Definition
Asthma is a common, long-term inflammatory disease of the lungs.
Considerations
During a consultation, the practitioner should consider the following attributes:
The presence of wheeze, cough or breathlessness
Any link with the seasons
Trigger factors (e.g. use of OTC NSAIDs)
Family history and links with atopic conditions (i.e. sensitivity to allergens)
Occupational factors that might precipitate Asthma
An objective test is required to diagnose Asthma (e.g. FeNO, spirometry and peak flow)!
Principles of Management
The overarching aims of Asthma management are risk reduction and symptom control. Within the management plan, the views / needs of the patient should be addressed.
Asthma management should achieve “Total Control”, which may be summarised as:
No day time symptoms
No night time issues (i.e. awakening as a result of Asthma)
No requirement for rescue medication (i.e. antibiotics and oral steroids)
No asthma attacks
No limitations on daily activities (i.e. walking)
Normal lung function
Low side effect incidence from the medication used
Patient-Centred Care
All consultations should take into account individual concerns, patient characteristics (i.e. health literacy, compliance level, inhaler technique and affordability), elements that might increase risks to the patient and co-existing disease states. Thus, an effective partnership between the healthcare professional and the patient is a must; here, communication skills are key.
The Asthma Management Cycle
The effective management of Asthma may be achieved by reference to a continuous cycle that involves patient assessment, treatment adjustment and response review.
Assessment
Consideration must be given to symptom control, risk factors and various comorbidities. The idea is to identify factors that can increase the burden of disease that can in turn precipitate poor health outcomes. Here, patient goals and preferences are important.
2. Treatment
Current recommendations (i.e. GINA guidelines) suggest that every adult and adolescent diagnosed with Asthma should be prescribed an inhaled corticosteroid (ICS) to decrease the likelihood of severe exacerbations. In addition, this patient population should also receive either a Short-Acting Beta2 Agonist (SABA) or low dose ICS-formoterol combination product. Importantly, it is crucial to review any actions that the patient may take to worsen the issue (i.e. smoking).
The use of SABA alone is no long recommended for Asthma management. This medication alone does not protect patients fully (i.e. does not reduce the underlying inflammation) and can indeed increase the risk of fatal exacerbations.
Patient education is key and the patient should fully understand aspects such as what Asthma is, how to use their inhalers effectively, why adherence is important, be able to use and apply their Personal Asthma Action Plan’ (PAAP), be able to self-monitor with a peak flow meter and attend regular medication reviews.
3. Response
Over time, the response to treatment should be closely monitored and evaluated.
Elements of interest are:
Symptom control
Exacerbation frequency
Side effect presentation
Overall lung function
Patient satisfaction with their PAAP
Good Clinical Practice
Succinct notes should be made within the patient medical record system (i.e. EMIS). Here, the background to the case should be logged alongside the basis for diagnosis and the coded diagnostic entry. The rationale for treatment initiation / modification should be clearly presented and the correct product(s) selected for electronic transfer (i.e. EPS) to the nominated Pharmacy.
