Asthma Resources

Peak expiratory flow rate (PEFR) is the volume of air forcefully exhaled at maximum speed. This can be measured using a peak flow meter or a spirometry device. Peak flow meters are portable, inexpensive and widely available. The technique is non-invasive, carries no risk to the person, can be taught and learned quickly, and can easily be mastered by the patient. Published evidence for the use of peak expiratory flow rate (PEFR) and peak flow monitoring in asthma is limited, despite the use of the peak flow meter being documented in national and international guidelines for many years. National and international guidelines recommend the use of easily calibrated spirometers, which can provide accurate results
with good technique, along with fractional exhaled nitrous oxide (FeNO) testing, which requires a greater analysis and interpretation of the results. Is the use therefore of the peak flow meter redundant? This article discusses the indications for use of peak flow meters, technique and clinical context.

Asthma is an inflammatory condition which leads to narrowed and hyperresponsive airways. In recent times, the standard approach to managing asthma has been to use an inhaled corticosteroid (ICS, the preventer) to dampen down the inflammation and a short-acting bronchodilator (the reliever) to open up the airways if the person with asthma needed symptom relief. If the preventer inhaler is doing its job, the reliever should not be needed more than three times per week. The British Thoracic Society/Scottish Intercollegiate Guidelines Network guidelines currently reflect this approach (BTS/ SIGN, 2019), but later this year these guidelines will be updated based on a collaboration with the National Institute for Health and Care Excellence (NICE). NICE previously published its own asthma guidelines, which were controversial in terms of their recommendations, with a focus on using preventer therapy if a reliever was needed three times a week or more, rather than prioritising the use of anti-inflammatory treatment for an inflammatory condition. It will be interesting to see what the joint recommendations will be. In the meantime, many clinicians with an interest in asthma management are looking to the Global Initiative for Asthma recommendations for a fresh approach to asthma management (GINA, 2023).

Here, Laura King, senior asthma practitioner, North-East London, explains why the time is now to pre-emptively act to avoid asthma attacks, which commonly peak in children and young people during mid-September.

The national care bundle for children with asthma is the first phase of a national plan to improve asthma care, focusing on integration of systems and effective communication. It follows several high-profile reports, national and global guidelines, with the aim of training clinicians to consistent standards, keeping children and young people (CYP) with asthma well, improving diagnosis, patient pathways and encouraging self-management. This article, the second in a two-part series, explores practical ways to implement the bundle in clinical practice and how to meet its requirements.

This article introduces the NHS England national care bundle for children with asthma, the main themes, and what is expected of clinicians in primary care. This is the first phase of a national plan to improve asthma care, with a focus on integration of systems and effective communication. It follows several high-profile reports, national and global guidelines, with the aim of training clinicians to consistent standards, keeping children and young people with asthma well, improving diagnosis, patient pathways and encouraging self-management. It explores the main themes of the asthma care bundle, and what it means for clinicians across the spheres from primary through to tertiary specialist care.

The Asthma+Lung UK helpline takes more than 1,000 calls a month from people who are struggling with their asthma and need advice and support to manage their symptoms. Asthma is a common lung condition affecting 5.4 million people in the UK, and is more prevalent among women than men (https://ukdataservice.ac.uk). The charity’s recent analysis finds that women are, shockingly, almost twice as likely to die from an asthma attack than men (Asthma+Lung UK, 2022).

#AskAboutAsthma is an annual awareness campaign that takes place in September. Now in its sixth year, the campaign is about making simple changes to children and young people’s care that will make a big difference to how they experience their asthma. Primary care clinicians are critical to making these changes, with general practice nurses (GPNs) playing a vital role.

The National Review of Asthma Deaths (NRAD) (Royal College of Physicians [RCP], 2014) identified many shortcomings in the way that asthma care is delivered, citing preventable factors in 90% of asthma deaths. Among deaths in children, poor recognition of risk of adverse outcome was found to be an important avoidable factor in 70% of deaths in primary care, rising to 83% in young people (RCP, 2014). The challenges of the pandemic over the past 18 months have arguably compounded the difficulties in providing good asthma care, with asthma reviews necessarily being managed in different ways, largely undertaken remotely. To further prevent avoidable deaths, it is important that primary care nurses are confident and competent in undertaking remote asthma reviews so that risks of adverse outcome are identified and effectively managed. As highlighted by the NRAD, parents/carers and children should be taught ‘how’, ‘why’ and ‘when’ to use their asthma medication, be able to recognise when asthma is not controlled, and know when to seek emergency help. This article gives a structured approach to undertaking a remote asthma review with children so that good asthma control and better outcomes can be achieved.

Some clinical issues never seem to reach the top of clinical or health policy priority lists, and asthma is one of them. The International Primary Care Respiratory Group (IPCRG) has initiated a social movement, Asthma Right Care, to disrupt this. For us, right care means doing the right things and only the right things in the right way for the right people at the right time in the right place, whatever that means in the local context. This piece summarises what we have learnt, what tools we have created, and what progress we have made. It invites you to join the Asthma Right Care movement by committing to have a different conversation about asthma with at least one colleague and person with asthma.

Hay fever and allergic rhinitis are common conditions seen in primary care which can have a huge effect on the quality of life of sufferers The most important step in diagnosing hay fever or allergic rhinitis is to take an allergy focused clinical history. There are many treatment options available, including allergen avoidance, antihistamines and nasal corticosteroids. Many medications are now available over the counter; patients need to know how to take their medication correctly. Asthma frequently co-exists with allergic rhinitis and can make asthma symptoms much worse. General practice nurses (GPNs) are ideally placed to offer advice and support to these patients. If initial treatments fail, patients should return to primary care as there are a wide range of therapeutic interventions which may help. For those whose symptoms are very severe or not responding, immunotherapy may be an option, and the patient should be referred.