How's My Asthma Doing Doc?

How to know how well controlled your asthma is

Man walking on sidewalk in neighborhood
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"How’s my asma doing?"

When my patient handed me a list of questions that included this question, I knew I had not done a very good job with her asthma education. While it turned out her asthma control was actually pretty good, I was disappointed that my education seemed to have failed and wondered what happened.

While I normally think my communication skills are pretty good, I clearly failed in this instance.

While I am sure that I did non-verbal things like looking directly at my patient, avoided interruptions, and encouraged her to discuss her perception of how her asthma was doing, I clearly failed to appropriately assess how well she understood her monitoring plan, use active listening to make sure she understood, and possibly did not summarize to make sure I was understanding her impression of her asthma control.

When my patient asked about her “asma,” she did not have sufficient insight into her:

  • Monitoring plan. While she had not been performing peak flows or recording her asthma symptoms as I would have liked, she was at least able to describe her asthma symptoms to me in some detail (so not a total failure on my part).
  • Asthma action plan. This roadmap for your asthma care is essential. While I had given an action plan to my patient in the past, we failed to stress its importance enough for my patient to use it regularly. The action plan describes how we wanted her to monitor her asthma, what defined optimal control, as well as what to do when control is poor, and when to call and when to seek emergency care. While my patient answered these questions reasonably well (i.e. She knew when to call and when to go to the emergency department (ED)), she did not know what to do and could not identify the early stages of poor control where a call or ED visit might have been avoided.
  • Impairment. My patient had a relatively mild impairment to her normal activities and thought this was normal for her asthma. She believed this was just a normal part of her asthma. We discussed how experiencing wheezing, chest tightness, cough, and shortness of breath leading to rescue inhaler use meant her asthma was not optimally controlled. Similarly, we discussed how often she was experiencing nighttime symptoms and how this was also a sign of poorly controlled “asma.” Finally, we discussed how I did not want her feeling that asthma should be limiting her activities and, if she felt that it was, we needed to adjust her medication.

    On the positive side, we had done some things well. She had received her flu shot at health fair because she said she remembered us discussing it. She also understood the concept of overuse of her rescue inhaler and that frequent rescue inhaler use was something definitely to let our office know about. She also let our office know that she had been trying a complementary treatment that she bought off the internet that had not worked and was now trying breathing exercises. Finally, she was aware of her asthma triggers and how to avoid them.

    So while the question “how’s my asma doing?” was not a total failure, it gave me some insight as to how and where I needed to make improvements in my asthma education.

    Make sure that you follow the asthma monitoring and treatment issues discussed in this article if you want to get control of your asthma.


    National Heart, Lung, and Blood Institute. Accessed: Februrary 4, 2014. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma.

    Bishop FL, Yardley L, Lewith GT. Why consumers maintain complementary and alternative medicine use: a qualitative study. J Altern Med. 2010 Feb;16(2):175–82.

    Centers for Disease Control. Flu​ vaccine. Accessed February 20, 2015.

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