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Maagg AhmaEecvely Olde Adl
A Edcaoal Gde o Pomog Bee Ahma Cool
Amog Olde Adl Lvg he Dc o Colmba
D i s t r i C t O C O L u M B i A D E P A r t M E n t O H E A L t H
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PREFACE Acknowledgements i
Letter to Instructors ii
Introduction iii
SECTION 1 INSTRuCTORS GuIdE
Background Q and A 1
How to Use the Curriculum 4
Health Education for Older Adults 6
Working with Older Adults in Health Promotion Programs 7
Cultural Competence 8
Asthma Learning Tool: Questionnaire 10
Instructor Questionnaire:
How Much Do You Know About Asthma in Older Adults? 18
SECTION 2 CuRRICulum REvIEw
Part I: Introction 21
A. Introduction and Icebreaker 22
B. Goal and Objectives 23
C. Pre-Program Questionnaire 24
D. DVD:Asthma and the Elderly 25
Part II: Astha Basics 26
A. Normal Lung Function 27
B. Asthma Causes and Symptoms 28
C. Asthma Episodes and Warning Signs 29
D. Asthma Emergencies 30
E. Asthma Triggers 31
F. Asthma Diagnosis and Management 32
table of contents
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Part III: daiy Sef manageent: Astha Sef-Care Skis 33
A. How Do You Achieve Good Asthma Control? 34
B. Identify Asthma Triggers 35
C. Recognize Early Warning Signs 40
D. Take Medicines Correctly 41
E. Partner on a Plan 43
Asthma Action Plan 44
F. Maintain Good Communication 45
Part Iv: Specia Consierations for Oer Ats ith Astha 47
A. Choosing An Asthma Healthcare Provider 48
B. When To See A Specialist 49
C. Medication Management and Multiple Health Conditions 50
D. Problems That Can Complicate Asthma Diagnosis 51
E. Understanding Case Management 52
Part v: liing Yor Best life 53
A. Smoking Cessation 54
B. Nutrition 55
C. Exercise 56
D. Tips for Feeling Great 57
E. Group Activities 58
F. Post-Program Questionnaire 59
SECTION 3 CuRRICulum PRESENTATION 61
SECTION 4 lESSONS lEARNEd 101
SECTION 5 RESOuRCES & GlOSSARY 105
Resources 105
Glossary 107
Toolkit Materials 110
Handouts 111
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Managing asthMa EEctivEly in OldEr adults
te d o comb depme o he
e kowee M v. Bk-seez, Ms,
chEs, w B Eo aee toeeo he (B.E.a.t. o he), e oow
o ob e me poeo
expee o epo Managing Asthma Effectively
in Older Adults: An Educational Guide for Promoting
Better Asthma Control.
Pamela M. Banks, RN
Nurse Consultant
Joshua Holloway, MD, FAAP
Medical Advisor
ravonia Brown-Hughes, PhD
Gerontological Consultant
Edwina Davis-Robinson, MS, CHES
Asthma Program Manager
Community Health Administration
District o Columbia Department o Health
Jossolyn Edwards, EdD
Educational Research Consultant
Yvonne Esipila
Asthma Program and Community Partners
Liaison Intern
Community Health Administration
District o Columbia Department o Health
Sharland Reed, MSW
Adult Education Consultant
Patricia L. Surratt, BA
Principal Editor
Lori aylor, BS, RR
Asthma Education Consultant
C. Olivia Williams
Senior Lie Advisor Consultant
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Angela Diggs
Congress Heights Seniors Wellness Center
Stacie Tweatt
Model Cities Senior Wellness Center
Teresa Moore
Hattie Holmes Senior Wellness Center
Brenda urner
Greater Washington Urban League Aging Program
Alyce Murrell
Emmaus Services or the Aging
Elise Nicholls
United Planning Organization
Washington Seniors Wellness Center
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Managing asthMa EEctivEly in OldEr adults
Dear Instructor,
Te prevalence o current asthma in the District o
Columbia has been consistently higher than the national
rate or the past seven years. Older residents (45-50
years o age) and elderly (65 years o age and older)
suering rom the eects o this serious but manageable
chronic condition is inordinately high. We appreciate the
commitment you have made to empower these individuals
with inormation about asthma and asthma management.
By using this toolkit and teaching theManaging
Asthma Eectively in Older Adults program, you make
a substantial dierence in the well-being and daily lives
o older adults with asthma. Your eorts will ensure
they have the tools necessary to become proactive in the
management o their asthma.
TeManaging Asthma Eectively in Older Adults program
is an eective, undamental asthma education program
specically designed or older adults living in the District
o Columbia. Te 90-minute session is easy to teach and
older adults respond well to it. Older adults gain helpul
asthma management skills and become more condent
about taking control o their disease.
You do not need to be an asthma expert to teach the
Managing Asthma Eectively in Older Adults program.
However, the program is intended to be used by health
educators, social workers, nurses, case managers and other
individuals who have knowledge and experience with
asthma and asthma care and work with the older adult
population.
I you are new to the subject o asthma or to teaching older
adults, these guidelines will provide you with the necessary
tools to actively engage older adults in the learning
process (through discussion, reection, role-playing, and
storytelling) that will lay the oundation or them to be
empowered participants in their own health care.
Te toolkit contains instructors guidelines, a curriculum,
Asthma and the Elderly DVD, a CD containing the
Managing Asthma Eectively in Older Adults power-pointpresentation and related handouts, as well as a copy o
Dr. om Plauts One Minute Asthma book. o prepare or
teaching the program:
1. View theAsthma and the Elderly DVD. Te DVD
provides a wealth o inormation about asthma and
asthma management and documents viewpoints
o older adults with asthma living in the District
o Columbia.
2. Review the One Minute Asthma book andamiliarize yoursel with theManaging Asthma
Eectively in Older Adults Curriculum and
Presentation.
3. Complete the Asthma Learning ool Questionnaire
and the Instructor Questionnaire: How Much Do
You Know About Asthma in Older Adults? Check
your answers and review any questions you answered
incorrectly.
4. Review the Instructors Guide and the remainder
o the toolkit or urther inormation about
implementing the program and working interactively
with older adults.
Tank you again or your dedication to programs and
services that benet older adults with asthma.
Te District o Columbia Department o Health
Community Health Administration,
Asthma Control ProgramDC Control Asthma Now (DC CAN)
Lee o ico
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Managing asthMa EEctivEly in OldEr adults
iodco
Source: DC Department of Health Burden of Asthma in the
District of Columbia 2009.
Ovevew
Te District o Columbia Department o Health (DOH)
Asthma Control Program launched the DC Control
Asthma Now (DC CAN) Program to address national
Healthy People 2010 asthma objectives, and to improve
the quality o lie or District residents who suer rom
asthma.Managing Asthma Eectively in Older Adults: An
Educational Guide or Promoting Better Asthma Control
is one component o a multi-pronged approach to reduce
asthma morbidity and mortality among older adults in the
District o Columbia.
Wha Ahma?
Asthma is a chronic disease o long-lasting sensitivity and
swelling (inammation) o the lining o the airways in the
lungs characterized by respiratory symptoms including:
diculty breathing or shortness o breath, wheezing,
coughing, and chest tightness. Symptoms can vary in
sensitivity rom mild intermittent to severe or persistent.
Asthma can be controlled with a comprehensive asthma
management plan, which includes proper medication and
trigger reduction.
Ahma ad Olde Adl
he Dc o Colmba
According to the 2007 Behavioral Risk Factor Surveillance
System (BRFSS) survey data, approximately 9 percent o
adult residents (40,000 adults) and 11 percent o children
(13,000 children) currently have asthma, and about 15
percent o adults have been diagnosed with asthma at
some point in their lie. Overall, the prevalence o current
asthma in the District o Columbia has been consistently
higher than the national rate or the past seven years.
Asthma is ofen thought o as a childhood disease, but it
aects all age groups. In the District o Columbia certainsubgroups are disproportionately aected and they include
the non-Hispanic black population; very young children
0-4 years o age, adolescent emales, and adults (45-50
years o age) and the elderly (65 years o age and older),
tobacco smokers, overweight and obese populations,
residents with less than or some high school education,
and households with an income less than $15,000 appear
to be the most aected by asthma.
Te District o Columbias middle aged and elderly
populations have the highest hospitalization rate among
the adult population. Tis is also consistent with the
increased proportion o hospital admissions rom
emergency departments (ED) among these groups. In
addition the District o Columbias older adult population
had the highest asthma deaths among all age groups.
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Managing asthMa EEctivEly in OldEr adults
Asthma in older adults is complicated because the normal
eects o aging can make asthma a diagnosis that is
dicult to identiy and treat.
Someasthmasymptomsaresimilartosignsofother
possible health conditions (congestive heart ailure,
chronic obstructive pulmonary disease).
eremaybeotherongoinghealthconcernsthat
make diagnosis and/or treatment more dicult.
Takingdierentmediationsand/ormonitoring
asthma properly can be challenging.
