TABLE IV.

Recommended interventions in difficult-to-control asthma^{50,52,57–59,73,79,80,86–90,100–104}

Adherence	Evaluative comments
Assess adherence through discussion and chart review	• Necessary components of clinical practice to ensure adherence to medications in adult and pediatric patients
Improve access to medications, self-report or electrònic follow-up, refill feedback, and peak flow prediction
Use shared decision-making
Use the objective measures of adherence, such as pharmacy refill records, electronic monitoring, written/digital tracking, or FeNO suppression	• These objective measures act as both an assessment and an intervention when self-monitoring and feedback are provided
Employ or refer for behavioral interventions	• Benefits include improvement in symptoms, health outcomes, and adherence
Consider use of digital platforms to enhance adherence	• Benefits adults and children
	• Allows for self-monitoring, feedback, asthma education
Ensure culturally sensitive interventions	• Important given higher prevalence of asthma in minority groups
Provide patient navigators and other forms of assistance	• Benefits adults with moderate-to-severe asthma in low-income urban neighborhoods
Refer to school-based asthma programs	• Benefits pediatric patients, specifically from low-income urban areas
Health literacy
Focus on use of universal health literacy precautions while communicating with patients	• Recommended by experts in all patient communication
Provide literacy-appropriate asthma action plan	• Ensure plan understood by the patient
Consider culturally sensitive interventions	• Use professional interpreters in person or via telephone
Provide patient navigators and other forms of assistance	• Ensures accurate 2-way communication
Inhaler technique
Assess inhaler technique through effective communication	• Key components for each patient visit to ensure the correct inhaler technique
Demonstrate correct inhaler use
Review at each visit

FeNO, Fractional exhaled nitric oxide.