My Doctor Online The Permanente Medical Group

Types

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Allergic asthma is the most common form of asthma. It is triggered by allergens that you breathe into your lungs. The most common allergens are:

• Dust mites
• Pet dander (most common triggers are from cats and dogs)
• Pollen
• Mold

Non-allergic asthma can be triggered by viruses, other kinds of infections, smoke, irritants, exercise, cold dry air, anxiety, or stress.

Childhood-onset asthma begins in childhood and most often occurs in response to common allergens in the home and outdoors.

Adult-onset asthma starts after age 20. It is not as common as asthma in children. More women than men have adult-onset asthma. While allergies can play a role, adult-onset asthma may be non-allergic.

Symptoms

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Asthma symptoms may be different for each person. Your symptoms may not even be the same each time you have a flare-up. Some common symptoms include:

• Coughing
• A tight feeling in the chest
• Wheezing (breathing with a whistling sound)
• Shortness of breath
• Difficulty breathing

Diagnosis

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We can diagnose asthma based on your physical exam, history, and symptoms and by doing lung function testing called spirometry. Spirometry measures the air taken into and exhaled from your lungs. This evaluation will help us determine if you have asthma. Based on your history, we may also recommend allergy testing if we suspect that you have allergic asthma.

Keep track of any patterns related to your symptoms and discuss them with us. You may want to keep an asthma diary to track and document your asthma symptoms.

For example:

• Are your symptoms worse in the spring or in the fall (allergy seasons)?
• Does exercise, a respiratory infection, or exposure to cold air trigger an attack?
• Do you have a family history of asthma or allergic disorders, such as eczema, hives, or hay fever?
• Have you had any occupational or long-term exposure to chemicals?
• Do you have fewer symptoms on weekends or vacations?

Lung Function Testing - Spirometry

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Spirometry is helpful in diagnosing asthma because there are other health conditions that can mimic asthma symptoms.

It is more accurate than using a peak flow meter and may be used to confirm your asthma diagnosis. The results of this test may tell us whether medication will be helpful in treating your condition. 

We conduct the test in the clinic, and it takes about an hour.

Causes

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We still do not know enough about the underlying causes of asthma. Current research shows that asthma is probably caused by many factors, including your genes, your immune system, how your lungs develop and grow in early childhood, and your exposure to infections and allergens in the environment.

Triggers

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Triggers can cause your asthma symptoms to get worse. If you avoid your triggers and limit your exposure to those you cannot avoid, you may need less medicine to keep your asthma in control.

The most common types of asthma triggers are:

• Allergies (allergens)
• Infections (including viral infections)
• Air pollutants, smoke, and other irritants
• Physical activity

Less common asthma triggers include:

• Stress.
• Changes in weather.
• Aspirin or other aspirin-like drugs such as ibuprofen.
• Sulfites (a preservative found in dried fruits; bottled lemon or lime juice; wine; molasses, which is often found in barbecue sauce; condiments; and many other foods). Read labels carefully.
• Live Christmas trees.

Lifestyle Management

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When your asthma is under control, you can live a healthy, symptom-free life. You should be able to:

• Work or attend school
• Play sports and be active
• Avoid Emergency Department visits
• Sleep without being awakened by asthma symptoms
• Use your quick relief medication no more than 2 days a week (other than for physical activity)

Asthma symptoms are not always consistent. Sometimes your symptoms will be in better control than at other times. By keeping track of your symptoms, you can predict when a flare-up is coming and do something about it before it gets worse.

There are 2 ways to monitor your symptoms. It is important to use at least one of them. For best results, use both:

• Use an asthma diary to keep track of your symptoms.
• Use a peak flow meter to measure your ability to push air out of your lungs.

We can work together to create a written asthma self-management plan to help you take action quickly when your asthma symptoms get worse.

Your Asthma Action Plan will tell you which medicines to use to keep your asthma in good control and how to take action if symptoms are starting or to prevent an asthma flare-up.

Managing Asthma Every Day

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Here are some tips for helping you to manage your asthma during your busy day:

• Take your medicines as prescribed.
• Make sure your medicines are always available to you including when you travel.
• Keep a copy of your asthma self-management plan with you.
• Talk with your supervisor about anything you need at work to control your asthma, such as keeping your work area free of triggers.
• Take breaks when needed.

Treatment

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Asthma medications are one of the keys to treating your asthma. Most people need more than one type of medicine to manage asthma.

There are 3 types of asthma medicines:

1. Long-term control medicines (also called "preventers" or "controllers"). Use these medicines to control your asthma. Usually they are used daily to prevent asthma symptoms and avoid flare-ups.

2. "Quick-relief" medicines ("relievers"). Use these medicines to relieve your asthma symptoms quickly. You may also need to use relievers to prevent flare-ups before physical activity or exposure to any of your triggers. Remember, these medicines do not reduce swelling or mucus.

3. Flare-up reversing medicines ("burst" medicines). Use these medicines for a severe flare-up of your symptoms.

Your Care with Me

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If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter. We may have you wait a few days to come in so allergy testing can be done at your first appointment.

Before your first office visit, we need for you to complete an Allergy new patient questionnaire. This will be provided by your personal physician when she or he schedules our visit. It is also available online, or you may arrive 15 minutes early and complete the form before your appointment.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.
  

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