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CME Training

This CME activity was put together by members of the Health Care Provider Workgroup (HCP) of the Indiana Joint Asthma Coalition (InJAC): Frederick E. Leickly, MD, MPH (Chair of the HCP workgroup and immediate past president of InJAC); Marti Michel, MSN, CNS, CPNP, AE-C (President of the Indiana Joint Asthma Coalition); David Blair, RPh; Kelly Henderson, PharmD; Jamie Lee, BS, RRT; Julie Koehler, PharmD.

Editorial support and review provided by: Judith Ganser, MD, MPH; Trisha Dane, MPH; Kathryn Nicely, MHC. Secretarial and emotional support provided by Kathy Such. 

As current chair of the HCP workgroup I want to thank this group for all their hard work on this project. One of the goals for the HCP workgroup as stated in the Indiana State Asthma Plan is to provide education for health care providers. This review and CME offering of the ‘NHLBI National Guidelines for the Diagnosis and Management of Asthma Expert Panel Report 3’ is a major step forward in helping lessen the burden of asthma in Indiana.

~Frederick E. Leickly, MD, MPH

 

 

Program Objectives:                
Upon completion of this educational activity, participants should be able to:      
                     
  ·        Discuss the significance of Expert Panel reports in regard to assessment and management of asthma in children and adults.
  ·        Describe pathophysiology, pathogenesis, and the natural history of asthma in general, and the role of inflammation in particular in this common chronic respiratory tract conditions.
  ·        Comprehend the rationale for changes in assessment of asthma and apply new methods in clinical practice. 
  ·        Apply four clinical components of asthma management in children older than 12 years of age and adults.
  ·        Classify severity and initiate treatment of asthma in young children using stepwise approach and incorporating components of severity by assessing impairment and risk.
  ·        Outline the importance of patient self-management in asthma-control and significant role of the patient/clinician relationship in promoting patient understanding adherence and control to promote enhanced quality of life for persons with asthma 
  ·        Explain how patients can manage asthma exacerbations and how physicians can communicate these techniques to patients.   
                     
Accreditation and Designation Statement:            
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Indiana University School of Medicine and Indiana State Department of Health.  Indiana University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians. The Indiana University School of Medicine designates this activity for a maximum of 2.0 AMA PRA Category 1 Credits™.  Participants should only claim credit commensurate with the extent of their participation in the activity. CME credits will be awarded from September 15, 2009 to September 14, 2010. 
Instructions:                  
  1.      View the PDF slides for each section. (Links to the sections and figures are provided for additional reference)
                     
 

2.      Please print off this check list to help keep track of your progress:                                          CLICK HERE TO DOWNLOAD
                     
  3.      Once you have completed all of the required sections on the check list, please register with the Indiana University School of Medicine Division of Continuing Medical Education and take the final test at http://cme.medicine.iu.edu/forms/AsthmaGuidelines.aspx. (CME credits will only be awarded from September 15, 2009 to September 14, 2010) 
                     
Sections:                  
Please click on the section number of each section in order to view the slides for that section. Also, keep track of your progress with the downloadable checklist, available above.  
    
Section 1 (PDF Slides):The Introduction
    Click Here for the link to the Introduction section of the guidelines.
                     
                     
  Section 2 (PDF Slides): Definition, Pathophysiology, Pathogenesis, and Natural History of Asthma
       Click Here for the link to this section of the guidelines.  
      ~Slide 5: The following figure may be helpful when reviewing this section.
      Figure 2-2: Factors Limiting Airflow in Acute and Persistent Asthma (page 15)
      ~Slide 6: The following figure may be helpful when reviewing this section.
      Figure 2-3: Airway Inflammation (page 17)
      ~Slide 8: The following figure may be helpful when reviewing this section.
      Figure 2-4: Host Factors and Environmental Exposures. (page 20)
                     
  Section 3: (Separated into four sections below)          
                     
    Section 3.1 (PDF Slides): Measures of Asthma Assessment and Monitoring  
        Click Here for the link to this section of the guidelines.
      ~Slide 11: The following two figures may be helpful when reviewing this section.
     

Figure 3-8: Validated Instruments for Assessment and Monitoring of Asthma (page 80)
      Figure 3-9: Sample* Patient Self-Assessment Sheet for Follow-up Visits.   (page 81)
                     
    Section 3.2 (PDF Slides):Education for a Partnership in Asthma Care    
        Click Here for the link to this section of the guidelines.
      ~Slide 9: The following three figures may be helpful when reviewing this section.
      Figure 3-13: Delivery of Asthma Education by Clinicians during Patient Care Visits. (pages 126 – 127)
      Figure 3-14: How to Use your Metered-dose Inhaler.  (pages 128)
      Figure 3-15: How to Control things that make your asthma worse. (pages 129 – 130)
                     
      ~Slide 10: The following two figures may be helpful when reviewing this section.
      Figure 3-16a School Asthma Action Plan. (pages 137 – 138)
      Figure 3-16b School Asthma Action Plan and Asthma Education Resources.  (pages 139 – 140)
                     
      ~Slide 12: The following figure may be helpful when reviewing this section.
     

