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:
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).
With so many new inhaled therapies available for treating asthma and chronic obstructive pulmonary disease (COPD), how does the busy healthcare professional make a prescribing decision which is safe and effective?
There are many components to consider when performing an annual asthma review. The Quality and Outcomes Framework (QOF) can help by prompting healthcare professionals to include such tasks as inhaler technique, peak flow and the Royal College of Physicians’ three questions (RCP3Q). However, these are only process measures. To perform a review adequately, it is important also to understand the more subtle aspects of asthma management in order to achieve the best outcomes for the patient. The ‘SIMPLES’ approach is one way in which this might be achieved (Ryan et al, 2013).
General practice nurses (GPNs) are well placed to ensure that patients with respiratory conditions receive high quality, safe, effective, evidence-based care. The National Review of Asthma Deaths (NRAD) (Royal College of Physicians [RCP], 2014) found that two out of three asthma deaths could have been prevented with better routine care. The key components of good asthma care, including the importance of correct inhaler technique, were highlighted by this landmark report. Poor inhaler technique is known to adversely impact upon control of respiratory disease and its symptoms. In 2013, the National Institute for Health and Care Excellence (NICE) published Asthma Quality Standards. However, NRAD found that despite the existence of such solid recommendations and guidance there were potentially avoidable factors related to the implementation of national guidelines in 46% of the deaths that were reviewed. Most recently, the Chronic Obstructive Pulmonary Disease (COPD) Quality Standard was added as an update to COPD guidance (NICE, 2016). Both documents include quality standards around inhaler technique.
Spirometry is very easy to do, and very easy to get wrong (Martin, 2010; personal communication). Not only is quality
assured spirometry dependent on the effort exerted by the patient, and the technical ability of the spirometer operator,
but also on the understanding of the results by the person interpreting them.
Interpretation of the results is essential if any meaningful decision is to be made about the patient’s care.
Respiratory disorders, in particular asthma and chronic obstructive pulmonary disease (COPD), have been recognised for many years and remain among the most common chronic long-term conditions that are seen in primary care. Despite the development of guidelines, standards and effective treatments, both diseases continue to carry a high morbidity and mortality, a significant societal cost in terms of lost school and work days, and high consultation and admission rates.This article follows the development of our knowledge of these common disorders and looks at how far we have progressed in our diagnosis, knowledge and treatments, as well as what the future may look like in terms of care management and treatment options.
Asthma is a common long-term condition affecting adults and children. Despite a number of evidence-based guidelines for treatment and new medications and inhaler devices, mortality rates remain static. Key findings from the National Review of Asthma Deaths (Royal College of Physicians [RCP], 2014) highlighted the importance of personalised asthma action plans (PAAPs) in good asthma care. This article looks at how healthcare professionals need to work with adults and children with asthma, involving them throughout the process, to produce a meaningful, useful plan that has been developed with the person, and parents or carers. The plan should be used as an educational tool to help understand how, when and why asthma medication should be used, what is meant by asthma control, and recognition of when control is slipping.
Success!