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Please review complete instructions, APA power point presentation template, resources from school and grading rubric Assignment: Asthma and Stepwise Management Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors.   One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment. To Prepare · Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children. · Consider how you might apply the stepwise approach to address the health needs of a patient in your practice. · Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Assignment - Instructions Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following: 1. Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient. 2. Explain the stepwise approach to asthma treatment and management for your patient. 3. Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific. 4. Please review the APA power point presentation template (Attached) and follow the guidelines 5. At least 5 references 6. Review the Assignment Rubric (Attached) Resources given by school https://www.youtube.com/watch?v=-DVZ9pl0rGY https://www.youtube.com/watch?v=D5PHANcdA_E&t=25s https://www.nhlbi.nih.gov/health-topics/guidelines-for-diagnosis-management-of-asthma Assignment: Asthma and Stepwise Management Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential tha t you recognize and distinguish minor asthma symptoms from serious, life - threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate managem ent options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors. One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach , which you explor e in this Assignment. To Prepare · Reflect on drugs used to treat asthmatic patients, including long - term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children. · Consi der how you might apply the stepwise approach to address the health needs of a patient in your practice. · Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Assignment - Instructions Cre ate a 5 - to 6 - slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following: 1. Describe long - term control and qui ck relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient. 2. Explain the stepwise approach to asthma treatment and management for your patient. 3. Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific. 4. Please review the APA power point presentation t emplate (Attached) and follow the guidelines 5. At le a st 5 references 6. Review the Assignment Rubric (Attached) Resources given by school https://www.youtube.com/watch?v= - DVZ9pl0rGY https://www.youtube.com/watch?v=D5PHANcdA_E&t=25s https://www.nhlbi.nih.gov/health - topics/guidelines - for - diagnosis - management - of - asthma Assignment: Asthma and Stepwise Management Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life- threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors. One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment. To Prepare  Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.  Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.  Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Assignment - Instructions Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following: 1. Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient. 2. Explain the stepwise approach to asthma treatment and management for your patient. 3. Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific. 4. Please review the APA power point presentation template (Attached) and follow the guidelines 5. At least 5 references 6. Review the Assignment Rubric (Attached) Resources given by school https://www.youtube.com/watch?v=-DVZ9pl0rGY https://www.youtube.com/watch?v=D5PHANcdA_E&t=25s https://www.nhlbi.nih.gov/health-topics/guidelines-for-diagnosis-management-of-asthma [Presentation Title Goes Here] [Your Name Here] Walden University [Heading Goes Here] Go to the Home tab at the top and click the New Slide or Layout button to access different formatting for your slides. Choose formatting that presents your information in the most logical way. Use consistent, grammatically parallel format for bulleted lists (for example, on this slide, each element begins with an imperative verb). [Heading Goes Here] Keep font of text consistent. Be sure headings are consistent in their spacing, placement, size, etc. Consider using the slide after the title slide to summarize your presentation’s points (like an abstract for a paper). Your slides can also contain entire paragraphs, like this one does. Citation rules apply to presentations just as they do to papers—when using or referencing another author’s ideas, you must cite that source. When incorporating a citation in a slide, do so just as you would in a traditional paper (Smith, 2010). According to Jones (2007), presentations aren’t very different from papers! [Heading Goes Here] [Heading Goes Here] Use APA style rules to format any tables and figures in your presentation: Figure 1. Bar graph showing useful information. From “Utilizing bar graphs,” by A. Jones, 2011, Journal of Handy Graphs, 76(2), p. 3. Reprinted with permission. Chart1 Category 1 Category 1 Category 1 Category 2 Category 2 Category 2 Category 3 Category 3 Category 3 Category 4 Category 4 Category 4 Series 1 Series 2 Series 3 4.3 2.4 2 2.5 4.4 2 3.5 1.8 3 4.5 2.8 5 Sheet1 Series 1 Series 2 Series 3 Category 1 4.3 2.4 2 Category 2 2.5 4.4 2 Category 3 3.5 1.8 3 Category 4 4.5 2.8 5 To resize chart data range, drag lower right corner of range. Remember to adhere to any assignment guidelines regarding presentation format. This template contains suggestions only. Keep in mind that there is no such thing as an “APA standard PowerPoint.” Review http://blog.apastyle.org/apastyle/2010/09/dear-professor.html for more information! [Heading Goes Here] References Always include a reference list at the end of your presentation, just like you would in a paper. Reference list entries take the same format they would in a paper: Jones, P. (2004). This great book. New York, NY: Publisher. Smith, W., & Cat, D. (2010). How to make a good presentation great. Presentations Quarterly, 45(4), 56-59. doi:10.123.45/abc 9/15/21, 11:42 AM Rubric Detail – Blackboard Learn https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16877161_1&rubric_id=_2591862_1 1/4 Rubric Detail Select Grid View or List View to change the rubric's layout.   Excellent Good Fair Poor Describe the long-term control and quick relief treatment options for the asthma patient from your practice, as well as the impact these drugs might have on your patient. 