Part two of a two-part article series discussing the physical therapist’s role in treatingasthmatic patients: Passing the AE-C examination.

In the September 2005 issue of Physical Therapy Products,1 we discussed the news that the National Asthma Educator Certification Board (NAECB) had recently approved physical therapists (PTs) to be eligible to take the certification examinaton to become a Certified Asthma Educator (AE-C).2 This eligibility is based on holding the physical therapy credential and reflects a policy change: Prior to this announcement, PTs had to have a minimum of 1,000 hours’ experience in providing asthma education, counseling, or coordination of services to be eligible to take the AE-C credentialing exam. Several other professionals—such as physicians (MD or DO), physician assistants, nurse practitioners, nurses, respiratory therapists, pulmonary function technologists, pharmacists, social workers, health educators, and occupational therapists—are eligible to take the examination based on their professional license, and they do not have an asthma-experience requirement.

Asthma education is in high demand due to the fact that this disease is becoming more prevalent—information released by the Centers for Disease Control and Prevention noted that between 1980 and 1996 there was a 73.9% increase in self-reported or proxy-reported 12-month prevalence of asthma, plus increases in days lost from school and work, physician’s office visits, emergency-department visits, hospitalizations, and deaths related to asthma.3 Asthma education is a billable procedure through Medicare and Medicaid. With these facts in mind, this article will walk you through the steps to apply for, take, and pass the AE-C exam.

Note: It will be most helpful for you to have access to three additional items to accompany this article if you intend to pursue the AE-C credential. First, keep a copy of the first article in this series.1 Second, visit the National Heart, Lung, and Blood Institute Web site, and print out the National Asthma Education and Prevention Program (NAEPP) Guidelines.4 This document is large and will take some time to download and print, but it is an excellent resource for asthma and will provide just about all you need to know to pass the AE-C exam. Third, study the information found on the National Asthma Educator Certification Board Web site.2 This site is a good source of information for the candidate taking the AE-C test.

The AE-C Examination

The AE-C examination is handled through the NAECB. You can register to take the examination online at the NAECB Web site or by mailing an application to the NAECB through the address for Applied Measurement Professionals Inc (AMP), Lenexa, Kan. If you don’t have Internet access or have questions about the test, call the Candidate Services Department at (888) 519-9901 to get more information. The examination is offered at more than 100 AMP Assessment Centers—which are usually located in H&R Block tax offices. By using H&R Block locations, AMP is able to offer computerized testing throughout the nation, making it easier to take the examination. Be aware that this is not handled by H&R Block; the firm is simply providing the testing locations. 

Questions about the examination should be directed to the NAECB or AMP. On the NAECB Web site, under “examination info and registration,” you will find a link to “find an assessment center”—this link connects you to the AMP Web site. You will also be able to link to a sample examination to get a feel for the way this test is given. You will need to go to “take a sample computerized examination” and then go to the respiratory therapist examination. Don’t worry about missing any of the respiratory therapy questions; this link is provided only to show you how the examination works. When you take the AE-C examination, its results are compiled as a “raw score” and a “scaled score.” Your “scaled score” must be 75 or higher to pass the examination and receive the AE-C credential.

The examination costs $275, and repeats cost $150. The AE-C credential expires after 5 years, and recertification costs $275. The examination consists of a different percentage of questions in each of the following areas:

- 20%—knowledge about the disease itself;

- 26%—patient and family assess- ment;

- 3%—asthma management; and

- 11%—organizational issues (asthma-program outcomes, the referral system, and professional networking).

The examination consists of 175 questions, but only 150 are scored; the other 25 are pretest questions. All of the questions are multiple choice or multiple-multiple choice. Each question falls into one or more of three categories:

- recall (remembering information or recognizing the need for specific information to deal with the issue);

- application (applying knowledge to different situations); and

- analysis/evaluation (analyzing a situation to determine a solution, and evaluating the effectiveness of actions/decisions).

The entire examination matrix is available on the NAECB Web site in the “candidate handbook” section. The matrix lists the four testing areas; gives details you should know about each area; and shows whether the test will deal with recall only, recall and application only, or recall, application, and analysis of that particular area. The section also includes sample test questions with the correct answer, and refers you to the matrix to see the area and testing category. Several review reference sources, including journals, books, guidelines and reports, and Web sites, are listed. Finally, information regarding the day of the test and an application form to print and mail, should you not be able to apply online for the test, are provided.

Test-Taking Tips

To know what steps are needed to manage asthma, it must be diagnosed and properly classified by severity—NAEPP Guidelines establish the classifications as mild intermittent, mild persistent, moderate persistent, and severe persistent. The patient’s classification and age determine the recommended treatment. Treatment differs slightly between infants and young children, and those older than 5 years of age—mainly in the choice of medications and the recommendation for using a spacer/holding chamber with a mask for delivery. The symptoms—precipitating factors (triggers), age of onset, family and social history, evaluation of an asthma attack and what works to stop it, the impact on the patient and family, and the patient’s and family’s knowledge of the disease—all contribute to the diagnosis, classification, and management of the disease.

