I’ve just completed a fantastic CPD session courtesy of the Red Whale platform.
I’m really enjoying developing myself via this online education tool and would recommend to others in the field of healthcare.
The session today concerned Asthma and its related management.
During the management of the asthmatic patient, a number of factors must be considered:
The Risks of Poor Control
The Diagnosis of Asthma
The Management of Asthma
Personal Asthma Action Plans and Annual Review
In brief, the risks of poor asthma control are increased morbidity and mortality. These points are obvious and we want to steer people away from these and promote quality of life. The aim is ‘Total Control’ and I will outline what that means later in the piece.
The diagnosis of Asthma comes largely down to the presenting symptoms and (family) history. Again, no surprises here with the typical symptoms being wheezing, shortness of breath, cough and breathlessness; all may be precipitated by either temperature extremes or exercise. Basically, if it sounds like Asthma then it probably is Asthma. Assessment strategies in the near term would be an Asthma questionnaire, spirometry and peak flow measurements. Generally, a 6 week trial of an inhaled corticosteroid (ICS) would be advised and if an improvement is noted then the likely diagnosis would be Asthma.
The aim of Asthma management is to achieve ‘Total Control’. This term refers to the patient using no rescue inhalers (i.e. Salbutamol), experiencing no daytime or night-time symptoms, being able to exercise with no symptoms, have no Asthma exacerbations and have effective lung function over time. To support this paradigm then we can educate on inhaler technique, smoking cessation and potentially stepping-up the medication. The management of Asthma can be summarised as in the image below. At the outset we would consider a low dose of ICS and possibly blend in a Leukotriene Receptor Antagonist (i.e. Montelukast). In the case of the latter, we would need to consider the lowest and most cost effective dose alongside a short duration trial at the outset (i.e. 4-8 weeks). Naturally, the approach would then be pushed further as outlined with a view to always fall back should the Asthma be well controlled. Here, we want effective management of the respiratory condition at the minimum effective dose.
Once the optimum inhaler combination / dose is achieved to reach ‘Total Control’ then the patient should be reviewed on an annual basis and have a Personal Asthma Action Plan (PAAP) in place. The annual review should consider aspects such as the level of disease control, the use / understanding of the steroid card, the level of bone protection needed and whether the patient has stopped smoking or if there is a plan in place. Furthermore, the PAAP should be outlined and the patient educated as how to proceed if experiencing an Asthma attack. This traffic light system is very easy to follow and extremely useful to the patient in an emergency.
As I say, the Asthma webinar from Red Whale was very informative and useful for my future practice both as a Clinical Pharmacist and Pharmacy Educator here at www.pharmascholar.co.uk.
The Red Whale Asthma Webinar - Thumbs up from www.pharmascholar.co.uk!!