Asthma is a chronic illness, frequently managed in primary care.
- In 2019/20, 6.5% of GP patients in England had asthma
- incidence of asthma is higher in children than in adults
- asthma accounts for 2-3% of primary care consultations and 60,000 hospital admissions/year in the UK.
The aim of this pathway is to ensure the effective monitoring of asthma, appropriate use of medication, and prevention/treatment of exacerbations.
Summary
Asthma is a chronic respiratory condition associated with inflammation and hyper-reactivity of the airways, resulting in breathing difficulties in patients. It affects people of all ages, and is characterised by variable and recurring symptoms, reversible airflow obstruction, and easily triggered narrowing of the airways.
An “acute asthma exacerbation”, commonly known as an “asthma attack”, refers to the onset of severe asthma symptoms that can be life-threatening.
There is no cure for asthma, but treatment and an asthma action plan, which includes monitoring lung function, avoiding triggers, and appropriately using medicines, can help patients manage it effectively.
Care pathway
This pathway is designed to assess the status of a patient’s asthma in order to effectively manage the condition and treat exacerbations appropriately.
1️⃣ Assess if appointment needed
Florey questionnaires will be sent to patients by the Head Office team via Accurx, asking them a few questions about their asthma. Once the patient responds, Reception will check the responses and action depending on the results.
- Open Accurx inbox and find the Florey inbox by going to: Sidebar → Floreys → Asthma (see Accurx for more information)
- Open the patient’s response
- Check the Asthma Control Test (ACT) score (last line in patient response box) and action using the colour-coded guide ⬇️
- Click button to ‘Save to record’ (in patient response box) and click ‘Done’ (in the top-right corner) once actioned
- Green (20-25) → patient’s asthma is controlled, current treatment can be continued and no review is needed
- Yellow (15-19) or red (5-14) → call the patient to book an appointment with the Nurse or Pharmacist F2F
Task HCA (or another member of the nursing team) to create or reissue a care plan for the patient
Explain what the appointment is for, advise the patient to bring all their inhalers to the appointment, ask the patient for their current smoking status and update on EMIS if the ‘Step 1c’ checkbox appears in the online list
ACT in green range
2️⃣ Send care plan
- Open the patient’s EMIS record & check for an existing care plan
- If there is an existing care plan that is still suitable for the patient’s current treatment, a new plan is not needed
- If there is no existing care plan, or if the patient has change medication etc., complete a new care plan
- Ensure that the care plan is saved to the patient’s record and that a copy is sent to the patient (whether new or old)
- Add codes for ‘Asthma annual review’ and ‘Asthma self-management plan review’
Use the template: ‘Asthma Action Plan - Adult Penrose Health’ or ‘Child Asthma Action Plan Penrose Health’
ACT in yellow or red range
2️⃣ Patient arrives for appointment
- Record that the patient has arrived in the appointment book
- Allow the patient a moment to relax before asking to capture data on height, weight, blood pressure, smoking status, and alcohol status (if possible) and add to patient’s EMIS record
3️⃣ Carry out review
- Open the clinical template: ‘Penrose Health - Asthma’ and complete both Observations and Control & Management pages
- Use RightBreathe for prescribing information
- Complete child/adult asthma action plan: ‘Asthma Action Plan - Adult Penrose Health’ or ‘Child Asthma Action Plan Penrose Health’
- Offer flu vaccine if eligible (i.e. asthma that require continuous or repeated use of inhaler or systemic steroids, or with previous exacerbations requiring hospital admission)
- Offer patient education and support in the community.
- Add a diary entry for the patient to have another review in 3, 6 or 12 months as appropriate
Be aware of the environmental effects of inhalers and understand options for patients → see NG80 Asthma inhalers and the environment patient decision aid (nice.org.uk)
- Refer through Consultant Connect, or
- Refer to service by boroughs
- Lewisham:
- Lambeth and Southwark: Single Point of Access e-Referral Service (e-RS) - use DXS Integrated Respiratory Service Referral Form
Resources for patient info/referral
Prevalence, risk factors & diagnosing
- NICE Guideline (NG80) - Asthma: diagnosis, monitoring and chronic asthma management
- NICE - Asthma: What are the risk factors?
- Improving asthma outcomes in the UK - House of Commons Library (parliament.uk)
- CESEL Guidelines - Adults & CYP