From the Guidelines
For a family medicine follow-up visit with an asthma patient, focus on assessing symptom control and medication adherence, and consider ordering spirometry to objectively measure lung function, particularly FEV1 and FEV1/FVC ratio, as recommended by the Expert Panel Report 3 1. When evaluating a patient with asthma, it is essential to ask about frequency of daytime symptoms, nighttime awakenings, rescue inhaler use, activity limitations, and any exacerbations since the last visit. Inquire about specific triggers and environmental exposures, and perform a physical exam including vital signs, oxygen saturation, and lung auscultation. Some key points to consider when managing asthma in a family medicine setting include:
- Assessing symptom control and medication adherence
- Ordering spirometry to measure lung function
- Considering a complete blood count to check for eosinophilia if allergic asthma is suspected
- Providing an asthma action plan with clear instructions for managing worsening symptoms
- Scheduling follow-up in 1-3 months for medication adjustments or 3-6 months for stable patients, as recommended by the National Asthma Education and Prevention Program 1. It is also crucial to ensure proper inhaler technique and adherence, and to consider stepping up therapy by adding or increasing medications like inhaled corticosteroids, long-acting beta-agonists, or add-on therapies like montelukast, as needed, based on the patient's specific asthma phenotype and severity, as discussed in the Mayo Clinic Proceedings 1. Additionally, the American Family Physician journal provides an overview of changes to asthma guidelines, emphasizing the importance of monitoring clinically relevant aspects of care and providing patients with practical tools for self-management 1. By following these guidelines and considering the individual patient's needs, family medicine physicians can provide effective and personalized care for patients with asthma, ultimately improving morbidity, mortality, and quality of life outcomes.
From the FDA Drug Label
The primary efficacy variable was the rate of asthma exacerbations during the 24-week, fixed steroid treatment phase An asthma exacerbation was defined as a worsening of asthma symptoms as judged clinically by the investigator, requiring doubling of the baseline inhaled corticosteroid dose for at least 3 days and/or treatment with rescue systemic (oral or IV) corticosteroids for at least 3 days.
The appropriate follow-up questions and laboratory tests for a patient with asthma in a family medicine setting are not directly addressed in the provided drug label. However, based on the information provided, asthma exacerbations can be defined as a worsening of asthma symptoms, and the rate of exacerbations can be measured.
- Key factors to consider when assessing asthma exacerbations include:
- Worsening of asthma symptoms
- Doubling of the baseline inhaled corticosteroid dose for at least 3 days
- Treatment with rescue systemic (oral or IV) corticosteroids for at least 3 days
- FEV1 % predicted and nocturnal asthma score may also be relevant in assessing asthma control 2
From the Research
Follow-up Questions for Asthma Patients
- What are the patient's current symptoms and how have they changed since the last visit? 3
- Are there any new triggers or exacerbating factors that may be contributing to the patient's asthma symptoms?
- How has the patient's treatment plan been working, and are there any issues with adherence or side effects? 4, 5
Laboratory Tests for Asthma Patients
- Pulmonary function tests, such as spirometry, to assess lung function and monitor treatment response 3, 6
- Blood tests to measure eosinophil count and other inflammatory markers, which can help guide treatment decisions 6, 7
- Allergy testing to identify potential triggers and guide avoidance measures
Monitoring and Adjusting Treatment
- Regularly review the patient's treatment plan and adjust as needed to achieve optimal control of symptoms 4, 5
- Consider adding or switching to different medications, such as biologics like omalizumab or mepolizumab, for patients with severe or uncontrolled asthma 6, 5, 7
- Monitor for potential side effects and adjust treatment accordingly
Additional Considerations
- Assess the patient's overall health and well-being, including any comorbidities or social determinants of health that may impact asthma management
- Provide patient education and support to promote self-management and adherence to treatment plans 3