I wish I could say all my patients have well controlled asthma but I doubt that will ever be the case since I have hundreds of them, and they all have unique trigger factors and symptom complexes. Some patients only have flare-ups associated with upper respiratory infections (common cold or sinusitis). Other patients rarely get colds but have difficulty breathing when the weather changes. Yet others primarily cough or wheeze when they are around cats, or dogs. Some people have seasonal asthma (the fall and winter generate the most frequent complaints). Asthma appears to have many faces. Amazingly characteristics of asthma and asthma triggers can change over time in the same individual.
Good asthma management requires follow-up doctor visits and review of treatment parameters at least twice yearly. My well-controlled asthma patients are asked to follow-up with me every six months. Sometimes people think they are doing well but according to breathing tests (spirometry) or asthma control tests (ACT), are not.
Doctors often have short segments of time (much too short in my opinion) to interview, examine and discuss treatment on follow-up visits which on average are 10 to 20 minute intervals. Many times your doctor has certain benchmarks she/he wants you to achieve (e.g. High peak flow rate or ACT score) but you may have your own desired goals that need to be communicated and addressed. When you and your doctor's expectations are not well aligned good asthma management may be difficult to achieve. So what can you do?
Here are 8 tips on how to prepare for follow-up appointments with your asthma care provider.
- 1) Get a small spiral notebook or log in order to write down important items of information concerning your asthma care and concerns. Of course, an electronic device such as your smart-phone or I-pad may suffice. If questions regarding your medications or treatment plan arise, in between doctor visits, write them down for future reference. Keep a record of the date and time of your follow-up visits in order to avoid missing an appointment. Write down and prioritize your main goals in asthma care to share with your doc.
- 2) Ask about your asthma action plan (AAP) at least once a year. Should maintenance medications (controller meds) be increased, lowered or stay at the same dose? Should you follow the same directives when you have an asthma flare-up? Did this plan work well the last time you used it for an asthma flare-up? If not, what should be adjusted? You definitely should have a written AAP.
- 3) Have your inhaler technique checked in order to identify any flaws that may have developed. I identify one or more flaws in inhaler 60-80 percent of the time on follow-up visits. Seriously, ask the doctor or nurse to observe how you take your inhaler once or twice a year.
- 4) Review your list of indoor trigger factors and previous suggestions on how to reduce exposure to them (pets, dust mites, fumes or fragrances etc.). Is there more you can do?
- 5) Ask about your last breathing test (spirometry or peak flow rate) and how it compares to your current result. When should you have another breathing test?
- 6) Ask about recommended vaccinations and when to get them. Should you have a pneumonia vaccine?
- 7) If you have allergic or non-allergic rhinitis is it under good control? Ask about how can you improve treatment in order to keep it from worsening asthma control.
- 8) Are there other health conditions which may be impacting your asthma control? Are you overweight? Do you snore loudly? Do you have high blood pressure or take medication to treat it? Did you smoke previously? Do you have frequent heartburn? Many other health problems can influence asthma control. Sleep apnea, obesity, certain blood pressure medications and chronic bronchitis and gastrointestinal reflux disease (GERD) may worsen asthma. This is an incomplete list but think about some of these disorders before your appointment.
The above tips may allow for a more efficient and productive follow-up visit next time you see your doctor. An asthma specialist is trained to comprehensively address all the above points but many primary doctors are capable if they have the time. Ask about seeing an allergist if goals (yours and/or your doctor's) are not being achieved.
Are your asthma care goals in alignment with your doctor's?
Do you know what your goals should be?
Published On: February 16, 2012