Assess for concomitant diseases
It is well accepted that certain diseases exacerbate asthma. In my practice allergic rhinitis, chronic sinusitis, and gastroesophageal reflux disease are common among asthmatic patients. I therefore find it useful to ask about postnasal drip, purulent rhinorrhea, and heartburn. Often treating these concomitant diseases alone greatly improves asthma control.
Obesity as a disease entity also deserves special attention. Not only is obesity associated with reflux esophagitis, but in itself it seems to be associated with poorly controlled asthma (at least in part by reflecting activity limitation). I often find that weight loss improves asthma control and long-term management of asthma, so I stress this fact to my overweight patients.
Review action plan
Part of modern asthma management is the action plan. Stated simply, an action plan is a list of initiatives an asthmatic patient will take depending upon the severity of a particular asthma attack. The main purpose of an action plan is the early recognition and appropriate management of an acute asthma attack by the patient to avoid prolonged disability and even death.
Action plans can be based on either symptoms, symptoms and β2-agonist use, or peak expiratory flow rate monitoring. Whatever plan is used, it must be individualized to meet each patient’s needs. The key to success is simplicity and utility.
During follow-up appointments I review the action plan to make sure that the patient understands the plan and that the patient has not lost the plan. I also believe that asthma is not a static disease; therefore, I often update the patient’s action plan based upon the changing pattern of the patient’s asthma.