Patients with bronchial asthma should regularly discuss their therapy with the attending physician and adapt it optimally.
- During the first year after the initial diagnosis every 1-3 months
- In long-term care every 3-12 months
- Every 4-6 weeks during pregnancy
- One week after an acute exacerbation
Your doctor will assess whether the therapy is working using a questionnaire ("GINA assessment of asthma control") that contains the following four questions:
During the past four weeks:
- Did you have asthma complaints more than twice a week?
- Did you wake up at night once or more often due to asthma symptoms?
- Did you need your bronchodilator metered dose inhaler (e.g. salbutamol) more than twice a week?
- Did you experience any activity limitation due to asthma?
If you can answer "no" 4 times, you can try to reduce the therapy ("STEP DOWN").
If you answer at least one of the questions with "yes", the therapy should be adapted and intensified ("STEP UP").
Before a possible "STEP UP" or "STEP DOWN", the intensity of the current therapy (therapy level) must of course be recorded (see step therapy).
Then your risk factors for poor asthma outcomes should be checked:
- Did you use more than one canister of broncho-dilator-spray during the last month?
- Did you take your asthma medication regularly as prescribed
- Have adverse drug reactions occurred?
- Did you apply the inhaler as trained?
- Do you suffer from obesity (BMI>30 kg/m²), chronic rhinosinusitis, reflux disease or food allergy
- Were you exposed to (cigarette) smoking, air pollution or allergens?
- Did you have any major psychological or socioeconomic problems?
- Was a lung function test performed and the FEV1 was <60%? (a lung function test should be performed 3-6 months after the initial diagnosis and then every one to two years)
- Were you ever in intensive care due to asthma
- Did you have one or more severe exacerbations during the past twelve months?
If you answered “yes” to any of the above questions, you should talk to your doctor about how your risk can be reduced.