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Editor's Message  |   November 2014
Physician's Role in Diagnosing and Managing Asthma
Author Affiliations & Notes
  • Sandra K. Willsie, DO
    From PRA Health Sciences in Lenexa, Kansas.
Article Information
Pulmonary Disorders
Editor's Message   |   November 2014
Physician's Role in Diagnosing and Managing Asthma
The Journal of the American Osteopathic Association, November 2014, Vol. 114, eS3. doi:10.7556/jaoa.2014.164
The Journal of the American Osteopathic Association, November 2014, Vol. 114, eS3. doi:10.7556/jaoa.2014.164
Abstract

Despite tremendous advances in the past 2 decades, asthma continues to be one of the most common underdiagnosed, undertreated, and mismanaged conditions. Yet, there is good quality care available that can drastically improve a patient's quality of life, if applied according to evidence-based guidelines, which are freely available to all physicians. In a brief review, Timothy J. Craig, DO,1  has provided case-based examples of appropriate ways to approach patients—a "must read" for busy practitioners attempting to do right by their patients.

In this supplement of The Journal of the American Osteopathic Association, Dr Craig provides a valuable discussion of the proper methods used to diagnose and manage asthma in adult patients. Citing what many physicians consider to be the criterion standard, Dr Craig guides us from patient presentation through follow-up visits using the standards set forth by the National Asthma Education and Prevention Program's (NAEPP) Guidelines for the Diagnosis and Management of Asthma, published by the National Heart, Lung and Blood Institute.2 He summarizes the presentation of patients with asthma, the tests used to aid in the diagnosis of asthma, and, along with medical treatments, the necessary and supportive role of the physician throughout the process. 
What I find to be most important in diagnosing and managing asthma is to obtain a thorough patient history at each follow-up appointment; discuss issues of compliance and review inhaler techniques; ensure that patients understand the difference between quick-onset reliever medications and controller medications (the latter of which absolutely should not be expected to relieve symptoms in a few minutes); and objectively assess pulmonary function with what some have alluded to as the fifth vital sign, spirometry. Time and again it has been shown that even patients with long-term asthma overestimate their pulmonary function, but the diagnosis of the severity of asthma must be made on the basis of objective measures. 
In 2014, the Global Initiative for Asthma (GINA) published the Global Strategy for Asthma Management and Prevention,3 with additional tips and therapies added since the publication of the NAEPP guidelines. Whether you ultimately choose to apply the NAEPP or the GINA guidelines in diagnosing and managing asthma, make sure you are consistent in your approach. And take the continuing medical education quiz to make sure you have gleaned key points from Dr Craig's educational exercise. You owe it to your patients to provide them the best level of care, and this supplement is aimed at updating your knowledge base of asthma to allow you to do so with confidence. (doi:10.7556/jaoa.2014.164) 
References
Craig TJ. Physician implementation of asthma management guidelines and recommendations: 2 case studies. J Am Osteopathic Assoc. 2014;114(11 suppl 3): eS4-eS15. [CrossRef]
National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007 [published correction appears in J Allergy Clin Immunol. 2008;121(6):1330]. J Allergy Clin Immunol. 2007;120(5 suppl): S94-S138.
Global Strategy for Asthma Management and Prevention. Bethesda, MD: Global Initiative for Asthma; 2014. http://www.ginasthma.org/local/uploads/files/GINA _Report_2014_Aug12.pdf. Accessed September 29, 2014.