Olderadultsmaybemorelikelytohavesideeects
rom asthma and non-asthma medications.
Patienteducationmayneedtobemodiedto
account or possible memory problems, loss o
coordination and muscle strength, hearing and
visual diculties, and depression.
Te DC CAN, in collaboration with its community
partners, developedManaging Asthma Eectively in
Older Adults: An Educational Guide or Promoting BetterAsthma Control in response to the ollowing:
disparitiesinasthmaprevalenceamongolderadults;
uniqueasthmaeducationandmanagement
considerations; and
feedbackfromolderadultswithasthmalivinginthe
District o Columbia.
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y using this toolkit and
teaching the Managing
Asthma Effectively in
Older Adults program, you make
a substantial difference in the
well-being and daily lives of older
adults with asthma. Your efforts
will ensure they have the tools
necessary to become proactive in
the management of their condition.
B
section 1
Instructors Guide
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s 1
Creating Asthma-Friendly Schools
Background Q and A 1
How to Use the Curriculum 4
Health Education for Older Adults 6
Working with Older Adults in Health Promotion Programs 7
Cultural Competence 8
Asthma Learning Tool Questionnaire 10
Instructor Questionnaire:
How Much Do You Know About Asthma in Older Adults? 18
s 1
Instructors Guide
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sEctiOn 1 / instructOrs guidE 1
Why wa he oolk developed?
Te purpose o this toolkit is to provide health educators,
clinicians, social workers, case managers, and other
proessionals serving older adults with culturally appropriate
inormation on asthma management. In return, these
health proessionals can better educate their patients as
well their patients caregivers.
Tis toolkit is designed to:
Oerafundamentalasthmaeducationcurriculum
specically designed or older adults.
Provideabroadrangeofresourcestoassurethe
success o the educational process, both or health
proessionals and their patients and amilies.
Highlightasthmaeducationinitiativesimplemented
in the District o Columbia and provide lessons
learned rom each.
Te toolkit is intended or educational purposes only; it is
not intended to replace the medical advice or services o a
licensed healthcare provider.
Why wa Managing Asthma Effectively in
Older Adults Program developed?
Te Asthma Control Program, DC Control Asthma Now
(DC CAN), District o Columbia Department o Health
(DOH), recognized the necessity o a multi-pronged
approach that included community-driven health
education initiatives to reduce asthma morbidity and
mortality among older adults in the District o Columbia.
In 2004, it launched the rst o several initiatives targeting
those seniors residing in wards 6, 7, and 8 o the District.
Te decision to select this audience was based on ndings
rom the 2002 Behavioral Risk Factor Surveillance System
(BRFSS) report that indicated these wards had the highest
asthma prevalence rates in the District o Columbia.
While educating older adults on asthma management was
the primary goal, a secondary goal was engaging older
adults in developing asthma education tools and creating
opportunities or them to share their perceptions o
asthma sel-management.
In 2005, DC CAN developed Sharing the Keys to Asthma
Managementand launched the Senior Asthma Education
Project to address this need. It provided community-based educational outreach on asthma management to
residents in wards 7 and 8, ages 55 years and over, who
have been diagnosed with asthma. Pre-and post-program
survey results indicated success in meeting educational
objectives. However, survey responses also indicated the
need or continued asthma education with this population,
particularly as it relates to the use o asthma medications,
and an asthma action plan. Te current programManaging
Asthma Eectively in Older Adults places an even greater
emphasis on these topics.
Backgod Q & A
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2 Managing asthMa EEctivEly in OldEr adults
Below we have summarized major education and ocus
group ndings that led to the content and design o this
toolkit (or a more detailed description o DC CAN asthmaeducation initiatives or older adults, please see Section 4).
Older Adults with Asthma
Asthmaisoenmisdiagnosedamongolderadults.
Olderadultsoendistrustedtheirasthmahealthcare
provider unless there was a long-term relationship.
Misdiagnosis or a perceived delay in the diagnosis o
asthma also caused eelings o distrust.
Someolderadultssaidtheyreliedontheirhigherpower to cure their illness. Many seniors said they
did not claim the diagnosis o asthma or rebuked
the diagnosis o asthma.
Olderadultsingeneralarenotmanagingtheir
asthma adequately.
Manyolderadultsdidnothaveasthmaactionplans.
Manyolderadultswerenotusingtheirprescription
medications properly.
Olderadultsneededtodevelopstrongpartnerships
with their providers
Asthma Healthcare Providers
Providersneededtobeeducatedonasthma
management or older patients.
Providerswerenotawareofproblemsuniqueto
older adults with asthma.
Additionally, we ound:
Educationalmaterialsneedtobeage-andculture-
appropriate.
Olderadultswantedtobeinvolvedincreationof
materials and program design.
Olderadultspreferredtohaveafacilitatorthat
reects their age group and culture.
Wha he goal o Managing Asthma Effectively
in Older Adults Pogam?
Te program empowers older adults with asthma to better
manage their condition through an interactive teaching
curriculum. It teaches older adults how to:
Identifyasthmatriggersandreduceorremovethem.
Detectasthmawarningsignsandtakeappropriate
action.
Takemedicinesaccordingtotheirhealthcare
providers instructions.
Communicateeectivelywiththeirhealthcare
providers.
Assisttheirhealthcareproviderwithcompleting(or
updating) an Asthma Action Plan.
Consequently, older adults learn to lead healthier, more
active lives.
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sEctiOn 1 / instructOrs guidE 3
Wha he phloophy o Managing Asthma
Effectively in Older Adults Pogam?
Te core element o the program is empowerment.
Trough the program, older adults learn to manage theirasthma and to become advocates in their own health
care. Te program addresses the physical, social and
psychological eects o asthma. For older adults, having
control over their asthma means having more control over
their lives. Tis program enables older adults to control
their asthma symptoms and empowers them to better
manage their asthma with the aid o their health care team,
amily and riends.
Wha he edcaoal heoy behd Managing
Asthma Effectively in Older Adults?
Te program is based on Hochbaum, Rosenstock and
Kegels Health Belie Model (HBM), a psychological model
that attempts to explain and predict health behaviors based
on the attitudes and belies o individuals, and current
research involving learning styles and older adults. Te
HBM is based on the theory that an individual will engage
in a health-related action i that individual:
Believesthatanegativehealthconditioncanbe
avoided.
Believesthatbytakingthesuggestedaction,he/shewill avoid a negative health condition.
Believesthathe/shecansuccessfullytakethe
suggested health action.
Learning style represents the manner in which individuals
consistently respond to and process inormation in a
learning environment. Research in this area suggests that
not all older adults are active, hand-on learners; but rather,
with aging, there is a tendency to become more reective
and observational in the learning environment. Teactivities inManaging Asthma Eectively in Older Adults
that enhance older adults learning experience include:
Useofreectiontosharefeelingsabutasthma.
Useofrole-playtorehearsenewskills.
Useofstorytellingtostimulateproblem-solving.
Useofobservationtoencourageretention.
As an instructor, you help to create a respectul,
supportive learning environment and build trust among
your audience. I respect, support and trust are present,
older adults become more interested in the inormation
presented. As a result, they are more likely to apply
knowledge they have learned in theManaging Asthma
Eectively in Older Adults program and experience better
asthma control.
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i. Maeal ad Eqpme
What materials and equipment are needed to teach
the program?
o teach the program, you need the ollowing:
Managing Asthma Eectively in Older Adults
Curriculum CD it contains your power point
presentation and related handouts.
LaptopwithLCDprojector.
Asthma and the Elderly DVD.
TelevisionwithDVDplayer.
Apenorpencilforeachattendee.
Afoldertocollectpre-andpost-program
questionnaires.
Handoutsforeachattendee:
Presentation Packet a copy o the power point
presentation
Pre-Program Questionnaire:
What Do You Know About Asthma?
What triggers Your Asthma?
Recognize Your Warning Signs
Asthma Action Plan
HowtoUseaMetered-DoseInhaler(MDI)
Post-Program Questionnaire:
What Do You Know About Asthma?
ii. seg
What is considered a good location to hold the session?
Go where your audience is. Te best places to hold the
session are senior wellness centers and other locations
that provide services or seniors. Look or sites that can
help identiy older adults with asthma and market the
program. Ofen sites can provide someone to assist with
acilitating the session. Te site should have a large room
(i.e., conerence room) with good acoustics, an adequate
number o desks or tables, a television with DVD player,
a laptop computer and a LCD projector.
How should the room be arranged?
Create a supportive learning environment. Organize the
room according to the needs o your audience. I possible,
make arrangements or the acility to position tables or
desks in a semi-circle i you are using a podium or circle
i you will be seated among your audience. Provide each
empty seat with a copy o the power point presentation
and handouts; place additional materials within easy reach
o your seat or podium.
What potential barriers should be considered?
Keep in mind that barriers or other obstacles may hinder
learning; declining hearing and vision are two potential
barriers.
Bepreparedtohelpindividualsmovecloserto
sound sources.
Useextravoiceandmediaamplication.
