Asthma Treatment and Monitoring

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The following course content

Introduction   

When hearing the phrase asthma, what comes to mind? If you're an advanced practice registered nurse (APRN) with prescriptive authority, you've definitely heard of asthma before. Even as a nurse or maybe before nursing school, conversations about prescription drug use and respiratory health existed every so often.

Presently, patients seek guidance and information on various health topics from APRNs, including medication management and respiratory health. The information in this course will serve as a valuable resource for APRNs with prescriptive authority of all specialties, education levels, and backgrounds, to learn more about medications that can treat and manage asthma.

Defining Asthma 

What Is Asthma? 

Asthma is a non-communicable chronic health condition that affects the airways of the lungs and affects millions of people nationwide. Asthma is often diagnosed in childhood and can resolve in adulthood or continue for the rest of a patient's life. Several studies postulate the cause of asthma, but there is no definitive cause.  

Genetics, age, environmental exposures, smoking, and a history of allergies are thought to play a role in asthma severity and development. Clinical presentation of asthma often includes trouble breathing, chronic airway inflammation, and airway hyperresponsiveness. Assessment for asthma often includes patient history, clinical presentation, spirometry testing, and pulmonary function tests (PFTs). 

What Are the Stages of Asthma? 

Since asthma is a chronic condition, several established guidelines can be used to determine the severity of asthma and explore possible medication options. Depending on the stage of asthma and patient response to existing therapy, treatment and management vary.  

The four stages of asthma include intermittent, mild, moderate, and severe. Based on the 2020 National Asthma Education and Prevention Program (NAEPP) guidelines, here is the standard criteria for what constitutes each stage of asthma (2). 

Intermittent asthma is characterized with the following clinical presentation and assessment (2): 

• Patient history of respiratory symptoms, such as cough, trouble breathing, wheezing, or chest tightness <2 times a week 
• Asthmatic flare-ups are short-lived with varying intensity  
• Symptoms at night are <2 a month 
• No asthmatic symptoms between flare-ups 
• Lung function test FEV 1 at >80% above normal values 
• Peak flow has <20% variability am-to-am or am-to-pm, day-to-day 

Mild persistent asthma is characterized with the following clinical presentation and assessment (2): 

• Patient history of respiratory symptoms, such as cough, trouble breathing, wheezing, or chest tightness 3-6 times a week 
• Asthmatic flare-ups may affect activity level and can vary in intensity 
• Symptoms at night are 3-4 times a month 
• Lung function test FEV1 is >80% above normal values 
• Peak flow has less than 20-30% variability 

Moderate persistent asthma is characterized with the following clinical presentation and assessment (2): 

• Patient history of respiratory symptoms, such as cough, trouble breathing, wheezing, or chest tightness daily 
• Asthmatic flare-ups may affect activity level and can vary in intensity 
• Symptoms at night are >5 times a month 
• Lung function test FEV1 is 60%-80% of normal values 
• Peak flow has more than 30% variability 

Severe persistent asthma is characterized with the following clinical presentation and assessment (2): 

• Patient history of respiratory symptoms, such as cough, trouble breathing, wheezing, or chest tightness continuously  
• Asthmatic flare-ups affect activity level and often vary in intensity 
• Asthmatic symptoms at night are constant 
• Lung function test FEV1 is <60% of normal values 
• Peak flow has more than 30% variability 

Based on patient history, clinical presentation, and these criteria, treatment can be administered to decrease the symptoms of the patient. If a patient presents with symptoms that are outside of your scope of work or understanding, you can always refer patients to a pulmonologist or asthma specialist.  

Often times, more severe cases of asthma and asthma emergencies require increased frequency and dosing of asthma-related medications. Health care provider professional discretion and patient condition should guide therapy. Consider reviewing a patient's medication history, pulmonary function, and health history prior to prescribing asthma medications (1). 

What Are Asthmatic Emergencies? 

Asthmatic emergencies are if a patient has asthma symptoms that are beyond what they typically experience and are unable to function without immediate medical intervention. Asthma emergencies can occur as a result of a patient being unable to access their asthmatic medications, being exposed to a possible allergen, or being under increased stress on the body.  

