Purpose and scope
The purpose of this best practice guideline (BPG) is to provide nurses and other health-care providers with evidence-based recommendations of foundational asthma care for adults with a diagnosis of asthma.
This guideline aims to assist nurses and other health-care providers help persons with asthma achieve asthma control, thereby minimizing and, ideally, preventing morbidity and mortality and improving quality of life. The scope of this guideline includes effective assessment and management interventions for adults (defined as persons aged 18 and older) who have a diagnosis of asthma. This guideline is designed to apply to all domains of nursing practice, including:
and across health-care settings including:
- acute care
- long-term care
- outpatient clinics
- community care
- home care
Registered Nurses’ Association of Ontario. (2017). Adult Asthma Care: Promoting Control of Asthma (2nd ed.). Toronto, ON: Registered Nurses’ Association of Ontario.
Do you want to learn about and implement the most- up-to-date evidence-based recommendations on this topic with your colleagues? Download and share the full best practice guideline (BPG), Adult Asthma Care: Promoting Control of Asthma.
See below for a snapshot of the recommendations from this BPG. We strongly suggest you review the full BPG before implementing the recommendations and good practice statements. The BPG also includes further resources to support implementation and evaluation.
Recommendation 1.1: At initial encounter, identify adults with an asthma diagnosis by reviewing the health record for an established asthma diagnosis, supported by the use of objective lung function measurements, and by asking two questions:
- Have you ever been told by a health-care provider that you have asthma?
- Have you ever used a puffer/inhaler or asthma medication for breathing problems?
Recommendation 1.2a: At every encounter, assess the person’s current level of asthma control according to the following criteria:
- Need for a fast-acting beta2 -agonist < 4 doses/week (including for exercise);
- Daytime symptoms < 4 days/week;
- Nighttime symptoms < 1 night/week;
- Normal physical activity levels;
- Mild, infrequent exacerbations;
- No absences from work or school;
- Forced expiratory volume in first second (FEV1) or peak expiratory flow (PEF) ≥ 90% of personal best*‡;
- Diurnal PEF variation < 10–15%*‡; and
- Sputum eosinophils < 2–3%*‡.
* Indicates important objective information for a complete assessment of asthma control, but may not be available.
‡ Performed and interpreted within health-care-provider scope of practice (including appropriate knowledge and skills) and in alignment with organizational policies and procedures.
Recommendation 1.2b: For adults with uncontrolled asthma, determine whether the person is currently experiencing an asthma exacerbation and, if so, the severity and need for urgent medical attention.
Recommendation 1.3: At every encounter, assess the person’s risk of future asthma exacerbations according to the following criteria:
- Current control of asthma,
- Severe exacerbations experienced,
- Exacerbations requiring systemic corticosteroids, and
- Use of emergency care or hospitalizations for asthma.
Recommendation 1.4: At every encounter, identify factors affecting the complexity of asthma management for the person, including age, sex, smoking habits, social determinants of health, triggers, and co-morbidities.
Recommendation 2.1: Develop an individualized, person-centred asthma education plan that addresses the following:
- Learning needs,
- Health literacy, and
Recommendation 3.1a: Provide asthma education as an essential component of care.
Recommendation 3.1b: Educate the person on the essential skills and self-management of asthma based on the person’s learning needs, including:
- Pathophysiology of asthma,
- Medications and device technique,
- Action plans,
- Trigger identification and management, and
- Smoking cessation (if applicable).
Recommendation 3.2: Evaluate non-pharmacological interventions for effectiveness and for potential interactions with pharmacological interventions.
Recommendation 3.3a: At every encounter, actively educate on correct inhaler device technique through observation, feedback, physical demonstration, and written instructions.
Recommendation 3.3b: Engage the person with asthma in shared decision-making with regard to the selection of an inhaler device.
Recommendation 3.3c: Educate the person with asthma on the difference between controller and reliever medications, their indications, and their potential side effects.
Recommendation 3.4: Where appropriate, assist and educate persons with asthma to measure their peak expiratory flow.
Recommendation 3.5: To support self-management, collaborate with the person with asthma to develop and review a documented asthma action plan, in one or a combination of the following formats:
- In writing, on paper,
- Electronically, or
Recommendation 3.6: Provide integrated asthma self-management support to adults with uncontrolled asthma who are at risk for severe exacerbations through multiple modalities/formats, such as:
- Home-care visits, or
Recommendation 3.7: Refer and connect persons with asthma to a:
- Primary care provider, and
- Certified asthma educator or certified respiratory educator.
Recommendation 4.1: At every encounter, evaluate the effectiveness of the overall plan of care in achieving asthma control.
Recommendation 5.1a: Develop multifaceted education programs that reinforce standardized, evidence-based asthma care for:
- Health-care providers, and
- Students entering health-care professions.
Recommendation 5.1b: Implement evidence-based education programs for health-care providers and students entering health-care professions that are facilitated by knowledgeable and skilled educators, and that focus on the core competencies of asthma care.
Recommendation 5.2: Asthma educators obtain and maintain a certified asthma educator or certified respiratory educator designation.
Recommendation 5.3: Provide a quality assurance program and standardized training for health-care providers who perform spirometry.
Recommendation 6.1: Organizations establish a corporate priority focused on the integration and evaluation of best practice asthma care across all care settings.
Recommendation 6.2: Organizations provide the resources and professional training necessary to integrate best practices for the assessment and management of adult asthma across all care settings.
Disclaimer: These guidelines are not binding for nurses, other health providers or the organizations that employ them. The use of these guidelines should be flexible and based on individual needs and local circumstances. They constitute neither a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) gives any guarantee as to the accuracy of the information contained in them or accepts any liability with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work.
Current edition published: May 2017
This BPG is intended to replace the RNAO BPG Adult Asthma Care Guidelines for Nurses: Promoting Control of Asthma (2004a), and its supplement (2007a).