Asthma Nursing Care Plans

A patient mid-exacerbation is frightened, hypoxic, and working every accessory muscle they have, and your first job is to stay calm because their anxiety and yours both make the attack worse. You are watching breath sounds, peak flow, and pulse oximetry, getting bronchodilators and steroids in fast, and reading the warning sign most people miss: the wheeze that quiets down because almost no air is moving. That silent chest is not improvement, it is a chest heading toward respiratory failure.

What is Asthma?

Asthma is a chronic inflammatory disease of the airways marked by hyperresponsiveness, mucosal edema, and mucus production. The inflammation drives recurrent cough, chest tightness, wheezing, and dyspnea. It affects roughly 26 million people in the United States and is the most common chronic disease of childhood.

Risk factors include family history, allergy, and chronic exposure to airway irritants or allergens such as grass and weed pollens, mold, dust, or animals. Common triggers and aggravators are airway irritants, exercise, stress or emotional upset, rhinosinusitis with postnasal drip, medications, viral respiratory infections, and gastroesophageal reflux.

The process starts when an inhaled irritant or allergen meets a hypersensitive bronchial tree, setting off airway inflammation and a surge in mucus. Airway resistance climbs, worst on expiration. Left uncorrected, the attack gets harder to treat because the mucus blocks inhaled medication from reaching the mucosa.

Nursing Care Plans and Management

Care ranges from outpatient management of mild symptoms to hospitalization for acute, severe attacks. Assess respiratory status through symptoms, breath sounds, peak flow, pulse oximetry, and vital signs. Take a medication allergy history, identify current medications, give the prescribed drugs and watch the response, provide fluids when needed, and be ready to assist with intubation and mechanical ventilation if acute respiratory failure develops. Keep talking to the patient and family the whole way through, because dyspnea makes both of them afraid.

Nursing Problem Priorities

1. Improve breathing pattern and gas exchange.
2. Maintain patent airways and reduce airway inflammation.
3. Manage pharmacologic therapy.
4. Prevent exacerbations.
5. Reduce anxiety and improve coping.
6. Promote rest and energy conservation, and provide patient education.

Nursing Assessment

Assess for these subjective and objective findings:

• Dyspnea, including orthopnea, and conversational breathlessness
• Wheezes, rhonchi, and other adventitious lung sounds
• Changes in respiratory rate and rhythm
• Changes in vital signs
• Chest tightness
• Cough
• Prolonged expiration and use of accessory muscles
• Nasal flaring
• Cyanosis
• Inability to mobilize secretions
• Abnormal arterial blood gases (hypoxia, hypercapnia)
• Confusion or loss of consciousness in severe hypoxia

Related factors include bronchospasm, mucosal edema, and bronchial secretions from inhaled irritants, infection, drugs, or allergens; an ineffective cough; and airway obstruction by secretions.

Nursing Diagnosis

Form the diagnosis from your assessment and clinical judgment about this patient. The label matters less than getting the priorities right and acting on them.

Nursing Goals

• The client maintains an effective breathing pattern with relaxed breathing, a normal rate, and no dyspnea.
• The client shows adequate gas exchange with arterial blood gases in normal range and no cyanosis or other signs of hypoxia.
• The client maintains a patent airway with clear breath sounds and an effective cough that clears secretions.
• The client stays free of respiratory distress and complications.
• The client takes part in treatment and explains the cause and management of the condition.

Nursing Interventions and Actions

1. Improving Breathing Pattern and Gas Exchange

Bronchial secretions and mucosal edema narrow the airway lumen, cut airflow, and raise blood carbon dioxide. The patient hyperventilates to blow off the excess. Airway narrowing, mucus, and obstruction also wreck gas exchange at the alveolar-capillary membrane, producing ventilation-perfusion mismatch, hypoxemia, and eventually hypercapnia.

Assess vital signs as needed. Rising respirations, tachycardia, and hypotension reflect hypoxia and the vasoconstriction that follows ventilation-perfusion mismatch.

Assess respiratory rate, depth, and rhythm. Changes here are an early sign of impending distress. Note whether the patient uses accessory muscles or cannot finish a sentence, both of which gauge the degree of respiratory distress.

Assess breath sounds and adventitious sounds. Wheezing is the classic finding, a high-pitched whistle from turbulent airflow. As severity climbs, the wheeze fills all of expiration, then becomes biphasic. In the most severe attack the wheeze can disappear because so little air is moving, a sign of dangerous airway narrowing and respiratory muscle fatigue. Faint breath sounds also signal decreased airflow.

