🏅Your Path to Certification
Earn your way up three evidence-based tiers. Each builds on the last. Finish all three and receive your Certified Prepared Patient · Asthma badge and printable certificate, recognized across the FFH Network.
Aware · Identity: Self-Advocate
You know your body and your condition. Layer 1 — Condition Literacy.
- Complete Modules 1–4 (Condition Literacy)
- Pass the "What Asthma Is" quiz (≥80%)
- Identify your severity (mild intermittent → severe persistent) and phenotype (T2-high allergic / eosinophilic vs non-T2 neutrophilic / paucigranulocytic / AERD / EIB / occupational / pediatric / pregnancy), your PEF personal best + zones, your FEV1 + FEV1/FVC + bronchodilator reversibility, your ACT score (or c-ACT for kids), your FeNO + blood eos + total IgE if T2-high or biologic candidate, your medication regimen with SMART dosing (ICS-formoterol controller + reliever per GINA), and your trigger map
- Build your one-page numbers card + daily AM PEF log + monthly ACT score + rescue-use count + oral-steroid-burst log + trigger diary + vaccination record + written Asthma Action Plan (Green/Yellow/Red zones) + inhaler-technique check date
Active · Identity: Care Team Member
You partner with your team and navigate the system. Layer 2 — Care & System Literacy.
- Complete Modules 5–7 (Self-Monitoring · When to Call vs ED · Comorbidity Awareness)
- Demonstrate teach-back on your SMART regimen (ICS-formoterol controller + reliever per GINA; SABA-only no longer recommended), correct inhaler technique with spacer (always use spacer with MDI; rinse mouth after ICS), the absolute rule of continuing ICS + LABA + SABA in pregnancy (uncontrolled asthma is worse than meds for the fetus), and your "when to call vs ED" decision rule (severe dyspnea unrelieved by reliever, tripoding, silent chest, drowsiness, cyanosis, can't speak full sentences, pulse ox <92%, PEF <50% after reliever)
- Complete one "great visit" prep + debrief with your PCP, Pulmonology, or Allergy/Immunology team (especially if biologic candidate)
- Establish Pulmonology or Allergy/Immunology referral if moderate-severe + not controlled (biologic-eligibility audit); Pharmacist inhaler-technique check; ENT if chronic rhinosinusitis or nasal polyps or AERD; Behavioral Health if PHQ-9 elevated; smoking-cessation counselor or Quitline 1-800-QUIT-NOW if applicable; school nurse Action Plan if child
- Successfully resolve one prior auth (e.g., for omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, tezepelumab), manufacturer copay-program application, or insurance-navigation issue via the AAFA Helpline
Certified Prepared Patient · Identity: Ambassador
You teach, mentor, fight stigma, and shape research & policy. Layer 3 — Advocacy & Ambassadorship.
- Complete Modules 8–10 (Family & Care Team · Talk to Kids/Partner/Employer + Mentor · Mastery & Graduation)
- Mentor 1 newly-diagnosed person or family via the AAFA peer-mentor program + Wall of Hope / ALA Open Airways for Schools / Allergy & Asthma Network Trusted Messengers, OR present at a faith-community / employer / school / community health worker education session about the SMART regimen, written Action Plan, and biologic-revolution opportunity for severe T2-high
- Sign the Prepared Patient Pledge
- Complete (or refresh) your written Asthma Action Plan (Green/Yellow/Red zones — AAFA / NHLBI template) AND distribute copies to family Ambassador + school nurse (if child) + employer/HR (if relevant) + emergency contacts; Caregiver Layer module if applicable
- Submit one advocacy action (story, World Asthma Day in May outreach, state-level stock-inhaler legislation advocacy, HEDIS asthma quality-metric equity tracking, AA / Puerto Rican / Indigenous biologic-prescribing-gap outreach, school-nurse staffing advocacy, air-quality + environmental-justice advocacy)
📋Master Pre / Post Assessment
Where You Stand — Confidence Before & After
Seven dimensions of being a Prepared Patient. Answer once at the start of your journey and again at the end. Your goal is to see real growth across understanding, self-management, communication, and optimal utilization — knowing when to call your team, when an issue can wait for clinic, and when to go to the ER. Your answers stay on this device unless you choose to share with your clinician.
📈 Your Pre→Post Growth
📞Know Who to Call — PCP / Pulm / Allergy First, ED for Red Flags
Asthma care runs as a long arc — diagnosis, severity classification, controller titration, biologic decisions, and (if exacerbation) acute management + post-exacerbation step-up. Most days are routine. Some days bring trigger-control or adherence calls. A few bring red flags. Knowing the right number to call — your PCP / Pulmonology / Allergy team, your Pharmacist, the AAFA Helpline, or 911 / ED — saves time, dignity, and lives. Save these numbers in your phone today. The numbers below are placeholders — your institution will fill in the right ones for you.