27 (27%) - 30 (30%) The presentation clearly and accurately describes in detail the long-term control and quick relief treatment options for the asthma patient from their practice. The presentation clearly and accurately describes in detail the impact these drugs might have on their patient. 24 (24%) - 26 (26%) The presentation accurately describes the long-term control and quick relief options for the asthma patient from their practice. The presentation accurately describes the impact these drugs might have on their patient. 21 (21%) - 23 (23%) The presentation inaccurately or vaguely describes the long-term control and quick relief options for the asthma patient from their practice. The presentation inaccurately or vaguely describes the impact these drugs might have on their patient. 0 (0%) - 20 (20%) The presentation inaccurately and vaguely describes the long-term and quick relief options for the asthma patient from their practice, or is missing. The presentation inaccurately and vaguely describes the impact these drugs might have on their patient, or is missing. Name: NURS_6521_Week3_Assignment_Rubric EXIT Grid View List View 9/15/21, 11:42 AM Rubric Detail – Blackboard Learn https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16877161_1&rubric_id=_2591862_1 2/4   Excellent Good Fair Poor Explain the stepwise approach to asthma treatment and management for your patient. 27 (27%) - 30 (30%) The presentation clearly and accurately explains in detail the stepwise approach to asthma treatment and management for their patient. 24 (24%) - 26 (26%) The presentation accurately explains the stepwise approach to asthma treatment and management for their patient. 21 (21%) - 23 (23%) The presentation inaccurately or vaguely explains the stepwise approach to asthma treatment and management for their patient. 0 (0%) - 20 (20%) The presentation inaccurately and vaguely explains the stepwise approach to asthma treatment and management for their patient. Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be speci�c. 27 (27%) - 30 (30%) The presentation clearly and accurately explains in detail how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. The presentation provides accurate and detailed examples to support the explanation provided. 24 (24%) - 26 (26%) The presentation accurately explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. The presentation provides accurate examples to support the explanation provided. 21 (21%) - 23 (23%) The presentation inaccurately or vaguely explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. The presentation provides inaccurate or vague examples to support the explanation provided. 0 (0%) - 20 (20%) The presentation inaccurately and vaguely explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease, or is missing. The presentation provides inaccurate and vague examples to support the explanation provided, or is missing. 9/15/21, 11:42 AM Rubric Detail – Blackboard Learn https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16877161_1&rubric_id=_2591862_1 3/4   Excellent Good Fair Poor Written Expression and Formatting - Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, �ow logically, and demonstrate continuity of ideas. Sentences are carefully focused-- neither long and rambling nor short and lacking substance. 5 (5%) - 5 (5%) Paragraphs and sentences follow writing standards for �ow, continuity, and clarity. 4 (4%) - 4 (4%) Paragraphs and sentences follow writing standards for �ow, continuity, and clarity 80% of the time. 3.5 (3.5%) - 3.5 (3.5%) Paragraphs and sentences follow writing standards for �ow, continuity, and clarity 60%–79% of the time. 0 (0%) - 3 (3%) Paragraphs and sentences follow writing standards for �ow, continuity, and clarity less than 60% of the time. Written Expression and Formatting - English writing standards: Correct grammar, mechanics, and proper punctuation 5 (5%) - 5 (5%) Uses correct grammar, spelling, and punctuation with no errors 4 (4%) - 4 (4%) Contains a few (1–2) grammar, spelling, and punctuation errors 3.5 (3.5%) - 3.5 (3.5%) Contains several (3–4) grammar, spelling, and punctuation errors 0 (0%) - 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding Total Points: 100 Name: NURS_6521_Week3_Assignment_Rubric EXIT 9/15/21, 11:42 AM Rubric Detail – Blackboard Learn https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16877161_1&rubric_id=_2591862_1 4/4 National Heart, Lung, and Blood Institute National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma Full Report 2007 August 28, 2007 Contents C O N T E N T S Acknowledgements and Financial Disclosures xi Acronyms and Abbreviations.................................................................................................... xix Preface ....................................................................................................................................xxii Section 1, Introduction .............................................................................................................1 Overall Methods Used To Develop This Report ......................................................................2 Background.............................................................................................................................2 Systematic Evidence Review Overview...................................................................................3 Inclusion/Exclusion Criteria..................................................................................................3 Search Strategies ................................................................................................................3 Literature Review Process...................................................................................................3 Preparation of Evidence Tables...........................................................................................6 Ranking the Evidence..........................................................................................................7 Panel Discussion .................................................................................................................8 Report Preparation ..............................................................................................................8 References..............................................................................................................................9 Section 2, Definition, Pathophysiology and Pathogenesis of Asthma, and Natural History of Asthma ...................................................................................................................11 Key Points: Definition, Pathophysiology and Pathogenesis of Asthma, and Natural History of Asthma..................................................................................................................11 