John, aged 15 years old, comes in to see you with his mother for his asthma review. He has been seen regularly for a number of years - however this year his symptoms aren't quite as well-controlled and he seems to have a persistent cold. How should he be assessed?
It is important to consider a structured review of people with asthma, covered in a time-efficient manner to improve patients' quality of life.1 Consider using the SIMPLE ( stop smoking, inhalers, monitoring, pharmacology, education) approach2 to management, or the SIMPLES (plus support) approach3 for difficult asthma. These approaches do not work without clarification of diagnosis and a robust search for other common co-morbidities.
Stages in a good asthma review include:
- Clarify diagnosis and look for other diagnoses.
- Establish extent of symptoms and disease control.
- Establish actual use of treatment (prescribed and over-the-counter [OTC]).
- Discuss other risk factors (eg smoking, work, psychosocial, BMI).
- Establish ideas, concerns and expectations of patient and carers.
- Develop a shared decision plan for moving forwards.