Asthma advice from Dr Andy Whittamore

New NICE guidelines on asthma treatment weren’t that well-received when they were launched in early 2018, but treating the condition remains a priority for the NHS. In a detailed Q&A Dr Andy Whittamore, clinical lead at Asthma UK, gives his judgement on the current state of asthma care and provides practices with strategies to improve treatments and medicine adherence

Is asthma being diagnosed and treated appropriately within primary care at the moment?

Asthma diagnosis can be difficult and take time. Asthma is a variable condition characterised by airway inflammation and bronchoconstriction; unfortunately, no commonly-used test is 100% reliable for identifying or ruling out asthma.

As clinicians, we only have a limited amount of time with asthma patients to decide on treatment but, when it comes to asthma care, there is room for improvement amongst some healthcare professionals.

Asthma UK’s recent research reveals that two thirds of people with asthma are not getting basic care from their GP or asthma nurse; this should include having a yearly review, a written asthma action plan and an inhaler technique check. This is concerning because basic asthma care is recommended by British Thoracic Society (BTS) guidance. Also, the National Review of Asthma Deaths revealed that two thirds of deaths from asthma attacks could be prevented with basic care.

Making sure every patient has a written asthma action plan is particularly important because those who use one are four times less likely to need to go to hospital for their asthma.

Asthma UK is also calling for the NHS in England to play its part and embed technology to help people manage their own asthma – for example, ensuring all GP surgeries send text message reminders for appointments and rolling out smart inhalers – which can track how a patient is using their inhaler so GPs can personalise their care and identify those most at risk.

What resources are available to support practices?

As already stated, every patient with asthma should have a written asthma action plan and Asthma UK offers these on its website to download. GPs can also signpost patients to the Asthma UK website to access additional information so that they can better understand their condition.

GPs can also signpost patients to the Asthma UK website to access additional information so that they can better understand their condition.

Asthma UK’s nurse-staffed helpline, and WhatsApp, take calls from both patients and healthcare professionals needing advice and support. The charity also has a quarterly email newsletter with the latest news, ideas and updates for healthcare professionals.

The charity provides regular updates for people with asthma on its Facebook page and Twitter account – it can be useful for practices to recommend patients follow these accounts as they give up-to-date tips and alerts on triggers such as cold weather, pollen, and the back-to-school peak of asthma attacks in children.

What should practices (including nurses, doctors and pharmacists) focus on this year?

As basic asthma care is proven to prevent deaths from asthma attacks, it’s vital that practices ensure they deliver this. They should make sure every patient has a written asthma action plan – and that this is recorded in their notes – that patients’ inhaler technique is observed and demonstrated at every opportunity, and that they use the inhaler videos from Asthma UK to inform patients.

Practices should also perform an audit of reliever medications used per patient, make sure reliever inhaler use is captured at every asthma review and exacerbation, and set up a system for flagging up reliever overuse.

Patients’ preventer adherence should be captured at every asthma review, as should exacerbation, and people with asthma should be directed to Asthma UK at every opportunity, especially at diagnosis.

I’d also encourage practices to make use of social media to provide ongoing education and support for people with asthma.

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