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PREVENTATIVE
MEDICINE

maintenance and an inhaled bronchodilator for exacerbations, incorporation of asthma management strategies based on evidence-
SMART uses the same inhaler for both prevention and rescue therapy. based guidelines for asthma attack prevention.
This strategy, delivering a corticosteroid and long-acting beta agonist
together, allows for a lower regular steroid dose, with additional doses Recommended patient education resources
as patients use the inhaler to relieve asthma symptoms. Only for- Allergy & Asthma Network: https://allergyasthmanetwork.org
moterol-containing formulations should be used, as it has a rapid onset American Lung Association: Asthma https://www.lung.org/lung-
bronchodilator effect, like albuterol. health-diseases/lung-disease-lookup/asthma.

Correct inhaler use: Provide skills training in using each type of in- References
haler prescribed. It may be helpful to have pictures of commonly-used 1. Control Asthma, 6|18 Initiative, Centers for Disease Control and
inhalers to confirm which inhaler the patient is using. Also discuss Prevention: https://www.cdc.gov/sixeighteen/asthma/index.htm
spacer devices and nebulizers if used. accessed 4/9/2022
2. AsthmaStats: Uncontrolled Asthma among Adults, 2016, Centers
Identification of triggers: Explain how to identify, avoid, eliminate for Disease Control and Prevention: https://www.cdc.gov/asthma/
or control asthma "triggers." It is important to stress that treatment asthma_stats/uncontrolled-asthma-adults.htm accessed 4/9/2022
measures without environmental control may be ineffective. 3. AsthmaStats: Uncontrolled Asthma among Children, 2012–2014,
Centers for Disease Control and Prevention:
Common asthma triggers: https://www.cdc.gov/asthma/asthma_stats/uncontrolled-asthma-
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• Common allergens include house dust mites, animal dander, molds, children.htm accessed 4/9/2022
pollen and cockroach droppings; 4. Strategies for Addressing Asthma for Healthcare Providers, Amer-
• Tobacco smoke; ican Lung Association: https://www.lung.org/lung-health-dis-
• Air pollution, strong odors or fumes; eases/lung-disease-lookup/asthma/diagnosing-treating-asthma/str
• Exercise-induced bronchoconstriction; ategies-for-addressing accessed 4/9/2022
• Medications such as aspirin or other non-steroidal anti-inflamma- 5. Asthma Triggers and Management, American Academy of Allergy,
tory drugs such as ibuprofen and beta-blockers; Asthma and Immunology: https://www.aaaai.org/Tools-for-the-
• Emotional anxiety and stress; Public/Conditions-Library/Asthma/Asthma-Triggers-and-Man-
• Viral and bacterial infections such as the common cold and sinusitis; agement-TTR accessed 4/9/2022
• Exposure to cold, dry air or weather changes;
• Acid reflux, with or without heartburn. John F. Freiler, MD is the founder of Premier Allergy of
Texas. A decorated Air Force Allergist-Immunologist, Dr. John
Monitoring: Patients should understand the importance of moni- F. Freiler retired from the military in the grade of Colonel in
toring their asthma daily, recognition of early asthma symptoms and 2021 with 22 years of active-duty military service to serve the
in treating their symptoms quickly. Encourage keeping diaries of med- San Antonio community. Dr. Freiler’s distinguished military career is no-
ication use, peak flow rates, environmental exposures, symptoms and table for having served as the Chief Consultant to the USAF Surgeon Gen-
actions taken, as these can be used in planning attack prevention and eral for both Allergy & Immunology and Internal Medicine.
management strategies. Additionally, he was selected to serve as core teaching faculty for the Air
Force’s sole Allergy and Immunology Fellowship Program. Dr. Freiler has
Premedicating to prevent onset of symptoms: Instruct patients on published numerous peer-reviewed manuscripts and has been active in the
medication measures to take when triggers cannot be avoided. For ex- mentorship and education of healthcare professionals throughout his ca-
ample, premedication with beta-agonist agents prior to exercise, irri- reer. He is board certified by both the American Board of Allergy and Im-
tants or exposure to known allergens, such as animal dander, may munology and the American Board of Internal Medicine. Dr. Freiler is a
prevent onset of asthma symptoms. member of the Bexar County Medical Society.

Conclusion: While it can be challenging to incorporate patient-fo- To learn more about Premier Allergy of Texas,
cused asthma education into routine care visits, busy clinicians can please scan the QR code above, or visit their Face-
identify the most important points to discuss with each patient. Col- book page at https://www.facebook.com
laboration with an asthma specialist, such as an Allergist or Pulmo- /profile.php?id=100069842199659.
nologist, can use useful to develop a comprehensive plan for

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