Asthmatic emergencies often require collaborative medical intervention, increased dosages of medications discussed below, and patient education to prevent future asthmatic emergencies (1).  

What If Asthma Is Left Untreated? 

Depending on the clinical presentation and severity of asthma, asthma can cause several long-term complications if left untreated. If asthma is not properly managed, several complications, such as chronic obstructive pulmonary disease (COPD), decreased lung function, permanent changes to the lungs' airways, and death can occur (1, 2).  

Defining Asthma Medications 

What Are Commonly Used Medications to Manage Asthma? 

Commonly used medications to manage asthma include inhaled corticosteroids, oral corticosteroids, short-acting beta agonists (SABAs), long-acting beta agonists (LABAs), long-acting muscarinic antagonists (LABAs), adenosine receptor antagonists, leukotriene modifiers, mast cell stabilizers, and monoclonal antibodies. The dosage, frequency, amount of asthma management medications, and medication administration route can all vary depending on clinical presentation, patient health history, and more.  

How and Where are Asthma Medications Used? 

Asthma medications can be used routinely or as needed for management of asthma symptoms depending on the patient. Asthma medications can be used at home, in public, and in health care facilities. Depending on the specific asthma medication and dosage, these medications can be taken by mouth, by an external device, such as an inhaler, via subcutaneous injection, or via intravenous solution (1).  

What Are the Clinical Criteria for Prescribing Asthma Medication? 

Clinical criteria for prescribing asthma medication can depend on the clinical presentation of a patient. Assessment of lung health and patient history are essential to determining the dosage and medications needed for adequate asthmatic symptom control.  

Clinical guidelines from reputable organizations, such as the National Asthma Education and Prevention Program (NAEPP), the National Institutes of Health (NIH), the Global Initiative for Asthma (GINA), and the American Academy of Family Physicians (AAFP) can provide insight into the latest recommendations for asthma management (1, 2). In addition, local laws or health departments might have recommendations for asthma medication guidelines.  

What Is the Average Cost for Asthma Medications? 

Cost for asthma medications can significantly vary depending on the type of medication, insurance, dosage, frequency, medication administration route, and other factors. Cost is among a leading reason why many patients cannot maintain their medication regime (3). If cost is a concern for your patient, consider reaching out to your local pharmacies or patient care teams to find cost effective solutions for your patients.  

Inhaled Corticosteroids Pharmacokinetics 

Health care provider professional discretion and patient condition should guide therapy. Consider reviewing a patient's medication history and health history prior to prescribing asthma medications.  

Drug Class – Inhaled Corticosteroids  

Commercially available inhaled corticosteroids include: ciclesonide (Alvesco HFA), fluticasone propionate (Flovent Diskus, Flovent HFA, Armon Digihaler), budesonide (Pulmicort Flexhaler), beclomethasone dipropionate (QVAR RediHaler), fluticasone furoate (Arnuity Ellipta), and mometasone furoate (Asmanex HFA, Asmanex Twisthaler).  

Clinical criteria for prescribing an inhaled corticosteroid includes adherence to the latest clinical guidelines, patient medical history, patient clinical presentation, and drug availability (4).  

Inhaled Corticosteroids Method of Action 

Inhaled corticosteroids have an intricate mechanism of action involving several responses to the immune system. Inhaled corticosteroids decrease the existing initial inflammatory response by decreasing the creation and slowing the release of inflammatory mediators. Common inflammatory mediators include histamine, cytokines, eicosanoids, and leukotrienes. Inhaled corticosteroids can also induce vasoconstrictive mechanisms, which, as a result, can lead to less blood flow, resulting in less discomfort and edema (4).  

In addition to anti-inflammatory properties, inhaled corticosteroids can create a localized immunosuppressive state that limits the airways' hypersensitivity reaction, which is thought to reduce bronchospasms and other asthma-associated symptoms. It is important to note that inhaled corticosteroids often do not produce therapeutic effects immediately, as many patients may not see a change in their asthma symptoms for at least a week after beginning inhaled corticosteroid therapy (4).  