Key Differences From 1997 and 2002 Expert Panel Reports ................................................12 Introduction ...........................................................................................................................12 Definition of Asthma ..............................................................................................................12 Pathophysiology and Pathogenesis of Asthma......................................................................14 Pathophysiologic Mechanisms in the Development of Airway Inflammation ......................16 Inflammatory Cells.........................................................................................................16 Inflammatory Mediators .................................................................................................18 Immunoglobulin E..........................................................................................................19 Implications of Inflammation for Therapy .......................................................................19 Pathogenesis ....................................................................................................................20 Host Factors ..................................................................................................................20 Environmental Factors...................................................................................................22 Natural History of Asthma .....................................................................................................23 Natural History of Persistent Asthma .................................................................................24 Children .........................................................................................................................24 Adults ............................................................................................................................25 Summary .......................................................................................................................27 Effect of Interventions on Natural History of Asthma..........................................................27 Implications of Current Information About Pathophysiology and Pathogenesis, and Natural History for Asthma Management .......................................................................28 References............................................................................................................................28 i ........................................................................... Contents August 28, 2007 Section 3, The Four Components of Asthma Management .................................................35 Introduction ...........................................................................................................................35 Section 3, Component 1: Measures of Asthma Assessment and Monitoring....................36 Introduction ...........................................................................................................................36 Overview of Assessing and Monitoring Asthma Severity, Control, and Responsiveness in Managing Asthma...................................................................................36 Key Points: Overview of Measures of Asthma Assessment and Monitoring .........................36 Key Differences From 1997 and 2002 Expert Panel Reports ................................................37 Diagnosis of Asthma .............................................................................................................40 Key Points: Diagnosis of Asthma .........................................................................................40 Key Differences From 1997 and 2002 Expert Panel Reports ................................................41 Medical History ..................................................................................................................41 Physical Examination ........................................................................................................42 Pulmonary Function Testing (Spirometry)..........................................................................43 Differential Diagnosis of Asthma........................................................................................45 Initial Assessment: Characterization of Asthma and Classification of Asthma Severity.........47 Key Points: Initial Assessment of Asthma ............................................................................47 Key Differences From 1997 and 2002 Expert Panel Reports ................................................48 Identify Precipitating Factors .............................................................................................48 Identify Comorbid Conditions That May Aggravate Asthma ...............................................49 Assess the Patient’s Knowledge and Skills for Self-Management......................................49 Classify Asthma Severity ...................................................................................................49 Assessment of Impairment ............................................................................................50 Assessment of Risk .......................................................................................................51 Periodic Assessment and Monitoring of Asthma Control Essential for Asthma Management .........................................................................................................................52 Key Points: Periodic Assessment of Asthma Control............................................................52 Key Differences From 1997 and 2002 Expert Panel Reports ................................................54 Goals of Therapy: Asthma Control....................................................................................55 Asthma Control..............................................................................................................55 Measures for Periodic Assessment and Monitoring of Asthma Control ..............................56 Monitoring Signs and Symptoms of Asthma ..................................................................57 Monitoring Pulmonary Function .....................................................................................58 Spirometry .................................................................................................................58 Peak Flow Monitoring ................................................................................................59 Peak Flow Versus Symptom-Based Monitoring