What to expect at the doctor's office

In order to carefully monitor your asthma according to National Institutes of Health guidelines, a doctor will generally do the following:

• Classify the severity of your asthma at the initial diagnosis according to the NAEPP classification system.
• Help you set goals and work with you to achieve them.
• Recommend measures to control asthma triggers, such as tobacco smoke, house dust mites, or cockroach, dog, or cat allergens.
• Provide you with a written "action plan" that explains how to manage your asthma on a daily or regular basis. These instructions should include what to do during an asthma attack.
• If you have moderate-to-severe persistent asthma, teach you how to monitor your peak flow and your asthma signs. Give you a record chart to track the results each day. (Some children may be too young for symptom or peak flow tracking.)
• Answer your questions and check to make sure you understand your medications.
• Adjust your treatment plan as needed. The doctor should be able to optimize your treatment plan, so that your asthma is under control and side effects are minimal.

At each visit, the physician will:

• Ask you whether your asthma symptoms are impacting your life in any way.
• Examine you and sometimes do formal breathing tests. Spirometry, or at least peak flow measurement, should be done at the time you are first assessed, after your symptoms have first been brought under control, and then at least every one to two years to make sure your asthma is still under control.
• Classify the severity of your asthma according to the NAEPP classification system at each asthma office visit.
• Assess for referral to specialty care, recommend in any of the following circumstances:
  • A single life-threatening asthma event.
  • Treatment goals are not being met within 3 weeks - 6 months of treatment, or the asthma is not responding to therapy.
  • Asthma diagnosis unclear.
  • Patient’s asthma classification is severe persistent asthma.
  • Patient is under age 3 with moderate persistent asthma.
  • Patient is a candidate for immunotherapy.
  • Patient has required more than two courses of oral steroids in a year, or continuous high-dose inhaled steroids.
  • Patient needs additional education or guidance.
• See if you understand your written action plan and assess your level of satisfaction with the treatment.
• Verify at each visit how and how much you use your medications, inhalers, or peak flow meter.

Reference

National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Rockville, MD. National Heart, Lung, and Blood Institute, US Dept of Health and Human Services; 2007. NIH publications 08-4051.

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