🚑 Go to the ED right away for any of these
Severe dyspnea unrelieved by reliever (multiple albuterol or ICS-formoterol doses don't help) · tripoding (sitting forward, hands on knees, can't lie back) · silent chest (wheeze stops because air movement is too low — paradoxical and ominous) · drowsiness, confusion, agitation (hypoxia or hypercapnia) · cyanosis (blue lips, fingers, nail beds) · can't speak in full sentences ("single-word dyspnea") · pulse ox <92% · peak flow <50% personal best after reliever · infants and young children with retractions, nasal flaring, head bobbing (kids decompensate fast; lower threshold) · pregnancy with worsening symptoms (uncontrolled asthma is worse than meds for fetus; aggressive treatment) · active suicidal intent or attempt (988 or 911/ED). When in doubt, go.
🧭 Same-day call to your bone-health team — most things are addressable in clinic, not the ED
For rescue inhaler use >4×/24hr (or any oral-steroid-burst need), PEF persistently in yellow zone (50–79% personal best for >48 hr), increasing nighttime awakenings, new persistent cough or wheeze, ACT score <20 for 2+ months, missed biologic dose (if on monthly or Q2-week SC), inhaler-technique concerns, or medication-adherence concerns, call your [Pulm / Allergy / PCP line: (555) 123-4567]. Most issues are addressable in clinic.
💬 Routine questions, refills, scheduling, peer support
Use [MyChart portal] first — most messages answered within 1 business day. For inhaler refills, spacer dispensing, biologic copay help, or inhaler-technique check, call [Pharmacy: (555) 222-9050]. For peer mentoring + family support + navigation + biologic-copay help, call the AAFA Helpline 1-800-7-ASTHMA (1-800-727-8462) — free, real humans, M–F. ALA Lung HelpLine 1-800-LUNGUSA. For AA / Puerto Rican / Indigenous / rural communities: AAFA + ALA chapters + Allergy & Asthma Network Trusted Messengers offer culturally-affirming + community-health-worker support. World Asthma Day first Tuesday in May.
🆘 Mood crisis · suicidal thoughts → 988 (call or text)
Depression and anxiety affect 30–40% of moderate-severe asthma patients. Mood-asthma loop is real: untreated mood worsens adherence + symptom perception + ED visits. Any thoughts of wanting to die or hurt yourself = call or text 988 (Suicide & Crisis Lifeline · free, confidential, 24/7). Active risk → 911 / ED. Veterans: 988 then press 1. Crisis Text Line: text HOME to 741741. Asking about suicide does not plant the idea. SSRIs are asthma-safe (sertraline, escitalopram); treating mood improves asthma control.
📚Condition Literacy & the 10 Prepared Patient Competencies
A Prepared Patient builds three kinds of health literacy — and grows into three identities. Each competency works through the FFH three pillars: Learn It · Live It · Share It.
Advocate for Self
You speak up for your own care, plan, pain, and goals.
Care Team Member
You partner with your team — not above, not below.
Ambassador
You teach, mentor, and shape research, policy & access.
🧬 Condition Literacy Learn It · Tier 1 Aware
"I know my body and my disease." The foundation. Without this, nothing else holds.
What Osteoporosis Is
A silent bone disease — bone mineral density (BMD) and microarchitecture quality drop until ordinary loads cause a fragility fracture (wrist, spine, hip, shoulder). About 10M Americans have osteoporosis; another ~44M have osteopenia. 1 in 2 women and up to 1 in 4 men over 50 will fracture in their remaining lifetime. Highly modifiable at any age. What osteoporosis is NOT: osteoarthritis (joint cartilage disease), osteomalacia (defective mineralization), Paget's disease (focal disordered remodeling), or normal aging.
Know My Numbers & Phenotype
Your asthma dashboard: PEF daily + personal best (Green ≥80% / Yellow 50–79% / Red <50%), FEV1 + FEV1/FVC (obstruction if FEV1/FVC <0.7), bronchodilator reversibility (≥12% AND ≥200 mL = asthma), ACT ≥20 controlled; <20 re-evaluate (c-ACT for kids 4–11). Phenotype: T2-high allergic / eosinophilic vs non-T2 neutrophilic / paucigranulocytic / AERD / EIB / occupational / pediatric / pregnancy — drives biologic candidacy. FeNO >50 ppb + blood eos ≥300/μL + total IgE for biologic eligibility. Rescue use >2x/week = not controlled; oral steroid bursts ≥2/year = biologic referral. Family hx atopic march. Equity: AA ~2–3x higher US asthma mortality; Puerto Rican children highest; structural disparities.
