Chart Your Patients’ Asthma Visits Like an Expert

Asthma is often triggered by allergies. Determining the allergy source, with a skin test, can help patients avoid extensive treatment.

Asthma is often triggered by allergies. Determining the allergy source, with a skin test, can help patients avoid extensive treatment.

This time of year brings changing weather and an uptick of respiratory viruses. For most physician offices, asthma visits rise with these trends. The diagnosis of asthma is often not the hard part; patients short of breath with coughing and wheezing make for a simple diagnosis. Other patients come in with the elusive and often undiagnosed cough, and a quick run of the spirometry can provide the answer. But navigating the art of managing and charting your asthmatic patients requires some skill.

The experts agree on the need to document two key points: severity and control. The components of severity are: intermittent, mild, moderate and severe. Begin the differentiation by stratifying the patient by the Rule of Twos using the key asthma indicators: nocturnal awakenings, use of short-acting beta-agonists inhalers, and interference in daily activities. If these indicators occur less than twice a week, then the patient is considered to have intermittent asthma; if the patient has these symptoms more than twice a week but not daily, then he/she falls into the mild persistent category. Moderate persistent is used for patients who experience the indicator symptoms daily, and severe persistent asthmatics suffer with symptoms throughout the day. It is critically important to follow and document pulmonary function tests and home peak flow levels in your moderate and severe patients. The moderate persistent asthmatic will demonstrate FEV1 values between 60-80% predicted, while more severe persistent patient values fall consistently under 60%.

The ACT (Asthma Control Test) is a standardized validated questionnaire that serves as another key component to the management process. The questionnaire provides a quick assessment of both severity and control. This form should be downloaded and printed from the back end of the AllerVision website — you will use it often! A score of less than 20 on the ACT signifies poor control, indicating that intervention or change in therapy is in order.

Always keep in mind that asthma is multi-factorial and heterogenetic; meaning there are lots of components at play. The detective work of good medicine means finding that trigger of your patient’s asthma, so the plan can center on avoiding those triggers whenever possible. Respiratory infections, especially viral, are common culprits that prove difficult to avoid. Stress and emotions also affect asthma, leading to exacerbations. However, a main trigger in most asthmatic exacerbations is allergic response. This fact is the impetus behind the NIH guideline stating that all persistent asthmatics be tested to identify their allergic triggers. The AllerVision testing program offers a comprehensive and regionally appropriate assessment. Perform the test, carefully document positive results along with correlation to the careful and detailed history, and take action to help the patient learn how to remove the offending allergen(s) from his or her environment. Because avoidance can be near-impossible, give serious consideration to allergen immunotherapy for your asthmatic patients. SLIT (sublingual immunotherapy) is a fantastic option in this case because it offers the benefits with significantly less risk than SCIT (subcutaneous immunotherapy, aka allergy shots).

Our next blog post will comment on making adjustments to asthma control through medications.

Dr. Dean Mitchell

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One thought on “Chart Your Patients’ Asthma Visits Like an Expert

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