In this MD Newsline exclusive interview with pulmonologist and critical care physician Dr. Komal Parikh, we discuss treatment strategies for patients with severe asthma and how to avoid asthma exacerbations and emergency visits for asthma.
How can we equip patients to avoid asthma exacerbations and emergency visits for asthma?
Dr. Komal Parikh:
“I think this comes down to establishing a rapport with the patient. A lot of pulmonologists will see patients starting at age 18 and then for the rest of their lives, ideally. And having that rapport and giving that trust to the patient and telling them, ‘if you feel like you’re having an asthma exacerbation, come to the clinic first.’
Constant reiteration of that point and education make it easier for patients to call up their pulmonologist or call up the clinic and say, ‘I’m not feeling well. I’d like to get seen in clinic today.’ A lot of pulmonologists will make access very easy for these patients and plug them into their clinic.
And we can give injections, steroids, [and] nebulizer treatments in clinic. So educating patients on these points and having them come to clinic first, making sure that understanding is achieved, and having that asthma action plan—all of those steps together can help in making sure that we avoid these ED visits.”
What is your treatment strategy for patients with severe asthma?
Dr. Komal Parikh:
“For patients with severe asthma, I tend to give them a little bit more attention because, for a lot of these patients, the severity of their asthma is very, very debilitating. I have some patients that don’t even leave their house, or they can’t even live in their house because they have asthma exacerbations in their own living situation.
So all of these patients get a very thorough workup along with the typical HPI, getting an accurate history, getting a good idea of what their triggers and exacerbations are like. Seeing what helps them, what makes them better. Then, aside from all of that, I work them up with a full CBC, checking eosinophils, IgE levels, a RAST (radioallergosorbent) panel, and I do allergy testing.
And after maximal inhaler therapy, including an inhaled corticosteroid and then a LAMA (long-acting muscarinic antagonist) and a LABA (long-acting beta-agonist), I’ll consider immunotherapy. So at that point, we’ll talk about the biologics and targeting different cytokines and other markers of inflammation in these patients.”