Improving Asthma Control: A Checklist for Your First Office Visit

James Thompson, MD Health Pro
  • Asthma is a clinical syndrome associated with periodic bouts of cough, wheezing, difficulty breathing and chest tightness. More than 24 million people in the U.S. have asthma. Although death rates from asthma have decreased over the last decade, quality of life factors have not correspondingly improved. Millions of Americans remain under-managed for asthma, resulting in several missed days of work or school over the course of a year.

     

    Key targets proposed by the NIH panel (National Heart Lung and Blood Institute) include proper identification of asthma followed by assessment of disease severity or control, and treatment based on a stepped care process that is based on established severity.

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    Your first visit to the doctor for asthma management should be comprehensive in order to accurately identify your level of impairment and the trigger factors associated with your asthma flare-ups. Many questions will be asked about medications taken, family history of allergy and asthma, your home and work environment and existing limitations attributed to asthma.

     

    You should be prepared for the first office visit and follow-up office visits in order to maximize potential for improving asthma control.

     

    Here is a checklist for preparing for your initial office visit with an asthma care provider:

     

    1)  Bring a list of all your medications currently being taken or previously taken for asthma and allergy treatment. It’s a good idea to bag up the current medications for review by the doctor or nurse. We often like to inspect your inhalers and spacers, review doses left on some of them, and check expiration dates. Bring your Asthma Action Plan if you have one.

     

    2)  Take some time to jot down a personal history of your asthma experience. It should include when it was first diagnosed and how it was treated initially. Include dates of ED visits and hospitalizations if you can. Estimate how many work days or school days have been missed on average, annually. Include how asthma has impacted your daily activities, sleep, exercise, sports or recreation. You should address activities or circumstances you avoid because of breathing problems.

     

    3)  Think about how asthma has limited you in the last four weeks and write it down. Include the number of times over this period you have used your reliever inhaler (usually a form of albuterol). How many times (daily) have you been short of breath or had other asthma symptoms? How many nights have you awakened with asthma symptoms over the last month? How do you feel overall about your current asthma management? These are questions you may face when you fill out an asthma questionnaire (for example the Asthma Control Test).

     

    4)  Be prepared to give information about your homes heating and cooling (Forced air or radiator heating? Central a/c?). Find out how old your home is and when the ducts were last cleaned. How old is your mattress, pillow or couch? How old is your bedroom or family room carpet?

     

    5)  What are your suspected trigger factors at home and away from home? Do you think outdoor allergens trigger asthma flare-ups? Do you have a seasonal asthma pattern, and if so, which seasons? Write all of this down.

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    6)  Write down whether you have concerns about how others perceive your asthma. Are you embarrassed about it at times? Are you open about your illness with friends and relatives?

     

    7)  Do you have side effects from any of the medications? List the side effects and how they were managed. What medication in the past has been most effective? What has been least effective?

     

    8)  How has the cost of asthma medications impacted you or your family? Is this a major concern of yours?

     

    9)  Do you feel you have a good understanding of environmental controls? Do you know whether you are allergic? Do you have bothersome nasal/sinus symptoms? List the trigger factors which have previously been confirmed by allergy tests.

     

    10) List, in order of importance, what improvements you want from your asthma care. This list tells your doctor what is important to you and may influence your asthma management plan.

     

    The above list is a framework for preparing to see an asthma care specialist for the first time. You often have very little time with the doctor or nurse. You need to be prepared for that tiny window of time (often less than 15 minutes) you have for the provider to get your medical history, environmental review and personal concerns. You may want to add or subtract from the checklist in order to tailor it to your needs.

     

    What would you add to this list?

     

    How comprehensive was your first visit with an asthma specialist?

     

    References:

     

    http://www.nhlbi.nih.gov/guidelines/asthma/index.htm

Published On: March 31, 2014