Lung and Respiratory Diseases

2 drs with opposite opinions

02/04/1999 05:43PM

Question:

I'm a freshman in college who's had asthma ever since I can remember. I have 2 brothers who have it too, and we've always all gone to the same dr.
I have a problem though. The dr I have at home is too far away to go to, and the dr at my school has pretty different ideas about asthma than my dr at home does. I should mention, my parents really disagree with the dr here. He believes in using asthma drugs regularly to prevent asthma attacks in the first place. I think our dr at home has the opposite approach, and my parents definitely agree more with him. They believe in trying to use the least amount of medications possible, and only when absolutely necessary. I have no idea which way is right. I do not like going against my parents beliefs, especially since they are still paying for everything for me, but I also don't like to go against what the dr tells me to do either, and the only dr I ever actually see is the one where I'm going to school. How am I supposed to know who to listen to? I'm mostly confused and just wish I never heard of asthma in the first place.

Answer:

I need to emphasize at the onset that no doctor can give you a good opinion about your health without knowing you; anything I say over the 'net is only worth so much insofar as your individual case is concerned. Having said that, perhaps a few comments will help.
Despite a greatly enhanced scientific understanding of asthma, asthma morbidity is rising worldwide, and certainly in the U.S. About 5-7% of the population carries a diagnosis of asthma, and it affects all age ranges, races, sexes, etc. Every year more people are diagnosed with asthma, and the costs associated with asthma, including both direct medical costs as well as indirect costs such as lost days of school/work, are rising. Experts disagree about what the causes of the worsening asthma epidemic are, but everyone agrees that it is getting worse, not better.
To address this, the National Heart, Lung, and Blood Institute (a part of the National Institutes of Health) has devoted a considerable amount of effort to educate both patients and doctors about the causes and treatment of asthma. Their report, which was extensively researched and put together by some of the best experts in the field, was most recently updated in 1997. According to these guidelines, the initial step in asthma management depends primarily upon the severity of the illness. Patients who have mild, infrequent (less than twice a month) symptoms, and who have otherwise normal lung function, may be treated with 'as-needed' medications, usually bronchodilators. Patients who have more frequent or severe symptoms, on the other hand, are specifically recommended to take anti-inflammatory medications on a regular basis. The key issue is making an accurate assessment of asthma symptoms and severity. It is EXTREMELY important to realize that patients often underestimate their own symptoms, and doctors may not ask enough questions to elicit a proper history. Thus, I cannot emphasize enough how important it is to make sure that your doctor (whichever one you settle on) is familiar with proper asthma diagnosis and management.
I can't tell you which doctor is right- more than likely, they differ in how severe they think your asthma is, and that's why they disagree on how to manage it. If so, you probably should get some objective measures of asthma severity, such as a home peak-flow meter and a diary to write down some measurements. If you haven't had 'breathing tests' done in the doctor's office recently, you should definitely do so. Then, you can sit down with your doctor (whichever one you relate to best) and decide what's best for you.
Would you like to read the NHLBI Information for Patients, which is based upon the findings I cited above? You can access it through the WWW at the link below.

Related Resources:

NHLBI Asthma Info

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Response by:

Stuart Green, MD
Assistant Professor of Medicine and Pathobiology
Pulmonary, Critical Care & Sleep Medicine
Department of Internal Medicine
College of Medicine
University of Cincinnati