Monday, November 13, 2017

Caring for patients with asthma: tools & apps

- Jennifer Middleton, MD, MPH

A recent AFP article on "Chronic Cough: Evaluation and Management" states that the prevalence of asthma in patients with chronic cough is between 24-29%. Asthma in adults can be a tricky diagnosis to make and manage, but several tools and apps can help family physicians provide excellent care to these patients.

In-office spirometry can help make the diagnosis of asthma in an adult patient with chronic cough; an obstructive pattern with an FEV1 or FVC that improves with bronchodilator challenge is highly suggestive of asthma and should then prompt an assessment of asthma severity to guide treatment. The Choosing Wisely campaign encourages physicians to "not diagnose or manage asthma without spirometry." If you'd like a refresher on interpreting spirometry, this 2014 AFP article on "A Stepwise Approach to the Interpretation of Pulmonary Function Tests" provides a helpful overview.

If your office doesn't have spirometry, however, a simple peak flow meter can still be useful in making an asthma diagnosis. A patient with as-yet-undiagnosed asthma won't know their personal best peak flow value, but apps like Calculate by QxMD or MDCalc can estimate a personal best based on your patient's age, height, and gender. If a patient with chronic cough produces a peak flow less than 80% of that predicted value, empiric treatment for asthma is reasonable pending formal outpatient pulmonary function testing.

Managing an asthma diagnosis can feel overwhelming to patients, especially given the complexities inherent in managing and monitoring symptoms. Helping patients learn how to use their medications correctly is a critical early step. A sizable proportion of asthma patients do not use their metered dose inhalers (MDIs) correctly; providing written patient education material can help, but demonstrating how to use an MDI in the office improves patients' technique even more. Monitoring symptoms and peak flow readings is also important, since teaching patients how to monitor and interpret their peak flows can reduce urgent treatment visits for asthma.

Available online tools to help physicians monitor their asthma patient population include the Interactive Asthma Action Plan available from the Agency for Healthcare Research and Quality and the Association of Clinicians for the Underserved's Asthma Clinical Support Tool. Family Practice Management has a Disease Management Toolbox for Asthma which includes flow sheets and patient self-assessment surveys. There's an AFP By Topic on Asthma highlighting AFP's best content on diagnosis and treatment along with patient education materials. Using the search box on the Community Blog (upper right hand corner of this page) will display recent posts describing new studies about asthma management and treatment. Any of these resources might be useful links to add to your AFP Favorites page.

What resources do you find helpful to diagnose and care for patients with asthma?