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#1 How one treats asthma can be based on symptoms which is usually helpful but to guide more significant therapy, certain diagnostic biomarkers such as sputum and bronchoscopic sampling must be utilized to aid in providing the most effective medications (Silkoff et al., 2015). Several other tests are available to diagnose asthma. Despites typical symptoms of wheezing, shortness of breath, and cough, the use of pulmonary function tests like spirometry, a device that measures the amount and speed of air flow in and out of the lungs is beneficial. During an asthma attack, a patient in the emergency department for example will have SPO2 monitored, expiratory flow rate with a peak flow meter, which measures hyperresponsiveness of the airway and blood sample taken to evaluate arterial blood gasses. Arterial blood gases or ABG, will show hypoxemia and respiratory alkalosis early on in an asthma exacerbation and if it were worse, would give results of respiratory acidosis and elevated carbon dioxide in the blood prompting the patient to require intervention via mechanical ventilation (McCance et al., 2019). Spirometry is critical in determining airflow obstruction thus diagnosing asthma. It measures the forced vital capacity and force expiratory volume in one second giving a ratio for the two with a value of less than 0.75 a confirmed case of asthma (Gelfand et al., 2018). With these tests, severity of asthma can also be determined which is useful in determining is treatment will be pharmacologic with bronchodilators and steroids or non-pharmacologic which interventions such as quitting smoking, avoiding allergic triggers and being physically active. #2 Recommended methods to establish an accurate diagnosis of asthma include collecting a detailed medical history from the patient, conducting a physical assessment with focus on the upper respiratory tract, chest, and skin, and having the patient perform spirometry to demonstrate the severity of obstruction while assessing reversibility of the attack. Objective assessments of pulmonary function are necessary for the diagnosis of asthma because medical history and physical examination are not reliable means of excluding other diagnoses or of characterizing the status of lung impairment. Although physicians generally seem able to identify a lung abnormality as obstructive, they have a poor ability to assess the degree of airflow obstruction (2007). The health care provider has collected the patient’s medical history and performed a physical exam to suspect the diagnosis of asthma. Spirometry can help determine the extent of lung tissue damage from frequent asthma attacks as well as the effectiveness of medications when performed before and after a bronchodilator is administered. Spirometry typically measures the maximal volume of air forcibly exhaled from the point of maximal inhalation (FVC) and the volume of air exhaled during the first second of this maneuver (FEV1) (2007). The spirometry measurements can guide this patient’s course of treatment in testing the effectiveness of short acting bronchodilators that are initiated for the treatment of early asthma to prevent the patient from having a delayed response and extensive lung tissue damage. With teaching and demonstration of correct use of necessary bronchodilator use to treat recurrent asthma attacks, this patient can successfully manage her illness and lead a normal and healthy life. As a nurse practitioner I would have the patient perform spirometry with the patient and educate on various degrees and severities of the readings. I think it is also crucial to emphasize the importance of correct medical management of asthma because she has been taking cough medicine and has not been not following the proper medication regimen when her asthma attacks occur. According to Bush (2019), most pediatric asthma is a simple disease to diagnose and treat if basic measurements are made and the child is given low dose therapy appropriately and regularly (Bush, 2019).