Author: Dr Andy Whittamore, In-house GP at Asthma UK
It is frustrating for all of us that we don’t get more time to explain symptoms, diseases and treatments, or to work through self-management strategies with our patients.
Asthma as a condition doesn’t fit well into recent models of care provision. We routinely invite people with asthma for an annual review at a time that’s convenient for the NHS but is rarely in line with the needs or wants of the patient. These reviews are often centred on targets which bear little relevance to patient outcomes.
Between annual reviews, a person might have several fluctuations of their asthma but not seek review unless they deem themselves ‘ill enough’ to need help. An annual test – whether it’s the RCP 3 Questions, Asthma Control Test, peak flow, spirometry or FeNO - does not tell us how someone has been throughout the year. Even reliever use across the year can fluctuate, so we may never find out when someone has been at risk of a life-threatening asthma attack.
Technology and asthma
In the near future, we expect digital technology in the form of smart inhalers and apps to monitor and support people with asthma better. Smart inhalers are already starting to be piloted in small settings, and we expect these to be more widely available in future years. In the meantime, we can all make better use of the technology and resources that most of us already have access to.
Give your patients homework! We know that patients don’t always take in all the information we give them, or know what to do if they have an asthma attack. Sharing our advice pages can save you time in the consultation and give your patients access to information whenever they need it. Certified by NHS England, Asthma UK’s resources are clear, evidence-based and up-to-date and will reinforce the self-management messages that you want to share.
Most GP surgeries use IT systems that can send emails or text (SMS) messages to individual patients or groups. These can include links to Asthma UK online resources to supplement the care you provide.
10 ways to improve care for people with asthma
- Before the appointment: Send patients a link to help them understand how to get the best from their asthma review.
- Care plans: Spend valuable time discussing self-management and working through a written asthma action plan, which you can download here. Practices using EMIS can do this digitally (see our how to guide), so you can save an action plan directly to the patient’s notes and share it by email.
- Inhaler technique: Reinforce your messages by directing your patient to these Asthma UK videos demonstrating correct technique for many of the most common inhalers.
- Triggers: Refer your patient to our triggers page so they can understand how to minimise the effect on their asthma.
- Key moments: The points in your patient’s journey when education is important are often the same times when they feel most overwhelmed. Providing links to relevant webpages can take away that stress.
- Diagnosis: During the diagnosis process, provide links to our Understanding asthma and Diagnosing asthma pages.
- Children: There are specific pages for parents about Asthma in children.
- Exacerbation: After an exacerbation, share the ‘What to do after an asthma attack' page.
- Referral: Details about specialist asthma care and possible tests.
- Seasonal campaigns: Send group SMS/email links to help people prepare for key peaks in asthma attacks such as hay fever season, colds and flu, or preparing to go back to school.
- SABA requests: Direct anyone requesting a reliever inhaler to our worsening asthma symptoms advice page. You could do this by SMS/email, by including the website on their prescription or even within the medication directions. You may also want to remind them how to use their inhalers.
- Personalised monitoring: Follow patients up by text or email. Ask them about their symptoms or medication use, and send them the RCP 3 Questions or Asthma Control Test to complete.
- Social media: Encourage all your asthma patients, carers and healthcare professionals to follow us on Facebook or Twitter for regular tips, weather and air quality alerts, and a supportive network.
- Asthma UK Helpline: Patients can contact our expert nurses on 0300 222 5800 (option 1) or visit our contact page for other ways of getting advice.
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Dr Andy Whittamore is a GP based in Hampshire, specialising in respiratory care. He’s Asthma UK’s in-house GP, where he works on building relationships with key opinion leaders in respiratory care, identifying emerging issues in asthma, and providing the charity with clinical expertise.