Lifestyle Force Field — Trigger Control + Adherence
Trigger reduction: dust-mite encasings + HEPA bedroom; integrated pest management (cockroach, mouse); mold remediation; pet dander mitigation; smoke-free home/car/workplace (active, passive, vaping, wood, cannabis); air-quality awareness (AirNow / IQAir); gas-stove ventilation; wildfire-smoke management. Annual vaccinations (flu, COVID, RSV if eligible, pneumococcal) — viral URI is the #1 exacerbation trigger. Allergen immunotherapy (SCIT or SLIT) disease-modifying for allergic asthma. Weight management (obesity worsens asthma; bariatric improves). Pre-treat exercise if EIB. Smoking cessation = most disease-modifying single behavior in non-T2 (Quitline 1-800-QUIT-NOW).
Medications + Inhaler Technique
GINA SMART regimen: ICS-formoterol as both daily controller AND reliever (SABA-only no longer recommended). Controllers: ICS → ICS-LABA → ICS-LABA + LAMA (Trelegy) → biologic. LTRA (montelukast): FDA black-box warning for neuropsychiatric effects. Biologics for severe T2-high: omalizumab (anti-IgE), mepolizumab/reslizumab/benralizumab (anti-IL-5), dupilumab (anti-IL-4Rα), tezepelumab (anti-TSLP; broadest including some non-T2) — life-changing. Oral steroids for exacerbations only; chronic use = biologic referral. Inhaler technique HIGH-LEVERAGE — ALWAYS use spacer with MDI; rinse mouth after ICS. Pregnancy: continue ICS + LABA + SABA — uncontrolled is worse than meds.
🤝 Care & System Literacy Live It · Tier 2 Active
"I'm part of the team. I navigate the system." Where most preventable ED visits, decompensation crises, and frustration happen — and where this course pays off the most. Optimal utilization lives here.
Self-Monitoring — PEF, ACT, Action Plan, Rescue Use
The numbers card travels. Daily AM PEF + personal best (2-week tracking finds it). Monthly ACT (or c-ACT for kids 4–11); ≥20 controlled, <20 re-evaluate. Written Asthma Action Plan (Green / Yellow / Red zones) from clinician — non-negotiable; copy on fridge + in phone + at school + with employer. Rescue use / month (>2x/week = not controlled). Oral steroid bursts / year (≥2 = severe + biologic referral). Nighttime awakenings / week. Trigger diary 1–2x/year. Pulse ox during exacerbations (<92% = ED). Smart inhalers (Propeller, Hailie) for adherence + technique tracking. Adherence drift is the #1 failure mode.
When to Call vs Go to ED — Asthma Red Flags
ED: severe dyspnea unrelieved by reliever; tripoding; silent chest (wheeze stops because air movement too low); drowsiness/confusion; cyanosis; can't speak full sentences ("single-word dyspnea"); pulse ox <92%; PEF <50% personal best after reliever; infants/young children with retractions, nasal flaring, head bobbing (lower threshold — kids decompensate fast); pregnancy with worsening symptoms. Same-day call: rescue use >4x/24hr, PEF persistently yellow, oral steroid burst needed, missed biologic dose, ACT <20 × 2 months. Mood crisis → 988 (30–40% prevalence in moderate-severe).
Comorbidity Awareness — The Asthma Ecosystem
Asthma-specific Module 7. Frame: the asthma ecosystem. Cross-references: Allergic Rhinitis (united airway; 60–80% coexistence); Chronic Rhinosinusitis with Nasal Polyps + AERD (ENT + biologics + aspirin desensitization); Atopic Dermatitis (atopic march; dupilumab dual-approved); GERD common comorbidity; Sleep Apnea (cluster); Obesity (worsens asthma; bariatric improves); Depression/Anxiety (30–40% prevalence; 988; SSRIs asthma-safe); Osteoporosis (chronic steroid bone loss — Sprint 9 cross-ref); steroid-induced diabetes + cataracts + infection (why biologics matter); pregnancy (continue meds); smoking. Vascular cluster (md5 7587a559b24ca8b9bab40b1756475d84) cross-referenced, NOT embedded. COPD companion course.
📣 Advocacy & Ambassadorship Share It · Tier 3 Certified
"I speak up. I lift others. I shape the future." This is what turns a Prepared Patient into a force multiplier for the whole community.
Family, Caregiver, Care Team — Action Plan + Inhaler-Technique Coach
The long-arc partnership. Ambassador roles: inhaler-technique coach (watch them use it; spacer with MDI; rinse mouth after ICS); Action Plan keeper (fridge + phone + school + employer); trigger watcher + adherence partner + biologic-injection helper + ED-rule reminder; pediatric Ambassador (school nurse Action Plan partnership — decisive for kids); family-history Ambassador (atopic march); equity Ambassador for AA / Puerto Rican / Indigenous / rural under-referred severe T2-high. Care team: PCP + Pulmonology + Allergy/Immunology + Pharmacist + ENT + Behavioral Health + Dietitian + Smoking cessation/Quitline + School nurse + AAFA peer + ALA + Family Ambassador.
