A majority of adults with asthma believe their symptoms are well-controlled. Asthma symptoms are viewed by them as a normal part of their life. Asthma symptoms can include:
- Shortness of breath
- Wheezing
- Persistent cough
- Chest pain
- Trouble sleeping
- Daytime fatigue
Asthma can change over time, with the seasons and with circumstances. Many surveys indicate that 40 to 50% of adults with asthma have partially controlled to uncontrolled asthma.
Factors contributing to uncontrolled asthma are:
- Non-adherence to treatment
- Incorrect medication interval and dose
- Improper inhaler technique
- Allergen exposure
- Changes in environment/weather
- Stress
- Anxiety and depression
- Obesity
- Smoking
According to GINA (Global Initiative for Asthma), asthma control has two parts. One part is addressing symptoms that impair daily activities and sleep. The other part is preventing future flare-ups.
Indications that asthma is not controlled include:
- Daytime symptoms
- Night time awakenings due to asthma symptoms
- Limitation of activity due to asthma symptoms
- Need for rescue inhaler
Risks for future flare-ups include:
- Unavoidable environmental exposures
- Uncontrolled symptoms
- Nasal polyps
- Sinusitis
In the GINA report, managing asthma is best accomplished by using a cycle of assessment, adjustment and review. Having asthma that is uncontrolled is directly related to reduced physical and mental quality of life scores. Work or school productivity then becomes impaired and absenteeism increases. An allergist is a doctor who is specialized in treating asthma, allergies, and immunological diseases. The nurses assist in overseeing your care and providing asthma treatment education. With a team approach, we help the person with asthma realize the benefits of well-controlled asthma.
The goal of asthma care is to find the minimum effective treatment level that keeps symptoms under control and reduces future risk. To accomplish this, the National Heart, Lung and Blood Institute recommends periodic monitoring of asthma control that is indicated to step-down or step-up therapy. The frequency of follow-up visits depends on the previous treatment decision and is as follows;
- 2 to 6 weeks when initiating or stepping-up therapy
- 1 to 6 months to monitor after control is achieved
- Every 3 months if stepping-down therapy
The communication in the allergy/asthma doctor visit will include focusing on setting mutually agreed upon treatment goals and on the use of objective measures to monitor symptoms. Regular visits allow for discussion of asthma triggers and limitations, with steps to take toward asthma symptom control.
There is a tendency to visit the doctor only when there is an asthma attack. This is not the most advantageous way to keep asthma in control. Visits are still needed, even when feeling well to reap the benefits of preventative care. With an asthma action plan that covers symptom recognition and times to use medication plus a plan of action for worsening symptoms, both adults and children with asthma can take the long walk for the long run.
Yvette, RN, BSN