DESCRIBING THE ROUTINE CARE FOR ASTHMA

The routine care given to an individual with asthma includes:
1. ASSESSMENT AND MONITORING
Establish Asthma Diagnosis: After a person seeks medical care for symptoms that suggest asthma, the diagnosis of asthma should be clearly established and the baseline severity of the disease classified to help establish the recommended course of therapy. Alternative diagnoses of symptoms that suggest asthma, including conditions affecting the upper and lower airways (e.g., upper airway obstruction/foreign body, bronchitis, pneumonia/bronchiolitis, chronic obstructive pulmonary disease, tumour/neoplasm, pulmonary embolism, congestive heart failure, vocal cord dysfunction, or viral lower respiratory tract infection) should be ruled out and may require additional tests. For the patient with a probable diagnosis of asthma after initial evaluation (i.e., symptomatic with normal spirometry and no alternative diagnosis), presumptive treatment may be necessary to reach a final diagnosis. Referral to a specialist may be necessary if the diagnosis is in doubt, other conditions are aggravating the asthma, or the contribution of occupational or environmental exposures needs to be confirmed.
Monitoring body system
The care given to individuals will be based upon measurements and observations, and regular monitoring of a patient’s condition will give health professional an indication of how successful their case and advice is being. (For example, a chronic condition like asthma requires daily attention. Depending on how severe your asthma is, that may include monitoring your breathing and taking medicine every day, even when you do have symptoms. Taking care of your asthma must become a routine part of your life, just like monitoring and taking diabetes or blood pressure medicines are for people with those chronic conditions).

2. CLASSIFY SEVERITY OF ASTHMA
Because asthma is characterized by varying signs and symptoms, for appropriate treatment and monitoring, the severity of such signs and symptoms must be classified at the initial and all subsequent visits. Initially and before treatment has been optimized, clinical signs, symptoms, and peak flow monitoring or spirometry are used to classify severity. After the patient's asthma is stable, severity is subsequently classified according to the level of medication required to maintain treatment goals.
Asthma severity in regard to the frequency of the symptoms (attacks) is classified into four stages, according to GINA guidelines [5]: intermittent - light cough and wheezing less than twice per week, night symptoms less than twice per month mild persistent - attacks at least once per week, chest tightness, shortness of breath, coughing and wheezing moderate persistent - affects the larger passageways in the lungs and trachea, intensified episodes of coughing and wheezing severe persistent - episodes during both day and night occur continually and can last for more than several days, persistent cough and wheeze.
Health-care providers should have the knowledge, equipment, staff or access to needed resources to aid in classification and proper management of all patients with asthma

3. SCHEDULE ROUTINE FOLLOW-UP CARE
Patients with asthma experience varying symptoms and severity because of the nature of asthma, their exposure to environmental allergens or irritants, or insufficient adherence to their medication regimen. For these reasons, they require adjustments in therapy and regular follow-up visits. The first follow-up visit should be scheduled within the month after initial diagnosis. Routine visits thereafter should be scheduled every 1--6 months, depending on the severity of asthma and the patient's ability to maintain control of symptoms.
Routine care includes clinical assessment of airway function over time. Spirometry is recommended at the initial assessment and at least every 1--2 years after treatment is initiated and the symptoms and peak