Asthma: Focus on correct, objective Dx and guideline-driven Tx

Other aspects important to the selection of appropriate therapies include the severity of disease, the level of asthma control, patient preference, and practical issues such as is the patient able to use a particular device, is the patient likely to adhere to the dosing schedule, and, of course, cost. “Cost overlies everything,” said Hayden, “because if a patient can’t afford to buy [a drug], or their insurance doesn’t cover it, or their deductible is so high that it is unlikely that they are going to use it, then we need to think of an alternative that is on their formulary that they are more likely to use.”

At every visit . . .
“We need to measure for control at every visit,” Hayden emphasized, explaining that we assess control in terms of impairment and risk. Impairment includes aspects such as the number of times the patient has had symptoms or used their reliever medication in the past 2 weeks. It can also include results of lung function tests.

Risk includes questions about occurrence of exacerbations, use of systemic corticosteroids, any unscheduled or acute visits for asthma, significant deterioration in lung function, and adverse effects from the medications that have already been prescribed.

Another event that should occur at every visit is review of inhaler technique, said Hayden. She explained that there’s a wide variety of inhalers available that utilize different techniques. “With inhaled medicine, if you are not using the inhaler correctly, you are not going to get good drug deposition in the airways where its meant to be.”

Hayden summarized, “Even people with mild disease can have severe exacerbations following a viral cold or an unfortunate air pollutant exposure, so primary care [practices] need to feel comfortable managing mild to moderate asthma and need to know when to refer those who are not responding appropriately to recommended treatment plans.”