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How to cope after an asthma attack

Karen Newell
MSc BA(Hons) RGN AsthmaDip
Specialist Asthma Nurse, Asthma UK

Carol White
RGN Asthma Dip
Specialist Asthma Nurse, Asthma UK

Asthma UK research this year revealed that one in four people who have had to seek emergency treatment for an asthma attack receive no information about follow-up treatment at all.(1) This is a worrying statistic given that the charity estimates that 75% of hospital admissions are preventable(2) and that experts say that one of the outcomes of asthma management should be that patients have virtually no need for unscheduled healthcare. Healthcare professionals have an important role to play in helping people with asthma to achieve this outcome, so how can they best achieve this, and what is Asthma UK doing to support them?
The healthcare professional and the patient need to work together to understand the patient's condition, including appropriate treatments, trigger avoidance and written information to guide the patient. The healthcare professional's role is one of education; listening to the patient and putting them at the centre of the process is important so they are able to understand their asthma and know what to do when their symptoms worsen. The need for this kind of information is highlighted by the type of calls made to the Asthma UK Adviceline; 30% of those who call to speak to an asthma nurse specialist do so because they are experiencing symptoms and are unsure what action to take.

Asthma management
Training for the healthcare professional is an essential part of asthma management. The British Guideline on the Management of Asthma states that: "In primary care, people with asthma should be reviewed regularly by a nurse or doctor with appropriate training in asthma management."(4) These regular, scheduled reviews with a trained healthcare professional can be used over time to build up a written personal asthma action plan for a patient that provides them with the written information that is key to helping them understand their condition and be in a position to self-manage. Asthma UK currently estimates that only 24% of people with asthma have a written personal asthma action plan.(3) This is despite campaigning by the charity and acknowledgement in the British Guideline on the Management of Asthma that: "Written personalised action plans as part of self-management have been shown to improve health outcomes for people with asthma."(4)
During a scheduled asthma review, the healthcare professional needs to look at the ways that asthma is affecting the patient's life, identify triggers and how to avoid them, show the patient what to do to prevent symptoms getting worse, talk to them about asthma medicines and check their inhaler technique. Asthma UK's Be In Control materials support healthcare professionals in formulating a healthcare plan over time for patients that helps them to take control of their asthma. Reviewed by a specialist expert panel and tested with people with asthma, the pack includes a personal asthma action plan, an asthma medicine card, a peak flow diary, and information on making the most of your asthma review and how to use the Be In Control materials guide for healthcare professionals.
There may also be times when patients need additional reviews to adapt their treatment to lifestyle or environment changes. Children, for example, may need to have their medication reviewed as they get older,  and young people who are about to start university may need to make changes to adapt to their new lifestyle away from home. People who are affected by seasonal changes will also need to be prepared in advance for changes in temperature and increases in pollen or viruses, and people who are going on holiday may need to adapt their medication to cope with the different environment or particular activities.

Support for healthcare professionals
Extra support for patients and healthcare professionals can be provided by the Asthma UK Adviceline, which is staffed by asthma nurse specialists. For patients who have difficulty in accessing care because of language difficulties, the Adviceline offers an interpreting service that allows people with asthma to talk to a specialist asthma nurse in the language of their choice via an interpreter. People with asthma can also contact an asthma nurse by email via the Asthma UK website. Frequently Asked Questions are available in 18 languages on the website, and English Frequently Asked Questions are available in Braille, on audio CD and tape or as a download from the website.

Emergency care
The majority of people with asthma should be able to live symptom-free if their asthma is well managed. Currently, however, Asthma UK estimates that there are still more than 69,000 hospital admissions for asthma every year.(5) This figure does not include those who seek emergency care for their asthma at their local surgery or walk-in clinic or those who are treated at the emergency department but are not admitted. According to the British Guideline on the Management of Asthma, one in six people who go to hospital because of an asthma attack need emergency treatment again within two weeks.(4) To address this issue, Asthma UK has launched a long-term project to improve emergency care and follow-up for people with asthma. The first stage of the project has been launched to tackle this problem and includes two new booklets for patients, After Your Asthma Attack and After Your Child's Asthma Attack, which have been developed to support healthcare professionals in primary and secondary care to provide the consistent treatment pathways that are essential to prevent asthma attacks.
After Your Asthma Attack and After Your Child's Asthma Attack have been produced by Asthma UK in response to feedback from both healthcare professionals and people with asthma. They can be given to patients who have been treated for an asthma emergency to ensure that they receive the appropriate care and to help them get their asthma back under control following an attack.
They include:

  • A section for the healthcare professional to fill in that shows what medicines the patient should be taking in the first few days after the attack.
  • Information on what care the  patient should expect during an asthma attack.
  • Information on what the patient can do to keep their asthma under control and prevent another attack.
  • A tear-off Asthma Attack Card for the patient to keep with them so that they, their family and friends know what to do should they have another attack.

The booklets complement the educational skills of the healthcare professional, while empowering people with asthma with the information that they need to ensure that they avoid further asthma attacks in the future. They stress that people with asthma need to make a follow-up appointment with their doctor or asthma nurse within 48 hours of an asthma attack and another one within two weeks to make sure they get their symptoms back under control. They also highlight that it is important that they then continue to work together with their doctor or asthma nurse, with the help of regular reviews and a personal asthma action plan, to keep their asthma under control and avoid another attack.
As a result, patients who might otherwise have continued only to seek emergency care for their asthma will be empowered with the knowledge and treatments they need to self-manage their condition.
 
Conclusion
It is Asthma UK's hope that these booklets, along with the Be In Control materials and the Asthma UK Adviceline, will support healthcare professionals in reducing the number of people with asthma needing unscheduled healthcare. With regular reviews and a written personal asthma action plan, the patient should not need unscheduled emergency care for their asthma.

References

  1. Asthma UK. National Asthma Panel. 2005.
  2. Anon. Cash limits mean asthma remains a neglected disease. Primary Care Report Partridge M 1991: Self care plans for people with asthma. The Practitioner 2000;235(1507):715-18,721.
  3. Asthma UK. National Asthma Panel. 2005.
  4. British Guideline on the Management of Asthma. Available from URL: http//www.brit-thoracic.org.uk/asthma-guideline-download.html
  5. Department of Health. Hospital episode statistics. Scottish Morbidity Record, Information Statistics Division; Health Solutions Wales; Hospital Inpatients System, Department of Health, Social Services and Public Safety.

Resources
Asthma UK
W:www.asthma.org.uk

National Respiratory Training Council
W:www.nrtc.org.uk

Respiratory Education and Training Centres
W:www.respiratoryetc.com

British Guideline on the Management of Asthma
W:www.brit-thoracic.org.uk/asthma-guideline-download.html