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Improving Asthma Control Dialogue With Patients

Improving Asthma Control Dialogue With Patients
Author Information (click to view)

Purvi Parikh, MD

Clinical Instructor
Departments of Pediatrics and Medicine
New York University Langone Medical Center
Principal Investigator
Parikh Institute of Research
Allergist
Allergy & Asthma Associates of Murray Hill

Purvi Parikh, MD, has indicated to Physician’s Weekly that she has no financial interests to disclose.

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Purvi Parikh, MD (click to view)

Purvi Parikh, MD

Clinical Instructor
Departments of Pediatrics and Medicine
New York University Langone Medical Center
Principal Investigator
Parikh Institute of Research
Allergist
Allergy & Asthma Associates of Murray Hill

Purvi Parikh, MD, has indicated to Physician’s Weekly that she has no financial interests to disclose.

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Study findings reveal a communication gap between patients with asthma and providers regarding conversation topics during routine office visits. The findings also reinforce the need to focus patient-provider conversations on symptoms, limits to daily activities, and the use of an asthma action plan.
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Healthcare providers tell their well-controlled asthma patients that they should experience few symptoms and no limits to everyday activities. And yet, many do.

According to the recent Observations of Patient Experience in the Nation (OPEN) Asthma Survey, 98% of adult asthma patients believe their symptoms are well or mostly controlled but still report experiencing wheezing, shortness of breath, and daytime fatigue at least once per week.

Additionally, 70% of nearly 3,000 patients surveyed say they limit everyday activities—such as walking, performing household chores, and getting enough sleep—as a result of their asthma. The findings suggest that many asthma patients accept symptoms as a normal part of life.

Also participating in the OPEN Asthma Survey were more than 850 healthcare providers, including allergists, pulmonologists, pediatricians, primary care physicians, nurse practitioners, and physician assistants. Overall, these providers suggested that well-controlled patients should experience asthma symptoms about once per month, according to the survey.

Signs of uncontrolled asthma in patients include:

  • Experiencing asthma symptoms more than 2 days per week.
  • Waking up at night due to asthma two or more times per month.
  • Refilling a quick-relief bronchodilator prescription more than two times per year.
  • Visiting the emergency room or hospital in the previous 12 months for treatment of an asthma exacerbation.

 

A Disconnect Between Patients With Asthma & Healthcare Providers

A surprising disconnect between patients and healthcare providers was also revealed through the survey. Only 34% of all asthma patients said they regularly discuss symptoms with their healthcare provider during routine office visits, with some variation observed depending of severity of the condition (Table). Even fewer (19%) reported discussing how asthma impacts daily life, and only 14% said they discussed an asthma action plan—a written document co-created by doctor and patient spelling out how to recognize, treat, and prevent asthma symptoms—with their provider. However, the majority of healthcare providers, particularly asthma specialists, reported regularly discussing these same topics with their patients.

The findings reveal a communication gap between patients and providers regarding conversation topics during routine office visits and reinforce the need to focus patient-provider conversations on symptoms, limits to daily activities, and use of an asthma action plan.

 

Bridging the Asthma Control Communication Gap

Clinicians can help bridge this gap, and help patients achieve better asthma control, with the following approaches.

  • Ask specific questions to identify persistent asthma, such as: “What everyday activities are limited, including sleep?” or “What lifestyle factors, such as diet, exercise, sleep, and stress, are affecting your asthma?”
  • Probe patient behaviors and beliefs that might be impacting asthma, with questions such as: “How great a priority for you is asthma management?” or “What are your fears or concerns about asthma and/or asthma medications?” This can help correct any misconceptions patients may have about asthma.
  • Track asthma control through use of objective clinical tools—such as spirometry and fractional exhaled nitric oxide tests—and daily symptom diaries. According to the OPEN Asthma Survey, these objective measures were only used in about 17% of routine care visits.
  • Co-create a personal asthma action plan and reassess and adjust it at every office visit. The asthma action plan should address the patient’s asthma triggers and how to avoid them, what medications to take and when to take them, and how to recognize signs of worsening asthma.
  • Ask patients to demonstrate how they use a meter-dose inhaler to ensure that they are administering it properly and receiving the full effect of the medication. Ask how often they refill their medications.

Improved communication extends to all healthcare providers on a patient’s healthcare team, including other doctors, asthma educators, respiratory therapists, school nurses and staff, pharmacists, and social workers. Collaborative, team-based healthcare benefits patients with improved outcomes and fewer hospitalizations and emergency department visits, according to research from the National Institutes of Health.

Readings & Resources (click to view)

Parikh P. OPEN-ing up about asthma. Allergy & Asthma Today. 2016;14:22-23. Available at http://mydigimag.rrd.com/publication/?i=326085#{“issue_id”:326085,”page”:20}.

 

Henriques C. Asthma survey reports most patients think disease is controlled, but it’s not. Lung Disease News. Available at http://lungdiseasenews.com/2016/04/11/asthma-survey-reports-patients-think-disease-controlled-not.

 

KGUN-9 ABC-TV, Tuscon (Sierra Vista), Arizone, Scripps-Media, Inc. BI activities asthma and allergies. Availablet at www.kgun9.com/morning-blend/bi-activities-asthma-and-allergies.

 

Allergy& Asthma Network. New survey: people living with asthma believe it is controlled, but persistent symptoms and limits to everyday activities tell a different story. Available at hwww.allergyasthmanetwork.org/new-survey-people-living-with-asthma-believe-controlled-but-persistent-symptoms-and-limits-everyday-activities-tell-different-story.

1 Comment

  1. Thanks for the great article. I must admit I have the same experience myself. I always thought that my asthma is well controlled until I changed my GP recently and realised it wasn’t. My GP changed my inhaler and advised to tweak 1-2 things in my daily routine and now it’s better. I also bought a hepa purifier for my house, which my GP actually didn’t advise me to, but I think it helped as well. 🙂 -Sam

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