This site is intended for health professionals only

Working on the asthma helpline: a personal view

Katherine Shepherd
BSc(Hons) Health Studies RGN NARTC Dipl Asthma Care
Helpline Nurse National Asthma Helpline

It is a frosty but bright, clear morning and I am on my way to the National Asthma Campaign's headquarters in London to work a bank shift on the Asthma Helpline. The National Asthma Campaign is an independent charity dedicated to conquering asthma and improving the quality of life for people with asthma through research, campaigning and offering help and advice. The Asthma Helpline was set up by the charity in October 1990. A team of asthma nurses provide this service, offering independent and confidential advice, information and support every weekday from 9am to 7pm, receiving an average of 320 calls a week.
We are all asthma nurse specialists on the Helpline and work according to the UKCC Code of Professional Conduct(1) and the British Asthma Guidelines.(2) We come from various nursing backgrounds. At the time of drafting this article, I was working as a practice nurse in Basingstoke, doing the occasional bank shift on the Helpline in my spare time, but now I am working full-time at the Helpline, covering for a nurse on maternity leave. The service is confidential - none of the callers can be traced, calls are not recorded and callers do not need to disclose their names. 
It should be understood that the Helpline is not an emergency service but offers support and information. This is why the service is provided weekdays only and not 24 hours a day. However, occasionally the inquirer does need emergency treatment. Although I have not experienced this personally, colleagues have had to advise people to dial 999. Unfortunately, we do not often get to hear of the outcomes of such events, which can be frustrating, although this type of call is the exception rather than the rule.

11.30 As I have not worked on the Helpline for a month one of the other nurses briefs me on what has been happening within the organisation and shows me the new Point of Diagnosis booklets (which can be obtained from the National Asthma Campaign). These are available to general practices. The two booklets, one for adults and one for children, are intended for use with people newly diagnosed with asthma.

11.45 I take my first call of the day, which is quite typical for this time of year. A 50-year-old woman has a cold that has caused an exacerbation of her asthma. She normally takes beclomethasone 100, two puffs twice a day, but has increased it to four times a day as advised in the self-management plan prescribed by her GP. She is taking her salbutamol every four hours but feels that she needs it more often. Her peak flow is normally 500 but is now only 300. She is reluctant to see her GP as she fears that he will prescribe a course of oral prednisolone. I discuss the advantages of taking a short course of oral steroids and try to reassure her that this might be the best way to get her asthma back under control. She seems to be satisfied with this and rings off. This call has lasted 20 minutes.

12.07 Although my caller has rung off I still need to log details of the call, such as gender of the caller, whether or not they themselves have asthma or their relationship to the person who has asthma, what their call was about, and to whom they were referred (eg, GP or practice nurse). This information can be useful as it helps us monitor common worries that the Campaign may be able to address. I also send her some of the Campaign's literature.

12.18 My next caller is a teacher who is after facts and figures about asthma. She particularly wants to know which areas of the UK have the highest incidence of asthma. However, I have to advise her that nobody has yet researched this and that this might be because what triggers asthma in one person may not in another. She then says that surely the incidence of asthma is greater in cities because of pollution. I advise her that many things found in the countryside such as rapeseed, tree moulds and pollens can be as much a problem as pollution for some people with asthma. I arrange to send her a copy of the Asthma Audit 2001 Summary.(3)

12.50 Time for a quick sandwich, having just finished speaking to the mother of a nine-year-old girl who has had asthma since she was a baby. Her daughter desperately wants a dog and her mother wants to know which breed is best for people with asthma. We are asked this question a lot and, as a dog owner myself, I always feel disappointed for the caller when I have to tell them that I am unable to recommend a particular breed of dog. I explain that it is the dander, not the hair, of the dog that tends to trigger asthma. I suggest perhaps a goldfish as a pet but agree that you cannot cuddle or stroke a fish.

13.27 My phone is ringing again. It is the mother of four- and six-year-old children who have been newly diagnosed with asthma. Many callers are either newly diagnosed as having asthma themselves or have relatives or friends in this position. Often reassurance and information is all that is needed. Sometimes the person is in denial that they have asthma, and by asking how the diagnosis was reached, explaining what asthma is, and discussing the medication and its effect, we can often help them come to terms with their condition. I also discuss with this caller how she might manage her children's asthma on a daily basis. The call lasts 30 minutes - on the Helpline we all realise that this is a luxury that GPs and asthma nurses are unable to give.

14.00 I come offline to attend the group clinical supervision session. This is held once a fortnight for the permanent members of the Helpline. We have the opportunity to discuss calls that may have been difficult, and how we might deal with them in the future. As a bank nurse, my clinical supervision sessions are not so regular but I find it very useful.

15.45 Having had a break I am back online. It's not long before the phone is ringing again. This time it is a 33-year-old man who has been recently diagnosed with asthma and is after some general information. We talk through his diagnosis and treatment and I arrange to send some of the Campaign's literature.

16.13 I take another typical call from the mother of a newly diagnosed six-year-old who has been using beclomethasone for two days but is concerned that her child's asthma is not improving. I check that she has been taught how to use the device correctly - a metered-dose inhaler and spacer in this case - and explain that beclomethasone is a preventive medication and can take up to two weeks before reaching its optimum efficacy. Fortunately the child has also been prescribed a b2-agonist (which is not always the case). I explain that this is a relieving medication and confirm with the mother that this is happening.

17.30 As is often the case at this time of day, the line has gone quieter. Mothers are preparing meals and others are preparing to go home from work. I now have time to tackle one of the many letters the Helpline receives from both the UK and abroad. Sometimes a member of the Press Office will appear needing verification about an aspect of asthma care or treatment. Sometimes we can get a lot of calls about items in the news that may be affecting asthma. This summer we received a lot of calls about the effect of Mount Etna erupting, and these quieter times can be used to conduct some research into these matters. This is what makes the job interesting.

18.31 I take my last call of the day from a 44-year-old man who is unhappy at having to pay for his prescriptions. Unfortunately I am able only to sympathise with him and agree that it is unfair.

19.00 The Helpline closes and I prepare for my journey home. Before working on the Helpline I misunderstood its purpose. I think that I regarded it more as an emergency service for people rather than as a source of information and support. I now make sure that all those attending my asthma clinics are aware of it. I advise those who have been newly diagnosed to either call the Helpline for information booklets or, if they have access to the internet, I give them the website address so that they can download the information. Sometimes I refer people to the Helpline if they are having difficulties coming to terms with the diagnosis so that they can have an independent opinion - this is particularly useful when inhaled steroid treatments are needed.

References

  1. UKCC. Code of Professional Conduct. London: UKCC; 2000.
  2. British Asthma Guidelines Coordinating Committee. British guidelines on asthma management: 1995 review and position statement. Thorax 1997; 52(Suppl):S1-24.
  3. National Asthma Campaign. Asthma Audit 2001. London: NAC; 2001.

Resource
National Asthma Campaign
Asthma Helpline
T:08457 010203
T:020 72262260
W:www.asthma.org.uk