Sharing — Talk to Family, School, Workplace, Equity Ambassador
Kids: "Your lungs are like trees; asthma narrows the branches; your inhalers open them up." Always send written Asthma Action Plan to school (nurse + classroom + PE + after-school) — make sure rescue inhaler is accessible. Partner: technique coach + Action Plan keeper + trigger watcher + adherence partner + ED-rule reminder. Family history atopic march (asthma + AR + eczema) — tell adult children + siblings. Equity Ambassador: AA + Puerto Rican + Indigenous + rural severe T2-high patients are biologic-eligible but under-referred — push for Pulm or Allergy audit. ADA covers asthma; FMLA for exacerbations + biologic infusions; workers'-comp for occupational asthma. Pregnancy: continue ICS + LABA + SABA. AAFA + ALA + Allergy & Asthma Network peer-mentor + World Asthma Day (May).
Mastery & Graduation — Sustained Engagement, Peer Mentor, Long-Arc Identity
Sustained control: ACT ≥20 month over month, rescue <2x/week, 0 oral steroid bursts/year, 0 ED visits, full activity. Daily SMART regimen + correct technique + AM PEF; monthly ACT; annual spirometry + vaccinations + Action Plan review; biologic-eligibility audit if severe. Peer mentorship via AAFA peer-mentor + Wall of Hope + ALA Open Airways for Schools + Allergy & Asthma Network Trusted Messengers + World Asthma Day (May). Advocacy: stock-inhaler legislation; HEDIS asthma quality-metric equity tracking; AA + Puerto Rican + Indigenous biologic-prescribing-gap closure; air-quality + environmental-justice; school-nurse staffing. Long-arc identity: asthma is a long disease; you are a Prepared Patient for life. Earn Certified Prepared Patient · Asthma.
👥My Care Team
Your team is bigger than just the doctor — and the care partner is part of it. Click any card to edit, or click the + tile to add a new team member. Saved on this device. The Force Field Emergency Card below auto-syncs from this list. Starter roster pre-populated for Asthma — your institution can edit any row. The Force Field Emergency Card auto-syncs from this list and surfaces the AAFA Helpline + the SMART regimen reminder + the spacer-with-MDI + rinse-mouth-after-ICS rules + the written Action Plan + the biologic-eligibility audit checklist.
📖Glossary — words you'll hear
Plain-English definitions for terms doctors and labs use. Tap to expand.
SMART regimen (GINA)
ICS (Inhaled Corticosteroid)
SABA / LABA / LAMA
Biologics for severe T2-high asthma
FeNO (Fractional Exhaled Nitric Oxide)
Peak Expiratory Flow (PEF)
Asthma Control Test (ACT)
Spirometry + Bronchodilator Reversibility
Spacer (Valved Holding Chamber)
Asthma Action Plan (Green / Yellow / Red zones)
AERD (Samter's Triad)
EIB (Exercise-Induced Bronchoconstriction)
Atopic March
🧪Screen & Lab Tutor — your PEF, FEV1, ACT, FeNO, eos, IgE, and what your asthma workup means
Screen & Lab Tutor — your asthma workup
In asthma, the most important "labs" are your PEF + personal best, FEV1 + FEV1/FVC + bronchodilator reversibility, ACT score, FeNO, blood eosinophils, total + specific IgE, and rescue + oral-steroid-burst counts. Your "normal" may be different from a friend's. Ask your team to write your personal baseline in the column on the right.
