Responsibility for success lies with both patient and professional. Responsibility for failure lies with the professional and asthma program unless proven otherwise.

Professionals at a given site must agree on the essentials of asthma education and asthma treatment. If they don’t, they will have to spend a lot of time explaining why their approach differs from that of other professionals the patient sees.

Education should take place at every contact of the patient and professional: in the office, the emergency department, the hospital ward and with the school nurse. It will usually be one on one, last less than five minutes and be specific to the patient’s needs.

Consistency of concepts, content and vocabulary as used in the 1997 NHLBI Guidelines will lead to more effective and efficient education. Problems occur when using a single word with different meanings. For example, though professionals in the same office refer to a wheeze as mild they have not agreed on how to distinguish it from one of moderate severity. Use of several words to mean the same thing, such as quick relief, reliever, rescue, fast acting beta agonist, quick acting beta agonist, short acting beta agonist, Ventolin or Proventil for albuterol also causes confusion. Patient understanding and effectiveness of the visit is enhanced when professionals use the same vocabulary.

Using written materials for patients that share the same language and concepts will bring consistency to asthma care. One Minute Asthma, the Pedipress asthma diaries and asthma action plans are designed to complement each other. Dr. Tom Plaut’s Asthma Guide for People of All Ages and the 1997 NHLBI Practical Guide for the Diagnosis and Management of Asthma are excellent resources for professionals

Equipment should be of good quality, and a single brand should be used for all patients. This will reduce problems in instruction and during use. Since professionals will only have to be familiar with one brand of each device, troubleshooting will be easy.

Nebulizer cups. The Pari nebulizer cups provide three to four times the benefit of other commonly used cups. More than 60% of the particles it produces are in the respirable range, and very little mist is lost on expiration. Treatment is faster, better and cheaper.

Peak flow meters. The most common problem is a falsely high reading due to the “spit “ or “pea shooter” maneuver.” This rarely occurs with the Mini-Wright, the Astech or PocketPeak but is a problem with most others. This problem can be avoided by placing the mouthpiece on the flat of the tongue.

Diaries and Asthma Action Plans should be uniform across the program to simplify instruction and interpretation. Age specific tools should be used for the under-five group.

Medicines. Use as few brands and inhaler types as possible because techniques for use vary. Errors in technique can cut effectiveness of treatment by inhaler or compressor driven nebulizer by 80 percent.