Allowadequatetimeforadjustmentswhengoingrom light to dark area or vice versa, such as showing
theAsthma and the Elderly DVD.
Reduceglareanddirectsunlight.
Usehighcontrastonvisualsandhandoutmaterial.
Readmaterialaloudwherepossible,suchasthepre-
and post-tests, and other handouts.
4 Managing asthMa EEctivEly in OldEr adults
How o ue he Cclm
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sEctiOn 1 / instructOrs guidE 5
iii. aclag he seo
Te program can be modied to meet the needs o the
audience, however it should be carried out in the general
order in which it is presented. Te curriculum has been
planned to make the 90-minute session as easy as possible
to implement through:
1. Power-point slides
2. Instructions and a script to generate discussion
3. Related handouts
Interactive group activities are included at the end o the
program to encourage older adults to work together to
address barriers to asthma sel-management.
Te curriculum is divided into ve topics:
1. Introduction 35 minutes
2. Asthma basics 10 minutes
2. Sel-care practices 15 minutes
3. Special considerations or older adults with asthma
10 minutes
4. Living your best lie 20 minutes
opics and activities in the lesson that are used to meet
the learning objectives, materials required, and the
time necessary to complete the section are indicated at
the beginning o each lesson topic. Te curriculum is
ormatted or group implementation but can be easily
adapted or one-on-one instruction as well.
Summary o How to Use the Curriculum
1. Gather materials needed or the session. I possible,
make arrangements or the acility to store them
or you.
2. When you are in the education room, arrange tables
or desks in a circle or semi-circle. I possible, make
arrangements or the acility to position them or you.
3. Provide each empty seat with a pencil or pen and
copies o handouts; place additional materials within
easy reach o your seat or podium.
4. Set up the laptop/LCD projector. Load theManaging
Asthma Eectively in Older Adults Curriculum CD.
5. Load theAsthma and the Elderly DVD.
6. Open the oolkit to SECION 3: Curriculum
Presentation and Suggested Lesson Script.
7. Begin the presentation. Discuss the topic or carry
out the activity indicated or each power point slide
using the script to generate discussion.
How to Respond to Dicult Situations
What i a participant shares inormation that is incorrect?
I a participant shares inaccurate health inormation
during a discussion, respectully thank him/her or the
comment or answer but ask the participant to speak
urther with their doctor about the inormation, ollow-
up with Doctors tell us that or Experts say and
then give the correct answer. Re-direct the class by
asking questions like What can you do instead? or
What would you do in this situation? Make sure that
the correct inormation is given to the audience without
embarrassment to the participant and without shedding a
negative light on the original source o the inormation.
What i I do not know an answer to a question?
Be honest. Reer them to their healthcare provider.
What i I cant complete the entire curriculum within thetimerame allotted?
Base learning activities and instructional approaches on
the needs and interests o your audience.
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Te astest growing segment o the older population are
elders, specically those who are 85 years o age and older.
Tis population is expected to double rom 5 million in2003 to 10 million in 2030, and to double again in 2050 to
20million.Additionally,theU.S.populationisbecoming
more culturally diverse as it ages. By 2050, older adults o
color will make up 35 percent (30 million) o the 65 and
older population.
Older Americans comprise a diverse population and are
not all the same. Tere is an increasing range o ages,
unctional and cognitive abilities, and health status.
Dierences among older adults are attributed to actors
such as culture, race, ethnicity, religion, language, sexual
identity, gender, income and education. Te growth and
diversity o the aging population presents challenges as
well as opportunities to providers in the elds o aging
and health.
o create health programs that change behavior, create
supportive environments and encourage good health
practices, theAmerican Journal o Health Promotion
suggests a ramework o our essential elements: awareness,
motivation, skill-building and opportunity (ODonnell,2005). Tis ramework is based on the idea that people
need to:
Knowwhat to do (awareness).
Bereadyto do it (motivation).
Learnhowto do it (skill-building).
Haveaccess to do it (opportunity).
Framework author Michael ODonnell suggests that
Successul eorts at health behavior change will have
a much greater chance o occurring i all our o these
components are ormally addressed in the programs
design (ODonnell, 2005).
Tese elements were considered in developing this toolkit
to assure that elderly patients had the hands-on knowledge
to manage their asthma and the skills necessary to partner
with their healthcare providers in sustaining an eectiveasthma management plan. Te next section is a reminder
to health proessionals that older adults comprise a
unique group with characteristics that requires specialized
attention in educational programs.
6 Managing asthMa EEctivEly in OldEr adults
Healh Edcao o Olde Adl
Reprinted from American Society on Agings Live Well, Live Long Issue Briefs
Series. Copyright 2006 American Society on Aging. San Francisco, CA.
www.asaging.org/CDC.
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1. Be awae ha olde adl ae o a homogeeo
gop.
A room ull o older adults may include a wide range oages and unctional and cognitive capacities. Tere may
also be big dierences between individuals based on
culture, race, religion, language, sexual identity, gender,
income, education, physical ability or other actors. Each
elder is a unique individual with distinct lie experiences.
Make sure to nd out about your audience beorehand.
2. Be awae o age ade.
Watch out or ageist attitudes that you may be expressing
inadvertently. Aging is sometimes negatively representedas a time characterized chiey by loss loss o physical
ability, loss o loved ones, and loss o social status. While it
is important to acknowledge loss, use this opportunity to
promote the positive side o aging.
Address elders ormally (using Mrs./Miss/Ms./Mr.)
unless they invite you to call them by their rst names.
Elder and older adult seem neutral and respectul, but
remember that people o varying cultural backgrounds
may not be comortable with the same descriptors. An
underlying respect or the elders youre working with willspeak volumes.
3. Be clve ad ojdgmeal.
Useeyecontactandothertechniquestoengageand
include everyone in a group or class. ry to acknowledge
and validate the needs o each individual while mainly
ocusing attention on the entire group. Base your
expectations o an individual on ability, not age. Establish a
positive, nonjudgmental tone that supports everyone.
4. Be awae o commcao dcle de o vo
o heag mpame o low leacy.
Makesureeveryoneinthegroupcanseeandhearyou.Use
a microphone i possible. Print materials or older adults
should be in a ont thats at least 14-point size, should not
use italics or script, and should have high contrast and
a clear, simple layout. Large-size visual aids can be very
helpul because they dont require that someone knows how
to read (a problem that aects one-third o older adults) orunderstand health terminology.
5. Be awae o ea ad coce ha olde adl
may have.
Elders may have many ears and concerns, such as losing
independence, being isolated, alling, getting injured,
having mixed eelings about participating, not being
accustomed to doing the activity, or eeling that the activity
is inappropriate. Acknowledge that societal attitudes toward
aging have changed over time. Listen to their concerns,validate their reality, and appreciate that you are in a
position to help them make positive changes in their lives.
6. Pay aeo o leag ad eachg yle.
Older adults can learn new skills (physical, mental
and social), but they may learn more slowly or need
dierent instructional techniques than younger adults. Be
prepared or a wide range o abilities among participants.
Break down components into small parts and give clear
explanations, both verbally and visually. Give participants
a lot o positive reinorcement and positive eedback. And
remember, every elder can improve his or her abilities. Be
sure to celebrate progress with the participants!
7. Ecoage ocal eaco amog pacpa.
For elders, one o the benets o participating in a group
setting is the opportunity to engage in social interaction.
Encourage peer education, sharing and interaction among
participants both in and out o class (or example, use
partner activities during a class).
8. Lea om elde theye he epe!
Appreciate that you are contributing to the empowerment
and quality o lie o elders in your program, and embrace
and value the lie experience they bring.
sEctiOn 1 / instructOrs guidE 7
Wokg wh Olde Adl Healh Pomoo Pogam
Reprinted from American Society on Agings Live Well, Live Long Issue Briefs
Series. Copyright 2006 American Society on Aging. San Francisco, CA.
www.asaging.org/CDC.
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How Ca i Commcae Moe Eecvely?
When a person has an inherent caring, appreciation and
respect or others they can display warmth, empathy
and genuineness. Te most important ways to enhance
communication is to:
Beopen.
Behonest.
Berespectful.
Benonjudgmental.
Bewillingtolistenandlearn.
Listening and observational skills are essential. Letting
people know that you are interested in what they have
to say is vital to building trust. Older adults have a rich
variety o lie experiences and will likely want to share
some o them, especially asthma experiences, during the
class. Recognize individuality and the diversity o your
audienceandembracethem.Usethesediscussionsto
enhance the learning process.
8 Managing asthMa EEctivEly in OldEr adults
Clal Compeece
Wha Clal Compeece?
Clal compeece beg wh a awaee o yo ow peoal bele ad pacce,
ad ecogo ha people om ohe cle may o hae hem. th mea moe ha
peakg aohe lagage o ecogzg he clal co o people. i mea chagg
pejdgme o bae yo may have o a people clal bele ad com.
Administration on Aging
coe me Bee:
Wm, Emp geee
c coe
Beoc compeee
appeo repe o c
deee
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sEctiOn 1 / instructOrs guidE 9
Wha Clally Appopae sevce Delvey?