| Test / Screen | What it measures | Typical adult range | What to ask if it's off | My baseline |
|---|---|---|---|---|
| PEF (Peak Expiratory Flow) | Home meter; track 2 weeks twice daily to find personal best; then zones. | Green ≥80% personal best · Yellow 50–79% · Red <50% | What is my personal best? My Yellow + Red thresholds? Bring to every visit. | [fill in] |
| FEV1 + FEV1/FVC (spirometry) | In-office. Obstruction if post-bronchodilator FEV1/FVC <0.7. FEV1 % predicted = severity. | FEV1 ≥80% predicted = good control; <80% poor control | What is my FEV1 % predicted? Trend? Is it reversible? | [fill in] |
| Bronchodilator reversibility | FEV1 improvement after SABA. Confirms asthma. | Increase ≥12% AND ≥200 mL = asthma | Did I show reversibility? If not + suspicion remains: methacholine challenge? | [fill in] |
| ACT (Asthma Control Test) | 5-question, 25-point survey monthly. c-ACT for kids 4–11. | ≥20 = controlled; <20 = re-evaluate | What is my ACT? <20 → step up controller or specialist referral. | [fill in] |
| FeNO (Fractional Exhaled Nitric Oxide) | Breath test. T2 inflammation marker. | <25 ppb low · 25–50 intermediate · >50 high T2 | What is my FeNO? Am I a biologic candidate? | [fill in] |
| Blood eosinophils | CBC differential. T2 marker. | ≥150/μL some T2 signal · ≥300/μL biologic threshold | Am I eligible for an anti-IL-5 biologic? Or dupilumab? | [fill in] |
| Total IgE | Serum total IgE. Drives omalizumab dosing in allergic asthma. | Varies (often 30–700 IU/mL); higher = more allergic | Am I a candidate for omalizumab (anti-IgE)? | [fill in] |
| Allergen-specific IgE | Skin prick test or blood test. Identifies specific allergic sensitization. | Positive results identify triggers + immunotherapy candidates | Which allergens am I sensitized to? Immunotherapy candidate? | [fill in] |
| Rescue inhaler use / month | SABA or ICS-formoterol as reliever puffs (excluding pre-exercise). | <2x/week = controlled; >2x/week = not controlled | Am I overusing rescue? Step-up controller indicated? | [fill in] |
| Oral steroid bursts / year | Prednisone courses for exacerbations. | 0 = ideal; ≥2/year = severe + biologic referral threshold | Am I a biologic candidate? Why have I needed bursts? | [fill in] |
| Vaccinations | Annual flu, COVID, RSV (60+, pregnant, infants), pneumococcal (PCV20 or PCV15+PPSV23). | All current | Am I current? Viral URI is #1 exacerbation trigger. | [fill in] |
| Vitamin D | Adequacy supports immune + airway health. | Target ≥30 ng/mL | Should I supplement? | [fill in] |
| BP + A1c + bone density (if chronic steroids) | Steroid-side-effect monitoring. | Per general guidelines | Am I on chronic oral steroids? Biologic referral instead? | [fill in] |
➕Add-On Modules & Earnable Badges
Stackable modules that match your situation. Complete one to earn an extra badge on your certificate. Your institution can add their own.
💨 Inhaler-Technique-With-Spacer Routine
Most patients use inhalers wrong. Pharmacist or AAFA video teach-back. ALWAYS spacer with MDI. Rinse mouth after ICS. Re-check at every visit.
📊 Peak Flow + Personal Best Baseline
$20 mechanical or $50 Bluetooth meter. Twice daily × 2 weeks. Highest reading = personal best. Then daily AM. Zones: Green ≥80% / Yellow 50–79% / Red <50%.
📋 Monthly ACT Routine
5 questions, 5 minutes. Free at AAFA. c-ACT for kids 4–11. ≥20 = controlled; <20 = re-evaluate. Bring score to every visit.
📜 Written Asthma Action Plan (Green / Yellow / Red)
AAFA / NHLBI template; signed by clinician; copies to fridge + phone + school + employer. Review annually.
💉 Biologic SC Injection Routine
For severe T2-high: omalizumab (Q2–4 wk), mepolizumab (monthly), benralizumab (Q4 wk × 3 then Q8), dupilumab (Q2 wk), tezepelumab (monthly). Many self-administered SC. Manufacturer training videos + nurse visits available.
🌿 Allergen Immunotherapy (SCIT or SLIT)
Disease-modifying for allergic asthma + allergic rhinitis. 3–5 year course. Reduces medication burden + progression. Coordinate with Allergy/Immunology.
🏠 Home Trigger-Reduction Sweep
Dust-mite encasings + HEPA bedroom; IPM for cockroach + mouse; mold remediation; pet dander mitigation; smoke-free home/car/workplace; gas-stove ventilation.
💉 Annual Vaccinations
Flu (any age) + COVID + RSV (60+, pregnant, infants) + pneumococcal (PCV20 or PCV15+PPSV23). Viral URI = #1 exacerbation trigger.
🎓 School Action Plan Partnership
Plan + rescue inhaler + emergency contacts at school. Annual review. Many states allow self-carry or stock inhalers.
🏭 Occupational Asthma + Workers'-Comp
Flour, isocyanates, latex, cleaning agents, hairdressing chemicals, agricultural exposures. Document exposure timeline. Workers'-comp + exposure removal essential.
🤰 Pregnancy Asthma Management
Continue ICS + LABA + SABA — uncontrolled asthma is worse than meds for fetus. Coordinate with Allergy/Pulm. Biologics in pregnancy: omalizumab has most data.
🚭 Smoking Cessation
Quitline 1-800-QUIT-NOW. Combine behavioral + pharmacologic (varenicline, NRT, bupropion). Most disease-modifying single behavior in non-T2 / smoking-related asthma.
📱 Smart Inhaler (Propeller / Hailie)
Tracks adherence + technique + location of use. Syncs with care team. Substantial evidence for improved adherence + outcomes.
🌫️ Air-Quality Awareness
AirNow + IQAir + BreezoMeter apps daily. N95 mask + HEPA indoors on high-pollution + wildfire-smoke days. Pollen app for seasonal trigger management.