Inhaled Corticosteroids Side Effects 

Every medication has the possibility of side effects, and inhaled corticosteroids are no exception. Common side effects of inhaled corticosteroids include oral candidiasis (thrush), throat irritation, headache, and cough.  

Patient education about rinsing their mouth and oral hygiene after use is essential to avoid the possibility of thrush and other oral infections and irritations. More severe side effects can include prolonged immunosuppression, reduction in bone density, and adrenal dysfunction (4).  

Inhaled Corticosteroids Alternatives 

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with inhaled corticosteroids, so additional medication, increased dosage, a change in frequency, or a new medication class might need to be considered (4).  

Oral Corticosteroids Pharmacokinetics 

Health care provider professional discretion and patient condition should guide therapy. Consider reviewing a patient's medication history and health history prior to prescribing asthma medications.  

Drug Class – Oral Corticosteroids  

Commercially available oral corticosteroids include methylprednisolone, prednisolone, and prednisone. Clinical criteria for prescribing an oral corticosteroid includes adherence to the latest clinical guidelines, patient medical history, patient clinical presentation, and drug availability (4).  

Oral Corticosteroids Method of Action 

Methylprednisolone and prednisolone have a method of action as intermediate, long-lasting, synthetic glucocorticoids, have COX-2 inhibitory properties, and inhibit the creation of inflammatory cytokines (5). 

Prednisone is a prodrug to prednisolone and has anti-inflammatory and immunomodulating glucocorticoid properties. Prednisone has a method of decreasing inflammation by reversing increased capillary permeability and suppressing the movement of certain leukocytes (6).  

Oral Corticosteroids Side Effects 

Every medication has the possibility of side effects, and oral corticosteroids are no exception. Methylprednisolone and prednisolone have possible side effects of skin changes, weight gain, increased intraocular pressure, neuropsychiatric events, neutrophilia, immunocompromised state, fluid retention, and GI upset.  

Consider monitoring symptoms and overall health of patients on systemic corticosteroids to assess for long-term side effects (5). Prednisone has possible side effects of changes in blood glucose, changes in sleep habits, changes in appetite, increased bone loss, an immunocompromised state, changes in adrenal function, and changes in blood pressure (6).  

Oral Corticosteroids Alternatives 

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with oral corticosteroids, so additional medication, increased dosage, a change in frequency, or a new medication class might need to be considered (6).  

Short-Acting Beta Agonists (SABAs)  

Health care provider professional discretion and patient condition should guide therapy. Consider reviewing a patient's medication history and health history prior to prescribing asthma medications.  

Drug Class – SABAs 

Common commercially available SABAs include albuterol sulfate (ProAir HFA, Proventil HFA, Ventolin HFA), albuterol sulfate inhalation powder (ProAir RespiClick, ProAir Digihaler), levalbuterol tartrate (Xopenex HFA), and levalbuterol hydrochloride (Xopenex) (4). 

SABAs Method of Action 

Short-acting beta-agonists (SABAs) have a rapid onset as broncho-dilating medications. SABAs, especially albuterol in emergent situations, are used often to quickly relax bronchial smooth muscle from the trachea to the bronchioles through action on the β2-receptors.  

While SABAs are effective bronchodilators in the short term for asthma symptoms, SABAs do not affect the underlying mechanism of inflammation. As a result, SABAs are often used for short-acting intervals, such as few hours, and have limited capabilities to prevent asthma exacerbations alone (4). SABAs can be administered via meter-dosed inhalers, intravenous, dry powder inhalers, orally, subcutaneously, or via nebulizer.  

SABAs Side Effects 

Every medication has the possibility of side effects, and SABAs are no exception. Because of the beta receptor agonisms, possible SABA side effects include increased heart rate, chest pain, chest palpitations, body tremors, and nervousness (4). Because of the short half-life of SABAs, chronic side effects are not typically observed.  

SABAs Alternatives 

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with SABAs, so additional medication, increased dosage, a change in frequency, or an additional medication class might need to be considered (4).  

Long-Acting Beta Agonists (LABAs) 

Health care provider professional discretion and patient condition should guide therapy. Consider reviewing a patient's medication history and health history prior to prescribing asthma medications.  

