What to know about the requirements, steps, and benefits of becoming a certified asthma educator (AE-C).

By Bill Pruitt, MBA, RRT, CPFT, AE-C, FAARC


Asthma is a chronic disease that impacts millions of lives every day. According to the Centers for Disease Control and Prevention, the United States spends $56 billion each year on asthma.1 In 2008, the disease was the cause for 10.5 million days of missed school for kids and 14.2 million missed days of work for their parents. In 2010, 1-in-12 adults and 1-in-11 children had asthma—totaling more than 25.5 million people.1

The disease crosses all demographic lines—gender, age, income, race, and educational level—but it tends to be more prevalent in women compared to men, in those 18 to 24 years of age compared to older adults, in multi-race and black adults compared to white adults, in black children compared to white children, in those who didn’t finish high school, and in those earning $75,000 or less. In addition, it is more prevalent in smokers and in obese adults.1 With the growing problem of asthma, there is an urgent need for caregivers who have a deeper understanding of the disease and increased skill in caring for the asthma patient and their family. Asthma is studied in educational programs for nurses, physicians, respiratory therapists, and other health care professionals, but the time dedicated to the topic may be too brief, the materials may be less than ideal in the depth and scope of coverage, and what is being taught may not be inclusive of the most current evidence-based practices.

Moreover, as time goes by and these students move into the world of health care, details and management strategies taught in school tend to fade, knowledge becomes outdated, new research shifts the focus of care and “best practice,” their familiarity with the new asthma medications and medication delivery devices may not stay current, and their teaching skills become more limited. In many instances, obtaining the asthma educator credential prevents this downward trend by sharpening the skills and knowledge of the health care provider. This article will explore the reasons for becoming a certified asthma educator (AE-C) and provide advice on how to make this a reality for those who deal with asthma every day.

Resources Are Available but Not Put into Practice

The National Institutes of Health contains the National Heart, Lung, and Blood Institute (NHLBI). The NHLBI established the National Asthma Education and Prevention Program (NAEPP), which, in 2007, released the third and most recent set of guidelines on the diagnosis and treatment of asthma called the Expert Panel Report-3 (EPR-3). The NHLBI also collaborated with the World Health Organization to release a set of guidelines aimed at the diagnosis and treatment of asthma across the world. These guidelines are referred to as the Global Initiative for Asthma or GINA guidelines, with the most recent updates released in 2012. These two sets of guidelines are valuable resources, which are available for free via the Internet, and they provide the best evidence-based approaches for asthma.2,3

Despite these readily available resources, gaps in management and problems in care of asthma patients persist. The Asthma Insight and Management survey found that asthma control and management in the United States was unsatisfactory when these issues were examined some two years after the release of the EPR-3 guidelines. The problems cited in this survey include:

“Insufficient access to respiratory specialists, inadequate implementation of asthma management practices, inappropriate prescribing and/or use of medications, lack of knowledge among patients regarding what constitutes good asthma control, and low expectations of both physicians and patients regarding adequate asthma control.”4

Assessing the Value of the Certified Asthma Educator

In a project that took place in Canada, researchers set about to develop quality indicators for assessing primary care for asthma. These indicators were evidence-based using a modified RAND Appropriateness Method to extract data from reviews of 135 full-text articles and five published sets of guidelines (including EPR-3 and GINA). These articles were selected from an initial search that produced a pool of 1,228 articles. The in-depth review of the full-text articles and guidelines produced an initial set of 45 indicators, which were given a ranking from a panel of 17 experts from a variety of disciplines including adult and pediatric pulmonologists, allergists, family practitioners, pediatricians, pharmacists, emergency department physicians, nurses, and respiratory therapists. From this blend of quality evidence-based materials and expert opinion, the top 15 performance indicators were established. Having asthma education from a certified asthma educator held the number one spot in the rankings of performance indicators for the quality of asthma care.5

Research by certified asthma educators is regularly published in the Journal of Asthma & Allergy Educators. This is the official journal of the Association of Asthma Educators, and the bimonthly peer-reviewed publication carries excellent articles that reflect the value of having asthma education offered by a certified asthma educator. The journal also increases the knowledge and understanding of the reader and provides research ideas for others to pursue. Other peer-reviewed publications often carry research articles that prove the worth of the AE-C both as researchers and as educators. Examples are found in publications such as the Journal of the American Pharmacists Association, the Journal of Pediatric Health, and Nursing Clinics of North America.6-8

There are billing codes available to be reimbursed for working with asthma patients. The best option to find out more is to talk with someone who is familiar with the various billing codes and who knows how asthma has been treated at the state level. Diagnostic tests, providing treatments, and provision of education all carry billing codes that can help support and justify having an asthma educator in the office, clinic, or department. Many insurers are now stipulating that education be provided by an AE-C before they will consider providing payment.

