachers, nurses, and gym coaches;
• start an “Open
Airways” program. The American Lung Association provides an
“Open Airways for Schools,” which is an asthma education
program designed to empower 8- to 11-year-old children and
their parents to take control of asthma. This interactive
program consists of six 40-minute lessons. It includes a
detailed curriculum and instructors guide, as well as colorful
posters and handouts in both English and Spanish. For more
information, call (800) LUNGUSA.
The American Association of Respiratory Care (AARC) has an
asthma education program called “Peak Performance USA” that is
available to RCPs who wish to work with their local schools to
develop and promote asthma education. It is free of charge to
AARC members simply by calling the executive office at (972)
John Wolfe, RRT, is a respiratory care professional in
Fort Collins, Colo, and serves as the chairman for the
Northern Council for the American Lung Association of
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Thornton E. Asthma management program provides special
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