Adult Checklist

Pediatric Checklist

The PACNJ Asthma Visit Checklist is a one-page two-sided
form to document asthma assessment and monitoring
at each patient visit.

National Heart, Lung. And Blood Institute National Asthma
Control Initiative, a Program of the National Institutes of Health
offers resources for health care professionals to reinforce the
implementation of the National Asthma Education and Prevention
Program’s (NAEPP) latest Guidelines for the Diagnosis and
Management of Asthma (EPR-3)

The EPR-3’s companion Guidelines Implementation Panel (GIP)
Report: Partners Putting Guidelines into Action
prioritized six
clinical practice recommendations:

  • Use inhaled corticosteroids to control asthma.
  • Use written asthma action plans to guide patient self-management.
  • Assess asthma severity at the first visit to determine initial treatment.
  • Assess and monitor asthma control at each follow-up visit and adjust treatment if needed.
  • Schedule follow-up visits at periodic intervals.
  • Control exposure to allergens and irritants that worsen the patient’s asthma.

The PACNJ Asthma Visit Checklists can help you
in the goal of asthma control for your patients with asthma.