SECTION 2:

The core components of an asthma review are:¹

• Current symptom control
  • Bronchodilator use
  • Validated symptom score
  • Time off work/school due to asthma

Asking general questions such as ‘how is your asthma today?’ is likely to result in a non-specific answer, such as ‘I am OK’.¹ Most practices use the Royal College of Physicians ‘3 Questions’ – as this is specified in the Quality and Outcomes Framework – but symptomatic asthma control is best measured using validated questionnaires, such as the Asthma Control Test (ACT), or Childhood Asthma Control Test (C-ACT) for children under 11 years.²

ACT includes four symptom/reliever questions plus a patient self-assessed level of control, which together provide a score: >20 represents good symptom control, 16–19 means not well controlled, and ≤15 is very poorly controlled.²

Measure FEV1 at start of treatment, after 3-6 months of controller treatment to record the patient’s personal best lung function, then periodically for ongoing risk assessment.² In most adults, lung function should be recorded at least every 1-2 years, but more frequently in higher risk patients and in children based on asthma severity and clinical course.² Lung function does not correlate strongly with asthma symptoms in adults or children, but low FEV1 is a strong independent predictor of risk of asthma attacks.²

Patients with asthma who are unable to use their inhaler correctly are at increased risk of poor asthma control, potentially resulting in an attack.³ The NRAD report found that in the 135 cases where the last asthma review was recorded in primary care, 29% did not have an assessment of inhaler technique.³ Most patients (up to 70–80%) are unable to use their inhaler correctly. Unfortunately, many healthcare professionals are unable to correctly demonstrate how to use the inhalers they prescribe.¹ Inhaler technique should be checked at every opportunity – ask the patient to show you how they use their inhaler, don’t just ask if they know how to use it, and identify any errors using a device-specific checklist.¹

As part of the non-pharmacological management of asthma, BTS/SIGN highlights the importance of avoiding direct or passive exposure to cigarette smoke, which adversely affects lung function, need for rescue medications for acute episodes of asthma and long-term control with ICS.¹ People with asthma and parents/carers of children with asthma should be advised about the dangers of smoking and second-hand tobacco smoke exposure, and should be offered appropriate support to stop smoking.¹