The Role of the Primary Care Physician in Helping Adolescent and Adult Patients Improve Asthma Control Barbara P. Yawn, MD, MSc Mayo Clinic Proceedings

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The Role of the Primary Care Physician in Helping Adolescent and Adult Patients Improve Asthma Control Barbara P. Yawn, MD, MSc Mayo Clinic Proceedings Volume 86, Issue 9, Pages 894-902 (September 2011) DOI: 10.4065/mcp.2011.0035 Copyright © 2011 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 1 Assessing asthma control and adjusting therapy in youths aged 12 years and older and in adults.12 The level of control is based on the most severe impairment or risk category. Assessment of the impairment domain is based on the patient's recall of the previous 2 to 4 weeks and by spirometry or peak flow measures. Symptom assessment for longer periods should reflect a global assessment, such as inquiring whether the patient's asthma is better or worse since the last visit. Before a step-up in therapy: (1) Review adherence to medication, inhaler technique, environmental control, and comorbid conditions. (2) If an alternative treatment option was used in a step, discontinue and use the preferred treatment for that step. ACQ = Asthma Control Questionnaire; ACT = Asthma Control Test; ATAQ = Asthma Therapy Assessment Questionnaire; EIB = exercise-induced bronchconstriction; FEV1 = forced expiratory volume in 1 second. Minimal Important Difference: 1.0 for the ATAQ; 0.5 for the ACQ; not determined for the ACT. Mayo Clinic Proceedings 2011 86, 894-902DOI: (10.4065/mcp.2011.0035) Copyright © 2011 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 2 Asthma APGAR questionnaire. From J Asthma Allergy,25 with permission. Mayo Clinic Proceedings 2011 86, 894-902DOI: (10.4065/mcp.2011.0035) Copyright © 2011 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 3 Stepwise approach for managing asthma in youths aged 12 years and older and in adults.12 EIB = exercise-induced bronchospasm; ICS = inhaled corticosteroid; LABA = long-acting inhaled β2-agonist; LTRA = leukotriene receptor antagonist; PRN = as needed; SABA = inhaled short-acting β2-agonist. Mayo Clinic Proceedings 2011 86, 894-902DOI: (10.4065/mcp.2011.0035) Copyright © 2011 Mayo Foundation for Medical Education and Research Terms and Conditions