🧪 In an Asthma Clinical Trial?
Trials currently exploring new biologics, ICS-formoterol regimens, allergen-immunotherapy enhancements, severe-asthma combinations. Search ClinicalTrials.gov.
+ Add Your Institution's Module
Local AAFA chapter, ALA Open Airways for Schools, school nurse training partnership, employer wellness program, faith-community partnership, asthma camp.
🛡️Force Field Emergency Card
🛡️ Force Field Emergency Card FRIDGE · WALLET · EMT-READY
A one-page emergency record for any EMT, ER, new doctor, or transition visit. Print one for the fridge, one for your wallet. Updates anytime. This is the document you hand to a stranger when you can't speak for yourself. Pair with the BHOF Helpline (1-800-231-4222) and the post-fracture treatment-gap rescue checklist.
🤝 My Care Team — call list for any clinician picking up my care
📘My Health Passport
📘 My Health Passport PATIENT-OWNED JOURNAL
This is your record — not your hospital's. Log every visit, capture every question for next time, and watch your own trends. Many of you get care at more than one hospital, on more than one record system. This Passport travels with you. Future versions will let you import data directly from your patient portals (the "Blue Button" vision).
🩺Working With a Prepared Patient · Asthma
Your patient is going through a structured, evidence-based course. Here's how to get the most out of every visit, drive ACT ≥20 with the SMART regimen, support the family / school / employer Ambassador roles (inhaler-technique coach + Action Plan keeper + trigger watcher + adherence partner), and partner well across the long asthma care arc. Built on the AHRQ SHARE Approach, IOM teach-back, alignment with the Global Initiative for Asthma (GINA) 2024 update, NHLBI 2020 Focused Updates, AAFA, ACAAI, AAAAI, ATS / ERS severe asthma guidelines, and the biologic-revolution evidence base for severe T2-high asthma. The AAFA Helpline (1-800-7-ASTHMA) is surfaced throughout.
The SHARE Approach — your 5-step playbook
Use these steps in any order. Cycle back. Use teach-back at every transition. Source: AHRQ Pub. No. 25-0005 (Oct 2024).
💬Teach-Back & Risk Communication
The two highest-yield, lowest-cost SDM techniques. Use both at every visit.
🔁 Teach-Back (1–2 min)
- "Just so I know I explained it well — what would you tell your family Ambassador about how to use your inhaler correctly with a spacer? About the difference between controller and reliever in your SMART regimen? About when to call me vs the ED during an exacerbation?"
- Open-ended ("what" / "how"), not yes/no.
- If they get it wrong: "I must not have explained it well — let me try a different way." Then teach-back again.
- Use it for: SMART regimen (ICS-formoterol as controller + reliever; SABA-only no longer recommended); inhaler technique (ALWAYS spacer with MDI; rinse mouth after ICS); written Action Plan (Green/Yellow/Red zones); biologic-eligibility audit (if severe T2-high and ≥2 oral-steroid bursts/year); pregnancy continuation rule (NEVER stop ICS + LABA + SABA); when to call vs ED (silent chest, tripoding, single-word dyspnea, pulse ox <92%); school Action Plan if child.
- Document teach-back in your note — it's a quality measure and a billable element of care.
🔢 Communicating Numbers
- Use absolute risk, not relative. "15 to 20 of every 100" beats "15–20%" beats "fairly common" beats "low risk."
- Keep denominators & timeframes constant when comparing options.
- Show, don't tell: icon arrays, photographs of dyskinesia vs tremor, written summary.
- For asthma numbers: give the trend, not just the value. "Your ACT was 14 six months ago, 18 three months ago, 22 now on the SMART regimen — that's controlled. Your FEV1 went from 75% to 88% predicted. Rescue use went from 5x/week to 1x/week. Excellent trajectory; let's consider a step-down trial in 3 months."
⚠️Asthma-Specific Clinical Guardrails
Diagnosis
- Spirometry pre + post bronchodilator is the gold standard. Obstruction = FEV1/FVC <0.7 post-BD. Reversibility = FEV1 ↑ ≥12% AND ≥200 mL after SABA confirms asthma.
- If spirometry normal but clinical suspicion remains: methacholine bronchoprovocation (PC20 <8 mg/mL = asthma).
- Phenotype workup: FeNO + blood eos + total IgE + allergen-specific IgE — identifies T2-high biologic candidates.
- Severity classification: mild intermittent → severe persistent based on symptom frequency, nighttime awakenings, rescue use, FEV1.
Evidence-Based Treatment (GINA 2024)
- GINA Step 1+: ICS-formoterol as both controller and reliever (SMART regimen). SABA-only is no longer recommended.
- Step up: ICS → ICS-LABA → ICS-LABA + LAMA (Trelegy) → biologic.
