Abstract

COVID restrictions forced working from home in 2020. A primary care respiratory specialist nurse saw an opportunity to complete asthma telephone consultations with patients that previously regularly DNA their reviews. A search was completed on patients overusing their SABAs and under using their ICS. Twenty-five patients were selected for review.
The issues found:
Twenty-patients didn't have a peak flow meter, were underusing using their ICS and overusing their SABAs. All twenty-five had a poor understanding regarding their condition and treatment. Some patients took convincing to monitor their peak flow but with a little persuasion all agreed. An in-depth asthma review was taken.
Let's get modern: On review of symptoms, PF and SABA use all twenty-five patients agreed to switch to the MART plan. Time was given to explain this strategy in depth.
Patients are given a personal choice of device. The MART plan was designed around the device. Each patient was followed up after one-week to check for any issues with their inhaler or treatment pathway. They were all given reassurance they could inform us if they felt the plan was not for them otherwise, they would be reviewed six and twelve weeks later.
Results/The Future: Twelve-weeks later each patient was re-assessed. Three patients remained very uncontrolled. They were reviewed in the surgery for FeNO measurement. Each patient had a high FeNO. Additional ICS was added (per our secondary-care consultant recommendation) with their MART plan.
Twelve-weeks later the additional ICS was not required by two patients. The third patient required a longer length of additional ICS. The remaining patients had a stable PF, importantly a stable maintenance pathway. The SABAs had gone!
Twelve months later all twenty-five patients remain well on the MART plan.
The AZ Asthma data extraction dashboard now supports us finding uncontrolled patients more efficiently.