AEC Asthma Pathway

To access the AEC pathway for asthma please follow the link to the Urgent Care section.

5 Top Tips for Asthma Action Plans


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:

Adult Asthma Control Test

Inhaler Technique

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.

Gloucestershire Formulary Recommended First Choice Inhalers


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.

Top Tips for Correct Inhaler Technique

For treatment of respiratory disorders inhalation therapy is the preferred administration route for efficacy and safety[1]. Inadequate inhaler instruction and poor inhaler technique can mitigate drug efficacy and can be a major cause of poor disease control[2].

Helping patients us their inhaler properly[3]:

  • Make sure your own knowledge is up to date (see new Glos Joint Formulary Guidelines -  and for pictures plus info on 1st line inhalers see - Please contact  or 0300 421 1565 to request CCG funded AIT (Advanced Inhaler Technique) training from an accredited Pharmacist.
  • Ensure inhaler is appropriate for patient – being able to coordinate actuation and inhalation can present a challenge for some patients on pMDI’s as well as some COPD patients do not have sufficient inspiratory flow to activate some DPI’s[4].
  • Ask patients to show you how they use their inhaler
  • Give verbal instructions with physical demonstration, not just a leaflet – use placebos especially for the new devices again contact Elaine Johnson as above who may be able to provide placebo devices or contacts.
  • Check inhaler technique regularly

Common techniques for all inhaled devices:

  • Remove mouthpiece cap (if present)
  • Hold device correctly (see leaflet)
  • Stand or sit upright and breathe out fully
  • Place mouthpiece between teeth and form a seal around mouthpiece with lips
  • Follow device instructions for correct inhaler technique (see leaflet)
  • Hold breathe for 10 seconds or for as long as possible to allow medication particles to settle deep in the lungs

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.

[1]  accessed 8.5.15

[2] Vincken E et al PCRJ. 2010;19:10-20

[3] Newman S P Eur Resp Rev 2005; 14:96, 102-108

[4] Bell J Br J Prim Care Nurse 2008; 2:37-39