Moving toward culturally appropriate service delivery
means being:
Knowledgeableaboutculturaldierencesandtheir
impact on attitudes and behaviors.
Sensitive,understanding,non-judgmental,and
respectul in dealings with people whose culture is
dierent rom your own.
Flexibleandskillfulinrespondingandadaptingto
dierent cultural contexts and circumstances.
According to the Oce o Minority Health, cultural
competency is one o the main ingredients in closing
the health disparities gap because culture and language
may inuence:
Health,healing,andwellnessbeliefsystems.
Howillness,disease,andtheircausesareperceived,
both by the patient/consumer.
ebehaviorsofpatients/consumerswhoareseeking
health care and their attitudes toward health care
providers.
edeliveryofservicesbytheproviderwholooks
at the world through his or her own limited set o
values, which can compromise access or patients
rom other cultures.
Adapted from U.S. Department of Health and Human Services.
(2008, August 10). Administration on Aging cultural competency guidebook.
Retrieved from http://www.aoa.gov/pro/adddiv/cultural/cc-guidebook.pd.
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10 Managing asthMa EEctivEly in OldEr adults
Copyright 2008, Pedipress, Inc. All rights reserved FromAsthma Charts & Forms or the Physicians Ofce and Managed Care,
Thomas F. Plaut, MD. Used with permission.
Ahma Leag tool: Qeoae
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14 Managing asthMa EEctivEly in OldEr adults
Ahma Leag tool: Awe
Copyright 2008, Pedipress, Inc. All rights reserved FromAsthma Charts & Forms or the Physicians Ofce and Managed Care,
Thomas F. Plaut, MD. Used with permission.
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sEctiOn 1 / instructOrs guidE 15
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16 Managing asthMa EEctivEly in OldEr adults
shortness of breath.
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sEctiOn 1 / instructOrs guidE 19
te alenose
1. am oe oe ew oo oe peope.
2. am o be e b be ooe.
3. soe o be o e oe.
4. Oe w m o exee.
5. M ee b o m epoe.
6. a pek fow mee e o moo ow e o.
7. a oe o m epoe e e/e
weez.
8. co f e m epoe.
9. some m mee e oee peee m be
e ee we peope ee oo
10. Mo m epoe be peee.
11. i oe , m epoe o e wo
w.
12. tobo moke mke m mpom woe.
2007 Gdele o Dagog ad Maagg Ahma:
Chlde Age 5-11 Yea
ico Qeoae: Awe Key
How Mch Do Yo Kow Abo Ahma Olde Adl?
Pee ompee beoe e Managing Asthma Effectively in Older Adults: An Educational Guide for
Promoting Better Asthma Control. (cek o we e e e ook).
re e qeo. awe e qeo b ek te, ale o no se.
noe
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here were so any
other things going on in
y boy, I int think
I neee to bring that [astha
syptos] up. I int think it was
anything serious...I just thought it
was a itte co in y throat an
y chest.
Carrie Leary, age 78
Asthma in older adults is complicated
because the normal eects o aging
can make asthma a diagnosis that
is difcult to identiy and treat.
The Managing Asthma Eectively
in Older Adults program empowers
older adults with asthma to better
manage their condition through an
interactive teaching curriculum.
T
section 2
Introuction & Astha Basics
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s 1
Creating Astha-Frieny Schooss 2
Introuction & Astha Basics
Part I: Introuction 21
A. Introduction and Icebreaker 22
B. Goal and Objectives 23
C. Pre-Program Questionnaire 24
D. DVD:Asthma and the Elderly 25
Part II: Astha Basics 26
A. Normal Lung Function 27
B. Asthma Causes and Symptoms 28
C. Asthma Episodes and Warning Signs 29
D. Asthma Emergencies 30
E. Asthma Triggers 31
F. Asthma Diagnosis and Management 32
Part III: daiy Sef manageent: Astha Sef-Care Practices 33
A. How Do You Achieve Good Asthma Control? 34
B. Identiy Asthma Triggers 35
C. Recognize Early Warning Signs 40
D. Take Medicines Correctly 41
E. Partner on a Plan 43
Asthma Action Plan 44
F. Maintain Good Communication 45
Part Iv: Specia Consierations for Oer Auts with Astha 47
A. Choosing An Asthma Healthcare Provider 48
B. When To See A Specialist 49
C. Medication Management and Multiple Health Conditions 50
D. Problems That Can Complicate Asthma Diagnosis 51
E. Understanding Case Management 52
Part v: liing Your Best life 53A. Smoking Cessation 54
B. Nutrition 55
C. Exercise 56
D. Tips or Feeling Great 57
E. Group Activities 58
F. Post-Program Questionnaire 59
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sEctiOn 2 / curriculuM rEviEW 21
TeManaging Asthma Eectively in Older Adults program
aims to empower older adults to become more condent
in managing asthma so that they can lead healthier, moreactive lives. As a result o the program, participants will
be able to 1) detect their asthma warning signs, 2) identiy
their asthma triggers, 3) limit their exposure to asthma
triggers, and 4) prevent or reduce their asthma symptoms.
Educational objEctivEs
th eco wll cove:
Icebreakeractivity.
Overviewoftheprogram.
Leag Objecve:
Te purpose o this section is to help establish a
comortable learning environment and identiy baseline
knowledge about asthma. o do this, your audience will:
Describeafavoriteactivity/pastimeanddiscuss
whether asthma symptoms have ever made the
activity less enjoyable.
Reviewthegoalandobjectivesoftheprogram.
CompleteHandout#2Pre-ProgramQuestionnaire.
DiscussandviewtheDVDAsthma and the Elderly.
Pa i: iodco
topc / Acve Maeal neededEmaed tme
tOtAL: 35 me
a. ioo iebeke nme (opo) 3 me
B. go Objee
ho #1 Peeo Pkeho #1 2 me
c. Pe-Pom Qeoe
ho #2 Pe-pom Qeoeho #2 10 me
d. vew dvd Asthma and the ElderlydvdAsthma
and the Elderly20 me
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22 Managing asthMa EEctivEly in OldEr adults
Introductions may seem easy, however i done incorrectly
it can mean the dierence between a successul program
and an unsuccessul one. Keep your introduction brie andavoid acronyms and jargon, say My name is Busy Bee and
I am a nurse instead o My name is Busy Bee and I am
an R.N. with CHES certication and I work or NIH
Always thank your host, and let your audience know that
you are excited to lead the discussion. Be sure to address
elders ormally (using Mrs./Miss/Ms./Mr.) unless they
invite you to call them by their rst names. An underlying
respect or the older adults youre working with will speak
volumes. Although asthma is a serious disease, try to
maintain an environment o inormality and levity. Displayenthusiasm, warmth, empathy and genuineness.
Create a comortable learning environment that is
non-threatening, supportive and inviting. Group
icebreakers are tools you can use to help create thistype o environment. Icebreakers are activities or modes
o discussion used to help individuals ease into a group
setting. Te icebreaker used in this program is intended
to help your audience identiy commonalities, recognize
that asthma aects people dierently, prompt them to
begin thinking about what better asthma control can
mean or them, and emphasize the overall goal o the
program to learn how to become as ree rom asthma
symptoms as possible. Icebreaker activities are usually
met with enthusiasm, however it is important to recognizethat some audience members may not want to participate.
Always begin the icebreaker by allowing them to exempt
themselves rom the activity.
goo mo/eoo/ee eeoe.
Weome o Managing Asthma Effectively in
Older Adults. M me , im
(e, o woke, ee, e.) Beoe
i e e, i wo ke o k
(M./M/M./M. o me) o ow/
eqe me o be ee. i m e exe o
e o o bo m w o
e
Beoe we k moe bo m, e e o
kow e oe bee b o
we e ommo. le k bo
we ejo o. tk o ome o ke
o o ome, wok, w m o e
e o me w . i o
wo e o ppe e , j
i p i w moe o o e ex
peo. i o
iodco ad icebeakea
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sEctiOn 2 / curriculuM rEviEW 23
iodcg he Managing Asthma Effectively
in Older Adults Pogam
TeManaging Asthma Eectively in Older Adults
curriculum is written to promote condence and success
by moving rom easy material to more dicult. Providing
the program description is no exception. Discuss the goal
o the program and the learning objectives then encourage
sel-directed determination o learning goals. o do
this, begin by introducing the program goal in general
terms we are here to talk about asthma and ways to stay
healthy. Next, oer a more concrete rationale or gathering
together to become more condent in managing asthma
so that we can lead more active lives. Lastly, describe the
anticipated outcomes (objectives) o the program at
the end o the program, you will be able to 1) detect your
asthma warning signs, 2) identiy your asthma triggers, 3)
limit your exposure to asthma triggers, and 4) prevent or
reduce your asthma symptoms. Next, ask your audience
to share personal goals or the program, inorm them that
you value their eedback and want to meet their learning
needs. Again, the curriculum can be modied to meet the
needs o the audience, however it should be carried out in
the general order in which it is presented.
