Discussing Severe Asthma Treatment With Telemedicine

Utilizing Telemedicine During COVID-19

Telemedicine is the practice of consulting with a doctor or another healthcare professional remotely, often by phone or video conferencing. Telemedicine has become much more popular and widely used in recent years with the advancement of technology, for convenience, and as a means to reduce healthcare costs. During the COVID-19 pandemic telemedicine has been widely utilized as a means to mitigate personal contact and try to control the spread of the virus.

This article will discuss the advantages and disadvantages of using telemedicine for the purpose of treating severe asthma and outline ways to optimize the benefits of telemedicine for severe asthma and culminate as a doctor's discussion guide which will help you to navigate your telemedicine visit.

Woman Using an Inhaler
Woman Using an Inhaler.  Fat Camera / Getty Images 

Types of Telemedicine

There are different types of telemedicine including:

  • Telecase management: Virtual consultation from healthcare professionals called case managers. Case managers are trained to look at the overall healthcare you are receiving via your entire care team and to identify any gaps in your healthcare.
  • Teleconsultation: A virtual appointment between you and your physician would be considered a form of teleconsultation. It could also be broadly defined as any type of communication in which your healthcare provider gives consultation regarding your condition and treatment.
  • Tele-education: May consist of your physician or another healthcare professional giving you instructions on your care in a virtual format, emailing you educational materials or even texting you instructions.
  • Telemonitoring: Telemonitoring may include the transmission of data such as vital signs using various technology or the submission of health questionnaire's tracking your symptoms or adherence to a treatment regimen.
  • Telereminder: The use of technology such as text messages or email to remind patients of appointments, necessary blood draws, or medical tests such as pulmonary function tests or imaging tests. Telereminder may improve compliance among patients and potentially improve outcomes.

While it is not completely necessary for you to understand the difference between these types of telemedicine, in the case of severe asthma, a combination of two of these types has been shown in studies to be most beneficial: telecase management and teleconsultation. 

Platforms and Privacy

There are many platforms available to facilitate telemedicine. Some examples of apps that have been designed for telemedicine include TeleHealth by Simple Practice, or eVisit. Some healthcare systems have created their own apps or software and some use simple video conferencing platforms such as Google Duo.

It is typical for your healthcare provider to select the app or software that they want to use and instruct you on downloading the technology prior to your appointment. It is important that you complete this process in advance so that you can best utilize your time with your provider.

Under normal circumstances the Health Insurance and Portability and Accountability Act (HIPAA) requires strict measures to be taken to insure patient privacy, and this is a major factor in determining what apps your physician may choose to use. While your healthcare provider still must take reasonable actions to ensure your privacy when using telemedicine during the COVID-19 pandemic some privacy laws have been relaxed to facilitate an increase in the use of telemedicine during this time. This is called the Notification of Enforcement Discretion.

Limitations of Telemedicine

There are a few obvious limitations to telemedicine. Unlike a traditional visit to the doctor unless you have your own healthcare equipment obtaining basic diagnostic tools such as vital signs is not always a possibility. You will still need to visit a hospital or clinic to obtain any necessary testing such as pulmonary function tests. Telemedicine is also not intended as a substitute for emergency medical care during an asthma attack but rather for the routine monitoring of your health.

Discussing Severe Asthma Treatment with Telemedicine

Vocabulary to Know

Using and understanding the correct terminology during your telemedicine visit can help you to avoid misunderstandings with your doctor that could potentially hinder your care. Here are some basic terms that are often used.

FeNO Test: This stands for Fractional Exhaled Nitric Oxide. Inflammation in your lungs can produce a substance called nitric oxide. Measuring the amount of nitric oxide can therefore give your doctor an idea of how much inflammation there is in your airways. This is simply done by having your exhale into a device capable of nitric oxide measurement. 

Maintenance Medication: Medications that are intended to reduce the frequency of asthma attacks but not helpful in relieving immediate symptoms of breathing difficulty. They are taken at regular intervals.

Nebulizer: A device that changes a liquid medication into a mist that can be inhaled.

Peak Flow Meter: A small handheld device that can be used to monitor your condition at home. It specifically measures the amount of air that you are able to force out of your lungs.

Pulmonary Function Tests: Pulmonary function tests (PFT's) measure the amount of air flow moving through the lungs. They are used to diagnose asthma and also to monitor the condition. Many of the other vocabulary terms in the section are components of PFT's (spirometry for example).

Rescue Medication: A rescue medication is an asthma medication intended specifically for relieving severe and immediate breathing difficulty in an emergency as opposed to a maintenance medication.

Spacer: A spacer is a plastic chamber that is used with an asthma inhaler to deliver the medication more effectively.

Spirometry: A test that measures the amount of air you inhale and exhale through a device called a spirometer.

Preparing for Your Visit

In addition to downloading and familiarizing yourself with any software or applications that will be used during your telemedicine visit we also recommend that you prepare by writing down any questions you have for your doctor (suggestions to follow), and any important information that your doctor may ask for (peak flow meter results etc...). If you have been so instructed please obtain any necessary testing well in advance of your visit (PFT's for example) so that you can discuss the results during your appointment.

Managing Asthma Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Questions During Your Visit

The following questions are examples only and all of these questions may not be applicable to you personally. You may think of modified questions that are more pertinent to your specific circumstances while reading them, however, which may be helpful in facilitating a discussion with your doctor. We have also included specific questions you might have during the current COVID-19 pandemic.

Symptoms

  • Are there lifestyle changes that might help me to better manage my symptoms?
  • At what point during an asthma attack is it necessary for me to seek emergency treatment?
  • During the current COVID-19 pandemic how can I differentiate breathing problems associated with my asthma and those that may be caused by the novel coronavirus?
  • Will wearing a face mask make my symptoms worse?

Causes and Risk Factors

  • How can I better identify conditions or substances that trigger my symptoms?
  • Do you have specific recommendations on ways to mitigate my risk of contracting COVID-19?
  • What can I do to better manage my health so that if I do become infected with COVID-19 I can decrease my risk for serious health complications?

Diagnosis

  • Is it safe to go to the hospital or clinic for PFT's during the pandemic?
  • At what point would you recommend I be tested for novel coronavirus?
  • I have heard that COVID-19 testing can be uncomfortable. Could this test trigger an asthma attack?

Treatment

  • Are there ways to minimize the side effects of my current medications?
  • What is the best way to get my medications during the pandemic?
  • Is it safe to go to the emergency room for asthma treatment during a pandemic?
  • When visiting a hospital or other healthcare facility for treatment how can a minimize my risk of getting COVID-19?
  • If I require treatment for novel coronavirus will this treatment interfere with the medications I am using for asthma?
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Article Sources
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  1. The New Era of Telemedicine Brings Positive Health Outcomes for Patients With Asthma. AJMC. https://www.ajmc.com/view/the-new-era-of-telemedicine-brings-positive-health-outcomes-for-patients-with-asthma

  2. FAQs on Telehealth and HIPAA during the COVID-19 nationwide public health emergency. U.S. Department of Health and Human Services. https://www.hhs.gov/sites/default/files/telehealth-faqs-508.pdf

  3. Using FeNO Tests to Monitor FeNO Levels. Asthma and Allergy Foundation of America. https://www.aafa.org/asthma/asthma-diagnosis/lung-function-tests/feno-tests-to-monitor-feno-levels.aspx

  4. Lung Function Tests. Asthma and Allergy Foundation of America. https://www.aafa.org/lung-function-tests-diagnose-asthma.aspx