Asthma Resources

Chronic breathlessness is very difficult to live with. It has widespread effects on both patients and those who care for them. And yet there are many ways that people can learn to cope with it, including using breathing techniques, adopting comfortable positions and using handheld fans and mobility aids. General practice nurses (GPNs) and other healthcare professionals have a vital role in helping people to manage their breathlessness. First, GPNs should acknowledge that breathlessness is difficult to live with and tell their patients that it is right that they have raised it as an issue to be addressed. Then, they can help patients to learn to manage their breathlessness and guide them to other sources of information and support. Some healthcare professionals find it hard to talk about breathlessness, but if they can help patients to see that it is an expected symptom, which is manageable, this could have a huge effect on their lives and help them to learn to live well with the condition.

Asthma is one of the most common long-term conditions (LTC) in the world. The UK has one of the highest prevalence rates of asthma worldwide, with asthma-related deaths continuing to rise each year. Supported self-management is imperative to enable people with asthma to live well. Low levels of self-management are linked to increased cost,
faster disease progression, early mortality, and increased multimorbidity (NHS England, 2024). This article highlights how primary care nurses, such as general practice nurses (GPNs), are well placed to support people living with asthma to self-manage their condition through the use of motivational interviewing and personalised asthma action plans (PAAPs), using a case study to demonstrate learning.

After a long wait, and years after updated international guidelines, the National Institute for Health and Care Excellence (NICE) has worked with the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN) to produce a unified guideline on asthma for the UK (NICE et al, 2024).

Asthma is one of the most prevalent lung conditions in the UK. Around eight in 100 people are diagnosed with it (Asthma + Lung UK, 2024). However, according to the British Thoracic Society (BTS, 2024), asthma affects around 12% of the UK population, with 160,000 people being newly diagnosed each year. This article focuses on the importance of finding the right inhaler to meet patient needs and lifestyle, while exploring the concepts of shared decision-making within respiratory reviews.

Asthma is the most common longterm condition in children and young people (CYP),  affecting one in 11 five to 18 year olds (Asthma + Lung UK, 2024a). That is around three in every classroom. Most cases are mild to moderate and, in most children, a few  simple interventions can vastly reduce asthma symptoms and risk of attack (Bush and  Fleming, 2015; British Thoracic Society/Scottish Intercollegiate Guidelines network  [BTS/SIGN], 2019; Levy, 2020; National Institute for Health and Care Excellence  NICE], 2021). The awareness campaign, #AskAboutAsthma, was established to encourage  everyone seeing CYP with asthma to have these interventions front and centre of their minds.

Here, Laura King, senior children and young people’s asthma practitioner for North-East London, explores the core themes for good asthma education, often called the ‘brilliant basics’. No matter how severe a patient’s asthma is, this is key learning that patients and their families/carers need to understand if they are going to manage their asthma effectively.

Fractional exhaled nitric oxide (FeNO) testing is a simple, safe, non-invasive test which is suitable for use in primary care provided it is carried out by a competent clinician who can interpret the results. Raised FeNO levels can only be found when type-2 airway inflammation is present (Wang et al, 2023). FeNO testing is currently regarded as an optional test to identify eosinophilic asthma for those with an intermediate probability of asthma. The question is, could FeNO testing lead to a more personalised approach for the management of airways diseases? This article discusses the current recommendations, the relevance of FeNO testing, along with the limitations and ways to utilise FeNO testing in a primary care setting.

Peak expiratory flow rate (PEFR) is the volume of air forcefully exhaled at maximum speed. This can be measured using a peak flow meter or a spirometry device. Peak flow meters are portable, inexpensive and widely available. The technique is non-invasive, carries no risk to the person, can be taught and learned quickly, and can easily be mastered by the patient. Published evidence for the use of peak expiratory flow rate (PEFR) and peak flow monitoring in asthma is limited, despite the use of the peak flow meter being documented in national and international guidelines for many years. National and international guidelines recommend the use of easily calibrated spirometers, which can provide accurate results
with good technique, along with fractional exhaled nitrous oxide (FeNO) testing, which requires a greater analysis and interpretation of the results. Is the use therefore of the peak flow meter redundant? This article discusses the indications for use of peak flow meters, technique and clinical context.

Asthma is an inflammatory condition which leads to narrowed and hyperresponsive airways. In recent times, the standard approach to managing asthma has been to use an inhaled corticosteroid (ICS, the preventer) to dampen down the inflammation and a short-acting bronchodilator (the reliever) to open up the airways if the person with asthma needed symptom relief. If the preventer inhaler is doing its job, the reliever should not be needed more than three times per week. The British Thoracic Society/Scottish Intercollegiate Guidelines Network guidelines currently reflect this approach (BTS/ SIGN, 2019), but later this year these guidelines will be updated based on a collaboration with the National Institute for Health and Care Excellence (NICE). NICE previously published its own asthma guidelines, which were controversial in terms of their recommendations, with a focus on using preventer therapy if a reliever was needed three times a week or more, rather than prioritising the use of anti-inflammatory treatment for an inflammatory condition. It will be interesting to see what the joint recommendations will be. In the meantime, many clinicians with an interest in asthma management are looking to the Global Initiative for Asthma recommendations for a fresh approach to asthma management (GINA, 2023).

Here, Laura King, senior asthma practitioner, North-East London, explains why the time is now to pre-emptively act to avoid asthma attacks, which commonly peak in children and young people during mid-September.