1. Asthma Education: Do We Know What We Expect Our Patients to Know? Amir Barzin, DO, MS Kelly Bossenbroek-Fedoriw, MD University of North Carolina – Chapel Hill Department of Family Medicine

2. Disclosures None

3. Background Asthma is one of the most common outpatient diagnoses In 2013 -2014, we looked at metered dose inhaler (MDI) and dry powder inhaler (DPI) use deficiencies Asthma action plans (AAPs) help guide therapy and outcomes

4. Question Do our students know how to use MDIs/PDIs? Do our students understand how to fill an AAP? Can we use residents as teachers to improve asthma education? Can we give residents an opportunity to increase their experience with teaching and exposure to students?

5. Intervention MDI and PDI education was led by residents working with students last year This year, we used AAPs as our teaching intervention

6. Method Identified residents interested in teaching Resident obligation: watch a 3-minute YouTube video on peak flow and view a short PowerPoint on how to fill out an AAP –Total obligation about 15 minutes –Self-directed During Family Medicine orientation, had residents lead a 40- minute teaching session on AAPs –Students filled a pre-teaching AAP –Residents taught and reviewed proper techniques for using a peak flow and filling out an AAP –Students do a post-teaching AAP

7. Clinical Cases John is a 10 year old boy who has had asthma for many years. He is very active, but smoke and cold weather are his triggers for his asthma. His asthma is relatively well controlled. He uses an albuterol inhaler when needed (albuterol 90mcg 2-4 puffs every 6 hours as needed and 4-8 puffs every 30 minutes when severely short of breath for 2 times) and an inhaled corticosteroid everyday (QVAR 40mcg 1 puff twice a day). He has a peak flow meter at home, and his current flows are 500, 550, and 600. Please fill out his asthma action plan. Sallie is an 8-year-old girl.. She has been battling asthma for many years. Her triggers are smoke, cold weather, pollen, and cat dander. Her asthma is difficult to control, and she has to use the following medications: Advair (fluticasone propionate/salmeterol) 100mcg/50mcg per spray - 1 puff twice a day every day; albuterol inhaler when needed (albuterol 90mcg 2-4 puffs every 6 hours as needed when short of breath and 4-8 puffs every 30 minutes when severely short of breath for 2 times). She has a peak flow at home, and her current flows are 400, 375, 425. Please fill out the asthma action plan.

8. Assessment Max Score 9/9

9. Results Cohort 1: (N=20; Max Score = 9) –Pre-Intervention average score: 3.75 –Post-Intervention average score: 8.15 –P-value: <0.001 Cohort 2: (N=22; Max Score = 9) –Pre-Intervention average score: 4.27 –Post-Intervention average score: 7.82 –P-value: <0.001 P-value between cohorts: <0.001

10. Conclusions/Discussion Asthma education interventions can improve outcomes in teaching MDI and DPI use and AAP efficacy Residents can, with a short, self-directed intervention, serve as skilled teachers for students Next Steps: –Can students translate their skills to teach other students and patients? –What can future residents do to expand on our current work? Limitations –Post assessment was performed immediately after intervention –Did not score how this impacted student/patient interaction

11. Please evaluate this session at: stfm.org/sessionevaluation