Assess the relationship of inspiration to expiration. Reactive airways let air in more easily than out. End-expiratory wheezing is mild; loud expiratory wheezing is moderate; loud biphasic wheezing is severe.

Assess for dyspnea, including nasal flaring, chest retractions, and accessory muscle use. Airway hyperreactivity narrows the airways and makes exhalation difficult, and the degree of hyperresponsiveness tracks with clinical severity. Breathlessness that interrupts normal conversation signals respiratory distress and developing hypoxemia or hypercapnia.

Watch for a paradoxical pulse of 12 mm Hg or greater. Pulsus paradoxus is an abnormally large drop in systolic pressure during inspiration; the normal fall is less than 10 mm Hg. A drop of 12 mm Hg or greater indicates severe airflow obstruction and can reach 40 mm Hg in severe attacks. Pulsus paradoxus that was present and then vanishes near respiratory arrest points to respiratory muscle fatigue.

Monitor oxygen saturation. Normal is 95 to 100%. In a mild episode room-air saturation runs greater than 95%, in a moderate episode 91 to 95%, and in a severe episode less than 91%.

Monitor peak expiratory flow rate and forced expiratory volume. These quantify severity. Peak expiratory flow rate is the maximum flow during a forced expiratory effort from fully inflated lungs; done well, it correlates with forced expiratory volume in 1 second (FEV1). During an exacerbation FEV1 and forced vital capacity drop sharply and improve with a bronchodilator.

Monitor arterial blood gases. Early in an attack you see respiratory alkalosis from hyperventilation. As obstruction worsens, carbon dioxide is retained and the rising work of breathing produces metabolic acidosis. Respiratory acidosis is the ominous finding, signaling pending respiratory failure and a likely need for mechanical ventilation. Because pulse oximetry is accurate, reserve ABGs for patients whose oxygenation does not come back over 90% with oxygen therapy.

Monitor skin and mucous membrane color. Cyanosis in the nail beds, lips, or earlobes, and central duskiness, indicate advanced hypoxemia that needs immediate attention.

Monitor weight and BMI. Obesity is a BMI of 30 kg/m² or greater. Obese adults tend to have more severe asthma and a 4 to 6 fold higher risk of hospitalization than lean adults with asthma.

Assess the client's level of anxiety. An emergency and an unfamiliar setting worsen symptoms, especially on a first attack. An anxious parent raises a child's anxiety and can deepen the attack, so a calm approach is central to care.

Keep the head of the bed elevated and position the patient for their respiratory effort. Elevation and a left lateral position protect against aspiration, ventilate the lower lobes, and ease pressure on the diaphragm. Mild cases can lie flat; as severity rises the patient sits up, then hunches forward with hands braced on the torso in the tripod position. The upright position improves oxygen delivery.

Encourage breathing exercises. Dysfunctional breathing adds to dyspnea even without hyperventilation. Pursed-lip, nasal, and lower rib cage and abdominal breathing, with relaxation and home practice, help correct the pattern and reduce airway collapse and breathing effort.

Plan rest periods between activities. The work of breathing is fatiguing. Activity raises metabolic rate and oxygen demand, so pace it to the patient's tolerance and medication response. Many patients do better exercising indoors or in warm, humid air than in cold, dry air.

Encourage expectoration, and suction if needed. Thick, copious secretions impair gas exchange in the small airways; deep suction when the cough cannot clear them.

Administer supplemental oxygen as ordered to correct and prevent worsening hypoxemia, during exacerbations or as long-term therapy.

Promote weight loss for patients with obesity. Obesity often precedes incident asthma and is tied to worse control and lower quality of life. In adults, a weight loss of at least 5% produces meaningful improvement in control.

Encourage a diet that helps both weight and allergen avoidance. High-sugar beverages and a diet heavy in sweets and dairy but low in vegetables and grains raise asthma risk. Omega-3 intake is linked to lower asthma incidence, omega-6 to higher risk in children.

Teach environmental control and allergen avoidance. Exposures and irritants drive exacerbations. Focus on the home, where 30 to 60% of time is spent. Clean and dust regularly; use a face mask or a double-bagged HEPA vacuum. For dust mites, use impervious covers, wash bedding in hot water, remove bedroom rugs, limit upholstered furniture and window blinds, and store clothes in closets and drawers.

