The Role of the Community Provider in Improving Asthma Control

Program Overview
Asthma is a complex cascade of conditions and interactions that lead to acute airflow obstruction, increased mucous production, airway remodeling, airway inflammation, and hyperresponsiveness. Asthma is usually thought of as a disease characterized by intermittent wheezing in response to an irritant or allergen. Unfortunately, this mind set has often led to treatment of symptoms of asthma as they occur and does not address the underlying causes of the condition. There is a growing body of evidence which now recognizes the role of airway inflammation in disease severity. Using invasive endobronchial and transbronchial biopsies, investigators have been able to assess the distribution and phenotype of inflammatory cells, particularly mast cells. They have found that asthmatic patients have more mast cells in the distal lung compared with the large airways. Studies have also shown that the peripheral airways account for the majority of airway hyper-responsiveness among asthmatics. Data from Wagner, et al. showed that, even in mild asthmatics with normal spirometry, peripheral airway resistance can be increased up to sevenfold when compared with control individuals. They also showed that these measurements correlated with responsiveness to methacholine challenge. These emerging data suggest that pharmacological targeting of peripheral airway inflammation may provide a significant clinical benefit in controlling asthma.

Target audience
This program has been designed for Community pulmonologists, primary care physicians, internal medicine physicians, physician assistants, nurse practitioners, nurses, pharmacists, respiratory therapists, and other health care providers involved in the care of patients with asthma.

Learning objectives
Upon completion of the educational activity, participants should be able to:
-Discuss the pathophysiology of asthma and associated small airway inflammation
-Describe the relevance of small airway inflammation to the exacerbation prone asthma phenotype and implications for effective pharmacologic therapy
-Review the current recommendations on the use of Spirometry for the diagnosis, treatment, and assessment of control in asthma management
-Demonstrate improved knowledge, application, and interpretation of Spirometry for the treatment of patients with asthma

Method of Participation
In order to receive credit, participants should read the entire monograph, complete and submit an evaluation and score at least 70% on the self-assessment test. Statements of Credit will be available upon successful completion of the self-assessment test. If you have questions about this CME/CE activity, please contact AKH Inc. at service@akhcme.com.

Disclosure Declaration
It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The faculty must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflict of interest is resolved by AKH prior to accreditation of the activity. AKH planners and reviewers have no relevant financial relationships to disclose.

Disclosure of Unlabeled Use and Investigational Products
This educational activity does not include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer
AKH Inc.ís activities are designed solely to provide healthcare professionals with information to assist in their practice and professional development. The activities are researched thoroughly, utilizing current literature and including practical experiences. AKHís activities are not to be considered a diagnostic tool to replace professional advice or treatment. The activities serve as a general guide to the healthcare professional, and therefore, they cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH educational activities do not endorse commercial products. The author(s) and the publisher specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the activities. AKH further disclaims any responsibility for undetected errors, or from the readerís misunderstanding of the activity.

Copyright © 2014 AKH Inc., Advancing Knowledge in Healthcare No part of this publication may be produced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical photocopying, recording, or otherwise, without the prior permission of the publisher.