Asthma reviews: an essential part of good care
Asthma reviews are essential in asthma management. Heather Henry provides a reminder of the essential topics to cover when conducting an asthma review
Asthma reviews are an essential part of long-term conditions management in general practice. An assessment of asthma control will help practice nurses to prioritise frequency and effort, but caution must be taken to not overlook those with poor control who do not seek help and/or do not adhere to treatment. Asthma reviews are an opportunity to assess, review and collaborate on clinical and self-management. Empathic communication and shared decision-making are key to relationship building.
People with asthma of any age need a structured review conducted by a health professional with expertise in asthma care at least once a year (British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN), 2019). People who have had a recent hospital admission for asthma also need a review within 48 hours (National Institute for Health and Care Excellence (NICE), 2022).
The period during and after the COVID-19 pandemic has been particularly challenging for primary care and specialist respiratory services. In their 2020 survey, Asthma UK (now Asthma and Lung UK) reported that basic asthma care levels – comprising an annual asthma review, an inhaler technique check and a written asthma action plan – have dropped by nearly 5%, and 40.1% of respondents had uncontrolled asthma.
Primary care nurses, therefore, face a major challenge of addressing a backlog of work created by the pandemic and at the same time ensuring that they meet Quality and Outcome Framework (QOF) requirements (Box 1). NHS England (2022) guidelines remind primary care practitioners of the variability of asthma symptoms and that it is inappropriate to monitor symptom free patients on minimal or no therapy. It advises that the frequency of prescription requests for those people be checked and then a decision can be taken by the practice on whether to remove them from the asthma register. However, patients with uncontrolled asthma who do not adhere to their treatment could be missed and may experience an asthma attack. BTS/SIGN (2019) guidelines advise clinicians to target care at those with poor symptom control and an increased risk of asthma attacks. Good knowledge of the patient population and assessment of social and environmental risks (Box 2), as well as clinical risks, are important.
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