To access the AEC pathway for asthma please follow the link to the Urgent Care section.
Explain what the aims of asthma treatment are i.e. – no daytime symptoms, no night time symptoms, no limitation on daily activity or exercise, little or no need for reliever medication, no ‘flare ups’, and normal lung function. Many people with asthma simply accept that they will wheeze or be short of breath and do not realise the aims of asthma treatment. Control of symptoms is possible in most cases with the right medication, device and compliance.
The following link will connect you with an asthma control test for adults which will provide you an object measure around their control:
The only effective inhaler device is one that the patient is able to use effectively. Never miss an opportunity to check inhaler technique and correct mistakes. If the prescribed inhaler cannot be used effectively after coaching, find one that can be!
Remember: pMDI = slow and gentle, dry powder devices = fast and hard
The following link will take you to the Gloucestershire Formulary recommended first choice inhalers which provides useful additional information together with pictures.
Look at the number of prescription requests for inhaled steroids and rescue medications. Does the number add up to the amount required? 1 canister of Salbutamol holds 200 doses; if 2 puffs are taken at one time, a person with well controlled asthma using less than 3 puffs a week should not need more than 2 inhalers in a year. Does that add up with the person in front of you? Clenil used at 2 puffs BD should last 50 days so should need replacing just under every 2 months. Find a good opening question to allow the person to be honest about forgotten doses. Ask about ‘flexible dosing’ for example.
Some people with asthma will know what ‘sets them off’, others may not have thought about it. Consider seasonal elements, infection, pets, exercise etc. Ask about occupational factors. Make a note and consider in any Asthma Action Plan.
Asthma action planning offers perfect opportunities to support brief interventions for smoking cessation in smokers in addition to health education opportunities in younger asthmatics to prevent them from smoking.
For treatment of respiratory disorders inhalation therapy is the preferred administration route for efficacy and safety. Inadequate inhaler instruction and poor inhaler technique can mitigate drug efficacy and can be a major cause of poor disease control.
Helping patients us their inhaler properly:
Common techniques for all inhaled devices:
Being alert to patients’ prescription use will enable you to gauge whether a patient is concordant with treatment – look for regular preventer use, ED attendances and frequent requests for relievers may indicate poor control.
 Vincken E et al PCRJ. 2010;19:10-20
 Newman S P Eur Resp Rev 2005; 14:96, 102-108
 Bell J Br J Prim Care Nurse 2008; 2:37-39