Who Are Certified Asthma Educators?

The National Asthma Educator Certification Board (NAECB) prepares and conducts the examination and enables those who pass the exam to have recognition as a certified asthma educator (AE-C). The NAECB website defines the asthma educator as “an expert in teaching, educating, and counseling individuals with asthma and their families in the knowledge and skills necessary to minimize the impact of asthma on their quality of life.”9 Professionals who hold the AE-C certification include licensed or credentialed individuals from the following list: physicians, physician assistants, nurses, respiratory therapists, pulmonary function technologists, pharmacists, social workers, health educators, physical therapists, and occupational therapists. A second group who is allowed to sit for the exam and hold the AE-C credential includes those who are providing asthma education, counseling, or coordination of services directly to asthma patients. A minimum of 1,000 hours of experience is needed before these individuals can take the certification exam.

How to Become a Certified Asthma Educator

The NAECB website provides information on the AE-C certification, including a link to the AE-C Candidate Handbook, which describes the application process, fees, exam locations, exam content, scoring, and other helpful information. The actual testing is performed by Applied Measurement Professional Inc (AMP), which also administers credentialing and certification exams for many other groups. (AMP is owned by the National Board for Respiratory Care and provides all the testing for the RRT, CRT, CPFT, RPFT, NPS, and other similar credentials.) The application is available online or in print and is valid for 1 year to allow the candidate ample time to schedule the examination.

The AE-C exam contains 175 questions, of which 150 are used in determining the candidate’s score and 25 are evaluated for possible use in other versions of the exam. These 25 questions are not identified in the exam and do not affect the final score. The exam is time-limited to 3 and one-half hours, and it is given via a computer (details on the procedure for taking a computerized exam are given in the NAECB Candidate Handbook). As of May 2013, the fee for the exam is $295 for a new candidate and $245 for recertification. If the exam has to be retaken, the fee is $195. The AE-C certification is valid for 7 years and is renewable within the year prior to expiration. To renew the certification and continue use of the AE-C initials, one must take and pass the examination—it is not renewed based on continuing education or by any other means.

The exam covers four content areas: the asthma condition, patient and family assessment, asthma management, and organizational issues. The Candidate Handbook contains a detailed content outline that describes the areas covered by the exam. This content outline is an excellent source and helps to focus study efforts in the key areas of the examination. For example, under the asthma condition content area, the outline states: “Describe to an individual with asthma differences between an allergen and an irritant, common triggers that provoke asthma, potential occupational risks in the development and control of asthma,” etc. The 175 test items in the exam generally provide a single question, a statement followed by a question, or a situation followed by a question. The question will have four possible answers—one must choose the best answer from the four. There is no penalty for guessing so the best strategy is to answer all of the questions. The questions concern all types and variants of asthma and cover an age range from toddlers through seniors. The exam also covers diseases that mimic asthma such as vocal cord dysfunction, comorbid conditions such as COPD, and caring for asthmatics in an emergency setting. According to the NAECB, the exam has a national pass rate of 67.4% and there are currently 3,264 AE-C certificate holders.9

There are more than 170 testing sites across the nation, and many of these sites are found in tax preparation offices. The exam is offered by appointment on Monday through Saturday at either 9:00 am or 1:30 pm. The rules about testing are very specific and give details on what happens if one is late or misses the exam, what can and cannot be carried into the exam room (including personal items such as cell phones), and what is considered misconduct.

