Book the follow-up appointment
No appointment for managing chronic asthma is complete without booking a follow-up appointment. For well controlled asthma treated with regular preventive medications, I tend to book appointments every 3 months. For strictly exercise-induced asthma or asthma managed with β2-agonists alone (ie, very mild asthma), assessment every year is sufficient unless the condition changes. The more brittle the asthma control or the more severe an exacerbation, the more often I schedule visits (this ranges from weekly to monthly).
Managing difficult-to-control asthma
Nearly all asthmatic patients will be sufficiently controlled by following the consensus guidelines and by agreeing to a systematic approach to follow-up. Nevertheless, some asthma cases remain difficult to control despite our best efforts.
I find it useful to review psychosocial barriers to asthma control with these patients. Often cultural and financial issues influence patient management. For example, some patients find β 2-agonist puffers more affordable than anti-inflammatory puffers and, therefore, rely solely on the β 2-agonists.
Patient support groups can be invaluable for difficult-to-control asthma (as well as all asthma cases). These groups give individuals support and encouragement to manage their chronic disease. Examples of these groups include Parents of Asthmatic Children and the Asthma Allergy Association.
Physicians should not forget their own support groups. Most respirologists are more than happy to offer advice and assistance in managing chronic asthma. Also there is the Family Physician Asthma Group of Canada (FPAGC), which offers family physicians support and guidelines for managing chronic asthma.
Asthma is a complex and challenging chronic illness. Nevertheless, patients should be able to enjoy full and active lives. Our goal as physicians should be to assist asthmatic patients to achieve and maintain a normal lifestyle. Through education, reinforcement, and regular follow-up appointments, we can achieve this goal.