Limit indoor pets. Animal dander, saliva, urine, and serum proteins are airborne indoor allergens. Remove animals from the home or at least the bedroom, filter heating and cooling vents, and bathe cats and dogs as often as twice weekly.

Teach avoidance of tobacco smoke. Both firsthand and secondhand exposure must be avoided, especially inside the home.

Teach about allergen immunotherapy. Consider it when symptoms clearly track to an unavoidable allergen the patient is sensitized to, when symptoms run most of the year, and when they stay hard to control on medication. Subcutaneous immunotherapy has shown improved outcomes and cost savings.

Administer asthma medications as ordered (see pharmacologic support).

Anticipate alternative treatment if life-threatening bronchospasm continues. General anesthesia is used for dynamic hyperinflation with profound hypercapnia that minute ventilation cannot fix. Magnesium sulfate has bronchodilating and anti-inflammatory effects and is sometimes used in moderate to severe pediatric asthma. Helium, less dense than nitrogen, lowers airway resistance and the work of breathing.

Assist with intubation and mechanical ventilation as needed. Some patients still require endotracheal intubation, and roughly 5 to 10% of asthma admissions go to intensive care for already-intubated patients or those at high risk of intubation. Ventilating acute asthma is tricky: high pressures can drop systemic blood pressure and, less often, cause barotrauma, pneumothorax, or pneumomediastinum.

2. Maintaining Patent Airways and Reducing Airway Inflammation

Hyperreactivity drives airway obstruction through smooth muscle spasm in the tracheobronchial tree, mucosal swelling and edema, and thick mucus from goblet cells. Allergens stimulate the parasympathetic nervous system, raising bronchomotor tone and tightening the airways.

Assess the effectiveness of the cough. Severe bronchospasm, thick secretions, and respiratory muscle fatigue all blunt it. Cough may be the only symptom in exercise-induced or nocturnal asthma; it is usually dry, and children with nocturnal asthma tend to cough after midnight and into the early morning.

Assess the amount, color, odor, and viscosity of secretions. Normal sputum is clear or gray and scant; green, yellow, or bloody, malodorous, or copious sputum is abnormal and raises airway resistance. Patients with asthma clear mucus poorly, and about 20 to 40% have increased sputum volume and hypersecretion, with mucus more viscous than in COPD.

Monitor oxygen saturation. A saturation under 90% signals an oxygenation problem. Pulse oximetry tracks severity, but lag and physiologic reserve mean a falling reading is a late finding marking a severely unwell or peri-arrest patient.

Monitor chest x-ray results. The film shows infiltrates, lung inflation, and barotrauma, and matters most when a foreign body or infection is possible. Its main value is revealing complications or alternative causes of wheezing.

Monitor labs as indicated. Check urea and electrolytes with high-dose or repeated salbutamol, which shifts potassium intracellularly and can cause transient hypokalemia. Eosinophilia is common but not specific to asthma.

Obtain peak expiratory flow rate or FEV1 before and after treatment. Both should improve with effective therapy, and serial values help decide between admission and discharge.

Keep environmental pollution low. Dust, smoke, and feather pillows aggravate symptoms. Indoor environmental controls clearly improve asthma. Urban indoor particulate levels can run twice those of non-urban homes, with smoking, sweeping, and stove use the main indoor sources.

Encourage fluids up to 3000 mL/day, within cardiac and renal limits. Fluids thin secretions, support ciliary clearance, and ease expectoration; warm fluids may reduce bronchospasm. Give fluids between meals rather than with them to avoid gastric distention against the diaphragm.

Limit alcohol and caffeinated drinks. Both raise gastric acid secretion, and acid in the distal esophagus can sharply increase airway resistance and reactivity through vagal reflexes. Patients with asthma are three times more likely to have GERD, which is a definite asthma trigger in 64% of cases.

Administer high-flow nasal cannula oxygen as ordered. HFNC raises PO2 in severe bronchial asthma, delivering 8 to 60 L/min through an air-oxygen mixing device with the oxygen concentration set from 21% to 100% to meet the patient's needs.

Assist with respiratory treatments such as spirometry and chest physiotherapy. Aerosol and nebulizer medications reduce bronchospasm and aid expectoration, and postural drainage and percussion clear sticky secretions and ventilate the lower segments. Be aware that chest physiotherapy can worsen bronchospasm in some patients.

