GIP in Focus
A Core Change in Asthma Assessment and Control Fueled by a Cup of Joe
Take one coffee shop in Denver, CO…
+ one stack of napkins with the shop’s distinctive green and black mermaid logo
+ two asthma experts
= One breakthrough idea about how to make asthma assessment and control more effective.
The two asthma experts on that fateful afternoon were Homer A. Boushey, MD, an internationally recognized pulmonary expert who has studied asthma and other diseases of the airways for more than 30 years, and Stuart W. Stoloff, MD, a family medicine practitioner and clinical professor of family and community medicine.
Both are members of the expert panel convened at the recommendation of the National Heart, Lung and Blood Institute’s National Asthma Education and Prevention Program (NAEPP), which developed the third report on the Guidelines for the Diagnosis and Management of Asthma (EPR-3). In fact, they co-authored the EPR-3’s chapter on improving asthma assessment and monitoring control.
When asked separately about the defining moment in their collaboration they both pointed to that meeting in the Mile-High City.
“I had the beginnings of an idea on how to take asthma from an episodic condition to one where there was longitudinal care and control,” said Dr. Stoloff, clinical professor of family and community medicine with the University of Nevada—School of Medicine, Reno, NV. “So I grabbed some coffee napkins and wrote it down, and then called Dr. Boushey to join me.”
Historically, clinicians have analyzed the severity of a patient’s asthma and used that measurement to specify a therapy. At the coffee shop, Stoloff and Boushey hit upon the idea that a more specific way to define asthma severity is to measure a patient’s impairment (symptoms and functional limitations) while simultaneously assessing the risk of future attacks over time—using history as a predictor.
“Measuring spirometry is the key to knowing whether a patient’s asthma is controlled, because patients can be in denial about the level of their own impairment,” said Dr. Boushey, chief of Allergy and Immunology, University of California, San Francisco Medical Center. “For instance, one patient told me that her asthma was under control but that she was unable to walk up a flight of stairs. During a follow-up visit, after taking her prescription, she told me that she was a ‘new woman,’ and had thought that her breathlessness was due to being overweight.”
Dr. Boushey encourages spirometry training for the clinician. He also urges clinicians to use a standardized asthma control test and questionnaire that pose critical questions such as how often a patient uses his/her inhaler; frequency of cough; and whether their cough wakes them at night.
“We need to change the way we look at the disease,” said Dr. Stoloff. “I wish more people would understand how good, how practical, and how easy our recommendations [guidelines] are to incorporate into their lives.”
While clearly frustrated over the slow adoption of science-based asthma guidelines, Dr. Stoloff remains enthusiastic about what can be accomplished once additional clinicians begin viewing themselves as “signs along the highway,” without which a patient can get lost.
“I saw a six-year-old who had been hospitalized many times and asked him what it was that he wanted: he told me ‘I never want to walk in the hospital again,’” said Dr. Stoloff. “I told him that if he and his mom did what I recommended, he had my guarantee that he wouldn’t set foot in the hospital again except to visit a friend.”
That guarantee remains uncontested, years later.
Also unbending is Boushey and Stoloff’s commitment to their breakthrough coffee-shop conviction that the key to better assessing and controlling asthma is two-fold: to measure the patient’s current impairment and to assess his or her risk of future attacks. They hope that clinicians will adopt this new approach, and the other scientifically proven guideline recommendations, to improve the quality of patient care, and thus the quality of patients’ lives.
Last Updated February 2011