Six Month Follow-Up Appointment Time

Have you ever had one of those appointments that completely slips your mind till it is just a matter of days away? It is almost time for me to prepare for one of those appointments. In my experience, this tends to happen with the appointments that are six months away, they always feel like they are an eternity away and then creep up so quickly. Thankfully, I took a look at the appointment notice on my bulletin board, although these appointments are populated in my patient portal, I am still sent a mailed notice about them. The email reminders are a bit hit and miss. This particular portal is a work in progress.

I cannot tell you what a big step it was to get to a level of stable disease that these appointments can now be at the every six-month stage. It is nice to finally be enjoying a stretch of good health and mostly stable asthma (knock on wood, as I do not want to jinx myself).

What I expect at my asthma follow-up appointment

This appointment is a series of tests, specifically sputum induction, methacholine challenges, and a follow-up stretched over two different days. My spirometry will be done at both, as those are normal components of those appointments. It is certainly not the most ideal arrangement, the sputum induction and the methacholine cannot be done on the same day. It has been some time since I have had a methacholine challenge test.

A methacholine challenge test is used to determine how reactive your airways may be. You breathe in methacholine through a nebulizer in increasing concentrations. There are a series of breathing tests that are conducted before, during (after each concentration), and after the test. I have previously had quite reactive/twitchy airways and I have tended to react quite quickly. It is important to note that you are given a bronchodilator to reverse any asthma symptoms and further spirometry is done to ensure you are back at your baseline.

Preparing for the appointment

This test comes with some prep including withholding one of my medications for 5 days and another for 48 hours. I forget about this requirement and the timelines. I don’t usually get anxious about fewer medications but I have had questions about one of my maintenance meds being a bit low so this may be an interesting experiment. I will be sure to report on how this preparation goes. I should note that I can still use my rescue inhaler if need be. I am curious to see if I have any great improvements in my airway hyperreactivity as this help provides answers about the status of my asthma.

Going into it with goals

What are my goals for this follow-up? The big question that I have for this appointment is if my asthma is actually in some degree of remission and what the plan is in terms of continuing biologics and maintenance medication use. My questions are about which biologic am I likely to stay with, and what maintenance dose of my inhalers is optimal.

I am part of a research medical center and I am always curious to hear about any developments in phenotyping or is there new information about my phenotype or possible endotype. We have had some conversations about immune complexes being involved. I am curious if there may be new information on this front.

One of the points of discussion from my last appointment was the impacts that oral corticosteroid use has had on my body, my exercise tolerance is much better however, there are some issues that I am still having and I wondered if there was anything else that could be done in terms of giving me a bit more exercise tolerance.

I would love to hear about your experiences with methacholine challenges, sputum indiction, or follow up appointments.