7. Treating Modifiable Risk Factors

Common modifiable risk factors regarding medications include inhaler and spacer techniques. Please refer to CM Asthma Device Quick Guide for a list of inhaled therapies and proper techniques. This guide includes a list of common asthma devices, techniques for use, and reasoning for utilizing a spacer with inhalers. 

Asthma action plans are a tool frequently used in asthma education to provide written guidance for patients and caregivers on how to treat asthma when well (green zone), exposed to a trigger or ill (yellow zone), or when an exacerbation requires emergency management (red zone).

Asthma Action Plan

Asthma Action Plan - Español 

Single Maintenance and Reliever Therapy (SMART) was introduced in EPR4 and GINA 2020. This can be found in the Asthma Stepwise Table as ICS/formoterol. SMART inhalers (Symbicort®, Dulera®, and their respective generics) include a quick reliever (formoterol) and an inhaled corticosteroid intended to be used as both a daily maintenance medication and as needed for symptoms. The SMART asthma action plan provides written guidance for patients and caregivers on how to treat asthma utilizing a SMART inhaler asthma when well (green zone), exposed to a trigger or ill (yellow zone), or when an exacerbation requires emergency management (red zone).

SMART Asthma Action Plan

SMART Asthma Action Plan - Español 

Asthma educators can assist with asthma education on physiology, inhaler education, and asthma action plan education via our in-person asthma classes and online asthma classes. Educational materials, online videos, and in-person asthma class registration can be found at Asthma Education. In addition, most of our respiratory therapists can provide asthma education as well as inhaler education in the inpatient and outpatient setting.

Children’s Mercy Asthma Program Coordinators

• Kylie Smith, BS, RRT-NPS, AE-C
• Maddie Buchanan, BHS, RRT-NPS, AE-C

(816) 302-3484 (ext 73484) or SpectraLink ext 40849

Indoor environmental triggers can be a source of poor asthma control. Management of aeroallergen triggers can be an effective adjunct therapy for asthma management.

Our Environmental Health Program has dedicated specialists who can assist with indoor environmental assessments for asthma triggers in poorly controlled patients. Referrals for home assessments and contact information can be found on the Healthy Homes Program website. When inpatient or outpatient, a referral order to “Clinic Referral Environmental Health/ Healthy Homes” will trigger a referral to our Environmental Health Program for assessment.  In addition, if a patient fulfills the High-Risk Asthma criteria, a referral for our Environmental Health Program is automatically placed.

Known environmental triggers:

• Irritants

• Respiratory tract infections

• Exercise

• Cigarette smoke/E-cigarette smoke

• Strong scents

• Allergens

• Pollens

• Dust

• Cockroaches

• Animals

Common modifiable risk factors regarding medications include inhaler and spacer techniques. Please refer to CM Asthma Device Quick Guide for a list of inhaled therapies and proper techniques. This guide includes a list of common asthma devices, techniques for use, and reasoning for utilizing a spacer with inhalers. 

Though non-compliance and non-adherence can lead to similar results with poor asthma control, the difference between the two is important to distinguish in order to effectively address care and behavior. Non-compliance implies a deliberate and intentional refusal by either parent or child to follow medical instructions and may be motivated by poor perception of disease process, disagreement between physician and patient/family or fear of side effects. 

Non-adherence implies a lack of following medical instructions that could be related to confusion, difficulty accessing medications, cultural or social barriers, or forgetfulness. 

Adherence tips – this is a printable list of tips for adherence that can be given to patients and families

• Non-adherence can be a significant barrier in asthma management
• Must be assessed at every clinic visit addressing asthma
• Rates of compliance with asthma medications have previously been studied as 30-70%³
• Techniques to improve adherence: 
  • Simplifying medication regimen
  • Asthma Compliance charts
  • Asthma tracking apps
  • Treating co-existing mental health illness
  • Addressing and socio-economic barriers
  • Address concerns/fears about medications including side effects
  • Placing medications in plain sight
  • Setting alarms on smartphones
  • Inquiring about cost and utilizing medications assistance programs 
    • Asthma CoPay Assistance Programs
    • Financial Assistance
    • Preferred Drug List

Environmental tobacco smoke and vaping/e-cigarette smoke is a known asthma trigger. Please talk to patients and families regarding tobacco smoke and vaping use.

Caregiver Tobacco and Smoking Cessation Support

Asthma Risks specific to environmental tobacco smoke include the following:

• Secondhand Exposure in children:

  • Development of asthma in pediatric¹ patients

  • Enhanced inflammatory response to allergens²

• Smokers with Asthma

  • Increased severity of symptoms

  • Increased ED visits and hospitalizations

  • Accelerated decline in lung function

  • Impaired response to glucocorticoids