Ongoing review of adults and adolescents with asthma

Ongoing review of adults and adolescents with asthma is integral to optimal management. In addition to reviewing patients following medication changes or exacerbations, schedule regular reviews:

• annually for well-controlled patients who have had no exacerbations in the past 12 months
• every 6 months for a patient who has had an exacerbation in the past 12 months, or who has risk factors for adverse asthma outcomes
• every 3 months for a patient with severe asthma (with consideration of specialist appointments), a patient who is a poor perceiver, or who has comorbidities that affect asthma control.

Explain to the patient that regular reviews help to detect and respond to changes in their asthma early, to minimise deterioration in lung function and exacerbations. Ongoing review also aids in titrating drug therapy to the lowest effective regimen.

At regular asthma reviews:

• address any concerns the patient has about their asthma
• assess asthma symptom control according to symptoms over the previous 4 weeks
• assess lung function with spirometry (every 1 to 2 years is usually enough, but perform more regularly for patients with poor control, severe asthma or risk factors for accelerated decline in lung function [see Risk factors for adverse asthma outcomes in adults and adolescents])
• update the written asthma action plan, if required, and confirm the patient’s comprehension of the plan
• risk factors for adverse asthma outcomes
• comorbidities
• drug therapy, including:
  • the need to step up or step down drug therapy (see Stepped adjustment of asthma therapy)
  • adherence
  • inhaler technique
  • any concerns the patient has about their treatment.

The ‘Asthma cycle of care’ has been established in Australia to assist general practitioners in managing asthma; it is a requirement of the Medicare Practice Incentive Program for asthma. For further information, see the National Asthma Council.