Patient discussions

Your Organizational Guidance

ebpracticenet urges you to prioritize the following organizational guidance:

Astma bij volwassenen: diagnose en monitoring in de eerste lijnPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2020Asthme chez l’adulte : diagnostic et surveillance en soins de santé primairesPublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2020

Patients’ preferences and goals should be discussed. Likely adherence with a daily controller should be considered when deciding between initial treatments. Also consider patient concerns about inhaler choice, including environmental issues (see Asthma + Lung UK: inhaler choices Opens in new window).[204] The patient should be able to use their inhaler device correctly, and a follow-up appointment should be arranged.[52]

It is essential to inform the patient that effective home management of symptoms greatly improves outcome. Self-monitoring on a daily basis should be encouraged by, for example, checking and recording peak expiratory flow (PEF) using the PEF meter. When the patient discusses these results with his or her physician, subsequent adjustment of medications can be made. It should be emphasized that attending follow-up is essential for a long and healthy life with asthma.

Poor adherence is often driven by a lack of disease education (e.g., not knowing when to take medication and a lack of belief that medication will improve asthma control) and should be addressed proactively.[205] Strategies to improve inhaler adherence include text/audiovisual message reminders, written action plans, and motivational interviewing.[206] Enhanced support may be required for patients transitioning into adulthood, as some studies report reduced adherence in patients >18 years of age.[207]

Telemedicine appears to be effective in improving asthma control and quality of life in adults with asthma.[208] eHealth interventions are effective in improving adherence to inhaled corticosteroid, particularly mobile device-based studies that include audiovisual and text message reminders.[209] Digital health technology that includes interactive features, such as daily diary entries, is associated with increased asthma control; the same is true for multidimensional interventions that combine several different types of digital health technology.[210] 

Pharmacist-led interventions can also improve inhaler technique and medication adherence in adults with asthma.[211][212]

The impact of home visits has been shown to be beneficial in children with asthma; however, there is currently insufficient evidence to recommend this intervention in adult patients.[213]

Environmental control strategies should also be discussed, including identifying and eliminating home and work/school exposure (indoor or outdoor) to allergens that can cause or worsen asthma, including house-dust mites, animals, cigarette smoke and other respiratory irritants, chemicals, and pollens and grasses.[52]

International guidelines vary in their recommendations regarding allergen mitigation, so local guidance should be consulted to inform the discussion with the patient. For example, the 2020 US asthma guidelines conditionally recommend a multicomponent, allergen-specific mitigation intervention in people with asthma who have symptoms related to identified indoor allergens, confirmed by history or allergy testing.[62]

Occupational exposure should also be discussed and assessed. Foods to which the patient is sensitive should be identified and avoided (e.g., foods containing sulfites).[52]

Patients should be counseled about avoiding specific drugs (e.g., aspirin and nonsteroidal anti-inflammatory drugs, beta-blockers) where necessary, immunization (e.g., influenza), smoking cessation (if applicable), treatment of comorbidities (e.g., gastroesophageal reflux, obesity, infections), correct use of medications and delivery devices, self-monitoring of symptom control, and the importance of an asthma action plan.[52] [ Cochrane Clinical Answers logo ] [ Cochrane Clinical Answers logo ]

Patients with asthma are at increased risk of depression and anxiety and these comorbidities may worsen asthma control. A mental health assessment should be arranged for those presenting with psychiatric symptoms.[52] Patients with asthma also have a significantly increased risk of suicidal ideation, suicide attempts, and suicide mortality.[214]​​

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