Objectives
By the end of Family Medicine Clerkship, students will be able to:
1. Establish an accurate diagnosis of asthma through a focused history and physical exam
a. Including family, occupational and environmental history
b. Including differentiating non-asthma causes of wheezing
2. Explain underlying pathophysiology of asthma to patients and/or family members
a. In relation to acute & recurrent episodes and prophylaxis principles
b. In relation to mechanism of action for relevant meds
c. In relation to red flags of impending asthma crisis
3. Assess asthma control at follow-up. Identify modifiable triggers for patients.
4. Describe the different medication delivery methods (and relevant compliance / educational issues).
5. Describe major medication categories
a. Including mechanism of drug action, particularly SABA and ICS
b. Benefits, risks, limitations
c. Use patterns, compliance, device use
6. Propose a management plan for patients with acute exacerbations.
Clinical Cards
References
Recommended Resources Addressing the Objectives
Childhood asthma: a guide for pediatric emergency medicine providers (23 pages) Detailed, thorough, very good approach to first-time wheeze as well as asthma. Pediatric focus, but concepts translatable to adults.
Objectives covered: 1ab, 2ab, 4, 5abc, 6
http://www.ncbi.nlm.nih.gov/pubmed/23915600
Kline-Krammes S, Patel NH, Robinson S. Childhood asthma: a guide for pediatric emergency medicine providers. Emerg Med Clin North Am 2013 Aug;31(3):705-732.
PMID:23915600
Calgary Guide articles on the pathophysiology behind the clinical and investigation findings of asthma
Objectives covered: 2ac
http://calgaryguide.ucalgary.ca/slide.aspx?slide=Asthma%20-%20Clinical%20Findings.jpg
http://calgaryguide.ucalgary.ca/slide.aspx?slide=Asthma%20-%20Findings%20on%20Investigations.jpg
Childhood Asthma: Diagnosis and Treatment (page 6 only) Very comprehensive; use this to learn how to monitor and followup asthma patients. If desired, this paper also provides additional information about asthma phenotypes in children, and how to predict if asthma in the pre-school child will be transient or permanent. The tables are particularly useful. Too much detail in Management sections.
Objectives covered: 1ab, 3, 5
http://www.hindawi.com/journals/scientifica/2012/674204/
an Aalderen WM. Childhood asthma: diagnosis and treatment. Scientifica (Cairo) 2012;2012:674204.
PMID:24278725
Foundational Knowledge
The Calgary Guide – Pathogenesis of asthma
http://calgaryguide.ucalgary.ca/slide.aspx?slide=Asthma%20-%20Pathogenesis.jpg
As well as entire section on obstructive lung disease:
Additional Resources
Comprehensive overview of pathogenesis, diagnosis, and management of asthma (20 pages) Great resource, more in-depth on pathophysiology, but multiple conflicts of interest (page 22)
Objectives covered: 1ab, 2a, 3, 4, 5bc, 6
http://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2007.01586.x/pdf
Bacharier LB, Boner A, Carlsen KH, Eigenmann PA, Frischer T, Gotz M, et al. Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report. Allergy 2008 Jan;63(1):5-34.
PMID:18053013
Top 10 causes of dyspnea in family medicine, plus clinical pearls (1 page)
Objectives covered: 1b
http://www.ncbi.nlm.nih.gov/pubmed/17872851
Ponka D, Kirlew M. Top 10 differential diagnoses in family medicine: dyspnea. Can Fam Physician 2007 Aug;53(8):1333.
PMID:17872851
Managing acute asthma exacerbations (Am fam physician – 8 pages) Handy, quick reference for recalling what to do to treat an acute asthma exacerbation in the ER.
Objectives covered: 6
http://www.aafp.org/afp/2011/0701/p40.html
Pollart SM, Compton RM, Elward KS. Management of acute asthma exacerbations. Am Fam Physician 2011 Jul 1;84(1):40-47.
PMID:21766754
Brief PubMed Fact sheet on medications for chronic asthma (uses lay language; short, easy read)
Objectives covered: 4, 5ab
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0033709/
U.S. National Library of Medicine. Fact sheet: Medication for people with chronic asthma. 2012; Available at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0033709/. Accessed June/5, 2014.
Patient Information
The asthma action plan (2 pages, in both English and French)
http://www.asthma.ca/adults/control/actionPlan.php
Asthma Society of Canada. Asthma Action Plan. 2014; Available at: http://www.asthma.ca/adults/control/actionPlan.php. Accessed June/5, 2014.
Respiratory inhalers chart (1 page) – clarifies the type and color of different inhalers, includes brand and generic names
http://www.alpha1canadianregistry.com/content/devices_poster.pdf
GlaxoSmithKline Inc. Respiratory Inhaler Identification Chart. 2005; Available at: http://www.alpha1canadianregistry.com/content/devices_poster.pdf. Accessed June/5, 2014.