Asthma Resources

#AskAboutAsthma is an annual awareness campaign that takes place in September. Now in its sixth year, the campaign is about making simple changes to children and young people’s care that will make a big difference to how they experience their asthma. Primary care clinicians are critical to making these changes, with general practice nurses (GPNs) playing a vital role.

The National Review of Asthma Deaths (NRAD) (Royal College of Physicians [RCP], 2014) identified many shortcomings in the way that asthma care is delivered, citing preventable factors in 90% of asthma deaths. Among deaths in children, poor recognition of risk of adverse outcome was found to be an important avoidable factor in 70% of deaths in primary care, rising to 83% in young people (RCP, 2014). The challenges of the pandemic over the past 18 months have arguably compounded the difficulties in providing good asthma care, with asthma reviews necessarily being managed in different ways, largely undertaken remotely. To further prevent avoidable deaths, it is important that primary care nurses are confident and competent in undertaking remote asthma reviews so that risks of adverse outcome are identified and effectively managed. As highlighted by the NRAD, parents/carers and children should be taught ‘how’, ‘why’ and ‘when’ to use their asthma medication, be able to recognise when asthma is not controlled, and know when to seek emergency help. This article gives a structured approach to undertaking a remote asthma review with children so that good asthma control and better outcomes can be achieved.

Some clinical issues never seem to reach the top of clinical or health policy priority lists, and asthma is one of them. The International Primary Care Respiratory Group (IPCRG) has initiated a social movement, Asthma Right Care, to disrupt this. For us, right care means doing the right things and only the right things in the right way for the right people at the right time in the right place, whatever that means in the local context. This piece summarises what we have learnt, what tools we have created, and what progress we have made. It invites you to join the Asthma Right Care movement by committing to have a different conversation about asthma with at least one colleague and person with asthma.

Hay fever and allergic rhinitis are common conditions seen in primary care which can have a huge effect on the quality of life of sufferers The most important step in diagnosing hay fever or allergic rhinitis is to take an allergy focused clinical history. There are many treatment options available, including allergen avoidance, antihistamines and nasal corticosteroids. Many medications are now available over the counter; patients need to know how to take their medication correctly. Asthma frequently co-exists with allergic rhinitis and can make asthma symptoms much worse. General practice nurses (GPNs) are ideally placed to offer advice and support to these patients. If initial treatments fail, patients should return to primary care as there are a wide range of therapeutic interventions which may help. For those whose symptoms are very severe or not responding, immunotherapy may be an option, and the patient should be referred.

With the ever-expanding role of general practice nurses (GPNs), alongside increased clinical scope and capacity, and increasing pressures of targets, it can be easy to simply ‘tick the boxes’ during an asthma review. However, an asthma review is not only to get an enhanced view of the child or young person’s asthma control in general, but also their individual perceptions, triggers, along with their own agenda or drivers (which may not be the same as the clinicians). By considering social, family or emotional influences, the review can answer crucial questions, such as, ‘Why has this child been to A&E again?’, ‘Why is this child getting through four reliever inhalers each month?’, or, ‘Why have these siblings missed their review again when one was so ill last year?’. This article explores how GPNs are well placed to educate patients and their families about asthma, to discuss inhaler technique, medication use and asthma triggers, as well as to ensure that children and families are aware of the importance of attending their next asthma review. It also discusses the use of tools in assessment and planning.

Celebrating 30 years of improving lives

Welcome to this issue of GPN. We are delighted to share the latest news in the world of Education for Health, especially at the start of this very special year — we are celebrating our 30th anniversary!

This is an important milestone in our charity’s history and one we are looking forward to celebrating in 2017. During the year we will thank those who have contributed to our success, reflect on our achievements and make ambitious plans for the future. We plan to mark our anniversary with a number of activities in May and June.

Toby Capstick highlights why healthcare professionals and patients need the new UK Inhaler Group standards.

Teaching correct inhaler technique has long been known to be key in the management of respiratory conditions; the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network asthma (BTS/SIGN, 2016) and National Institute for Health and Care Excellence chronic obstructive pulmonary disease (COPD) (NICE, 2010) guidelines give almost identical advice to healthcare professionals; namely, that inhalers should be prescribed only after patients have received training in the use of the device, and have demonstrated satisfactory technique, which is repeated regularly thereafter. This recommendation is emphasised in the NICE asthma and COPD quality standards (NICE, 2013; 2016).

Here, Chris Loveridge reflects on a patient story where the focus slipped away from the patient resulting in a failure of care.

As nurses, one of the first things we are taught is how to communicate with patients. It is also important to look out for clues that might help to assess their condition. For example, in patients with breathlessness this could mean:

• Observing how they walk towards us, the degree of breathlessness
• Looking at their skin colour when they reach us — both at their hands as they greet us and their lips when they are talking
• Reaching across to reassure and feel the texture of their skin and perhaps even the radial pulse. Once taught, these skills are never forgotten and, added to a conversation, can encourage patients to relate how they feel, and thus, begin the process of history-taking.

The UK has one of the highest death rates from asthma in Europe (Global Asthma Network, 2014). Every day three people die from asthma, two-thirds of these deaths are preventable (Asthma UK, n.d.). Why asthma still kills: The National Review of Asthma Deaths. Confidential Enquiry Report (NRAD) was published in 2014 by the Royal College of Physicians (RCP). It is the largest worldwide study looking into why people die from asthma and the first to adopt a UK-wide focus. The NRAD identified that only a fifth of people with asthma are receiving all the basic elements of asthma care which could help them manage their asthma effectively and reduce their risk of experiencing an asthma attack. It provided valuable insights and clear practical recommendations which, if implemented, could improve care and reduce the number of asthma deaths (RCP 2014).