Drug Class – LABAs 

Common commercially available LABAs are salmeterol and formoterol (7).  

LABAs Method of Action 

Long-acting beta-agonists (LABAs) have a rapid onset like SABAs, but also have a longer half-life. LABAs are used often as asthma maintenance medications to relax bronchial smooth muscle from the trachea to the bronchioles through action on the β2-receptors. While SABAs are effective bronchodilators in the short term for asthma symptoms, LABAs are effective bronchodilators in the long term for asthma symptoms.  

Like SABAs, LABAs do not affect the underlying mechanism of inflammation. LABAs can be administered via meter-dosed inhalers, intravenous, dry powder inhalers, orally, subcutaneously, or via nebulizer. LABAs are often effective for 12-hour durations (7). 

LABAs Side Effects 

Every medication has the possibility of side effects, and LABAs are no exception. Like SABAs, because of the beta receptor agonisms, possible LABA side effects include increased heart rate, chest pain, chest palpitations, body tremors, and nervousness (7). Other more prolonged side effects can include changes in blood glucose levels and changes in potassium levels with prolonged LABA use (7).  

LABAs Alternatives 

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with LABAs, so additional medication, increased dosage, a change in frequency, or an additional medication class might need to be considered (4).  

In addition, there are combination inhaled corticosteroid/LABA medications that can be considered, such as fluticasone propionate and salmeterol (Advair Diskus, Advair HFA, AirDuo Digihaler, AirDuo RespiClick, Wixela Inhub), fluticasone furoate and vilanterol (Breo Ellipta), mometasone furoate and formoterol fumarate dihydrate (Dulera), and budesonide and formoterol fumarate dihydrate (Symbicort) (4). 

Long-Acting Muscarinic Antagonists (LAMAs) 

Health care provider professional discretion and patient condition should guide therapy. Consider reviewing a patient's medication history and health history prior to prescribing asthma medications.  

Drug Class – LAMAs 

Common commercially available LAMAs include two inhalation powders via inhalers known as tiotropium bromide (Spiriva Respimat) and fluticasone furoate, umeclidinium, and vilanterol (Trelegy Ellipta) (4).  

LAMAs Method of Action 

Both drugs mentioned above are long-acting muscarinic antagonists (LAMAs). LAMAs work to alleviate asthmatic symptoms by antagonizing the type 3 muscarinic receptors in bronchial smooth muscles, resulting in relaxation of muscles in the airway (4). Because LAMAs are long-acting, they are not recommended for cases of acute asthma exacerbations or asthmatic emergencies (4). 

LAMAs Side Effects 

Possible LAMA side effects include urinary retention, dry mouth, constipation, and glaucoma (4).  

LAMAs Alternatives 

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with LAMAs, so additional medication, increased dosage, a change in frequency, or an additional medication class might need to be considered (4). 

Adenosine Receptor Antagonists Pharmacokinetics 

Health care provider professional discretion and patient condition should guide therapy. Consider reviewing a patient's medication history and health history prior to prescribing asthma medications.  

Drug Class – Adenosine Receptor Antagonists 

The commercially available adenosine receptor antagonist for asthma management is theophylline as a pill or intravenous (8). 

Adenosine Receptor Antagonists Method of Action 

The method of action for theophylline is acting as a nonselective adenosine receptor antagonist, acting as a competitive, nonselective phosphodiesterase inhibitor, and reducing airway responsiveness to histamine, allergens, and methacholine (8).  

Adenosine Receptor Antagonists Side Effects  

Common side effects of theophylline include GI upset, headache, dizziness, irritability, and arrythmias (8).  

Adenosine Receptor Antagonists Alternatives 

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with theophylline, so additional medication, increased dosage, a change in frequency, or an additional medication class might need to be considered (4). 

Leukotriene Modifiers Pharmacokinetics 

Health care provider professional discretion and patient condition should guide therapy. Consider reviewing a patient's medication history and health history prior to prescribing asthma medications.  

Drug Class – Leukotriene Modifiers 

Commercially available leukotriene modifiers include montelukast (Singular) and zafirlukast (Accolate) as oral pills taken once a day. Zileuton (Zyflo CR) is a 5-lipoxygenase inhibitor that also modifies leukotriene activity (4).  

