Asthma / COPD

OVERVIEW

The prevalence of asthma / chronic obstructive pulmonary disease (COPD) is steadily increasing in the United States, and the need for effective primary care is critical. Students need to learn how to manage adults and children who present with acute exacerbations of chronic respiratory conditions, and how to work collaboratively with these patients and families to prevent exacerbations and to maximize exercise tolerance and freedom from symptoms.

Red objectives: Universal

Blue objectives: Advanced clerkship and SubInternship

TOPIC LEARNING GOALS AND OBJECTIVES (Organized by ACGME Competencies)[i]

Patient Care

GOAL: Students will accurately assess signs and symptoms of patients who present with shortness of breath, cough, and/or wheezing.

OBJECTIVES: Students will be able to:

Obtain a clinical history and examination regarding the target symptoms.

Perform appropriate examination of the respiratory system.

Incorporate clinical tools necessary to diagnosis and evaluate COPD and asthma.

	Demonstrate and interpret the use of peak flow in the management of asthma.
	Discuss utilization and interpretation of spirometry.

GOAL: Students will appropriately discuss use of inhalers and peak flow meters with patients.

OBJECTIVES: Students will be able to:

	Explain indicators of control and complications of incompletely controlled asthma to their patients.
	Describe the risks of uncontrolled asthma and goals of management to patients.
	Demonstrate use of an inhaler.
	Demonstrate use a peak flow meter and a home monitoring system for exacerbation management.
	Develop an asthma care plan for a patient

GOAL: Students will demonstrate focused documentation of evaluation, staging and management of asthma and COPD.

OBJECTIVE: Students will be able to:

Write a SOAP note for asthma and COPD SOAP TEMPLATE

Medical Knowledge

GOAL: Students will understand the significance of asthma / COPD in health promotion and disease prevention.

OBJECTIVES: Students will be able to:

	Describe the USPSTF recommendations for screening for asthma / COPD.
	Discuss the epidemiology of asthma and COPD, including racial, ethnic, and socioeconomic differences.

GOAL: Students will understand the pathophysiology and risks of untreated asthma and COPD.

OBJECTIVES: Students will be able to:

	Distinguish
	Describe the staging of asthma and COPD
	Describe how to make the diagnosis of asthma / COPD.
	Describe the end-organ complications of incompletely treated asthma / COPD.
	Discuss and defend the initial evaluation of a patient with a new diagnosis of asthma / COPD.

GOAL: Students will understand the rationale for treatment plans for asthma / COPD.

OBJECTIVES: Students will be able to:

	Describe the appropriate therapy for asthma / COPD.
	Discuss the evidence for the role of lifestyle changes.
	Discuss the side effects and costs of commonly used medications for chronic respiratory diseases.

Practice-Based Learning and Improvement

GOAL: Students will understand the role of monitoring control of asthma / COPD in practice and community settings.

OBJECTIVES: Students will be able to:

	Consider the impact of environment and neighborhood on adherence to treatment plans and lifestyle changes.
	Describe how chronic respiratory disease control is monitored in the assigned clerkship site.

GOAL: Students will understand the role of practice-based improvement.

OBJECTIVES: Students will be able to:

	Recognize the importance of practice analysis for a population with asthma / COPD.
	Identify opportunities for improving the system of care for patients with asthma / COPD in the practice population.

Interpersonal and Communication Skills

GOAL: Students will understand the importance of effective communication with patients and families in the management of asthma / COPD.

OBJECTIVES: Students will be able to:

	Describe the long-term treatment plans for asthma / COPD.
	Include patients and families in the development of treatment plans.
	Demonstrate effective listening skills and empathy to improve patient adherence to lifestyle modifications, smoking cessation, and medication use, monitoring of symptoms.

GOAL: Students will demonstrate sensitivity to individual and cultural differences in the development of treatment plans.

OBJECTIVES: Students will be able to:

	Discuss with patients and families the importance of lifestyle changes, especially reduction of tobacco exposure, in the management of asthma / COPD.
	Develop treatment plans in the context of each patient's life and environment.

Professionalism

GOAL: Students will demonstrate the ability to care for patients with chronic respiratory illness who are from diverse patient backgrounds and at different points in their illness.

OBJECTIVES: The student will be able to:

	Demonstrate sensitivity and responsiveness with patients who are not adhering to treatment plans.
	Reflect on personal frustrations when patients are not adherent to plans.
	Demonstrate understanding of the relationship of asthma / COPD to culture, age, gender, and disabilities.
	Accept patients who, despite medical advice, continue with unhealthy behavior, such as tobacco use, despite the risk of adverse consequences.

Systems-Based Practice

GOAL: Students will understand the impact of health care systems and environment on the management of asthma / COPD.

OBJECTIVES: Students will be able to:

	Analyze barriers to effective integrated treatment of asthma / COPD.
	Consider the role of other disciplines (e.g., pharmacy, nursing, social work, and allied health) in the treatment of asthma / COPD.
	Describe cost-effective strategies for treatment of asthma / COPD using different formularies.

RESOURCES

COPD

COPD

COPD Gold: guidelines for COPD evaluation and management

http://goldcopd.com/GuidelinesResources.asp?l1=2&l2=0

COPD

AAFP: COPD Lecture: Dr. Barbara Yawn

ASTHMA

Guidelines for the Diagnosis and Management of Asthma--Update 2007

http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf

Immunization update

Supplemental reading

Mintz M. Asthma Update: Part I. Diagnosis, Monitoring, and Prevention of Disease Progression. Am Fam Physician 2004;70:893-8. http://www.aafp.org/afp/20040901/893.html.

Mintz M. Asthma Update. Part II: Medical Management. Am Fam Physicians 2004;70:1061-6: http://www.aafp.org/afp/20040915/1061.html.

Work Related Asthma

Youakim S. Am Fam Physician 2001;64:1839-48

http://www.aafp.org/afp/20011201/1839.pdf

Use of Leukotrienes In Management of Asthma and Allergy

Scow D, Luttermoser G, Dickerson K. Leukotriene Inhibitors in the Treatment of Allergy and Asthma. Am Fam Physician 2007;75:65-70.

http://www.aafp.org/afp/20070101/65.pdf

Organizations

American Association of Allergry, Asthma and Immunology

http://www.aaaai.org/

American Lung Association

http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22542

Educational Resources

Joyce A. Copeland, M.D.

Clerkship Director

Duke Family Medicine

[i]

Clerkship/Post-Clerkship Workgroup members: Ann O'Brien-Gonzales, PhD (Chair), Alexander Chessman, MD (EC Liaison), Caryl Heaton, DO, Janice Nevin, MD, MPH, Lauren Oshman, MD, Deborah McPherson, MD, Mark. E Quirk, EdD, David Schneider, MD, MSPH, William B. Shore, MD, Richard Usatine, MD

Resource Title: COPD_Asthma

Current URL: http://fammed.musc.edu/fmc/data/Asthma_COPD.htm

Family Medicine Curriculum Resource (FMCR) Project

HRSA Contract (Contract No. 240-00-0107) to the Society of Teachers of Family Medicine

October 2004