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PERIODIC ASSESSMENT AND MONITORING
Periodic assessment and monitoring of asthma control should be performed to determine whether the goals of therapy are met (ie reduction of current impairment and future risk, achievement of normal activity levels including exercise). Several tools are used to allow the patient and parents to record and describe the symptoms (eg asthma control test [ACT], childhood ACT, asthma quiz for kids, diaries). Improvement of symptoms may be observed within days, while max benefit may be achieved after 3-4 months. Regular follow-up is recommended to determine the minimum controlling dose and necessary dose adjustments. Follow-up 1-3 months after initiation of therapy, then every 3-12 months thereafter.
Monitoring Signs and Symptoms
The following signs and symptoms should be monitored: Daytime asthma symptoms (eg wheezing, cough, chest tightness or shortness of breath); nocturnal awakening as a result of asthma symptoms; frequency of use of beta2-agonist (inhaled, rapid-acting) for relief of symptoms; and inability or difficulty in performing normal activities because of asthma symptoms.
Pulmonary Function
Results of pulmonary function in children ≤5 years of age are unreliable or may not be reproducible. In spirometry, a low FEV1 is associated with increased risk of severe exacerbations.
For peak flow monitoring, peak flow meters function best as tools for ongoing monitoring and not for diagnosis. Refer to the patient’s written asthma action plan for the patient’s personal best peak flow. Because measurement of PEF is dependent on effort and technique, patient instructions, demonstrations, and frequent reviews are recommended.
Quality of Life
Any school day missed because of asthma, any reduction in usual activities (eg home, school, recreation, exercise), any sleep disturbance due to asthma, and any change in the caregiver’s activities due to asthma should be noted.
History of Asthma Exacerbations
The frequency, rate of onset, severity, and cause of asthma exacerbation should be monitored.
Monitoring Adherence to Therapy
The adherence to drug regimen, the patient’s concerns about drug regimen, and the adverse effects experienced with the drug regimen should be noted.
Monitoring Patient-Provider Communication and Patient Satisfaction
The patient’s negative attitude toward medication and/or reluctance towards self-management are risk factors for severe exacerbations.
DISCHARGE AND FOLLOW-UP
Before discharge, the patient should be stable (eg able to eat and drink and get out of bed). Family/caregivers should be given instructions on signs of recurrence and worsening asthma. Additionally, a written individualized action plan should be made, and inhaler technique and adherence should be checked and corrected. It should also be reiterated that the reliever should be taken on an as-needed basis and not routinely. ICS-containing therapy should be started or increased to reduce the risk of another attack. While lung function measurement using spirometry is strongly recommended prior to discharge. Follow-up should be arranged within 2-5 days and within 1-3 days if the patient is <5 years old. Lastly, adequate medication supply should be ensured until follow-up.