Goal ad ObjecveB
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24 Managing asthMa EEctivEly in OldEr adults
Admeg he Pe-Pogam Qeoae
Be aware that older adults may not be amiliar with
tools or tests such as Likert scales that others may take
or granted. TeManaging Asthma Eectively in Older
Adults curriculum uses a multiple-choice questionnaire
to determine change in the participants knowledge,
attitudes and skills related to asthma management. Read
the questionnaire directions to the group and ask i there
are any questions. Read each question number ollowed
by the question. Allow or appropriate periods o time or
responding to questions. Inorm your audience that they
may stop you at any time. I you are ortunate enough to
have a co-acilitator or helper, encourage him/her to move
around the room to oer assistance. Afer administering
the pre-program questionnaire, explain the rationale
or completing the same questionnaire at the end o
the program.
Beoe we be o o, pee we
ew qeo bo m. some o o
m kow m o e we, ome m
kow o ew o oe
ok. We ome w e o omo
expeee ee o m, we e
ee o e moe
i w k o o ompee e me qeoe
e e o e pom. B o we
oe beoe e pom, oe e e
pom, i w be be o e ow m o
ee w i o o mke e pom
bee.
Pe-Pogam Qeoaec
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sEctiOn 2 / curriculuM rEviEW 25
iodcg he Senior Citizen Asthma Education
and In-Home Environmental AssessmentPlo
pojec (sCAEiEAP) adAsthma and theElderlyDVD
In 2004, the DC Department o Health Asthma Control
Program (DC CAN) partnered with the Greater
WashingtonUrbanLeagueandlaunchedaneducational
program called the Senior Citizen Asthma Education
and In-Home Environmental Assessment Pilot project
(SCAEIEAP). Inormation gained rom this program
was the impetus or developing theManaging Asthma
Eectively in Older Adults oolkit.
Begin the discussion by posing a question to your
audience did you know that the District o Columbia
has one o the nations highest asthma rates? Inorm
them that asthma aects District residents o all ages,
races and ethnic groups and older residents (45-50
years o age) and elderly (65 years o age and older) are
severely impacted by this serious but manageable chronic
condition. Discuss the background o the SCAEIEAP
program, as well as the goals, ndings and results o the
program per the related curriculum slides (slide numbers
6-10) and suggested lesson script. Next, introduce the
Asthma and the Elderly DVD.
Te DVD is an integral part o the curriculum. It provides
a wealth o inormation about asthma and asthma
management and documents viewpoints o older adultswith asthma living in the District. Group activities that
enhance the older adults learning experience are based on
scenarios rom the DVD. Afer viewing the DVD, provide
a brie opportunity or your audience to give their initial
reaction to the DVD. Pose a ew questions such as:
WhatdidyouthinkabouttheDVD?
What,ifanything,didyoulearn?
Whatdidyoundmostinteresting?
Couldyouidentifywith(relateto)anyoftheseniors
in the DVD who/why/why not?
Responses to these questions will give you better insight
aboutthelearningneedsofyouraudience.Usethis
inormation to identiy curriculum topics that may require
greater attention.
DVD:Asthma and the Elderlyd
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26 Managing asthMa EEctivEly in OldEr adults
Pa ii: Ahma Bac
TeAsthma and the Elderly DVD provides an
introduction to asthma basics. In this section, you will
build on that inormation by discussing the physiologyand unction o the respiratory system and answering key
questions about asthma.
Educational objEctivEs
th eco wll cove:
Basicphysiologyoftherespiratorysystem.
Basicfactsaboutasthma.
Leag Objecve:
Te purpose o this section is to help ensure that all
participants have the same basic inormation about
asthma. o do this, your audience will:
Deneasthma.
Answerbasicquestionsaboutthedisease:
What happens when we breathe?
What is asthma?
What causes asthma?
What are asthma symptoms?
What is an asthma episode?
What are asthma triggers?
What are asthma warning signs?
When is asthma an emergency?
How is asthma diagnosed and treated?
topc / Acve Maeal needed Emaed tme
a. nom l ocm cd o
Peeo Pke
tOtAL:
10 me
B. am ce smpomcm cd o
Peeo Pke
c. am Epoe W scm cd o
Peeo Pke
d. am Emeeecm cd o
Peeo Pke
E. am tecm cd o
Peeo Pke
. am do Memecm cd o
Peeo Pke
This section is adapted from the National Heart, Lung, and Blood Institute. (2008, September 5).
Guidelines for diagnosis and management of asthma. Retrieved fromhttp://www.nhlbi.nih.gov/guidelines/asthma.
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sEctiOn 2 / curriculuM rEviEW 27
Wha happe whe we beahe?
Your respiratory system makes breathing possible. With
each breath, you take in air through your nose and mouth,
and your lungs ll up and empty out. A normal respiratory
system includes your:
Nose
Mouth
roat
Larynx(voicebox)
Trachea(windpipe)
Lungs
Diaphragm
When you breathe in (inhale), your respiratory system
allows oxygen in the air to get into your lungs so that the
oxygen can travel to your blood. Your blood delivers the
oxygen to all parts o your body. Oxygen is important
because your cells need it or energy and growth. Without
oxygen, the bodys cells would die. Your lungs remove
carbon dioxide (a waste product o breathing) when air is
breathed out (exhaled).
Wha Ahma?
Asthma is a chronic (ongoing) disease that makes it more
dicult or you to get air in and out o the lungs. It is ofen
thought o as a childhood disease, but requently asthma
is diagnosed as a new condition in older adults. For some
people, it may be a continuing problem rom younger years.
When you have asthma, your airways (breathing tubes)
are sensitive. Tey may react to things that usually
dont bother people without asthma that are called
triggers. When airways react, they may tighten and
become inamed and swollen making it dicult or
you to breathe. Your diculty in breathing may change.Sometimes you will eel ne. Other times you may have
breathing problems. Although asthma cannot be cured,
most people with asthma can control it.
Appomaely 22.9 mllo Ameca had
ahma 2006, cldg almo 2.5 mllo
people ove he age o 65. Moe ha oe
mllo people ove he age o 65 had a
ahma aack o epode. the Dc o
Colmba ha oe o he ao hghe
ahma ae. Olde ede, 45 yea ad
olde, ae eveely mpaced by h choc
deae.
nomal Lg coa
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28 Managing asthMa EEctivEly in OldEr adults
Wha Cae Ahma?
Te exact cause o asthma isnt known. Many health
experts believe that several actors come together to cause
asthma, such as:
Afamilytendencytodevelopallergies(atopy).
Parentswithasthma.
Respiratoryinfectionsduringchildhood.
Exposuretocertainvirusesatanearlyage.
Other risk actors include, but are not limited to the
ollowing:
Gender-Childhoodasthmaoccursmorefrequently
in boys than in girls; but by age 40, more emales
than males have adult asthma.
AirwayHyperactivity-Asthmaismorelikelyto
develop in people with a very reactive (sensitive)
airway.
Allergies-Allergiesandasthmaoengotogether.
Many people with asthma also have allergies. Sources
o indoor allergens include pet dander, dust mites,
cockroaches, and mold. Sources o outdoor allergies
include pollen, grass and mold.
CigaretteSmoke-Severalstudiesconrmthat
cigarette smoking is linked with an increased risk or
developing asthma. Numerous ndings link second-
hand smoke exposure to the development o asthma
in early lie.
Obesity-Asthmaismorecommoninoverweight
adults and nearly twice as common among obese
adults.
Health experts have been ocusing attention, over the past
ew years, on the disproportionate burden o asthma on
minorities, particularly Arican-American and Hispanicchildren residing in inner cities (NIAID). Research on
the causes, treatments, and prevention o asthma is being
conducted to help reduce disparities in the incidence and
prevalence o this disease. Minorities experience higher
rates o emergency department (ED) visits, hospitalization,
and deaths due to asthma. Arican-American women,
or example have the highest death rate due to asthma
among all races. Tese dierences in rates, diagnosis, and
treatment may be linked to poverty, urban air quality,
indoor allergens, lack o education about asthma, andinadequate medical care.
Tere is still a lot unknown about causes o asthma,
and more research is being done to understand better
the causes o this chronic condition, including genetics
dierences between races and their responses to allergens.
Studies have shown, however, that education programs
are needed or low-income Arican American patients to
improve asthma healthcare.
Wha ae Ahma sympom?
Symptoms may include, but are not limited to the ollowing:
Coughing.
Breathinghardandfast.
Shortnessofbreathatrestorwithexercise.
Troubleexhaling.
Wheezing(awhistlingnoiseinthechest
while breathing).
Chestpainortightness.
Coughingupphlegm.
Nighttimeawakeningwithshortnessofbreath.
Headaches.
Fatigue,tiredness,orlethargy.
Ahma Cae ad sympomB
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sEctiOn 2 / curriculuM rEviEW 29
Wha a Ahma Epode?
