How Primary Care Physicians Can Help Patients To Improve Asthma Control

Many adolescents and adults with asthma continue to have poorly controlled disease, often attributable to poor adherence to asthma therapy.

Failure to adhere to recommended treatment may result from:

- desire to avoid regular reliance on medications
- inappropriate high tolerance of asthma symptoms
- failure to perceive the chronic nature of asthma
- poor inhaler technique



Severe asthma - differential diagnosis and management (click to enlarge the image). Related: Common Asthma-related Comorbidities. Medscape, 2011, (figure).

If asthma treatment is not working, check DAT:

Diagnosis - not asthma at all (VCD, CF, FBA), asthma plus AR, GERD

Adherence - compliance with medication

Technique - NEB, HFA with spacer, DPI, etc.

3 C's of care - communication, continuity, concordance (finding common ground) are critical for asthma management (http://goo.gl/8gJM6).

Few adolescents or adults with asthma currently have asthma “checkup” visits, usually seeking medical care only with an exacerbation. Therefore, nonrespiratory-related office visits represent an important opportunity to assess baseline asthma control and the factors that most commonly lead to poor control.

Tools such as the Asthma Control Test, the Asthma Therapy Assessment Questionnaire, the Asthma Control Questionnaire, and the Asthma APGAR provide standardized, patient-friendly ways to capture necessary asthma information.

For uncontrolled asthma, physicians can refer to the stepwise approach in the 2007 National Asthma Education and Prevention Program guidelines to adjust medication use.

However, doctors must consider step-up decisions in the context of:

- quality of the patient's inhaler technique
- adherence - 24% of asthma exacerbations are attributable to ICS medication nonadherence http://goo.gl/1i8ET
- ability to recognize and avoid or eliminate triggers



Dr. Barbara Yawn, Family Physician and Director of Research at the Olmsted Medical Center in Rochester, MN, discusses her article appearing in the September 2011 issue of Mayo Clinic Proceedings on ways physicians can enhance patient education for asthma control by not missing opportunities.

References

The Role of the Primary Care Physician in Helping Adolescent and Adult Patients Improve Asthma Control. Barbara P. Yawn. Mayo Clinic Proceedings September 2011 vol. 86 no. 9 894-902.

24% of asthma exacerbations are attributable to ICS medication nonadherence http://goo.gl/1i8ET

Concepts have changed: “compliance” has been replaced by “adherence” but meaning remains the same: 50% of asthmatic patients are poorly adherent to therapy (http://goo.gl/3en5Q).