Emerson Ecologics – Managing Asthma with the Stoplight Tool
Over 22 million Americans have asthma and it is one of the most common pediatric chronic diseases, affecting about 6 million children. Asthma is a condition characterized by cough, difficulty breathing, wheezing and chest tightness. Asthma has several underlying pathological mechanisms including bronchoconstriction, bronchial hyperreactivity, and underlying inflammation and airway edema.
The National Asthma Education and Prevention Program (NAEPP) first published guidelines for care in 1991 and published the most recent update in 2007. One of the key clinical activities recommended by the NAEPP is the development of a written asthma action plan in partnership with the patient. An asthma action plan is a written tool which outlines appropriate care for an asthma patient. The stoplight tool is on example of a written asthma action plan that categorizes severity of asthma into a red, yellow, or green zone. Each zone corresponds with a different stage of asthma and outlines the signs and symptoms, treatment plan, and follow-up steps for each stage.
The green zone describes well-managed asthma. This is an asymptomatic patient. Patients in the green zone should have peak flow readings at 80-100% of their best peak flow. The medications listed for patients in the green zone are typically preventative. The plan should include the medication name, the dosage and route of administration and the time to take the medication.
The green zone is the section of the asthma action plan that will most likely be the most robust in naturopathic treatment modalities. Naturopathic medicine provides an opportunity to improve the patient’s health by supporting healthy immune function, promoting healthy smooth muscle tissue, and encouraging an appropriate cellular response when exposed to irritants.
The yellow zone describes a patient whose asthma is not currently controlled but does not yet indicate the need for emergency medical care. Symptoms include cough, wheeze, chest tightness, shortness of breath, or waking during the night due to asthma symptoms. Patients in the yellow zone can perform some, but not all of their daily activities. Their peak flow falls between 50-79% of their best peak flow. These patients require the use of a quick-relief medicine, usually a short-acting beta₂-agonist. The asthma action plan gives patients guidelines for when to seek further care by providing a flow chart for steps to take if symptoms do not resolve, such as taking additional medication or calling their physician.
The red zone describes a medical emergency. Typically, the patient is very short of breath, quick-relief medications have not worked, patients cannot perform usual activities, or a patient has been in the yellow zone for over 24 hours. The asthma action plan discusses warning signs such as visible cyanosis or trouble walking and talking due to shortness of breath. In the red zone, peak flow readings are usually below 50% of a patient’s best peak flow. The treatment plan describes emergency treatment suggestions as well as when to seek emergency care at the hospital.
For an asthmatic patient, the risk of a severe asthma attack is very real and very frightening. The written action asthma plan allows patients to feel comfortable that there is an established protocol for all possible scenarios with chronic asthma and allows physicians to be sure they have covered all aspects of a patient’s asthma management. If you are not comfortable providing care in all zones on the action plan, the patient should be referred for co-management with a pulmonologist or other appropriate healthcare practitioner.
For an example of an Asthma Action Plan, visit the National Institute of Health website at: http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.pdf