3. Pharmacologic Support

Therapy is stepwise: quick-relief drugs for immediate symptoms and long-acting drugs for control. Anti-inflammatories are essential for persistent asthma because inflammation is the underlying problem, though they carry systemic effects with long-term use. Pressurized metered-dose inhalers are the preferred route because they target delivery to the airway.

Short-acting beta-2 agonists relax bronchial smooth muscle to relieve bronchospasm in acute attacks and prevent exercise-induced or nocturnal bronchospasm. This class includes albuterol sulfate and levalbuterol.

Anticholinergics block acetylcholine and inhibit the parasympathetic action on airway smooth muscle. Ipratropium, related to atropine, has antisecretory effects and reduces secretions from the nasal mucosa.

Oral corticosteroids give short courses for prompt control of poorly controlled acute attacks and long-term prevention in severe persistent asthma, suppressing and reversing inflammation. They also reverse the beta-2 receptor down-regulation that comes with frequent beta-2 agonist use. This class includes prednisone, methylprednisolone, and prednisolone.

Inhaled corticosteroids are the most potent anti-inflammatory agents and the least likely to cause systemic effects because they are topically active and poorly absorbed. Beclomethasone reduces airway hyperresponsiveness, and fluticasone and budesonide are potent metered-dose options.

Long-acting beta-2 agonists are not for acute bronchospasm. Combined with corticosteroids they prevent symptoms. Salmeterol relaxes bronchiolar smooth muscle and can aid expectoration.

Leukotriene receptor antagonists block the leukotrienes that cause bronchospasm, vascular permeability, mucosal edema, and inflammatory cell infiltration. Montelukast is chewable, dosed once daily, and has no significant adverse effects.

4. Preventing Exacerbations

Early treatment and education, including a written action plan, drive exacerbation management. Quick-acting drugs relieve obstruction, systemic corticosteroids reduce inflammation, oxygen supports severe cases, and lung-function monitoring gauges the response.

Assess the patient's and family's history of allergies, triggers, respiratory infections, and prior interventions. Respiratory changes or infection can set off an attack, and a family history of eczema, allergic rhinitis, or urticaria points to reactive airway disease.

Assess use of over-the-counter medications and their effects. Some interact with prescribed drugs and can worsen an attack. Caregiver beliefs that nothing bad happens off medication erode adherence.

Assess the patient's readiness to manage their own condition. Handing asthma responsibility to a child too early leads to poor self-management; some children self-administer inhalers by age nine without the skill to do it well.

Assess the patient's and caregiver's health beliefs. Adolescents with uncontrolled asthma are more likely to see their symptoms as normal than peers with controlled asthma, which undermines self-management.

Teach the patient to avoid people with respiratory infections, cover the mouth and nose when coughing or sneezing, and dispose of tissues. About 80 to 85% of childhood asthma episodes follow a viral exposure, and human rhinovirus C shows up in most children presenting to the ED with acute asthma.

Teach avoidance of stressful situations and strenuous exercise, which can provoke exercise-induced bronchoconstriction. Baseline control should be good enough to prevent exertional symptoms.

Teach parents to modify the home to cut dust, pets, indoor plants, and allergenic foods, and to change filters. Use impervious covers, wash bedding in hot water, remove bedroom rugs, and limit upholstered furniture. Keep areas dry and store firewood outdoors to control mold.

Teach handwashing technique and get a return demonstration. Rhinovirus illness is a major trigger in children with asthma, so hand hygiene matters.

Teach the disease, its symptoms, and its triggers. Understanding the process lowers anxiety and improves participation in treatment.

Review the signs of an oncoming attack with parents and child: shortness of breath, wheezing, chest pain. Teach what to do and when to call the provider. Children often cannot describe symptoms clearly or recognize an attack coming on, so account for the child's developmental ability.

Inform parents about allergy skin testing for perennial indoor allergens, interpreted against the patient's history.

Teach medication administration and device technique, and warn against over-the-counter drugs without provider advice. Parents gain confidence in transferring responsibility once the child can administer treatments independently, clean the devices, and use the correct dose.

Connect families with community agencies for support. School-based asthma education improves knowledge, self-efficacy, and self-management in children aged 4 to 17 years.

5. Reducing Anxiety and Improving Coping

Anxiety is the strongest predictor of breathlessness in asthma, tied more closely to asthma-related health than lung function is. It sharpens symptom perception and worsens coping. Repeated hypoxia and hypercapnia may sensitize fear circuits so that the sensation of breathlessness itself triggers an outsized fear response.

