Asthma Control: Understanding Pitfalls and Tips on What You Can Do

James Thompson, MD Health Pro
  • More than 24 million people in the U.S. have asthma. For a majority of them, it can be controlled. Death rates from asthma peaked more than a decade ago, but since then they have steadily decreased. That’s the good news. The bad news is that the control of asthma, as reflected by emergency room visits and missed work or school, has not fallen proportionately.


    Why does this discrepancy exist at a time when advances in medications and asthma action plans are so plentiful?


    Increasing costs of doctor visits and asthma medications are likely a factor. Also, while health experts continue to more clearly understand the impact of environmental triggers--such as pollens, molds, dust mites, weather changes and pollution—the price tag on removing carpets, purchasing dust mite covers and expensive air filter devices can be overwhelming.

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    In addition, other medical disorders have been shown to worsen asthma control. These include obstructive sleep apnea, gastrointestinal reflux disease (GERD) and chronic sinusitis. The impact of stress, anxiety, and depression on asthma management also is now better understood, but not well addressed in current treatment guidelines.


    Even a person’s level of religious belief can be a factor. A study in Detroit, Michigan, involving more than 1,000 participants, found that those with a stronger religious faith were less consistent in their use of asthma controller medications.


    Asthma is a very complex disorder which requires a comprehensive management plan based on an individual’s home, school/work environment and related triggers. Previous response to medications and the current level of severity must be reviewed. Doctors must also address whether other physical, psychological or nutritional factors are making asthma control more difficult. Based on the Detroit study, doctors probably should spend an additional moment to explore a patient’s or parent’s disposition on faith as it relates to their use of medication over time. This understanding may influence the doctor’s approach in prescribing and monitoring asthma control.


    What can you do to assist your doctor in improving asthma control?

    Here are 10 tips:

    1) Review established and suspected allergic and irritant triggers which are unique to your home, school or work environment. Discuss what additional steps may be taken to reduce or avoid these triggers.


    2) Review the role of your controller medications and the schedule for taking them (once daily, twice daily or more often?). Ask how long your controller should be taken before stepping down, or off.


    3) Have your doctor or nurse critique your inhaler technique. I find minor flaws in inhaler technique on follow-up visits more than 50 percent of the time.


    4) Inform your asthma care provider about any nasal or sinus symptoms. Upper airway inflammation or infection often contributes to poor asthma control. Have your nasal spray technique checked if you are on an intranasal steroid.


    5) Learn more about signs and symptoms of obstructive sleep apnea, GERD and chronic sinusitis. If you suspect you have one or more of these problems, inform your doctor.


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    6) Review sites on HealthCentral which discuss anxiety and other mental health disorders. These conditions are quite common, but often are overlooked in asthma management discussions. It is very important to discuss feelings of depression with your caregiver. Asthma control may be greatly compromised when a person is depressed.


    7) Monitor your Asthma Control Test (ACT) score. Most asthma doctors have this assessment done at each visit. Other monitoring tools exist which are just as good.


    8) Ask about your lung function test. A pulmonary function test or at least an assessment of your Peak Flow Rate should be done periodically to determine your lung function. We do peak flow rates every visit. (Many patients track them at home with their own peak flow meter).


    9) Get an asthma action plan from your doctor and have it updated at least once a year.


    10) Share any concerns you have about the long term use of medications as it relates to your personal beliefs. Hopefully your doctor will be attentive and incorporate what he/she learns into the decision process.


    I hope this was helpful




Published On: March 08, 2013