This wk we finished our last case of the semester discussing asthma. One aspect that stood out for many was the hx of nighttime coughing/awakening and whether that fit w/ asthma. Love this as it’s important and good to discuss.
@kelzj3 @CincyMedicine @CincyMedPeds @UCincyIM
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Diagnosing asthma can be tough because the symptoms are non-specific. Cough may be the only indicator for some patients. Regardless of the symptoms, the timing and frequency of symptoms is very important, including nighttime symptoms.
2/8

Nighttime sx are 1 aspect used to classify asthma severity. In med school I learned Rules of Two to assess asthma severity. In Rules of Two there are only 4 questions, 1 is about nighttime sx! ACT is another frequently used tool and also includes nighttime sx.
3/8

These tools assess severity in pts already diagnosed, but the importance of nighttime sx highlights the need to incorporate these questions into your routine hx when asthma is on your DDx. When assessing timing & frequency, remember to specifically ask about nighttime sx.
4/8

This study sought to validate Rules of Two and nicely shows some different tools and classification criteria. Interestingly, in this study patient self-assessment performed poorest (seen in other studies).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954651/pdf/bumc0027-0079.pdf

5/8

This highlights the importance of not just asking patients how they feel or think their asthma is controlled, but to ensure you dive deeper, asking about specific symptoms and their frequency/timing.

Here is a great review of asthma to file away.
https://pubmed.ncbi.nlm.nih.gov/29273246/ 

6/8

More important than the medical aspect of the case this wk was thinking about how we can help pts think about behavioral change using motivational interviewing. The principles used in MI are helpful in so many patient discussions and really help us be patient centered. How?

7/8

1. Focus on pt talking, provider listening!
2. Emphasis on getting to know pt- routine, stressors, barriers, strengths, priorities
3. Reflective statements- shows u r listening, grounds discussion in pt’s own statements
4. Centers plan/advice/goals around pt’s preference

8/8