Welcome to the training on Identifying and Treating Children with Asthma provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
Goal
The goal of this module is to equip Texas Health Steps providers and other health-care professionals to identify asthma, apply a stepwise treatment approach when managing asthma patients in a primary care setting and make appropriate referrals for specialty care.
Target Audience
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Specify what is involved in diagnosing asthma.
- Assess risk factors for asthma and counsel patients and families about risk-reduction strategies.
- Differentiate between the categories of asthma medications and medication delivery systems.
- Apply a recommended stepwise approach as part of managing asthma patients in a primary care setting and help educate patients on self-management.
Please note this module expires on 2/26/2024.
This module was released on 2/26/2021.
Accreditation Statement
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hour(s) of Continuing Nursing Education.
Social Workers
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hour(s) of Continuing Social Work Education.
Certified Health Education Specialists
Sponsored by The Texas Department of State Health Services, Continuing Education Service, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to 1.25 total entry-level Category I contact education contact hours.
Disclosures
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support. - Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose. - Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center. - Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
Browser Requirements
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- American Academy of Pediatrics. (2017). Clinical Tools to Assess Asthma Control in Children.
- American Academy of Pediatrics. Medical Home Chapter Champions Program on Asthma, Allergy and Anaphylaxis.
- American Institute for Preventive Medicine. (2003). Asthma trigger diary to share with patients and their caregivers.
- American Lung Association. Open Airways for Schools educational program to help young people learn to manage their asthma at school, with resources for children, parents and schools.
- Asthma and Allergy Foundation of America and the National Pharmaceutical Council. (2020). Asthma Disparities in America.
- Centers for Disease Control and Prevention. (2020). Asthma Action Plans.
- Centers for Disease Control and Prevention. (2018) National Health Interview Survey. Current Asthma Population Estimates.
- Medical History for Asthma: Review Figure 3-1 from the NAEPP Expert Panel Report 3. The figure provides a list of the Suggested Items for Medical History, including key symptom indicators that health-care providers should look for when considering a diagnosis of asthma.
- National Heart, Lung, and Blood Institute. (2020). Focused Updates to the Asthma Management Guidelines: Clinician's Guide. (Stepwise charts, included.)
- National Library of Medicine, MedlinePlus. (2020). Lung Function Tests.
- Texas Commission on Environmental Quality (TCEQ). (2020). Texas Daily Air Quality Forecast.
- Texas Health and Human Services Commission. (n.d.). Children’s Health Insurance Program (CHIP).
- Texas Medicaid & Healthcare Partnership. Home Health Services (Title XIX [19]) form required for chamber coverage for patients enrolled in Medicaid.
- Texas Medical Board. (n.d.). Respiratory Care Practitioner licensing.
- U.S. Environmental Protection Agency. (2019). Integrated Pest Management.
- U.S. Environmental Protection Agency. (2018). Asthma and Outdoor Air Pollution data sheet.
- U.S. Environmental Protection Agency, Green Book website. Texas ozone status: view the attainment status of counties as of Sept. 30, 2020.
- AIRNow.gov. (2020). Air Quality Index: A Guide to Air Quality and Your Health.
- American College of Chest Physicians. Patient Education Resources: Asthma. (In English and Spanish)
- American Lung Association. (2020). Asthma Patient Resources and Videos.
- American Lung Association. (2020). For Parents of Children with Asthma.
- American Lung Association. (2020). Kickin’ Asthma.
- American Lung Association. (2020). Open Airways for Schools.
- Asthma and Allergy Foundation of America. Asthma and Allergy Educational Materials and Tools for Patients and Caregivers.
- BrainPOP. Educational video about asthma.
- Centers for Disease Control and Prevention. (2019). Kids and Asthma resources, including podcasts, fact sheets and fun books for children with asthma.
- Centers for Disease Control and Prevention. (2020). Asthma Action Plans.
- How to Control Dust Mites video.
- Nationwide Children’s Hospital. (2020). Asthma Program Resources.
- Texas Health and Human Services Commission, Department of State Health Services. (2019). Parents and Caregivers Asthma Management.
- Texas Health and Human Services Commission. (2020). Your Texas Benefits.
- Texas Health and Human Services Commission. (n.d.). Children with Special Health Care Needs Program.
