The Importance of Follow-Up Doctor Visits
It's so nice to have warmer weather and longer days of sunshine. "Sprinter" as some have called the first two seasons this year (winter-spring), has been long and cold for many of us in the Midwest. The month of May not only represents the end of cold weather, final exams and graduations but in addition, Asthma Awareness Month.
As health expert MacNaughton suggested in one of the key action points, "seeing your asthma provider at least once every six months is highly recommended."
I think regular follow-ups are crucial to achieve good asthma control because four out of the six key actions can be addressed at the appointments: use of controllers, review of inhaler technique, reviewing the role of environmental triggers and tracking asthma control.
Some parents/patients have a difficult time grasping the concept of following up with their doctor when there appears to be nothing wrong. Some questions I've heard in the office are:
"Why do I need to come back if I'm not sick?"
"If my child is not coughing or wheezing, what are you going to do for her?"
I understand why it may seem unnecessary to disrupt the daily routine when everything appears to be going well, but a follow-up visit allows your provider to keep you one step ahead of future problems. Review of peak flow rates or pulmonary function tests can sometimes identify and address problems not yet evident by cough or shortness of breath. Wheezing can be heard by the doctor at times when there are no complaints of shortness of breath, cough or chest tightness.
Data on how often controller medication is refilled after one year is abysmal (less than 10% in some reports). Refill rates plummet months after the initial office visit, so follow-up appointments may identify misconceptions or misunderstandings about controllers, or problems related to getting refills. If your doctor sees you nine to 12 months after the first visit (or a follow-up visit) too much time goes by that allows for potential under-treatment and possible asthma flare-ups. Perhaps your doctor would like to step down or off certain medications at your follow-up appointment.
Several months of poor inhaler technique can be avoided by having routine follow ups with your asthma care provider. Assessment of your inhaler technique may result in the recommendation of getting a spacer. Spacer attachments may improve inhaler technique and decrease the amount of medication landing on the tongue and throat (which may increase some oral and throat side effects with steroid based inhalers).
Environmental controls can play a huge role in reducing allergy triggers and preventing flare-ups of allergic rhinitis and asthma. But implementing only one or two recommendations instead of several of them may result in little or no impact. Follow-up appointments present an opportunity to provide more information and resources for dust mite, mold and pet control measures.
Allergists have a checklist of their own to assist patients in reducing exposure to indoor triggers. Of course, things can change over time, and lead to new recommendations (new home, new carpet, new pet etc.).
The importance of having an Asthma Action Plan (AAP) has been discussed in many postings about asthma management. Modifications to the plan should be made periodically if necessary. Sometimes medications/doses are changed based on how the AAP has worked out, or other factors such as change in age, or emergence of side effects. Follow-up appointments allow your provider to review the AAP and fine tune it in order to better meet your needs. Tailoring therapy to individual needs and circumstances is an important part of good asthma control.
Asthma management is an ongoing process that requires an unwritten contract between you and your health care provider, which takes into account various goals and benchmarks agreed upon by both parties (you and your doctor). Regular follow-up visits may help to achieve good asthma control and minimize flare-ups.
How often do you see your asthma care provider?