Didn’t You Know Your Severity?

The other day I was in the online patient portal for my primary care physician (PCP). I was scheduling an appointment with her for a reason that was totally unrelated to asthma. The portal made me confirm all the things one might expect: home address, contact phone number, insurance information, etc. Then I came to the medical information section: Allergies to latex, mold, dust - yep, that’s me!

Mild intermittent asthma

Huh, I had no idea I’d been categorized way back in 2013! Dr. PCP and I don’t really discuss my asthma much. She is aware and interested in the broad strokes of my asthma and allergy care plans but largely defers to my allergist.

This label is clearly not an integral part of my treatment. I am a bit puzzled how my PCP categorized me. I was going to a different primary care provider in an unaffiliated clinic when I was referred to the allergist. Back in 2013, I was still on a combination inhaler plus leukotriene modifier. I was controlled, but not nearly as well as I am today. I certainly agree that now I meet the criteria for mild asthma. It is slightly puzzling to me that I don’t recall ever hearing this proclamation from her.

Would this data change my treatment?

No, probably not. As I already mentioned this doctor is not actively involved in my asthma care. We have a good working relationship and are generally on the same page about treatment goals. This underscores why open notes from your medical chart can be beneficial.

I am usually pretty on top of my health and goings on at my doctors’ appointments. Yet, I still managed to miss an important “official” diagnosis of my asthma severity. The data available to me in the patient portal is not full notes. It is still more than I was able to see last time I was looking at the records.

Does my severity classification matter?

The complicating factor in these labels is trying to fit many different people into a few simple categories. By steroid dosing, lung function, and quality of life measures I sit solidly in the mild persistent category. My Ventolin use tells a more moderate story. That’s OK, even if I am a bit upset that the official label has been lurking right under my nose for so long.

Even today with good control on the lowest medication dose since diagnosis, I don’t meet the criteria for intermittent asthma.¹ I use a daily controller which puts me Mild Persistent category.¹ I understand that my physical activity level is a confounding factor anytime I discuss my treatment options with my team. We agree that good control and physical fitness are worth the risks of additional medication for me at this time.

I feel like until “daily activities” are clearly defined, I will have a hard time embracing a severity categorization. I know everyone has different lives. Is an active commute to work (brisk walking or bicycling) requiring a rescue inhaler interfering with my daily activities or exercise-induced bronchospasm or none of the above? Knowledge may be power but in this asthmatic is sparks more questions.