- U.S. Environmental Protection Agency. (2019). Integrated Pest Management programs.
- American Lung Association. (2019) Video: How to Clean a Nebulizer.
- Boston Children’s Hospital. (2015) Video: Cleaning an MDI and Spacer.
- Centers for Disease Control and Prevention. (2018). Video: Know How to Use Your Asthma Inhaler.
- How to Control Dust Mites (video). (2011).
- Mayo Clinic. (2018). Video: How to use a dry powder tube inhaler.
- National Jewish Health. Video: Devices to Inhale Medication (Asthma Inhalers, COPD Inhalers).
- University of North Carolina Children’s Hospital. (2015). Video: Using an MDI and spacer with a mask.
- Allergy & Asthma Network. (2020). Can you smoke if you have asthma?
- Al-Shamrani, A., Bagais, K., Alenazi, A., Alqwaiee, M., & Al-Harbi, A. S. (2019). Wheezing in children: Approaches to diagnosis and management. International Journal of Pediatrics and Adolescent Medicine, 6(2), 68-73.
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- American Academy of Allergy, Asthma & Immunology. (n.d.). Primary Care Summary (of specialist referral guidelines).
- American Academy of Pediatrics. (2016). Medical Home Chapter Champions Program on Asthma (MHCCPA).
- American Institute for Preventive Medicine. (2003). Asthma Triggers Diary.
- American Lung Association. (2020). Asthma and Teens.
- American Lung Association. (2020). Asthma Medication in Schools.
- American Lung Association. (2020). Pet Dander.
- American Lung Association. (2020). The Link Between Asthma and Weight.
- American Lung Association. (2020). Airways Clinical Research Centers.
- American Lung Association. (2016-2018). State of the Air City Rankings. Most Polluted Cities.
- Asthma and Allergy Foundation of America. (2020). Asthma Disparities in America.
- Asthma and Allergy Foundation of America, New England Chapter. (2020). Childhood Asthma.
- Asthma and Allergy Foundation of America. (2020). What People With Asthma Need to Know About Face Masks and Coverings During the COVID-19 Pandemic.
- Asthma and Allergy Foundation of America. (2019). 2019 State Honor Roll of Asthma and Allergy Policies for Schools.
- Castro-Rodriguez, J. A. (2010). The asthma predictive index: A very useful tool for predicting asthma in young children. The Journal of Allergy and Clinical Immunology, 126(2), 212–16.
- Centers for Disease Control and Prevention. (2020). Most Recent Asthma State or Territory Data.
- Centers for Disease Control and Prevention. (2020). Common Asthma Triggers.
- Centers for Disease Control and Prevention. (2020). Flu & People with Asthma.
- Centers for Disease Control and Prevention. (2020). Health Department-Reported Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) in the United States.
- Centers for Disease Control and Prevention. (2018). Asthma Mortality Data.
- Dental News. (2020). The Connection Between Asthma and Oral Health.
- Eggo, R. M., Scott, J. G., Galvani, A. P., & Meyers, L. A. (2016). Respiratory virus transmission dynamics determine timing of asthma exacerbation peaks: Evidence from a population-level model. Proceedings of the National Academy of Sciences, 113(8), 2194-2199. (Abstract).
- Family Care Centers. (2019). Nocturnal Asthma: Facts, Causes, Symptoms, Triggers, and FAQs.
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- How to Control Dust Mites. (video). WaysandHow.com.
- Giangioppo, S., Bijelic, V., Barrowman, N., & Radhakrishnan, D. (2019).Emergency department visit count: a practical tool to predict asthma hospitalization in children. Journal of Asthma, 57(10), 1043-1052.
- Hanson, J. R., Lee, B. R., Williams, D. D., Murphy, H., Kennedy, K., DeLurgio, S. A., Sr., …Reddy, M. (2016). Developing a risk stratification model for predicting future health care use in asthmatic children. Annals of Allergy, Asthma & Immunology, 116(1), 26-30. (Abstract).
- Zonglin, H. Wu, H., Zhang, S., Lin, Y., Li, R., Xie, L. . . . , Ming, W. K. (2020). The association between secondhand smoke and childhood asthma: A systematic review and meta‐analysis. Pediatric Pulmonology, 55(10), 2518– 2531.