When your asthma symptoms are worse than usual, you
may experience an asthma episode. Te words asthma
attack, asthma problem, asthma episode, and asthma
are-up all mean the same thing. Not all asthma episodes
are the same. Sometimes symptoms can get worse, and
additional symptoms may appear to cause an asthma
episode. Some are worse than others. During an asthma
episode, it gets harder or you to breathe and to keep
your airways clear. One or more signs o asthma trouble
characterize an asthma episode:
Coughing.
Wheezing.
Chesttightness.
Shortnessofbreath.
Wha Happe Dg a Ahma Epode?
During an asthma episode, air has more trouble getting in
and out. It gets harder to get rid o the used air and bring
in new air. Tree things happen to the airways during anasthma episode:
1. Infammation Te airways become swollen and
irritated. Tis also makes the airways smaller and
makes breathing more dicult.
2. Bronchospasm (or bronchoconstriction) Te
muscles around the airways tighten up and make
the airways smaller.
3. Mucus Production Inamed airways produce
excess mucus, which clogs the already narrowed
openings. Mucus normally helps the airways stay
moist. But during an asthma episode, too much
mucus is produced. Airways are tubes through which
air passes on the way to and through the lungs.
Te ollowing illustration shows the dierence between a
normal airway and one in the midst o an asthma attack.
Wha Ae Ahma Ealy Wag sg?
Early warning signs are changes that happen just beore or
at the beginning o an asthma episode. I you have asthma,
you have to know your own body well enough to recognize
when these changes happen. By recognizing these signs,you can stop an asthma episode or prevent one rom
getting worse. Early warning signs may include, but are not
limited to the ollowing:
Signsofacold,orallergies(sneezing,cough,nasal
congestion, sore throat and headache).
Frequentcoughing,especiallyatnight.
Loosingyourbreatheasilyorshortnessofbreath.
Troublesleepingbecauseofduetodiculty
breathing, coughing or wheezing.
Feelingtired,upset,grouchy,ormoody.
Reducedpeakowreadings.
Wheezingorcoughingaerexercise.
Ahma Epode ad Wag sgc
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30 Managing asthMa EEctivEly in OldEr adults
Whe ahma a emegecy?
An asthma episode can lead to a medical emergency i
asthma symptoms are not controlled. Go to the emergency
department (ED) or call 911 right away i you notice any o
these signs:
Youhunchoverwhenyoubreathe.
Yourlipsorthetipsofyourngerareblue.
Youhavetroublewalkingortalking.
Youaresuckingintheskinbetweenyourribs.
Youarebreathingveryslowly.
Youfeelworseaeryourmedicinehashadtimeto
start working (within 10-15 minutes).
Ahma Emegeced
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sEctiOn 2 / curriculuM rEviEW 31
Wha ae Ahma tgge?
When people have asthma, the airways in their lungs
react to things that usually do not bother people without
asthma. Tese things are called asthma triggers. For many
people, triggers may be:
Allergic reactions to:
Pets.
Dustmites.
Cockroaches.
Mold.
Pollen.
Grass.
Food.
Irritants:
Dust.
Cigarettesmoke.
Cleaningproducts.
Perfumeorotherstrongodors.
Other actors:
Physicalresponsestochangingweather,orcoldair.
Stressorstrongemotions.
Viralinfections,especiallyupperrespiratorytract
inections like the common cold.
Somemedicinesmaytriggerasthmasymptomsand
others may make asthma medicines less eective.
Ahma tggeE
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32 Managing asthMa EEctivEly in OldEr adults
How Ahma Dagoed?
A proper diagnosis o asthma is the rst step toward
reducing your symptoms and improving your health. Your
healthcare provider may base a diagnosis o asthma on:
Yourmedicalhistory.
Aphysicalexamination.
Anyfamilyhistoryofasthmaorallergyproblems.
ChestX-rays-toruleoutotherpotentialcauses.
Spirometry-tomeasurehowmuchairthelungscan
hold and how well the respiratory system is able to
move air into and out o the lungs.
Monitoringpeakexpiratoryow(PEF)-usinga
peak ow meter to monitor the amount o orce with
which air is blown out o your lungs.
Diagnosis and treatment in older adults may present some
special concerns, including:
Someasthmasymptomsaresimilartosignsofother
possible health problems (congestive heart ailure,
chronic obstructive pulmonary disease).
eremaybeotherongoinghealthconcernsthat
make diagnosis and/or treatment more dicult.
Takingmanydierentmediationsand/ormonitoring
asthma properly can sometimes be challenging.
Olderadultsmaybemorelikelytohavesideeects
rom asthma and non-asthma medications.
Wha ype o ahma do yo have?
o assess your long-term asthma status, your healthcare
provider will check how ofen you had asthma symptoms
when you were not taking any asthma medication. Tere
are two main types o asthma:
Intermittentasthma-whenasthmasymptomscome
and go. For example, you may have symptoms two
times a week or less, or you may wake up because oasthma two times per month or less. In addition, the
time between these symptoms may be a ew weeks or
a ew months.
Persistentasthma-whenyouexperienceasthma
symptoms all the time.
Persistent asthma is classied as mild, moderate, or severe.
Your healthcare provider decides which type you have
based on:
1. What you can and cant do because o your asthma.
2. How much and what type o medicine you need.
3. ests o your breathing ability.
Asthma can be controlled. For intermittent asthma, being
controlled may mean your asthma rarely bothers you.
For severe persistent asthma, control means having ewer
symptoms that keep you rom doing what you want to do.
In the ollowing sections we will discuss ways to keep your
asthma under control.
How ahma maaged?
Asthma can be controlled success depends largely on
sel-care skills.
Sel-care skills include:
Avoidingtriggers.
Recognizingsymptomsandtakingaction.
Takingmedicinesappropriately.
Monitoringyourresponsetotreatment.
Gettingregularfollow-upcare.
Gettingimmediatehelpwhenneeded.
Ahma Dago ad Maageme
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sEctiOn 2 / curriculuM rEviEW 33
Educational objEctivEs
th eco wll cove:
IdentifyingAsthmaTriggers.
RecognizingEarlyWarningSigns.
PartneringonaPlan.
TakingMedicinesCorrectly.
MaintainingGoodCommunication.
Leag Objecve:
Te purpose o this section is to discuss asthma sel-
care practices. Te audience will use inormation gained
to better manage asthma symptoms and assist their
healthcare provider with completing a personalized
asthma action plan. o do this, your audience will:
Identifypersonalasthmatriggersanddiscusswaysto
remove or reduce them.
ReviewHandout#3WhatTriggersYourAsthma?
Recognizeearlywarningsignsandidentify
appropriate action to take when they occur.
ReviewHandout#4RecognizeEarlyWarningSigns.
Identifykeycomponentsofanasthmaactionplan.
ReviewHandout#5AsthmaActionPlan.
Distinguishbetweenrescueanddailycontroller
medicines and discuss medicine delivery devices.
ReviewHandout#6HowToUseAMetered-Dose
Inhaler (MDI).
Discusswaystoenhancecommunicationwith
healthcare providers.
Pa iii: Daly sel Maageme: Ahma sel-Cae skll
topc / Acve Maeal needed Emaed tme
a. how do yo aee goo am coo?cm cd o
Peeo Pke
tOtAL:
15 me
B. ie am te
ho #3 W te yo am?ho #3
c. reoze E W s
ho #4 reoze E W sho #4
d. Pe O a P am ao P
ho #5 am ao P ho #5
E. tke Mee coe
ho #6 how to ue a Meee-doe
ie (Mdi)
ho #6
. M goo commocm cd o
Peeo Pke
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34 Managing asthMa EEctivEly in OldEr adults
Successul asthma control takes cooperation between the
person diagnosed with asthma, their healthcare provider,
and all members o their healthcare team (respiratorytherapists, pharmacists, asthma educators, dieticians and
nutritionists especially i ood allergies cause asthma
symptoms, and anyone else helping them to manage their
asthma). Family and close riends can help also.
Control o asthma depends on three things:
Beingabletogetgoodmedicalcare.
Workingwithyourdoctortodevelopanasthma
action plan.
Havingasthmaself-careskills.
Getting good medical care is essential. In the next section
we will talk more about medical care and what to look or
when choosing an asthma doctor. An asthma action planis a written plan you get rom your healthcare provider
and help to complete. Te action plan is important because
it gives you inormation on how to control your asthma
it is your personal guide to staying healthy. It includes
inormation about your asthma triggers, symptoms,
medicines, and more. Sel-care skills are things that you
do yoursel to help keep your asthma under control. Te
most important sel-care skills are:
Identifyingasthmatriggers,reducingorremoving
them when you can.
Recognizingearlywarningsigns,andtaking
appropriate action.
Workingwithyourhealthcareprovidertodevelop
an asthma action plan and ollowing it.
Takingyourmedicineaccordingtoyourhealthcare
providers instructions.
Maintaininggoodcommunicationwithyour
healthcare provider, other members o your care
team, and your amily and close riends.
