A Seasonal Reminder

By Ravinder Chawla, MD 

A little attention now can prevent a bigger problem later.

Seasonal changes can be particularly challenging for patients living with asthma or COPD. Changes in temperature, allergens, respiratory infections, air quality, and daily routines can contribute to worsening symptoms. For some patients, what starts as increasing cough, wheezing, or shortness of breath can quickly become an urgent care visit, an ED visit, or a hospitalization. 

The good news is that many of these situations give us an opportunity to intervene earlier. 

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Start with a simple question: “How are you really doing with your breathing?”

A medication list does not always tell us how well a patient’s respiratory disease is controlled. At the next visit, it may be worth asking about nighttime symptoms, increasing use of a rescue inhaler, shortness of breath with activities that used to be easy, missed work or activities, recent urgent care or ED visits, and whether the patient feels that their breathing has changed from their usual baseline. 

For patients with asthma, having a written action plan can also help patients recognize worsening symptoms and understand what to do before a flare becomes severe. 

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Before calling it “treatment failure,” check the basics

One of the most common and easily overlooked issues is how the patient is actually using the inhaler. For example: 

• Is the patient taking the maintenance medication consistently? 
• Are they using the device correctly? 
• Do they understand which inhaler is for daily control and which is for quick relief? 
• Is cost preventing them from filling the prescription? 
• Are side effects making them reluctant to use it? 

A simple question such as, “Can you show me how you use your inhaler?” sometimes uncovers the problem immediately. 

For COPD, GOLD specifically recommends considering inhaler technique and adherence when a patient is not responding adequately to treatment. 

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Look beyond the inhaler

Respiratory care is not only about prescribing another medication. For appropriate patients, it may also mean addressing smoking or other exposures, vaccinations, pulmonary rehabilitation, physical activity, nutrition, environmental triggers, and appropriate follow-up. 

It is also important to make sure the diagnosis itself is sound. In COPD, spirometry remains an important tool for confirming airflow obstruction and avoiding treatment decisions based solely on symptoms or a historical diagnosis. 

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When documentation matters

Good documentation is ultimately about telling the patient’s clinical story. 

When step therapy or a medical necessity determination is involved, a clear note can make an important difference. Rather than simply documenting that a medication was “requested,” it is helpful to capture: 

• The patient’s current symptoms and level of disease control 
• Frequency of rescue medication use 
• Recent exacerbations, ED visits, or hospitalizations 
• Current medications and adherence 
• Inhaler technique and any barriers to proper use 
• Previous therapies tried and the patient’s response 
• Any adverse effects, intolerance, or contraindications 
• Relevant pulmonary testing or clinical findings 
• Why the requested therapy is appropriate for this particular patient 

This is not about documenting more for the sake of documentation. It is about making the clinical reasoning visible. 

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One small opportunity at the next visit

For patients with asthma or COPD, we can learn a great deal by spending a few extra minutes asking what has changed since the last visit and how the patient is managing their breathing at home. 

The goal is simple: Recognize worsening disease earlier, help patients use their medications effectively, and make sure the right treatment is available when they need it.

A few thoughtful questions today may prevent an ED visit tomorrow. 

Dr. Ravinder Chawla is the former Chief Medical Officer of HealthTeam Advantage.