- Schauberger, E. M., Biagini, J. M., He, H., & Martin, L. J., Kroner, J., Ryan, P. H., . . . Arshad, S. H. (2018). The Pediatric Asthma Risk Score (PARS) Predicts Atopic and Non-atopic Asthma Better than the Asthma Predictive Index. Journal of Allergy and Clinical Immunology, 143(2), AB12.
- Lizzo, J. M., & Cortes, S. (2020). Pediatric Asthma (book).
- Mayo Clinic. (2020). Asthma medications: Know your options.
- Mayo Clinic. (2020). Asthma: Steps in testing and diagnosis.
- Mayo Clinic. (2019). Mold Allergy.
- Mayo Clinic. (2019). Treating asthma in children under 5.
- McQuaid, E. L., & Landier, W. (2018). Cultural Issues in Medication Adherence: Disparities and Directions. Journal of General Internal Medicine, 6(2), 200-206.
- Merianos, A. L., Jandarov, R. A., Gordon, J. S., Lyons, M. S., & Mahabee-Gittens, E. M. (2020). Child tobacco smoke exposure and healthcare resource utilization patterns. Pediatric Research, 88, 571–579.
- Merianos, A. L., Jandarov, R. A., & Mahabee-Gittens, E. M. (2019). Association of secondhand smoke exposure with asthma symptoms, medication use, and healthcare utilization among asthmatic adolescents. Journal of Asthma, 56(4), 369-379.
- Merianos, A. L., Jandarov, R. A., & Mahabee-Gittens, E. M. (2017). Secondhand Smoke Exposure and Pediatric Healthcare Visits and Hospitalizations. American Journal of Preventive Medicine, 53(4), 441-448.
- National Heart, Lung, and Blood Institute. (2020). 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group.
- National Heart, Lung, and Blood Institute. (2020). 2020 Focused Updates to the Asthma Management Guidelines: Clinician's Guide.
- National Heart, Lung, and Blood Institute. (2012). National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the diagnosis and management of asthma.
- Pulmonology Advisor. (2019). Improving Asthma Care in the Pediatric Population.
- Tenero, L., Piazza, M., & Piacentini, G. (2016). Recurrent wheezing in children. Translational Pediatrics, 5(1), 31-36.
- Texas Commission on Environmental Quality (TCEQ). (2020). Today’s Texas Air Quality Forecast.
- Texas Health and Human Services Commission. (n.d.). Texas Health Steps.
- Texas Department of State Health Services. (2016). 2016 Child Asthma Fact Sheet—Texas.
- Texas Health and Human Services Commission. (2020). Medicaid Pharmacy Prior Authorization & Preferred Drug List.
- Texas Medicaid & Healthcare Partnership. (2020). Texas Medicaid Provider Procedures Manual (TMPPM).
- Texas Medical Board. (n.d.). Respiratory Care Practitioners Licensing.
- UpToDate. (2020). Patient education: Trigger avoidance in asthma (Beyond the Basics).
- U.S. Department of Justice. (2020). A Guide to Disability Rights Laws, including the Individuals With Disabilities Education Act and Title II of the Americans with Disabilities Act.
- U. S. Environmental Protection Agency. (2020). National Ambient Air Quality Standards (NAAQS) for PM.
- U.S. Environmental Protection Agency. (2020). Green Book: Texas Nonattainment/Maintenance Status for Each County by Year for All Criteria Pollutants.
- U.S. Environmental Protection Agency. (2019). Integrated Pest Management (IPM) Principles.
- U.S. Environmental Protection Agency. (2018). Asthma and Outdoor Air Pollution.
- U.S. Food and Drug Administration. (2020). FDA requires Boxed Warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair); advises restricting use for allergic rhinitis.
- U.S. Food & Drug Administration. (2020). FDA finalizes enforcement policy on unauthorized flavored cartridge-based e-cigarettes that appeal to children, including fruit and mint.
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- World Health Organization. Genetics and Asthma.
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- Asthma and Allergy Foundation of America.
- Texas Department of State Health Services. (2019). Asthma Program Home.
The medical definitions in this module were obtained or adapted from the American Academy of Allergy, Asthma & Immunology, Mayo Clinic, Tom Wade, MD, U.S. National Library of Medicine and WebMD.