How Do Yo Acheve Good Ahma Cool?a
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sEctiOn 2 / curriculuM rEviEW 35
When you have asthma, certain things can irritate your
airways. Tese things are called triggers because they can
trigger asthma symptoms by causing:
eairwaysbecomeswollenandirritated
(inammation).
emusclesaroundtheairwaystightenupandmakethe airways smaller (bronchospasm).
Toomuchmucusproduction,whichclogsthe
already narrowed openings.
Te rst step toward asthma control is guring out what
triggers your asthma symptoms. Te most common
asthma triggers are:
Respiratory Inections colds, u, and sinus
inections. Respiratory inections are one o the most
common asthma triggers.
Allergens things that can trigger an allergic
reaction and irritate your airways.
Irritants irritants can bother anyones airways, but
i you have asthma they can cause asthma symptoms.
Exercise exercise can irritate airways.
Emotions strong emotions can cause asthma
symptoms.
Chemicals many people have asthma reactions
rom breathing in certain chemicals.
Seasonal Changes some people have more asthma
symptoms during a particular time o year, usually
the all and spring because there is more pollen in
the air.
Medicines some medicines may cause problems
or people with asthma, some may trigger asthma
symptoms and others may make your asthma
medicines less eective.
Foods - or some people milk, wheat, corn, soy, nuts,
sugar, or other oods may irritate or trigger asthma
symptoms.
GERD (acid refux disease) may be an underlying
cause or contributor o asthma. In such cases,
successul treatment o the digestive problem will
ofen clear up the asthma.
Dierent people may have dierent triggers. Once you know
your triggers, you can do more to keep yoursel healthy.
sElf-carE skill #1
idey yo ahma gge ad elmae
o edce yo epoe o hem.
idey Ahma tggeB
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36 Managing asthMa EEctivEly in OldEr adults
Wha tgge Yo Ahma?
Be o
ce e wee
P
Mee
oo
Poe
d me e
oe o oe
so emoo epoe -
, , e.
se
Peme, bo eoo, e.
so em me p, e
e
co, oe epo eo
Mo, mew
tobo moke
a poo moke, me, e.
cokoe-e we e bo p
am - e we, e
(fke om e k)
Oe
1. reew e o ommo m e.
2. cek e oe eem o mke o m woe.
3. i o e o e, keep e o w o e o ebe e me o
e m epoe o e. cek e o ee w e m e bee pee mke oe.
4. se omo w o oo, m oe e.
now o kow w e o m, o o ee .
1. remoe o o e e. s w o ome. i o ee ep k. yo m oe
e m be be o o.
2. lm be o e e. i o ompee o e e, o o ke
e oom omeoe mok o k e o o o ome e e
e, ke pe, e.
3. i e e obe, k o oo bo k o qk-ee mee beoe o e
o e.
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sEctiOn 2 / curriculuM rEviEW 37
Way o remove o Avod tgge
Review the ollowing ways you can remove dierent
kinds o triggers. Check the ones that you will try. Afer
removing or reducing your asthma triggers, share any
results with your doctor.
Indoor Air Pollution
Change air lters once a month. Tis is a simple
and eective way to lter the air that is circulated
throughout your home. Buy special allergen lters
(available at most hardware and home stores) i
possible. Tey last up to three months and are designedto remove more allergens, irritants and other unwanted
things rom the air.
Outdoor Air Quality
Limit outdoor activities when news reports indicate
pollen counts are high or air quality is poor due to
high humidity or high heat-index (code yellow and
code red days).
Mold and Mildew
Reduce air humidity with a dehumidier.
Stay out o damp places, like basements, etc.
Useableachsolutiontopreventmoldandmildewin
sinks and tubs; wear a mask or have someone else do it
or you. White distilled vinegar may be an alternative.
It is excellent or killing mold and bacteria.
Have heating, ventilation and air conditioning systems
cleaned and serviced regularly.
Fix all water leaks.
Some orms o mold are toxic (very harmul to yourbody) and require immediate attention and removal
by a proessional.
Animals
Pets are great company. Research shows that older adults
who have pets can actually live longer than those who live
alone. However, pets shed hair and dander (akes rom
their skin), which can be triggers or people with asthma
or allergies.
Wash hands immediately afer contact with pets or
other animals.
Vacuum oors daily using a HEPA air lter.
Keep pets outdoors or in certain rooms keep them
out o your room and never let pets sleep in your bed.
In some cases your doctor may tell you that nding a
new home or your pet is best.
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38 Managing asthMa EEctivEly in OldEr adults
Dust Mites
Dust mites are tiny insects that are too small to be seen
without a microscope. Tey live in bedding, pillows,
comorters, stued animals, quilts, and blankets.
Dust with a damp cloth and vacuum requently using
a HEPA air lter remove carpet i possible, especially
rom your bedroom.
Encase your mattress and pillows with vinyl covers.
Wash your sheets and blankets weekly in hot water.
Avoid eather pillows and down comorters.
Useadehumidier.Reduceindoorhumidityto
less than 50%, i you can. Dust mites thrive in high
humidity.
Remove stued toys and other dust-collecting objects
rom your bedroom. Any that are not removed should
be cleaned ofen.
Clean curtains and woodwork ofen.
Replace urnace lters each month during the winter
season, i possible.
Cockroaches
Cockroach waste, eggs and remains can be signicant
triggers or people with asthma and allergies.
Keep ood in tightly sealed containers.
Wash dishes daily and dry all dishes thoroughly.
Keep bathtubs and sinks dry when not in use.
Keep rooms as clutter-ree as possible.
Keep trash in enclosed bins and remove rom your
home daily.
Usepoisonbaitortraps;trytoavoidchemical
treatments unless absolutely necessary. Be out o your
home when used.
Cold Air
ry to breathe through your nose when outdoors.
Wear a scar that covers your nose and mouth.
Pollen
Useairconditioningtoavoidhavingtoopenwindows,
i possible.
Limit outdoor activities when the news reports indicate
pollen counts are high.
Foods
Eliminate polyunsaturated vegetable oils, margarine,
vegetable shortening, all partially hydrogenated oils
that might contain trans-atty acids, all oods that
might contain trans-atty acids (such as deep-ried
oods).
Experiment with eliminating (one at a time) wheat,
corn, soy and sugar or six to eight weeks to see i the
condition improves.
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sEctiOn 2 / curriculuM rEviEW 39
Smoke and other Irritants
Smoking can trigger asthma and cause sudden symptoms.
So can smoke rom someone elses cigarette called
secondhand smoke.
I you smoke quitting now can help your lungs
work better.
Ask amily and riends not to smoke in your home or car.
Avoid places where people smoke indoors.
Limit the use o wood-burning stoves.
Avoid using strong-smelling cleaners and other
products.
Inections (Colds and Flu, etc.)
Wash hands requently with soap and warm running
water.
Stay away rom people who have colds or other viral
inections, i possible.
Get prompt medical treatment or cold symptoms and
respiratory inections.
Get a u shot each year and the pneumonia vaccine
i you are 65 years o age or older, or i your doctor
recommends it.
Medicine
Some medicines may cause problems or people with
asthma. ell your doctor i any medication triggers your
asthma or causes an irregular heartbeat. Do not stop
taking any prescriptions without your doctors approval.
Some common drugs that can aect asthma include:
Blood pressure medicine, heart medicine, and some
medicines used to treat glaucoma may trigger asthma
symptoms they include: Beta-blockers (propranolol,
nadolol, timolol, atenolol) and ACE inhibitors.
Aspirin, ibuproen, and naproxen may trigger asthma
symptoms these medicines may be ound in cold
medicines or pain remedies also.
Sleeping pills, tranquilizers, and other sedatives can
slow breathing this can be unsae or people with
asthma.
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40 Managing asthMa EEctivEly in OldEr adults
a pek fow mee e o ow we o
e o. i mee ow o
bow o o o e eep be.te ke o pek fow mee
o peo be oe. yo peo be
oe e e o 3 pek fow oe ke
we o e o m mpom.
yo ee poe w ow o ow o:
Useapeakowmeter.
Findyourpersonalbestscore.
Usethepersonalbestscoretodene
o eme zoe.
u o pek fow mee ee ep
o e m mpom e
e em beoe e woe.
Te second sel-care skill is recognizing asthma early
warning signs. Early warning signs are changes that
happen just beore or at the beginning o an asthma
episode. Tey may appear hours or days beore your
asthma gets out o control. I you have asthma, you have to
know your own body well enough to recognize when these
changes happen. By recognizing these signs, you can stop
an asthma episode or prevent one rom getting worse.
Tink about the symptoms you have had beore an asthma
episode. Review the list below and check the symptoms
that you have experienced. alk to your doctor so that you
can take action to get your asthma under control.
Signs o a cold, or allergies (sneezing, cough,
nasal congestion, sore throat and headache).
A tight eeling in your chest.
Frequent coughing, especially at night.
Cant do normal activities.
A need to clear your throat ofen.
Loosing your breath easily or shortness o breath.
rouble sleeping due to diculty breathing,
coughing or wheezing.
Feeling tired, upset, grouchy, or moody.
Restlessness.
Reduced peak ow readings.
