How to be Proactive and Get the Best Treatment in Asthma
- Friday, September 11, 2009, 23:11
- Asthma
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- Andrew:
- As people hear about newer strategies and higher standards for control, what role should they play with their doctor or in seeking out a specialist – an allergist or pulmonologist – to make sure they get the latest standard of care?
“One of the barriers to getting proper care is inadequate information sharing by the patient.”
- Dr. Nathan:
- I’ve stressed this before: first and foremost, you want to try to have a good physician-patient relationship. You want to increase the communication, and you want to try to achieve what we call patient satisfaction. One of the barriers to getting proper care is inadequate information sharing by the patient, which sometimes happens because patients are concerned about the consequences of their fear or embarrassment. Patients may hold doctors in such high esteem that they don’t want to disappoint them.
Another barrier is that physicians are rushed. Managed care has made it so that they have to see a lot of patients in a short time, so they don’t get to spend as much time with them. Many times physicians use some inappropriate terminology. Most importantly, patients commonly fail to remember what the physician said.
It’s our obligation to make sure patients understand what we’re trying to tell them. They can benefit greatly, as my patients do, by writing things down. I write down what their medications are and what they’re used for. I give my patients an action plan, so they know exactly what to do. These are some of the things we can do to benefit our patients in the long run.
- Andrew:
- We mentioned at the outset that many people feel good when, in fact, they’re not doing so well. The peak flow meter is a device that can help, and I wonder how widely that should be used among people who have ongoing chronic asthma?
- Dr. Nathan:
- The peak flow meter is a reasonable device for getting objective information to correlate with how you feel subjectively. Some of the studies show conflicting data. There are studies that show if you use a peak flow meter regularly, you can identify the onset of your symptoms more quickly; this objective measure will help to reduce your need to be hospitalized. But there are other studies that don’t point that out. What I try to do with my patients is say, “Let’s use the peak flow meter. Let’s see what kind of improvement we’re getting in your lung function with the therapy that I’m recommending.” Once patients are better controlled and have a better grasp of how to correlate their symptoms with their objective data, I don’t feel it’s necessary to use the peak flow meter on an ongoing basis. I try to encourage them to use it once they start to feel bad so they can try to determine how bad they are. In other words, if their lung function is dropping about 10 or 20 percent, that tells me they just need to use the rescue inhaler a little bit more frequently. If those symptoms continue, or their lung function has dropped 30 or 40 percent from what they normally are, that tells me they probably need to get onto an oral steroid – something that’ll bail them out quickly.
- Andrew:
- So the device plays a role in fine-tuning or adjusting medications.
- Dr. Nathan:
- Absolutely!
- Andrew:
- To summarize, Dr. Nathan, what would you like our audience of asthma patients and family members to take home from this discussion about their ability to control asthma better than ever before, and the importance of doing it?
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