Action Plan ......................................60 Monitoring Quality of Life ...............................................................................................61 Monitoring History of Asthma Exacerbations .................................................................63 Monitoring Pharmacotherapy for Adherence and Potential Side Effects ........................63 Monitoring Patient–Provider Communication and Patient Satisfaction ...........................63 Monitoring Asthma Control With Minimally Invasive Markers and Pharmacogenetics.........................................................................................................64 Pharmacogenetics in Managing Asthma........................................................................66 Methods for Periodic Assessment and Monitoring of Asthma Control ................................66 Clinician Assessment ....................................................................................................67 Patient Self-Assessment................................................................................................67 Population-Based Assessment ......................................................................................67 Referral to an Asthma Specialist for Consultation or Comanagement ...................................68 References ........................................................................................................................82 ii August 28, 2007 Contents Section 3, Component 2: Education for a Partnership in Asthma Care .............................93 Key Points: Education for a Partnership in Asthma Care......................................................93 Key Points: Provider Education ............................................................................................95 Key Differences From 1997 and 2002 Expert Panel Reports ................................................95 Introduction ...........................................................................................................................96 Asthma Self-Management Education at Multiple Points of Care ............................................97 Clinic/Office-Based Education ...........................................................................................97 Adults—Teach Asthma Self-Management Skills To Promote Asthma Control ...............97 Written Asthma Action Plans, Clinician Review, and Self-Monitoring .........................98 Patient–Provider Partnership .....................................................................................99 Health Professionals Who Teach Self-Management ................................................ 100 Education With Multiple Sessions ............................................................................ 101 Children—Teach Asthma Self-Management Skills To Promote Asthma Control .......... 101 Emergency Department/Hospital-Based Education ......................................................... 102 Adults .......................................................................................................................... 102 Emergency Department Asthma Education ............................................................. 103 Hospital-Based Asthma Education........................................................................... 104 Children ....................................................................................................................... 105 Educational Interventions by Pharmacists ....................................................................... 106 Educational Interventions in School Settings ................................................................... 107 Community-Based Interventions...................................................................................... 108 Asthma Education ....................................................................................................... 108 Home-Based Interventions .............................................................................................. 109 Home-Based Asthma Education for Caregivers........................................................... 109 Home-Based Allergen-Control Interventions................................................................ 109 Other Opportunities for Asthma Education ...................................................................... 111 Education for Children Using Computer-Based Technology ........................................ 111 Education on Tobacco Avoidance for Women Who Are Pregnant and Members of Households With Infants and Young Children........................................................ 112 Case Management for High-Risk Patients ................................................................... 113 Cost-Effectiveness .......................................................................................................... 114 Tools for Asthma Self-Management .................................................................................... 115 Role of Written Asthma Action Plans for Patients Who Have Asthma .............................. 115 Role of Peak Flow Monitoring .......................................................................................... 120 Goals of Asthma Self-Management Education and Key Educational Messages .............. 121 Establish and Maintain a Partnership .................................................................................. 124 Teach Asthma Self-Management .................................................................................... 125 Jointly Develop Treatment Goals..................................................................................... 131 Assess and Encourage Adherence to Recommended Therapy ....................................... 131 Tailor Education to the Needs of the Individual Patient .................................................... 133 Knowledge and Beliefs ................................................................................................ 133 Health Literacy ............................................................................................................ 134 Cultural/Ethnic Considerations..................................................................................... 135 Maintain the Partnership.................................................................................................. 135 Asthma Education Resources ......................................................................................... 140 Provider Education .............................................................................................................. 