Review courses are available to help prepare one for the AE-C exam. The NAECB does not participate or promote any review course to avoid any conflict of interest. The NAECB website suggests checking with professional organizations, such as the American Lung Association, American Association for Respiratory Care, Association of Asthma Educators, and National Respiratory Training Center, for courses to help prepare for the exam.9

When preparing for the exam, keep the following in mind: The examination is challenging—make sure to get a good night’s sleep before taking the exam. Do not be late—arriving more than 15 minutes late will block entry into the exam room. Know where the test center is located and how long it will take to drive there (also consider traffic delays, time of day). It may be useful to make the trip to the testing center on a day before the scheduled exam to check the location, the route, and possible issues with travel conditions. On the day before and on the day of the exam, avoid foods that might be disagreeable or cause ill health. During the exam, remember the following:

  • Read carefully. Many questions include a lot of text before asking the question and the text may include several issues or problems, but the question only asks about one particular issue. Reading too quickly and jumping to the answers may cause one to miss the actual focus of the question.
  • Make the best choice. Make the best choice to answer the question. When encountering a difficult question that does not have a clear, correct answer, select an answer and move on, but take note of the question, then return after reaching the exam’s end to re-evaluate. Answer all the questions. There is no penalty for guessing, but all unanswered questions will be counted as wrong.
  • Watch the time. There are 3 and one-half hours available to complete 175 questions. This averages just over 1 minute per question. Remember, don’t get stuck on one question. The clock on the lower corner of the computer screen will help keep track of the time (this feature can be toggled on-off as desired). Taking a bathroom break is allowed but does not stop the clock—time will run straight through without pause from start to finish.

The Value of an AE-C Certification

Becoming an AE-C is rewarding, challenging, and brings a sense of assurance and confidence when caring for the asthma patient and their family. Preparation for the exam provides in-depth knowledge of this disease, its diagnosis and management, the educational issues, the pharmacologic treatment options (including both the medications and the delivery devices), strategies for self-management in the home, strategies for the emergency department, and the best practice guidelines for providing acute inpatient care. Health care continues to evolve; quality of care is becoming a major issue, readmissions to the hospital for certain diagnoses are carrying penalties for reimbursement, more care is being offered in the home, and case management is becoming a must. Obtaining the AE-C sharpens the skills and knowledge of the health care provider and is becoming more valuable in this changing environment.

RT 

Bill Pruitt, MBA, RRT, CPFT, AE-C, FAARC, is a senior instructor and director of clinical education in the department of Cardiorespiratory Sciences, College of Allied Health Sciences, at the University of South Alabama in Mobile. Pruitt also works as a PRN therapist at Springhill Medical Center and volunteers at the Victory Health Partners Pulmonary Clinic in Mobile, Ala. For further information, contact [email protected].

 References
  1. CDC. Asthma’s Impact on the Nation (2012). http://www.cdc.gov/asthma/impacts_nation/AsthmaFactSheet.pdf Accessed May 2, 2013.
  2. National Heart, Lung, and Blood Institute. EPR-3 asthma guidelines. http://www.nhlbi.nih.gov/guidelines/asthma/. Accessed April 28, 2013.
  3. Global Initiative for Asthma. GINA guidelines. http://www.ginasthma.org/. Accessed May 1, 2013.
  4. Murphy KR, Meltzer EO, Blaiss MS, Nathan RA, Stoloff SW, Doherty DE. Asthma management and control in the United States: results of the 2009 Asthma Insight and Management survey.  Allergy  Asthma Proc. 2012;33(1):54-64.
  5. To T, Guttmann A, Lougheed MD, et al. Evidence-based performance indicators of primary care for asthma: a modified RAND Appropriateness Method. Int J Qual Health Care. 2010;22(6):476-485.
  6. Bunting BA, Cranor CW. The Asheville Project: long-term clinical, humanistic, and economic outcomes of a community-based medication therapy management program for asthma. J Am Pharm Assoc. 2006;46(2):133-47.
  7. Rance KS, Trent CA. Profile of a primary care practice asthma program: improved patient outcomes in a high-risk population. J Pediatr Health Care. 2005;19(1):25-32.
  8. Meyerson KL. Asthma Network of West Michigan: a model of home-based case management for asthma. Nurs Clinics North Am. 2013;48(1):177-84.
  9. National Asthma Educator Certification Board. Certified Asthma Educator (AE-C) Candidate Handbook. http://www.naecb.org. Accessed May 4, 2013.