- Severe T2-high → biologic: omalizumab (anti-IgE), mepolizumab/reslizumab/benralizumab (anti-IL-5 or IL-5Rα), dupilumab (anti-IL-4Rα), tezepelumab (anti-TSLP — broadest including some non-T2). Manufacturer copay programs cover most patients.
- Oral steroids for exacerbations only (prednisone 40–60 mg × 5–7 days). Chronic oral steroids = severe disease + biologic referral indicated.
- Allergen immunotherapy (SCIT or SLIT) disease-modifying for allergic asthma. 3–5 year course.
- Pregnancy: continue ICS + LABA + SABA — uncontrolled asthma is worse than meds for the fetus.
The Asthma "NEVER" / "ALWAYS" List
- NEVER use LABA without ICS in asthma (historical black-box warning for asthma death with LABA monotherapy).
- NEVER recommend SABA-only (GINA 2024 — SABA-only is associated with worse outcomes).
- NEVER stop ICS + LABA + SABA in pregnancy — uncontrolled asthma is worse than meds.
- AVOID NSAIDs in AERD (aspirin desensitization is the only treatment if needed).
- ALWAYS use spacer with MDI; rinse mouth after ICS.
- ALWAYS write a written Action Plan (Green/Yellow/Red zones) for every patient + distribute copies.
- ALWAYS audit for biologic eligibility if severe + not controlled or ≥2 oral-steroid bursts/year.
- ALWAYS audit inhaler technique at every visit (pharmacist or trained staff).
- ALWAYS update vaccinations (flu, COVID, RSV, pneumococcal).
Quality Metrics for a Prepared Patient · Asthma
- ACT ≥20 month over month; rescue use <2x/week; 0 oral steroid bursts/year; 0 ED visits; full activity; spirometry annually; vaccinations current; written Action Plan.
- Specialty referrals: PCP for mild; Pulmonology + Allergy/Immunology for moderate-severe + biologic management; ENT for AERD + nasal polyps + chronic rhinosinusitis; Behavioral Health for the 30–40% mood prevalence.
- Equity tracking: ACT control + biologic-uptake by race/ethnicity — close the AA / Puerto Rican / Indigenous biologic-prescribing gaps.
🌍Equity, Cultural Competence & Trust
Asthma has well-documented access + outcome gaps. African Americans have ~2–3× higher US asthma mortality than white Americans. Puerto Rican children have the highest US prevalence + mortality. Indigenous + rural communities face under-studied gaps. Drivers (all modifiable in principle): urban air pollution (historical redlining); indoor allergens (substandard housing — cockroach, mouse, mold); tobacco smoke exposure; specialty-care access (Pulm + Allergy density lower in minority + rural); biologic-prescribing gaps (severe T2-high AA + Puerto Rican patients under-referred + under-prescribed); insurance gaps; language barriers; school resource gaps (fewer nurses, fewer stock-inhaler programs); wildfire smoke + climate change. Occupational asthma in agricultural workers + indoor cleaners. LGBTQ+ care-access disparities documented but less-studied. Repair starts in your office.
- Track biologic-uptake by race / ethnicity in your panel. Refer eligible severe T2-high patients to Allergy / Pulm for biologic-eligibility audit.
- Default to written Asthma Action Plans for ALL patients — and distribute to family, school, employer.
- Match the messenger when possible: AAFA chapters, ALA Open Airways for Schools, Allergy & Asthma Network Trusted Messengers (community health workers).
- Use qualified medical interpreters — never family, never minor children. Asthma conversations (inhaler technique, biologic consent, action-plan rules, pregnancy management) must be in the patient's primary language.
- Invite the family Ambassador in with patient consent — especially school nurses for pediatric patients.
- Telehealth closes rural + equity gaps for follow-up + adherence support — advocate for parity coverage.
- Occupational asthma: ask about workplace exposures (flour, isocyanates, latex, cleaning agents, hairdressing, agricultural); workers'-comp + exposure removal.
- Pregnancy: continue ICS + LABA + SABA — uncontrolled asthma is worse than meds for fetus.
- Mood crisis resources: 988; 741741; 988 then press 1 for veterans. Depression / anxiety affect 30–40% of moderate-severe asthma.
🏥Customize for Your Institution
Clone this course and replace the highlighted blocks with your own information. Each editable field below is a placeholder — change it once and it propagates through the patient view.
📞 What Should Replace the When-to-Call Block
- Pulmonology / Allergy / Immunology on-call / triage line
- AAFA Helpline 1-800-7-ASTHMA (1-800-727-8462) M–F
- ALA Lung HelpLine 1-800-LUNGUSA
- Asthma-aware pharmacy (inhaler-technique check, biologic copay programs, spacer dispensing)
- ENT referral (chronic rhinosinusitis, nasal polyps, AERD)
- Behavioral Health referral (depression/anxiety 30–40% prevalence)
- Smoking-cessation Quitline 1-800-QUIT-NOW
- School nurse Action Plan distribution (pediatric)
- Mood crisis: 988 (call or text) · 741741 (text HOME) · 988 then press 1 Veterans
- Patient portal login URL with Ambassador proxy
👤 Who Is Your Asthma Care Navigator?