Fever.
Wheezing.
Wheezing or coughing afer exercise.
Rapid heartbeat.
sElf-carE skill #2
recogze Ealy Wag sg.
recogze Ealy Wag sgc
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sEctiOn 2 / curriculuM rEviEW 41
Medicines are a key part o controlling asthma. Tey are
prescribed or two main reasons: (1) to avoid asthma
symptoms beore they start, and (2) to stop symptoms
once they have started. You can keep your asthma under
control by knowing how and when to use medicines
your healthcare provider prescribes.
Tere are two main types o asthma medicines:
1. Quick-Relie (Rescue) Medicines
Tobetakenwhenyouneedthem.
Usedtorelaxmusclesthattightenaroundyour
airways.
Workfasttoprovideimmediatereliefofasthma
symptoms.
2. Long-erm (Daily) Controller Medicines
Tobetakendailyevenifyoufeelne.
Usedtocontrolinammationinyourairways.
Preventsymptomsandattacks.
Qck-rele Medce
Te names quick-relie , rescue, reliever, and
emergency medicines all mean the same thing. Everyone
with asthma needs a quick-relie medicine to stop asthma
symptoms beore they get worse. Tese medicines, alsoknown as ast-acting beta2-agonists, are taken at the rst
sign o asthma symptoms or when you are experiencing
an asthma episode or attack. Quick-relie medicines work
ast, usually within 10-15 minutes afer taking them. Your
healthcare provider may recommend that you take this
medicine at other times like beore exercise.
Quick-relie medicines taken by inhaler or nebulizer:
Common brand names or inhaled rescue medicines are:
Albuterol (Proventil, Ventolin, or generic albuterol),
Xopenex, Maxair, Combivent, and Alupent.
Quick-relie medicines taken by mouth:
Oral corticosteroids (such as prednisone) can be used
over a short (3- to 10-day) course to gain initial control o
asthma and to speed resolution o exacerbations. When
oral corticosteroids are used short-term, the risk o side
eects is low. Tere are serious side eects associated with
long-term use o oral corticosteroids.
Log-tem Cool Medce
How do you know when your quick-relie medicine is
not enough?
I you answered yes to any o these questions, your asthma
is not under control. alk to your healthcare providerabout adding a long-term controller medicine to your
treatment plan. Te names controller, preventive,
and long-term control medicines all mean the same
thing. Long-term controller medicine works to reduce
inammation o the airways. Controller medicines are
inhaled using a metered-dose-inhaler (MDI), discus
inhaler or taken by mouth.
sElf-carE skill #3
take Yo Medce he rgh Way.
ollow he rle o two
do o e o qk-ee e moe
wo me week?
do o e wke p w m moe
wo me mo?
do o e o m pepo moe
wo me e?
2001 Baylor Health Care System. All rights reserved. Rules of Two
is a federally registered service mark of Baylor Health Care System.
take Medce Coeclyd
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42 Managing asthMa EEctivEly in OldEr adults
Taken by metered-dose inhaler (MDI) or discus inhaler:
Combination Terapywo-in-one medicines containing corticosteroids and
long acting beta2-agonists (includingAdvairand
SYMBICORT) reduce inammation o the airways and
relax muscles around the airways.
Inhaled corticosteroids
Tese medicines are the most eective anti-inammatory
medicines or most people. Tey are very dierent rom
the steroids taken by some athletes. Like many other
medicines, inhaled corticosteriods can have side eects.
But doctors agree that the benets ar outweigh the risks
o side eects. Brand names o inhaled corticosteroids
include:AeroBid, Asmanex, Azmacort, Beclovent,
Flovent, Pulmicort Turboinhaler, Pulmicort Respules,
QVAR, Vanceril.
Inhaled long-acting beta2-agonists
Tese medicines can help to prevent symptoms when
taken with inhaled corticosteroids. Tey should not beused alone. Tey also should not be used to treat serious
symptoms or an attack. Brand names o inhaled long-
acting beta2-agonists include: Sereventand Floradil.
aken by mouth
Leukotriene modiers, or anti-leukotriene medicines are
available in pill orm and used alone to treat persistent
asthma or with inhaled corticosteroids to treat moderate
asthma. Tey are not as eective as inhaled corticosteroids
or most patients. Brand names include: Singulair, Zyo,
and Accolate.
Ahma Medce Delvey Devce
Make sure the medicine gets to your lungs!
Inhalers
Many asthma medicines come as sprays and powders in
an inhaler. An inhaler is a hand-held device that delivers
the medication right to the airways in your lung where
it is needed. Tere are several kinds o inhalers; the most
common is a metered-dose inhaler (MDI).
Holding Chamber (commonly reerred to as a spacer)
Your doctor may instruct you to use a spacer with your
MDI. A spacer is a device that helps asthma medicine get
deep into your lungs. It ts together with your inhaler like
a puzzle.
Nebulizer
A nebulizer is a device that creates a mist out o your
asthma medicine, which makes it easy to breathe the
medicine into the lungs.
Many older adults have conditions such as arthritis that
limittheabilitytouseaMDI.Useofspacerswithinhalers
or nebulized medicines may improve drug delivery to
lower airways and reduce symptoms more eectively. Be
sure to review the best ways to use inhalers, spacers and
other medicine delivery devices with your healthcare
provider. ell your healthcare provider i you notice
changes in your ability to use medicine delivery devices.
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44 Managing asthMa EEctivEly in OldEr adults
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sEctiOn 2 / curriculuM rEviEW 45
Individuals diagnosed with asthma must recognize that
they are the most important members o their healthcare
team. Tey must advocate or themselves one way
or them to do this is to communicate eectively with
everyone involved in helping to manage their asthma and
to expect the same in return. Encourage your audience
to use the ollowing strategies to maintain successul
communication with healthcare providers.
Writedownquestionsandthingsyouwanttotalk
with the healthcare provider about. Include any
new symptoms. ake the list with you to medical
appointments.
SharetheinformationfromtheWhat Triggers Your
Asthma?handout with your healthcare team, amily
and riends.
Keepacopyofyourmedicalrecordsandalistofall
o the medicines you are currently using, includingprescribed and over-the-counter medicines, herbs,
supplements, and home remedies. ake copies with
you to your medical appointments and share with
amily and riends.
Whenitcomestoyourhealth,dontbeshyask
questions i you dont understand something. Your
healthcare team is there to do everything they canto help you better manage your asthma they wont
mind repeating something, explaining something in
a dierent way, or using dierent words.
Re-evaluateyourasthmaactionplanwithyour
healthcare provider on a regular basis. I you have
diculty reading your asthma action plan, ask your
healthcare provider or a plan with a larger ont size.
Requestinstructionsifyourasthmasymptomsare
worsening.
Askforademonstrationonhowtoproperlyuse
your metered dose inhaler and/or spacer and other
asthma tools. ell your healthcare provider i it
is becoming more dicult to use your medicine
delivery devices.
sElf-carE skill #5
Maa Good Commcao
Maa Good Commcao
Adapted from American Academy of Allergy Asthma and Immunology.
(2008, November 7). Seniors and asthma. Asthma control for the mature
adult. Retrieved from http://www.aaaai.org.
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46 Managing asthMa EEctivEly in OldEr adults
Commcao Poblem / solo
Poblem Poble solo
te ee poe o membe e
wo i o o e.
ak em o o oe wo o o o kow
o ee o, k em o o moe oeme ee wo.
te ee poe o membe k
oo .
ak em o ow ow e wo m
bee e w o o e. repe
w w , o ow wo, o mke e
o e.
i eem e ee poe e
e b o o e me o we o
o qeo.
i o epob o k
qeo. remembe, e me
wok o ep o mpoe o e. i
ee, mke moe ppome we
ow qeo beoe o o.
im embe o k qeo. hee poe e ke e o
qeo ee . Oe o e mo mpo
p o e job o e o e
omo, mo e o o .
i emembe ee e ee
poe .
tke pe p o o ppome. tke
oe o k e ee poe o we
ow w o o o. i eo,
ke pe eoe.
te ee poe me
o o e me eo bo m
eme meme opo.
ak o moe omo o oe pe
o e omo (webe, b, e.)
Source: American Lung Association. (2005). Breathe well, live well an asthma management program for adults. New York, NY: Author.
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sEctiOn 2 / curriculuM rEviEW 47
Educational objEctivEs
th eco wll cove:
Howtochooseanasthmahealthcareprovider.
Whentoseeaspecialist.
Medicationmanagementandmultiplehealth
conditions.
Problemsthatcancomplicateanasthmadiagnosis.
Understandingcasemanagement.
Leag Objecve:
Te purpose o this section is to review the characteristics o
a good asthma healthcare provider, recognize when the need
to see a specialist arises, discuss management o multiple
health conditions, including the role and benet o case
management, and discuss potential social and psychological
eects o asthma. o do this, your audience will:
Describecharacteristicsofagoodasthmahealthcare
provider.
Discusswhentoseeaspecialist.
Describeapproachestoasthmamanagementwhen
other health conditions are present