Figure 3-10: Sample Asthma Action Plans.  (pages 117 – 119)
                     
    Section 3.3 (PDF Slides): Control of Environmental Factors and Comorbid Conditions That Affect Asthma
        Click Here for the link to this section of the guidelines.
                     
    Section 3.4 (PDF Slides): Medications          
        Click Here for the link to this section of the guidelines.
      ~Slide 11: The following three figures may be helpful when reviewing this section.   
      Figure 18: Estimated comparative daily dosages for inhaled corticosteroids.  (summary page 49)
      Figure 4-4b: Estimated comparative daily dosages for inhaled corticosteroids in Children. (pages 314 - 316)                                                                            Figure 4-8b: Estimated comparative daily dosages for inhaled corticosteroids for youths >=12 years of age and adults   (pages 349 -350)
                     
      ~Slide 24: The following figure may be helpful when reviewing this section. 
      Figure 3-22: A summary of the available long-term control medication choices. (pages 243-246)
                     
                     
  Section 4: (Separated into four sections below)          
                     
    Section 4.1 (PDF Slides): Managing Asthma Long Term: Overview 
        Click Here for the link to this section of the guidelines.
                     
    Section 4.2 (PDF Slides): Managing Asthma Long Term in Children 0-4 Years of Age and 5-11 Years of Age
        Click Here for the link to this section of the guidelines.
      ~Slide 8: The following figure may be helpful when reviewing this section. 
      Figure 4-1a: Stepwise Approach for Managing Asthma in Children 0-4 Years of Age  (page 305)
                     
      ~Slide 9: The following figure may be helpful when reviewing this section.
      Figure 4-1b: Stepwise Approach for Managing Asthma in Children 5-11 Years of Age (page 306)
                     
      ~Slide 20: The following figures may be helpful when reviewing this section.
      Figure 11: Classifying Asthma Severity and Initiating Therapy in Children (summary page 40)                                                                                                         Figure 4-2a: Classifying Asthma Severity and Initiating Treatment in Children 0 – 4 Years of Age  (page 307) 
      Figure 4-2b: Classifying Asthma Severity and Initiating Treatment in Children 5 – 11 Years of Age  (page 308)
      ~Slide 21: The following figures may be helpful when reviewing this section.
      Figure 12: Assessing Asthma Control and Adjusting Therapy in Children  (summary page 41)                                                                                                          Figure 4-3a: Assessing Asthma Control and Adjusting Therapy in Children 0 – 4 Years of Age  (page 309)
      Figure 4-3b: Assessing Asthma Control and Adjusting Therapy in in Children 5 – 11 Years of Age  (page 310)
                     
    Section 4.3 (PDF Slides): Managing Asthma Long Term in Youths Greater Than 12 Years of Age and Adults 
   
    Click Here for the link to this section of the guidelines.
      ~Slide 7: The following figure may be helpful when reviewing this section.
      Figure 4-5: Stepwise Approach for Managing Asthma in Youths ≥12 Years of Age and Adults (page 343)
      ~Slide 8: The following figure may be helpful when reviewing this section.
      Figure 4-8b: Estimated Comparative Daily Dosages for ICS for Youths >12 Years of Age and Adults  (page 349)
                     
    Section 4.4 (PDF Slides): Managing Asthma Long Term: Special Situations 
   
    Click Here for the link to this section of the guidelines.
                     
  Section 5 (PDF Slides):Managing Exacerbations of Asthma        
      Click Here for the link to this section of the guidelines.        
                     
      ~Slide 5: The following figure may be helpful when reviewing this section.
      Figure 5-1: Classifying Severity of Asthma Exacerbations in the Urgent or
Emergency Care Setting  (page 375)
      ~Slide 8: The following figure may be helpful when reviewing this section.
      Figure 21: Management of Asthma Exacerbations: Emergency Department and Hospital-based Care  (summary page 55)
      ~Slide 9: The following figure may be helpful when reviewing this section.
      Figure 21: Management of Asthma Exacerbations: Emergency Department and Hospital-based Care  (summary page 55)
      ~Slide 12: The following figures may be helpful when reviewing this section.
      Figure 5-8: Checklist for Hospital Discharge of Patients Who Have Asthma  (page 405)
      Figure 5-7: Emergency Department-Asthma Discharge Plan  (page 402)          Figure 5-7b: Emergency Department Asthma Discharge Plan: How to Use Your Metered-dose Inhaler (page 403)
      Figure 3-10: Sample Asthma Action Plans (pages 117 – 119)
This program is supported by Grant/Cooperative Agreement #U59/CCU525032 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.