Leukotriene Modifiers Method of Action 

Montelukast and zafirlukast work to control asthma-related symptoms by targeting leukotrienes, which are eicosanoid inflammatory markers. Montelukast works in particular by blocking leukotriene D4 receptors in the lungs, thus allowing decreased inflammation in the lungs and increased relaxation of lung smooth muscle (9).  

Zafirlukast works by being a competitive antagonist at the cysteinyl leukotriene-1 receptor (CYSLTR1) (10). Zileuton is a 5-lipoxygenase inhibitor, in which 5-lipoxygenase is needed for leukotriene creation. Blocking 5-lipoxygenase decreases the formation of leukotrienes at several receptors. As a result of decreased leukotriene production, there is decreased inflammation, decreased mucus secretion, decreased bronchoconstriction (11). 

Leukotriene Modifiers Side Effects 

Possible side effects of montelukast include headaches, GI upset, and upset. Neuropsychiatric events, such as nightmares, changes in sleep, depression, and suicidal ideation are more severe side effects associated with montelukast.  

Possible side effects of zafirlukast include headache, GI upset, and hepatic dysfunction (9).  

Possible side effects of zileuton include hepatic dysfunction, changes in sleep, changes in mood, headaches, and GI upset. When the leukotriene modifiers, neuropsychiatric side effects are to be monitored for in particular, especially for suicidal ideation (9,10,11).  

Leukotriene Modifiers Alternatives 

Some patients might not report their symptoms alleviating with leukotriene modifiers, so additional medication, increased dosage, a change in frequency, or an additional medication class might need to be considered (4). 

Mast Cell Stabilizer Pharmacokinetics 

Health care provider professional discretion and patient condition should guide therapy. Consider reviewing a patient's medication history and health history prior to prescribing asthma medications.  

Drug Class – Mast Cell Stabilizer 

A commercially available mast cell stabilizer is cromolyn available via metered-dose inhaler and nebulizer solution (12).  

Mast Cell Stabilizer Method of Action 

Cromolyn has a method of action in which it inhibits the release of inflammatory mediators from cells, such as the release of histamine and leukotrienes (12).  

Mast Cell Stabilizer Side Effects 

Every medication has the possibility of side effects, and cromolyn is no exception. Common side effects of cromolyn include dry throat, throat irritation, drowsiness, dizziness, cough, headache, and GI upset (12).  

Mast Cell Stabilizer Alternatives 

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with mast cell stabilizers, so additional medication, increased dosage, a change in frequency, or an additional medication class might need to be considered (4). 

Monoclonal Antibody Pharmacokinetics 

Health care provider professional discretion and patient condition should guide therapy. Consider reviewing a patient's medication history and health history prior to prescribing asthma medications.  

Drug Class – Monoclonal Antibody 

Commercially available monoclonal antibodies include Omalizumab (Xolair), mepolizumab (Nucala), reslizumab (Cinqair), benralizumab (Fasenra), dupilumab (Dupixent), and tezepelumab-ekko (Tezspire). Omalizumab, mepolizumab, benralizumab, dupilumab, and texepelumab-ekko are available via subcutaneous injection. Reslizumab is available via intravenous solution (4). 

Monoclonal Antibody Method of Action 

Omalizumab is an anti-IgE monoclonal antibody that works by inhibiting the binding of IgE to mast cells and basophils. As a result of decreased bound IgE, activation and release of mediators, such as histamine, in the allergic response are decreased (13).  

Mepolizumab, reslizumab, and benralizumab are interleukin (IL)-5 antagonists. These IL-5 antagonists inhibit IL-5 signaling, allowing for a decrease in the creation and survival of eosinophils. However, the full method of action for IL-5 antagonists is still unknown, as more evidence-based research is needed (4, 15).  

Dupilumab is an IgG4 antibody that inhibits IL-4 and IL-13 signaling by binding to the IL-4Rα subunit. This inhibition of the IL-4Rα subunit allows for the decrease of IL-4 and IL-13 cytokine-induced inflammatory responses (14). 

