Important Information
| Good asthma review | Patient education and self-management |
Difficult asthma |
| Undertake structured proactive clinical reviews. Consider undertaking reviews by telephone for those patients who cannot attend regularly | Be aware of those with complex needs, e.g. ethnic minorities, socially disadvantaged groups, adolescents and the elderly | Defined as persistent symptoms and/or frequent exacerbations despite treatment at step 4 or 5. |
| Maintain register of asthma patients using READ codes to ensure meaningful data collection | Provide self-management advice focusing on individual needs | Identify mechanism of persisting symptoms and assess adherence to treatment |
| Clinical review should be structured and should use a standard recording system. | Give specific advice on recognising loss of asthma control | Difficult asthma is commonly associated with poor adherence to maintenance treatment and coexistent psychosocial morbidity |
| Use of standard recording systems helps prompt for causes of sub-optimal control such as poor inhaler technique, under-treatment, poor adherence. Check Inhaler technique and record lung function | Summarise actions required if asthma control deteriorates and include information on how to seek help, the role of oral steroids and how to safely increase medication | Refer for specialist advice |
| Patient education and understanding of the role of medication is important to aid compliance and concordance. Use written asthma action plans | Self-management will only achieve better health outcomes if the prescribed asthma treatment is appropriate and within recommended guidance | |
| Practices should ensure that there is a robust local notification system for hospital discharge, (ideally within 48 hrs), such that they can facilitate early practice-based review. This review will explore the reasons for the asthma exacerbation and review the patient's action plan | ||