141 Methods of Improving Clinician Behaviors ....................................................................... 141 Implementing Guidelines—Recommended Practices .................................................. 141 Communication Techniques ........................................................................................ 143 Methods of Improving System Supports .......................................................................... 144 Clinical Pathways ........................................................................................................ 144 Clinical Decision Supports ........................................................................................... 145 References.......................................................................................................................... 146 iii Contents August 28, 2007 Section 3, Component 3: Control of Environmental Factors and Comorbid Conditions That Affect Asthma ............................................................................................ 165 Key Points: Control of Environmental Factors and Comorbid Conditions That Affect Asthma................................................................................................................................ 165 Key Differences From 1997 Expert Panel Report ................................................................ 166 Introduction ......................................................................................................................... 167 Inhalant Allergens ............................................................................................................... 167 Diagnosis—Determine Relevant Inhalant Sensitivity ....................................................... 167 Management—Reduce Exposure.................................................................................... 169 Immunotherapy ............................................................................................................... 172 Assessment of Devices That May Modify Indoor Air ........................................................ 174 Occupational Exposures ..................................................................................................... 175 Irritants ................................................................................................................................ 175 Environmental Tobacco Smoke ....................................................................................... 175 Indoor/Outdoor Air Pollution and Irritants......................................................................... 176 Formaldehyde and Volatile Organic Compounds......................................................... 176 Gas Stoves and Appliances......................................................................................... 176 Comorbid Conditions........................................................................................................... 177 Allergic Bronchopulmonary Aspergillosis ......................................................................... 177 Gastroesophageal Reflux Disease .................................................................................. 178 Obesity ............................................................................................................................ 179 Obstructive Sleep Apnea ................................................................................................. 179 Rhinitis/Sinusitis .............................................................................................................. 180 Stress, Depression, and Psychosocial Factors in Asthma ............................................... 180 Other Factors ...................................................................................................................... 181 Medication Sensitivities ................................................................................................... 181 Aspirin ......................................................................................................................... 181 Beta-Blockers .............................................................................................................. 182 Sulfite Sensitivity ............................................................................................................. 182 Infections ......................................................................................................................... 182 Viral Respiratory Infections .......................................................................................... 182 Bacterial Infections ...................................................................................................... 183 Influenza Infection ....................................................................................................... 183 Female Hormones and Asthma ....................................................................................... 183 Diet.................................................................................................................................. 184 Primary Prevention of Allergic Sensitization and Asthma .................................................... 184 References.......................................................................................................................... 190 Section 3, Component 4: Medications ................................................................................ 213 Key Points: Medications ..................................................................................................... 213 Key Differences From 1997 and 2002 Expert Panel Reports .............................................. 215 Introduction ......................................................................................................................... 215 Overview of the Medications ............................................................................................... 216 Long-Term Control Medications ...................................................................................... 216 Inhaled Corticosteroids ................................................................................................ 216 Mechanism .............................................................................................................. 216 Inhaled Corticosteroid Insensitivity........................................................................... 217 Efficacy of Inhaled Corticosteroids as Compared to Other Long-Term Control Medications as Monotherapy ................................................................................... 