Assess for anxiety. Rapid, shallow breathing from anxiety worsens asthma. Tools like the Beck Anxiety Inventory capture somatic symptoms such as nervousness, dizziness, and inability to relax.

Monitor oxygen saturation, since rising anxiety can be an early sign of hypoxia.

Evaluate how well the patient and family understand the diagnosis. They are absorbing new information that changes self-image and lifestyle, and their perceptions shape which interventions fit.

Provide comfort measures and a calm presence. Calm lowers oxygen consumption and the work of breathing, and emotional issues are hard to face during physical distress.

Acknowledge the patient's concerns and explain every procedure simply. Anxiety falls as the patient understands the plan, and shared, plain language builds trust and prevents misinterpretation.

Keep significant others updated and involve them in planning. Family anxiety transfers to the patient, and including the family restores a sense of control.

Assure the patient and family of close, consistent monitoring, without empty reassurance. A trusted, present person gives a sense of security while keeping the situation real.

Identify the patient's previous coping strengths and current areas of control to focus attention on their own capabilities.

Encourage relaxation techniques. Stay with the patient and coach slow, deep breathing, focused breathing, guided imagery, and progressive relaxation, with music therapy or biofeedback as appropriate.

Assess the family's resources and coping skills. Care coordination across settings reduces symptoms, unscheduled visits, activity limits, and school absences.

Assess relationships and support within the family, especially the parent-child bond, and refer for counseling when maladaptation shows. Primary caregivers are often single mothers carrying both daily care and care coordination.

Check on siblings and peers, and help the family recognize every member's needs. When attention centers on the diagnosed child, other members can feel abandoned.

Explore the family's feelings about the child and the diagnosis. Open history-taking surfaces psychological stress early, and naming fears reduces anxiety.

Discuss family goals and expectations. Families may expect home management to cure the disease, and unrealistic hopes lead to frustration when recovery plateaus.

Allow the family to grieve the "loss of the perfect child," a normal early reaction to a chronic diagnosis that can deepen into depression if it persists.

Help the family name realistic and unrealistic fears. After discharge, patients with high illness-specific panic fear were hospitalized 50% less often than those with low panic fear, and higher asthma-related anxiety in adolescents tracked with taking symptoms more seriously and acting on them.

Encourage positive family relationships and model them. Family conflict and maternal criticism are tied to greater asthma severity, and a negative emotional climate worsens severity through child depression.

Identify role changes and watch for parental depression. Maternal depression may shape a child's stress response and immune function and breed beliefs and practices that interfere with management.

Provide clear, accurate, repeated information and refer to community agencies and support groups. Emotion blocks recall, so reinforcement reduces misconceptions and fear of the unknown.

Help the family build a home care plan with age-appropriate goals tied to activity tolerance, and teach accurate use of the nebulizer, peak flow meter, and metered-dose inhaler, including cleaning and adherence strategies. Continuous nebulization may beat the inhaler-and-chamber method in severe exacerbations. Teach preventive use of bronchodilators before exercise to head off exercise-induced asthma.

Teach parents the signs of depression, especially in adolescents, and refer as needed. Poorer asthma control tracks with more child depression and PTSD, and emotional dysregulation can impair pulmonary function under stress.

6. Promoting Rest, Energy Conservation, and Patient Education

Exercise-induced asthma is acute bronchoconstriction triggered by physical activity in airways that are already reactive, often underdiagnosed because the asthma is otherwise silent. Beyond respiratory symptoms, patients commonly report fatigue, low energy, and daytime sleepiness, and severe fatigue is common in severe, uncontrolled asthma and tracks with worse quality of life.

Assess the patient's response to activity, since dyspnea and the work of breathing drain energy reserves. Bronchoconstriction can hit within minutes of finishing exercise.

Assess the level of fatigue and look for other causes. Post-exercise bronchoconstriction can also occur with normal resting spirometry in people with atopy, allergic rhinitis, or cystic fibrosis, and even in healthy cold-weather athletes. Cold or dry air, pollutants, intensity and duration of exercise, and a coexisting infection all add to it.

Monitor vital signs during and after activity, watching for tachypnea, tachycardia, and rising blood pressure as the lungs work to oxygenate tissue. Monitor vital signs every 4 hours and track the work of breathing, since higher fatigue tracks with more severe dyspnea and worse control.