Tezepelumab-ekko is an IgG antibody that binds to the thymic stromal lymphopoietin (TSLP) and prevents TSLP from interacting with the TSLP receptor. Blocking TSLP decreases biomarkers and cytokines associated with inflammation. Knowing this, the full method of action for Tezepelumab-ekko is still unknown, as more evidence-based research is needed4,15.  

Monoclonal Antibody Side Effects 

Possible side effects of omalizumab include injection site reactions, fracture, anaphylaxis, headache, and sore throat (13). Possible side effects of mepolizumab, reslizumab, and benralizumab include injection site reactions, headache, and hypersensitivity reactions (4). Possible side effects of dupilumab include joint aches, injection site reactions, and headache (14). Possible side effects of tezepelumab-ekko include injection site reactions and headache (14). 

Monoclonal Antibody Alternatives 

While there are clinical criteria for asthma medications, everyone can respond to medications differently. Some patients might not report their symptoms alleviating with monoclonal antibodies, so additional medication, increased dosage, a change in frequency, or an additional medication class might need to be considered (4). 

Nursing Considerations 

Nurses remain the most trusted profession for a reason, and APRNs are often pillars of patient care in several health care settings. Patients turn to nurses for guidance, education, and support. While there is no specific guideline for the nurses' role in asthma education and management, here are some suggestions to provide quality care for patients currently taking medications to manage asthma or concerned about possibly having asthma. 

• Take a detailed health history. Often times, respiratory symptoms, such as a cough or trouble breathing, are often dismissed in health care settings, or seen as "common symptoms with everyone." If a patient is complaining of symptoms that could be related to asthma, inquire more about that complaint.  

Ask about how long the symptoms have lasted, what treatments have been tried, if these symptoms interfere with their quality of life, and if anything alleviates any of these symptoms. If you feel like a patient's complaint is not being taken seriously by other health care professionals, advocate for that patient to the best of your abilities.  

• Review medication history at every encounter. Often times, in busy clinical settings, reviewing health records can be overwhelming. Millions of people take asthma medications at varying dosages, frequencies, and times of day. Many people with asthma take more than one medication to manage their symptoms.  

Ask patients how they are feeling on the medication, if their symptoms are improving, and if there are any changes to medication history.  

• Be willing to answer questions about asthma, respiratory health, and medication options. Society stigmatizes open discussions of prescription medication and can minimize symptoms of asthma, such as a chronic cough.  

There are many people who do not know about medication options or the long-term effects of undiagnosed or poorly managed asthma. Be willing to be honest with yourself about your comfort level discussing topics and providing education on asthma medications and asthma clinical assessment options.  

• Inquire about a patient's life outside of medications, such as their occupation, living situation, and smoking habits. Household exposures, such as carpets or pets, can trigger asthma. Occupations with high exposure to smoke can also trigger asthmatic symptoms. Smoking, living with someone who smokes, or residing in an area with high levels of pollution can also influence asthma symptoms.  

Discuss possible solutions to help with symptoms, such as improving ventilation, increasing air quality, and mask wearing when possible.  

• Communicate the care plan to other staff involved for continuity of care. For several patients, especially for patients with severe asthma, care often involves a team of nurses, specialists, pharmacies, and more. Ensure that patients' records are up to date for ease in record sharing and continuity of care. 

• Stay up to date on continuing education related to asthma medications, as evidence-based information is always evolving and changing. You can then present your new learnings and findings to other health care professionals and educate your patients with the latest information. You can learn more about the latest research on asthma and asthma-related medications by following updates from evidence-based organizations.  

How can nurses identify if someone has asthma?  

Unfortunately, it is not always possible to look at someone with the naked eye and determine if they have asthma. While some people might have visible asthmatic symptoms, such as wheezing or trouble breathing, asthmatic clinical presentation can significantly vary from person to person.  

APRNs can identify and diagnose if someone has asthma by taking a complete health history, listening to patient's concerns, and offering pulmonary function testing. 

What should patients know about asthma medications?  

Patients should know that anyone has the possibility of experiencing side effects medications for asthma management, just like any other medication. Patients should be aware that if they notice any changes in their mood, experience any sharp headaches, or feel like something is a concern, they should seek medical care.  

