Asthma Checklist

Asthma Checklist: A Tool for Implementing Guidances and Expert Reports in Practice was developed with input from over 140 AstraZeneca PRECISION Advisors whose goal was to develop a point-of-care resource that clinicians could consider as a component of their ongoing patient care. The Asthma Checklist compiles key concepts found in multiple guidances and expert reports on asthma assessment, management, and patient education into a single tool. It is designed to aid health care providers in the following:

Assessment of Asthma

For every patient, the assessment of asthma should include an evaluation of 1:

Asthma control

for symptom control and future risk of adverse outcomes

Treatment issues

for inhaler technique and adherence

Comorbidities

for contributions to symptom burden and present impairment in quality of life and functional capacity

Lung function

for an important assessment of future risk

Understanding Asthma Control

Control represents the extent to which the manifestations of asthma are minimized and treatment goals are met.2 Once therapy is initiated, adjustment decisions are guided by monitoring the level of asthma control.2

The components of control are outlined in the National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (NAEPP).

For adults and adolescents 12+ years of age, the NAEPP suggests classifying asthma control as well-, not well-, or very poorly controlled based upon both impairment (eg, quantification of daytime symptoms, nighttime awakening, interference with normal activity, and validated control questionnaires) and risk (eg, exacerbations, loss of lung function, and adverse effects from medications).2

The final level of control is based on the most severe impairment or risk category with subsequent assessments and adjustments initiated to optimize the patient’s status.2

Asthma Management Cycle

Asthma outcomes can improve after the introduction of control-based guidelines or practical tools that help implement control-based management strategies. The Global Initiative for Asthma (GINA) Global Strategy for Asthma Management and Prevention describes asthma management as a continuous cycle that involves the concepts of assess, adjust, and review response.1

Asthma Checklist

Asthma Checklist: A Tool for Implementing Guidances and Expert Reports in Practice lists assessments that may be appropriate to use with a patient at every visit.

Assessments are for:

All patients regardless of asthma control

Patients with uncontrolled symptoms and/or risk factors for exacerbations

ASSESS, ADJUST, and REVIEW RESPONSE

ASSESS, ADJUST, AND REVIEW RESPONSE is a guide that health care providers can use to personalize an asthma management plan for their adult and adolescent patients.

The ASSESS items (in green) and associated ADJUST items may be appropriate for all patients regardless of asthma control.

The ASSESS items (in yellow and red) and associated ADJUST items may be appropriate for patients with uncontrolled symptoms and/or risk factors for exacerbations.

To REVIEW RESPONSE, a visit is scheduled within 2 weeks to 6 months to review the patient’s response to selected ADJUST items.

Guidances and Expert Reports

Asthma Checklist: A Tool for Implementing Guidances and Expert Reports in Practice and ASSESS, ADJUST, AND REVIEW RESPONSE are based on key US and other guidances and expert reports including:

Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA). 2020. Accessed November 24, 2020. https://ginasthma.org/wp-content/uploads/2020/04/GINA-2020-full-report_-final-_wms.pdf.

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (EPR-3). National Institutes of Health; National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program. 2007. Accessed November 24, 2020. https://www.nhlbi.nih.gov/sites/default/files/media/docs/asthsumm.pdf.

Difficult-to-treat & Severe Asthma in Adolescent and Adult Patients Diagnosis and Management. Global Initiative for Asthma (GINA). 2019. Accessed November 24, 2020. https://ginasthma.org/wp-content/uploads/2019/04/GINA-Severe-asthma-Pocket-Guide-v2.0-wms-1.pdf.

Asthma: Diagnosis and Monitoring of Asthma in Adults, Children and Young People. National Institute for Health and Care Excellence (NICE). 2017. Updated 2020. Accessed November 24, 2020. https://www.nice.org.uk/guidance/ng80/resources/asthma-diagnosis-monitoring-and-chronic-asthma-managementpdf-1837687975621.

Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Accessed November 24, 2020. https://www.ncbi.nlm.nih.gov/books/NBK63952/.

Lung Disease Including Asthma and Adult Vaccination. Centers for Disease Control and Prevention (CDC). Updated 2016. Accessed November 24, 2020. https://www.cdc.gov/vaccines/adults/rec-vac/health-conditions/lung-disease.html.

Recommended Child and Adolescent Immunization Schedule. Centers for Disease Control and Prevention (CDC). 2020. Accessed November 24, 2020. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html.

Expert Panel Report 4 (EPR-4) Working Group. National Institutes of Health: National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program.

Resources for Additional Information

Expert Panel Report 4 (EPR-4) Working Group. Accessed November 24, 2020. https://www.nhlbi.nih.gov/about/advisory-and-peer-review-committees/national-asthma-education-and-prevention-program-coordinating/EPR4-working-group.

Role of Immunotherapy in the Treatment of Asthma. Accessed November 24, 2020. https://effectivehealthcare.ahrq.gov/products/asthma-immunotherapy/research.

The Clinical Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management. Accessed November 24, 2020. https://effectivehealthcare.ahrq.gov/products/asthma-nitric-oxide/research.

Effectiveness and Safety of Bronchial Thermoplasty in Management of Asthma. Accessed November 24, 2020. https://effectivehealthcare.ahrq.gov/products/asthma-nonpharmacologic-treatment/thermoplasty-systematic-review.

Effectiveness of Indoor Allergen Reduction in Management of Asthma. Accessed November 24, 2020. https://effectivehealthcare.ahrq.gov/products/asthma-nonpharmacologic-treatment/research-indoor-allergen-reduction.

Intermittent Inhaled Corticosteroids and Long-Acting Muscarinic Antagonist for Asthma. Accessed November 24, 2020. https://effectivehealthcare.ahrq.gov/products/asthma-pharmacologic-treatment/research-2017.

Work-related Asthma for Healthcare Professionals—The National Institute for Occupational Safety and Health (NIOSH). Accessed November 24, 2020. https://www.cdc.gov/niosh/topics/asthma/professionals.html.

References: 1. Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA). 2020. Accessed November 24, 2020. www.ginasthma.org. 2. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (EPR-3:). National Institutes of Health; National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program. 2007. Accessed November 24, 2020. www.nhlbi.nih.gov.

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