Review inhalation technique
It seems obvious that we can have the best asthma medications in the world but treat asthma successfully only if these medications are delivered in sufficient quantities to the airways. Nevertheless published studies reveal that only 45% to 55% of asthma patients use their metered dose inhalers (MDI) correctly and that 50% to 65% of non-respiratory specialist physicians do not know how to use MDIs.
It is, therefore, imperative for family physicians not only to teach and to reinforce the correct use of inhalation devices, but to be familiar with their use themselves. Busy family physicians often use trained office staff for this purpose. In my office I am setting up a system for my patients to be instructed in metered dose inhalers use, peak expiratory flow rate monitoring, and allergen avoidance by a nurse trained in asthma management.
An excellent review of inhalation devices was recently published.
Reinforce the avoidance of precipitating factors
Often physicians believe that the cornerstone of asthma management is anti-inflammatory medications. This belief is held by many patients as well. However, relying on drugs often leads to neglecting obvious environmental triggers of asthma that are avoidable and will lead to improved asthma control if removed from the patient’s environment.
I spend some time asking about the patient’s bedroom to ensure that no obvious factors are making the patient’s asthma more difficult to control. One of the more common mistakes I find is the frequent use of humidifiers in the patient’s room. The increase in humidity often leads to a proliferation of house dust mites, which are potent precipitators of asthmatic inflammation.
Other common things to look for are pets in the house (especially cats) and smokers. I also inquire about over-the-counter medications that the patient is using, looking particularly for acetylsalicylic acid-containing compounds.