In a busy family practice, we often summarize a patient’s state of health into standard statements, such as “Have you been feeling well?” or “Is your disease well controlled?” However, with asthmatic patients it is important to probe deeper into the control of symptoms.
I find three questions particularly pertinent in assessing patients’ control of asthma: Have you had any nocturnal symptoms? What is your activity level and has it been limited by your asthma? Has your asthma resulted in any time away from school or work?
If patients have no nocturnal symptoms, have normal activity levels, and have not been absent from work or school, I consider them well controlled. If I find that patients are not well controlled, I then take the time to review their understanding of asthma and the medications they are receiving.
I do not routinely ask about emergency room visits or hospital admissions unless the patient has been out of town. In our community I receive all records of any emergency room visits or hospital admissions. If, however, patients have been to an emergency room or have been admitted to hospital, I, as a rule, treat them as a treatment failure, and I extensively review the asthma management. Although some acute asthma attacks are unavoidable, more often than not, I find something that needs further reinforcement or clarification (ie, improper inhalation technique, poor understanding of an action plan, or an avoidable precipitating factor.)
At this point I also review the patient’s asthma diary. Nearly all my asthmatic patients keep some form of asthma diary, usually a combination of subjective (ie, symptoms) and objective (ie, β2-agonist use or peak flow measurement) findings. Although many articles evaluate asthma monitoring with a peak flow monitor, and monitors are valuable in asthma management, I believe the most useful asthma diary is one that the patient will use. Therefore, I attempt to tailor the diary to the patient.