Asthma Care: More Than Testing and Treatment

Asthma Care Starts with Getting to Know Our Patients

Our asthma care patients usually come to us because they are experiencing symptoms like coughing, shortness of breath, or wheezing. Before we jump into testing, we start by listening to our patients first. This approach allows us to build a better relationship with our patients, because we can get to know their personalities, sensitivities, and needs. Once we understand the person and the troubles they are having, we can then cater our testing and treatment recommendations to them. This results in better experiences and outcomes for our patients.

Asthma Testing

The first step in our asthma testing is to identify triggers such as allergies, sinus trouble, or gastroesophageal reflux (GERD). Then we proceed with the appropriate testing for the suspected triggers. This may include allergy testing, CT scan and rhinoscopy if there are sinus issues, and sometimes we check for mold in the lungs as well. Other triggers like GERD, cold air, perfumes, and cigarettes can be identified by looking at history and with additional tests.

We use breathing tests like a spirometry pulmonary function test to determine the openness of the airway. We also have a highly specialized nitric oxide test which indicates inflammation of the airway; this can be a very helpful tool when diagnosing mild asthma.

Mild asthma is often overlooked. It can be very difficult to diagnose, especially in cases of chronic cough, which can be "off and on." We are the only outpatient practice in Washington, DC that offers methacholine challenge testing on an outpatient basis. It is essentially a lung stress test. Following a normal breathing test, methacholine is inhaled, and if the patient is bothered by it (numbers in the normal breathing test worsen), we can conclusively diagnose mild asthma.

Asthma Treatment

If an asthmatic is healthy and is relatively symptom-free, regular breathing / lung function tests are recommended (usually annual) to monitor the condition, and no other treatment may be necessary. In symptomatic cases, treating asthma is very similar to treating allergies. The therapies include avoiding triggers, using proper medication, desensitization in the case of allergic asthma, and biologicals, which are injections used to reduce inflammation.

Avoidance

For an asthmatic, avoidance means staying away from triggers like cold air and cigarette smoke.

Medications

Emergency inhalers, like bronchodilators, may be used as needed or before exercise. An anti-inflammatory medicine like the pill montelukast or a steroid inhaler may be used for more chronic asthma. If those don't work well individually, we may combine treatments to use an airway opener and an anti-inflammatory at the same time.

Our goal is to minimize the amount of medication that needs to be taken. Addressing the triggers completely - for example, identifying and treating the allergies that trigger asthma - will yield the best outcome for asthma patients.

NOTE: About 80% of asthma sufferers also have allergies.