Watch for signs of hypoxia: a change in level of consciousness, shortness of breath, tachycardia, irritability, fatigue, and restlessness. In the most severe attack the patient may struggle, grow confused and agitated, and pull off their oxygen saying they cannot breathe. That is life-threatening hypoxia.

Cluster care and disturb the patient only when necessary, doing everything at once rather than spreading it out, and avoid any care or procedures during an attack. Clustering conserves energy, since rising oxygen consumption and work of breathing can tip into metabolic acidosis.

Position the patient for comfort and rest. During attacks, children are more comfortable sitting or standing than lying down; a child willing to lie down is either at the end of an attack or too exhausted to stay upright. Support the arms on an over-bed table with pillows to ease muscle fatigue and aid chest expansion.

Schedule rest in a calm, quiet environment, limit visitors, and integrate nursing care for uninterrupted sleep. Implement energy-saving techniques such as a shower chair and sitting to perform tasks, which preserve a sense of control while conserving energy.

Teach the reason for conserving energy and avoiding fatigue. Rest lowers oxygen demand. Help plan a schedule for bathing, feeding, and rest that prevents an attack or speeds its resolution.

Allow activity to resume gradually as tolerated, and reinforce limits on anything that triggers attacks while encouraging provider-approved activity such as walking or swimming. Indoor or warm, humid environments are easier than cold, dry air, and even older adults benefit from staying active. Teach the patient to stop activity before fatigue worsens.

Allow a parent or significant other to stay during care, since their presence reduces the child's anxiety and fear and lowers oxygen expenditure.

For education, assess the patient's cognitive ability, educational level, and health literacy, since low health literacy is tied to worse quality of life and more ED visits. Assess knowledge of asthma and status asthmaticus, past and present therapies and the response to them, trigger awareness, tobacco use, and the ability to use asthma medications. Status asthmaticus, an acute severe attack resistant to outpatient therapy, is a medical emergency that needs aggressive hospital management.

Teach self-management built on asthma facts, self-monitoring, the role of medications, inhaler technique, and environmental control. Knowledge of self-management cuts hospitalizations and lowers anxiety.

Teach trigger avoidance: known allergens, temperature extremes, chemicals, and fumes. Keeping the house clean and pets out of bedrooms goes a long way.

Teach the warning signs of an attack and the value of early treatment, and provide a written daily self-management plan. Treatment within 6 hours of an attack can cut the chance of hospitalization, and validated asthma action plans should be reviewed.

Review all medications, including short versus long-acting agents and the zone system with each drug's dose per zone. Short-acting beta-agonists relieve acute attacks fastest and should be used before inhaled steroids so the airways open and let the anti-inflammatory reach deeper into the lungs. Rinsing the mouth after inhaled steroids prevents oral yeast infection. Reinforce that controller medications are needed even when no attack is happening, and teach the difference between nuisance side effects and true adverse effects.

Teach correct technique for nebulizer treatments, Diskus, metered-dose inhalers with spacers, and dry powder capsules, with a return demonstration. For a metered-dose inhaler, demonstrate how to hold it, pause 2 to 5 minutes between puffs, and clean it.

Teach peak flow meter use and establish the patient's personal best. Have the patient measure and record peak flow each morning before medication and in the late afternoon for 2 weeks; the highest regular reading is the personal best used to set the zones:

• Green zone: 80 to 100% of personal best signals all clear.
• Yellow zone: 50 to 80% signals caution and may call for a temporary increase in medication.
• Red zone: Less than 50% is a medical alert. Take a beta-adrenergic agonist, and if peak flow does not return to the yellow or green zone, notify the provider.

Discuss the pneumococcal and yearly influenza vaccines. Adults with asthma should receive the 23-valent pneumococcal polysaccharide vaccine, since they carry an estimated 12 to 17% population-attributable risk of pneumococcal infection. Stress avoiding people with active respiratory infections.

Address long-term management: control allergens and precipitators, avoid air pollutants such as perfumes, aerosol sprays, and powders, and monitor continually. Review breathing exercises and effective coughing, since pursed-lip and diaphragmatic breathing strengthen respiratory muscles and help control dyspnea.

Have the patient keep emergency numbers handy, wear a medical alert bracelet, and set up a buddy system for fast help, which is both practical and reassuring. Refer to support groups, including those sponsored by the American Lung Association and the public health department, where patients learn new ways to manage the illness and make changes such as smoking cessation.