- Name, role, photo, scheduling link.
- What teach-back / check-ins they own (SMART regimen, inhaler-technique with spacer, written Action Plan distribution, biologic-eligibility audit, vaccinations, school Action Plan partnership, smoking-cessation referral, caregiver wellness for parents of asthmatic children).
- How patients and Ambassadors reach them between visits / across transitions.
- How they handle prior-auth navigation (biologics: omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, tezepelumab), manufacturer copay-program applications, and SCIT/SLIT immunotherapy logistics.
📚 Add Your Own Modules
- Your asthma clinical trial protocols (biologic combinations, novel ICS-formoterol regimens, immunotherapy enhancements — link to ClinicalTrials.gov).
- Your severe-asthma program — biologic-prescribing pathway, infusion / injection scheduling, expected outcomes.
- Your in-clinic spirometry + FeNO + skin-prick allergy testing.
- Local peer support partners (AAFA chapter, ALA Open Airways for Schools, Allergy & Asthma Network Trusted Messengers, faith-community partnerships, school nurse training).
🎨 Re-skin in 2 Lines of CSS
--inst-primary: your brand color- Replace the FFH × AAFA · NHLBI · GINA × [Your Institution] cobrand in the hero
- Drop in your logo PNG (white version) — same 48px height as FFH logo
📚 Evidence Base — what this course is built on
- AHRQ SHARE Approach — 5-step shared decision making framework. AHRQ Pub. 25-0005, Oct 2024. ahrq.gov/sdm
- AHRQ Health Literacy Universal Precautions Toolkit (3rd ed.) — teach-back, plain language, accessible materials. AHRQ Pub. 23-0075, March 2024.
- GINA · Global Initiative for Asthma 2024 main report — international evidence-based guidelines; SMART regimen, severity classification, biologic decision-making.
- NHLBI 2020 Focused Updates to the Asthma Management Guidelines — US guideline source for ICS, ICS-LABA, ICS-LABA + LAMA, biologics, allergen avoidance, allergen immunotherapy.
- AAFA · Asthma and Allergy Foundation of America — patient education, peer-mentor program, Wall of Hope, Action Plan templates, AAFA Helpline 1-800-7-ASTHMA (1-800-727-8462).
- American Lung Association (ALA) — Open Airways for Schools curriculum; ALA Lung HelpLine 1-800-LUNGUSA; LUNG FORCE advocacy.
- Allergy & Asthma Network — patient advocacy + Trusted Messengers (community health workers).
- ACAAI · American College of Allergy, Asthma & Immunology — practice parameters, biologic decision aids.
- AAAAI · American Academy of Allergy, Asthma & Immunology — severe asthma management, biologic guidance, atopic march, allergen immunotherapy.
- ATS / ERS · American Thoracic Society / European Respiratory Society — severe asthma diagnosis + management guidelines.
- EPA · AirNow — Air Quality Index for trigger avoidance.
- CDC · Tobacco Cessation Quitline 1-800-QUIT-NOW.
- FDA · Montelukast neuropsychiatric warning — boxed warning; counsel patients (especially adolescents).
- World Asthma Day · first Tuesday in May.
- National Asthma Awareness Month · May.
- 988 Suicide & Crisis Lifeline — call or text 988, free, confidential, 24/7. Depression/anxiety 30–40% prevalence in moderate-severe asthma.
- FFH Prepared Patient · COPD course (Sprint 10 companion) — asthma-COPD overlap, smoking-cessation, pulmonary rehab cross-reference.
- FFH Prepared Patient · Depression and Anxiety courses — bidirectionally cross-referenced for the 30–40% mood prevalence + 988.
- FFH Prepared Patient · Osteoporosis course (Sprint 9) — cross-referenced for chronic-steroid bone loss; biologic-revolution makes this less common.
- FFH Cluster Courses (HTN / T2D / CHF / CAD / post-MI / post-stroke / Alzheimer's / MS / brain tumor / cirrhosis / CKD) — the canonical comorbidity cluster module (md5 7587a559b24ca8b9bab40b1756475d84) is CROSS-REFERENCED from this Asthma course's Module 7, NOT embedded or modified. Asthma is not a cluster member; OSA cross-talk is cluster-relevant.
- Force Field Fact Sheet · Asthma — the 16-square primer (companion file). This deep course extends and operationalizes the fact sheet.
Course content is educational and not a substitute for medical advice from your own clinicians. Institutions cloning this course are responsible for accuracy of all customized blocks.