YES WE CAN Children’s Asthma Program

This case study was prepared for CDC by Dr. LaMar Palmer of MAS Consultants. The purpose of the case study is to share the experience of one community as they attempt to address the problem of asthma. It does not represent an endorsement of this approach by CDC.

YES WE CAN Children’s Asthma Program: Patient and Family Education

The asthma education program is administered at the clinic during scheduled visits and reinforced during home visits. The instruction is based on the current asthma knowledge and understanding of the individual child and caregiver. The asthma team members providing patient and family education learn quickly what families know by asking questions. Education is interactive and is also tailored to each child’s circumstances while based on sound educational theory and experience. Messages are simple and limited to no more than three topics each visit. Asthma education also teaches skills the child and caregiver need to administer medications, avoid triggers, and improve environmental conditions in the home. Education also includes problem-solving skills aimed at improving patient and caregiver abilities to make the behavior changes required to achieve and maintain better control of the child’s asthma.

The NAEPP guidelines consider patient education as one of the four cornerstones of asthma management. These guidelines recommend five key educational messages for patients, and all are included in the YES WE CAN program.

Basic Facts About Asthma

• The contrast between asthmatic and normal airways
• What happens to the airways in an asthma attack

Roles of Medications

• How medications work
  • Long-term control: medications that prevent symptoms, often by reducing inflammation
  • Quick relief: short-acting bronchodilator relaxes muscles around airways
• The importance of long-term control medications, and why they differ from quick relief

Skills

• Inhaler use (patient demonstrates)
• Spacer/holder chamber use
• Symptom monitoring, peak flow monitoring, and recognizing early signs of deterioration

Environmental Control Measures

• Identifying and avoiding environmental precipitants or exposure

When and How to Take Rescue Actions

• Responding to changes in asthma, using the Asthma Action Plan

Instruction includes asthma management skills and skill demonstrations.

Chronic conditions such as asthma require day-to-day self-management that can be time consuming and inconvenient. To help patients make health behavior changes, the instruction is designed to foster patient self-efficacy or confidence to apply the knowledge and skills routinely each day. Instruction also emphasizes patient and caregiver skills and the demonstration of those skills to verify the child’s ability to properly use the MDI, spacer, and peak flow meter, and the caregiver’s ability to properly use the Asthma Action Plan.

The instruction mirrors the team approach to addressing asthma.

The instruction mirrors the active partnership philosophy established and maintained between the asthma team and the caregiver and child. The asthma team recognizes that the child and the family are the primary asthma care providers. Whereas the health care professionals are experts on asthma, the family is the expert on fitting asthma self-management into their daily life. The asthma team supports the family in this role, and health care decisions are made together. Caregivers are prompted to discuss the impact of asthma on the family and on the child’s activities and emotions, and to discuss the challenges and barriers faced in managing the child’s asthma day after day. Education is part of the team effort to help the family define their desired outcomes and actions needed to achieve those outcomes.

Asthma education is based on an assessment of the family’s needs.

Education is tailored to each family. Tailoring education saves time, makes the encounter more effective, and improves family satisfaction with the care. Factors considered when tailoring the education include:

• current asthma knowledge and skill levels
• cultural background
• language
• educational level
• literacy level
• learning disabilities
• readiness to learn
• level of "life skills"
• coping abilities
• psychosocial issues

Learning and behavior change are considered processes and not events.

Acquiring knowledge and understanding and applying skills related to the learning takes time. Asthma self-management education requires behavior changes on the part of the child (primarily medication adherence) and the family (primarily changing environmental conditions in the home). Encouragement for the learners and reinforcement of key behaviors are important to the family and the child’s ability to sustain behavior changes. Repetition of key learning points, review of patient knowledge and understanding, skill demonstrations, and feedback are all required to ensure that the patient and caregiver fully grasp and internalize the educational messages. Every member of the asthma team takes part in promoting self-management education. Although the clinical case manager has overall responsibility, the CHW and the clinician instruct, review, and reinforce learning whenever they are in contact with the family. Checklists and other job aids are used to guide the review process.

Patient and family education is based on best practice guides.

The goal of the asthma education lessons is to provide consistent, evidence-based patient education that is presented efficiently, effectively, and in an interactive manner. Each lesson conforms to a common format that includes:

• guideline information comprised of key points and recommendations for each topic
• key messages for the child and the family
• strategies for interactively delivering the key messages
• resources, handouts, visual aids, patient educational materials.

Asthma education lessons

There are 18 asthma education lessons. Lesson titles include:

• What Is Asthma?
• Long-Term Control Medications–Inhaled Corticosteroids
• Long-Term Control Medications–Long–Acting Bronchodilator
• Long-Term Control Medications–Long–Action Bronchodilator: Theophylline
• Long-Term Control Medications–Leukotriene Receptor Antagonists
• Long-Term Control Medications-Cromolyn Sodium and Nedocromil Sodium
• Quick-Relief Medication: Albuterol
• Quick-Relief Medications: Anticholinergics
• The family receives instruction on the asthma medications prescribed for their child.
• Peak Flow and Symptom Monitoring
• Finding the Personal Best Peak Flow
• Understanding Asthma Action Plans
• Correct Use of MDI and Spacer Devices
• Correct Use of a Dry Powder Inhaler
• Medication: Reading Prescription Labels and Getting Results
• Medication: Tracking Puffs in a Canister
• Identifying and Controlling Asthma Triggers
• Recognizing and Managing Severe Asthma Episodes
• Physical Activity: Exercise and Asthma

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