217 Efficacy of Inhaled Corticosteroid and Adjunctive Therapy (Combination Therapy) .................................................................................................................. 217 Dose-Response and Delivery Device ...................................................................... 218 Variability in Response and Adjustable Dose Therapy ............................................. 219 Safety of Inhaled Corticosteroids ............................................................................. 220 iv August 28, 2007 Contents Key Points: Safety of Inhaled Corticosteroids ..................................................................... 220 Key Points: Inhaled Corticosteroids and Linear Growth in Children .................................... 222 Oral Systemic Corticosteroids ..................................................................................... 224 Cromolyn Sodium and Nedocromil .............................................................................. 224 Immunomodulators ...................................................................................................... 225 Omalizumab ............................................................................................................ 225 Antibiotics ................................................................................................................ 226 Others ..................................................................................................................... 226 Leukotriene Modifiers .................................................................................................. 227 Inhaled Long-Acting Beta2-Agonists ............................................................................ 229 Safety of Long-Acting Beta2-Agonists ...................................................................... 231 Key Points: Safety of Inhaled Long-Acting Beta2-Agonists ................................................. 231 Methylxanthines .......................................................................................................... 234 Tiotropium Bromide ..................................................................................................... 235 Quick-Relief Medications ................................................................................................. 235 Anticholinergics ........................................................................................................... 235 Inhaled Short-Acting Beta2-Agonists ............................................................................ 235 Safety of Inhaled Short-Acting Beta2-Agonists ......................................................... 236 Key Points: Safety of Inhaled Short-Acting Beta2-Agonists................................................. 236 Systemic Corticosteroids ............................................................................................. 237 Route of Administration ................................................................................................... 238 Alternatives to CFC-Propelled MDIs ............................................................................ 238 Spacers and Valved Holding Chambers ...................................................................... 239 Complementary and Alternative Medicine ........................................................................... 240 Key Points: Complementary and Alternative Medicine ....................................................... 240 Acupuncture ....................................................................................................................240 Chiropractic Therapy ....................................................................................................... 241 Homeopathy and Herbal Medicine................................................................................... 241 Breathing Techniques...................................................................................................... 241 Relaxation Techniques .................................................................................................... 242 Yoga................................................................................................................................ 242 References.......................................................................................................................... 252 Section 4, Managing Asthma Long Term: Overview ......................................................... 277 Key Points: Managing Asthma Long Term ......................................................................... 277 Key Differences From 1997 and 2002 Expert Panel Reports .............................................. 278 Introduction ......................................................................................................................... 279 Section 4, Managing Asthma Long Term in Children 0–4 Years of Age and 5–11 Years of Age .......................................................................................................................... 281 Diagnosis and Prognosis of Asthma in Children .................................................................. 281 Diagnosis of Asthma........................................................................................................ 281 Prognosis of Asthma ....................................................................................................... 281 Prevention of Asthma Progression .................................................................................. 282 Monitoring Asthma Progression....................................................................................... 283 Treatment: Principles of Stepwise Therapy in Children ...................................................... 284 Achieving Control of Asthma ........................................................................................... 285 Selecting Initial Therapy .............................................................................................. 285 Adjusting Therapy........................................................................................................ 286 Maintaining Control of Asthma......................................................................................... 288 Key Points: Inhaled Corticosteroids in Children .............................................................. 289 Key Points: Managing Asthma in Children 0–4 Years of Age ............................................ 289 v Contents August 28, 2007 Treatment: Pharmacologic Issues for Children 0–4 Years of Age....................................... 290 FDA Approval …