Tip One

Classification relies heavily on one particular pulmonary-function test called spirometry. Read about spirometry testing and visit a pulmonary-function-testing laboratory (in a hospital, clinic, or pulmonologist’s office) to see how it is done and what the recorded documents look like (graphics and text). If possible, volunteer to have the test done to understand what is required to obtain accurate information. In addition to (or sometimes instead of) spirometry, peak flow testing can be used to classify and monitor asthma. Spirometry testing will include a peak flow measurement and is seen graphically on a flow-volume curve. (Spirometry often records flow-volume curves in addition to volume-time curves.)

PTs should know the details about spirometry and prebronchodilator and postbronchodilator tests. The prebronchodilator test provides a baseline for the forced expiratory volume after one second (FEV1) and records the other significant measurements used to define obstructive lung disease—namely, the forced vital capacity (FVC) and the ratio of FEV1/FVC. 

Next, the inhaled medication is given, and the patient waits about 15 minutes to allow the medication to work. Finally, the patient performs the postbronchodilator test, and the results are evaluated to see if the bronchodilator helped. You should be familiar with this test and with the graphics to be able to recognize normal results versus results that show obstruction, and what is defined as a significant response to an inhaled bronchodilator. See the American Association for Respiratory Care guideline for spirometry to learn more about this test.5 

Tip Two

It is important to know the names, classifications, and delivery methods of the medications used to prevent and treat asthma attacks. The NAEPP provides great detail about this in its Guidelines.4 Know the medications used in long-term management and those used to manage exacerbations—both home-based and emergency medical care/hospital-based. You will notice that many of the same medications are mentioned in all these situations. However, the frequency (and sometimes the dose) increases with the severity of the classification and/or asthma exacerbation.

Tip Three

Part one of this article series1 included a table (reprinted on this page) that describes the classifications, medications, and educational activities for asthma with patients more than 5 years old. You should be able to reproduce this table from memory. When you first enter the examination room and get ready to take the AE-C test, you should receive some blank paper and a pen or pencil. Take 5 minutes and reproduce this table on the blank sheet. You will find it very useful to have it in front of you during the examination, and you will not violate any test-taking rules as long as this information is from memory and is written down in the examination room on blank paper. Also, take note of the small differences between information in this table versus treatment of patients less than 5 years old.

Tip Four

Read the entire NAEPP Guidelines4 and highlight the specific areas that are most relevant. Then, reread the Guidelines, taking your own notes, and start learning the material. Finally, study your notes and refer back to the Guidelines whenever you need clarification.

Tip Five

Review the sample test and matrix on the NAECB Web site, and read through the chapter on asthma in a recent respiratory therapy or nursing textbook. Seeing the material in several different contexts and in various presentations will help you remember it. Also, these texts often provide cases to study, which helps you sharpen your knowledge, assessment, and decision-making skills. The more you read and experience the information, the better your knowledge and recall of it will be. You will also improve your ability to assess, establish treatment plans, and help patients and families manage asthma correctly with the best outcomes.

Tip Six

Visit an asthma clinic or an asthma specialist’s office. Regardless of your level of expertise in asthma management, you can still learn more about dealing with the patients and families, the tests used to diagnose and monitor asthma, and the many medications used to keep this disease in check. Notice how the professionals provide education and reinforcement, and what is being discussed. Do the professionals provide written materials and a written asthma plan? If so, read it. If you are going to teach about asthma, you should be able to prepare your own materials. Also, take a look at the medications and delivery devices used in the clinic or office.

Finally, take the test. If you pass, you will have earned the AE-C credential and you can be proud of the accomplishment. Moreover, you will have a much greater understanding of asthma and will have improved skills and knowledge to help asthmatics live a better life. If you don’t pass, review the areas in which you were weak and retake the test. You can do it with some time and effort, and obtaining the AE-C credential will help both you and your patients. Good luck!

William C. Pruitt is a full-time instructor in the department of Cardiorespiratory Sciences at the University of South Alabama in Mobile, Ala, and a PRN respiratory therapist at Springhill Medical Center in Mobile. He is also a registered respiratory therapist, a certified asthma educator, and a certified pulmonary-function technologist. He can be reached at wpruitt@jaguar1.usouthal.edu.

References

1. Pruitt W. Asthma Education. Physical Therapy Products. 2005;16:36-39.

2. National Asthma Educator Certification Board. Available at: http://www.naecb.org/exam_information.htm Accessed July 31, 2005.

3. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report, Surveillance Summary from March 29, 2002. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5101a1.htm#tab1 Accessed July 31, 2005.

4. National Heart, Lung and Blood Institute. National Asthma Education and Prevention Program Guidelines. Available at: http://www.nhlbi.nih.gov/guidelines/index.htm#asthma Accessed July 31, 2005.

5. Association for Respiratory Care. Clinical Practice Guideline for Spirometry. Available at: http://www.rcjournal.com/online_resources/cpgs/spirupdatecpg.html Accessed July 31, 2005.