IN life it’s always good to have a plan. Asthma is no different.
The good thing about asthma is that if managed correctly, symptoms can often be completely reversed. Unfortunately, if not managed well, symptoms can deteriorate quickly leading to hospital admissions or worse.
Self-care is key to managing a chronic disease like asthma. Coaching people on how to self assess the progression or regression of their symptoms through a written plan is very helpful, and allows the person to take some control over their own care. Concordance is defined as the agreement of both patient and practitioner in how to proceed with care. A personalised written asthma action plan can help achieve concordance.
A typical written asthma plan will include the following components:
- A brief description of the inhalers to be used. A note is made here about the difference between the reliever and preventer inhalers.
- Some detail around the number of puffs of each inhaler to be used and when.
- Information on how to assess symptoms (such as peak flow variations).
- What to do if symptoms suddenly get worse: how long to maintain increases in inhaler use, and when to return to maintenance levels.
- Information on when to seek urgent help in an emergency.
- How often to attend review at the local respiratory clinic.
The guidance for the management of asthma (SIGN 141) recommends that every asthmatic patient should have a written personal asthma action plan (PAAP). Indeed more than this, the evidence for the use of PAAPs with asthmatics according to SIGN 141 is grade A.
The national review of asthma deaths (NRAD) says the following statement about personal asthma plans: “There is strong research evidence of the effectiveness of PAAPs. In only 44 (23%) of the 195 patients who died was there a record of them having been provided with a PAAP in either primary or secondary care.
“For 65 of the 195 patients who died (33%), there was no record of them seeking medical assistance during the final attack; 11 (17%) of these had been provided with a PAAP. A further 22 patients sought medical assistance but died before treatment could be administered, of whom eight (36%) had been provided with a PAAP. This suggests a need for improved advice for patients on the recognition and emergency self-management of asthma attacks. Wider use of PAAPs has the potential to prevent death from asthma by increasing the number of people who take appropriate action and seek help.”
The lessons from NRAD are far reaching for all those involved in the care of asthmatics. It occurs to me that PAAPs are a very straight forward way to instruct the patient how to self manage. At no time is this more important than as their condition deteriorates.
A patient that knows what to do as their condition deteriorates is less likely to have the most severe of outcomes.
In community pharmacy we often check steroid, lithium or warfarin books to check that appropriate monitoring is taking place. Perhaps adding the personalised asthma plan to this list as we dispense might just save a life.
Johnathan Laird is a GP pharmacist independent prescriber with a special interest in asthma. He is based in based in Aberdeenshire.