Download Asthma Control Test™ (ACT)

Asthma Guidelines, Diagnosis
and Management
Alison Hughes
Respiratory Specialist Nurse
Solent NHS Trust
Definition of asthma
“A chronic inflammatory disorder of the
airways… in susceptible individuals,
inflammatory symptoms are usually associated
with widespread but variable airflow
obstruction and an increase in airway response
to a variety of stimuli. Obstruction is often
reversible, either spontaneously or with
treatment.”
Thorax 2003
• More than five million people in the UK are
being treated for asthma
• Many emergency admissions are believed to
be avoidable
• Many people who die from asthma had well
recognised identifiable risk factors
British Guideline on the
Management of Asthma
BTS/SIGN 2008
Updated 2011
The aim of asthma management is
disease control- this is defined as:
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No daytime symptoms
No night-time symptoms
No need for rescue medication
No limitations on activity, including exercise
No exacerbations
Normal lung function (in practical terms FEV1
and/or PEF <80% predicted or best) with
minimal side effects from treatment
Adult with symptoms that may be due to Asthma
Adults
Adults
Adults
Adults
Adults
Adults
Recommended daily doses
Assessment: Royal College of
Physicians of London three questions
IN THE LAST WEEK / MONTH
YES
NO
“Have you had difficulty sleeping because of your asthma
symptoms (including cough)?”
“Have you had your usual asthma symptoms during the day
(cough, wheeze, chest tightness or breathlessness)?”
“Has your asthma interfered with your usual activities
(e.g. housework, work, school, etc)?”
Date
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Page 24
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Applies to all patients with asthma aged 16 and over.
Only use after diagnosis has been established.
© Imperial College London
Outcomes and audit. Thorax 2003; 58 (Suppl I): i1-i92
Asthma Control Test™ (ACT)
1.
In the past 4 weeks, how much of the time did your asthma keep you from getting
as much done at work, school or at home?
2.
3.
During the past 4 weeks, how often have you had shortness
of breath?
During the past 4 weeks, how often did your asthma symptoms (wheezing,
coughing, shortness of breath, chest tightness or pain) wake you up at night,
or earlier than usual in the morning?
4.
During the past 4 weeks, how often have you used your rescue
inhaler or nebulizer medication (such as salbutamol)?
5.
How would you rate your asthma control during the past
4 weeks?
Copyright 2002, QualityMetric Incorporated.
Asthma Control Test Is a Trademark of QualityMetric Incorporated.
Patient Total Score
Score
Quality Outcome Framework (QOF)
• Current QOF indicators
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Asthma register
Annual asthma review
Confirmation of diagnosis
Smoking status of 14-19 year olds
• NO necessity to check inhaler technique or
measure lung function
• No necessity to measure asthma control
What do patients care about?
• No bad asthma days
• No restriction on their life
• PEF is not important to patients
What do we care about?
• No chronic symptoms
• No asthma attacks or emergency visits
• Minimal need for quick relief (as needed)
beta₂ agonists
• Patients can maintain normal physical activity,
including exercise
• Lung function as close to normal as possible
• Minimal (or no) adverse effects from medicine
Medication
• £1 billion spent on respiratory drugs- not
including antibiotics
• Respiratory items are the most expensive
category in the BNF
• inhalers
• Relatively low volume of respiratory
prescriptions
Source: NHS information Centre
Inhalers
• Seretide (all) is the most expensive drug
• Seretide 250 evohaler is the most expensive
individual item
• Symbicort 200 is the 5th most expensive item
• Of the top 5 costliest drugs to the NHS,
currently 3 are inhalers
Source: NHS Information Centre
Barriers for using inhalers
• Sub optimal communication between HCP &
patient
• Lack of opportunity to discuss fear of side
effects
• Patients under-estimate the severity
• Over-estimate their level of control
• Technique
• The most expensive inhaler is an inhaler not
taken correctly
• Could cost 50p per puff!
• The right inhaler and the right technique is
very important
• Devices such as the AIMS, in-check and 2-tone
can help
Resources
• Self management materials available free
from Asthma UK
• ‘Be in control’
• ‘My asthma material’
• Interactive inhaler demo
Asthma or COPD?
• Does the medication fit in with a diagnosis of
asthma?
• Could the patient have COPD but believe it’s
asthma?
• Portsmouth Hospital local guidelines
• Based on the NICE 2010 COPD guidelines
Differential Diagnosis
Questions