Nurses should also teach patients to advocate for their own health in order to avoid untreated or undetected asthma and possible chronic complications from asthma or asthma-related medications.  

Here are important tips for patient education in the inpatient or outpatient setting: 

• Tell the health care provider of any existing medical conditions or concerns (need to identify risk factors). 
• Tell the health care provider of any existing lifestyle concerns, such as tobacco use, other drug use, sleeping habits, occupation, diet, menstrual cycle changes (need to identify lifestyle factors that can influence asthmatic medication use, asthma severity, and asthma management). 
• Tell the health care provider if you have any changes in your breathing, such as pain with deep breathing or persistent coughing (potential asthma exacerbation symptoms or possibility of asthma medications not being as effective for treatment). 
• Tell the nurse of health care provider if you experience any pain that increasingly becomes more severe or interferes with your quality of life. 
• Keep track of your health, medication use, and health concerns via an app, diary, or journal (self-monitoring for any changes). 
• Tell the health care provider right away if you are having thoughts of hurting yourself or others (possible increased risk of suicidality is a possible side effect for montelukast use). 
• Take all prescribed medications as indicated and ask questions about medications and possible other treatment options, such as non-pharmacological options or surgeries. 
• Tell the health care provider if you notice any changes while taking medications or on other treatments to manage asthma (potential worsening or improving health situation). 

Research Findings 

What Research on Asthma Medication Exists Presently? 

There is extensive publicly available literature on asthma and asthma-related medications via the National Institutes of Health and other evidence-based journals (1,2,4).  

What are some ways for people who take asthma medications to become a part of research? 

If a patient is interested in participating in clinical trial research, they can seek more information on clinical trials from local universities and health care organizations. 

Conclusion

Asthma is a chronic condition that affects many people from their childhood to their aging years. As more medications for asthma come onto the market and more evidence-based approaches to asthma and lung care emerge, APRNs will be at the forefront of primary care and asthma care across the lifespan.  

Case Study #1 

Susie is a mom to a 15-year-old named Jill. She arrives at the pediatric asthma and allergy specialist practice for a new patient visit. Susie reports that she notices Jill is having trouble sleeping at night and coughing more during the day for the past month. Jill plays soccer with her school, but her mom is concerned about coughing and trouble sleeping interfering with her sports.  

Susie knows that her dad has asthma, and Jill spends a lot of time with her aunt who smokes cigarettes. Jill has a history of generalized anxiety disorder and reports no smoking, no drinking, and no recreational drugs. Jill also wants to learn more about her lung health, as she wants to play soccer professionally one day.  

• What are some specific questions you’d want to ask about Jill’s coughing and respiratory health? 
• What are health history questions you would want to highlight? 
• What are some tests or lab work would you suggest performing?  

Case Study #2 (Continued) 

Susie also shares that she is dating a new partner who vapes in the home, and they recently got a pet puppy in the home. She states that Jill had trouble sleeping at night and coughing a lot when she was younger, but Susie thought Jill grew out of it. Susie wants to learn more about if Jill has asthma like her grandfather, if there are any ways to manage this cough, and if there are any tests that can determine Jill’s lung health in the office today. 

• What sort of tests can be done in-office to assess pulmonary function? 
• What sort of environmental exposures can trigger respiratory conditions?  

Susie agrees to have Jill do allergy testing and to do an in-office pulmonary function test for teenagers. Jill also wants to learn more about spirometry that you mentioned earlier and how to monitor her health outside of the office since she’s busy with school and soccer and doesn’t want to come to the office every time there’s a problem.  

Susie is open to medication options for Jill but doesn’t want anything that will interfere too much with Jill’s social time with her friends. Susie and Jill also want to know if this is a health condition that Jill will have forever or if Jill will grow out of this.  

• Knowing Susie’s concerns and Jill’s age, what are some talking points about reducing possible asthma triggers? 
• How would you explain asthma as a chronic health condition to an adolescent patient?  
• Given Jill and Susie’s concerns about medications, what would be some possible medication options to consider after reviewing Jill’s pulmonary function test results and patient history? 

➁ Complete Survey

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