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Staying in control of asthma

Asthma is one of the most common long-term conditions in the UK, affecting 5.4 million people, or one in five households. 

Asthma is a complex condition that can start at any time of life and affects the airways - the small tubes that carry air in and out of the lungs. When a person with asthma comes into contact with something that irritates their airways (an asthma trigger), the muscles around the walls of the airways tighten so that they become narrower, and the lining becomes inflamed and starts to swell. 

Sometimes sticky mucus or phlegm builds up which can narrow them further. All these reactions cause the airways to become narrower and irritated - causing the symptoms of asthma which are coughing, wheezing, shortness of breath and tightness in the chest.

Every day, more than 200 people in the UK are hospitalised because of their asthma.1 Three of these people will die.2 An estimated 75% of hospital admissions for asthma are avoidable with the right care and management.3

What causes asthma?

People are more likely to develop asthma if they have a family history of asthma, eczema or allergies. It's likely that this family history, combined with certain environmental and lifestyle factors, influences whether or not someone develops asthma.

Many people think of asthma as a childhood problem, but in fact, it can appear at any age. Many people are diagnosed with asthma for the first time in adulthood. In older people, their symptoms are less likely to be triggered by allergies such as house-dust mites, animals and pollen. Symptoms are more likely to be triggered by: 

  • Flu, colds or other viral infections.
  • Exercise.
  • Laughing or getting excited.
  • Depression or anxiety.
  • Some medicines.
  • Irritants such as cigarette smoke, cold air, perfumes and chemical fumes.
  • Hormonal changes (in women).

Controlling asthma 

Asthma is a long-term condition, but with the right care and management, people with asthma can live full and active lives. Patients who are in control of their asthma should:

  • Have few or no symptoms during the day or night.
  • Have little or no need for their reliever inhaler.
  • Be able to exercise without problems.

However, according to our National Asthma Panel Survey, 73% of people with asthma did not have their symptoms under control.4 Most people experience worsening symptoms in the lead up to an asthma attack, so it's vital that patients and their healthcare professionals can recognise when their asthma is not under control. Worsening symptoms can include:

  • Needing more and more reliever treatment.
  • Waking at night with coughing, wheezing, shortness of breath or a tight chest.
  • Having to take time off work or feeling like they cannot keep up with normal level of activity or exercise.

There is a common misconception that asthma attacks only happen to people with severe asthma - but in fact, people with mild asthma can, and do, have asthma attacks which can result in hospitalisation and death.

Asthma UK recently revealed data showing that people with asthma considerably underestimate their risk of an asthma attack. More than half of people with asthma (52%) don't think they are at risk of an attack - but in reality, nine out of ten of those people have at least one risk factor.5 This means that half of all adults with asthma, or more than two million people in the UK, are unaware they are at increased risk of an attack.

Asthma management in primary care

Healthcare professionals have a crucial role to play in helping their patients to regain control and avoid asthma attacks. Good asthma care and management should include the following:

Written asthma action plans

Everyone with asthma should receive a written asthma action plan, so that they know what steps to take when their symptoms get worse. People without an action plan are four times more likely to end up in hospital with their asthma. Currently, only 12% of people with asthma say they have one. 

Regular asthma reviews

All asthma patients should have a review with their doctor or asthma nurse at least once a year, which can help them control their symptoms better, for example by discussing their 'triggers' and making sure inhaler technique is correct and that they are using their preventer inhaler regularly, as prescribed. 

Patients should have reviews every year, even if symptoms are well controlled, or more often if symptoms are difficult. Reviews should also be given a month or so after asthma medicines are changed and within 48 hours of a serious attack. Patients will also need another review one to two weeks after a serious attack to make sure their symptoms are under control. 

Peak flow measurement

Peak flow measurement, using a peak flow meter, is a useful self-management tool as it can tell someone with asthma what is actually going on in their airways and can help them recognise whether their medicine is effective. 

Healthcare professionals can show patients how to use their peak flow meter, encouraging them to know their 'best' peak flow and to monitor this regularly.

Improving standards of care

Earlier this year, the National Institute for Health and Care Excellence (NICE) introduced the first ever quality standard for asthma care, giving clear guidelines to healthcare professionals on how people with asthma should be treated. These have the potential to prevent asthma attacks that can lead to hospitalisation and death - but only if they are successfully applied.

Asthma UK has launched a campaign called Compare Your Care, urging Clinical Commissioning Groups in England to sign a pledge to implement the quality standard by 2016. As part of the campaign, Asthma UK will ask patients to take an online quiz to find out if their current asthma care corresponds with what they should be receiving. 

This aims to engage people with asthma in their own care and could help reduce the burden on the NHS and make it easier for GPs and asthma nurses to promote good self-management to their patients.

 

Resources

Asthma UK 

www.asthma.org.uk/hcp

0800 121 62 44

 

References

1.   Hospital Episode Statistics. Department of Health; Scottish Morbidity Record, Information Services Division, NHS Scotland; Health Services Wales; Hospital Inpatients System, Department of Health, Social Services & Public Safety Northern Ireland.

2. Office for National Statistics, General Register Office for Scotland, Northern Ireland Statistics & Research Agency.

3. Lahdensuo A, et al. Guided self management of asthma - how to do it. BMJ 319;7212 (1999): 759-60.

4. Asthma UK. National Asthma Panel 2010.

5. Triple A: Avoid Asthma Attacks Test results. Available at: www.asthma.org.uk (53,807 responses from 31 January 2012 to 4 April 2013).