A primary care physician called me. He was worried—his asthmatic patient was renewing his rescue inhaler prescription too often. Could I meet with the patient and try to solve the problem?
Why did he call me? I am a Certified Asthma Educator, or A-EC. An A-EC must pass the National Asthma Educator Certification Board exam. To qualify to sit for the exam, one must be an MD, RN, or have completed over 1000 hours in the field of asthma education. There are fewer than 4000 A-EC’s worldwide. The exam covers many topics related to asthma and is very difficult, with a 67.9% passing rate.
With the explosive growth of asthma around the country, and indeed, around the world, coupled with overburdening of primary care doctors and dwindling numbers of allergists, this new class of educators has been created to fill the gap in treatment. This translates into asthma sufferers living fully productive lives–less work and school missed and better general well-being. But many people still haven’t heard of what an asthma educator does and why we are needed.
I am a life-long asthmatic, as well as a mother of 2 young asthmatic boys. About 10 years ago I left teaching for the New York Public School System to create an Asthma Education program that combined my three main interests: drama, asthma and teaching. My program, which was run in New York City schools, camps, and community organizations, used role play to teach children, all children, about asthma in a 45-minute lesson. I also led workshops for parents and teachers. The program helped both children and adults be better prepared for handling situations that can present themselves. These situations include asthma triggers and sudden asthma attacks. Effective asthma manage involves not only those with the condition itself, but those around them who must cooperate in reducing conditions conducive to asthma, and to emergency care.
As an A-EC, I am continuing my program of raising asthma awareness, but also getting into the details of patient care. A-ECs counsel those living with asthma. We help ensure patients understand their medications, take them correctly, explain how to follow asthma action plans, and display proper device usage. We counsel about triggers, and other contributing factors. We also provide referrals and patient resources when needed.
In the real-world example cited above, the patient understood he had asthma, but did not understand the damage it was doing to his productivity and overall health. This patient had a rescue inhaler prescribed by his primary care physician, but never saw a need to visit an asthma specialist until his doctor began to worry about the overuse of albuterol, a powerful stimulant. I met with the patient to discuss the case. We attacked the problem from many directions. First, we evaluated his triggers. We found cold weather, exercise, and indoor airborne allergens were all leading to asthma attacks and the use of the rescue inhaler. To reduce these triggers, we shifted the patient’s exercise patterns and schedule to lighten those problems. We also implemented an allergen-reduction plan in his apartment. We removed several dust-collecting bedding items and installed a high-quality air filter. I referred the patient to an asthma specialist, who prescribed a long-term corticosteroid to control inflammation. We then created a custom Asthma Action Plan. This gave the patient specific steps on what to do based on specific symptoms he was experiencing. We discussed his understanding of the medicines he was prescribed, and how important it was to take them, even when he was feeling fine. The patient never fully understood how much his asthma had affected his life until this point. I followed up with the patient several times and was very pleased to learn that the patient had almost entirely eliminated use of the rescue inhaler and had his asthma totally under control.
As any asthma specialist will tell you, the keys to better asthma care are both medical and behavioral. Working with an AE-C, who understands the intricacies of those behavioral issues and has the time to review and reinforce them for the patient, is an invaluable complement to the specialist’s knowledge and experience. While it might sometimes be difficult to find us, we are out there raising awareness each day in our communities. Asthma Educators are qualified to work with patients on their individual needs and give them control of their asthma, and their lives.
(Graphic by PNASH)
Harriet Spitzer-Picker has written asthma programs for managed care companies, as well as the Asthma Basics curriculum for the New York City Department of Health. She graduated from Pace University where she studied Theatre and Psychology, and received her Masters in Educational Theater from New York University. Harriet is a New York State certified teacher and taught in the New York Public Schools. She lives in New York with her husband and two boys, all of whom are asthmatic and have food allergies.