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Monitoring adult asthma in primary care

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Authoring team

In primary care, people with asthma should be reviewed at least annually by a nurse or doctor with appropriate training in asthma management.

  • when assessing asthma control use closed questions e.g. “do you use your reliever (blue inhaler) every day?” which is likely to yield more useful information
  • review should incorporate a written action plan
  • healthcare professionals should be aware that the best predictor of future asthma attacks is current control (1)
    • patients with good control of symptoms with treatment have a lower risk of exacerbation
    • in contrast, patients with poor lung function and with a history of exacerbation in the previous year may be at greater risk of future exacerbation for a given level of symptom. Hence closer monitoring of these individuals should be considered

The factors that should be monitored and recorded include:

  • symptomatic asthma control: best assessed using directive questions such as the RCP ‘3 questions’ or the Asthma Control Questionnaire or Asthma Control Test, since broad non-specific questions may underestimate symptoms
  • lung function, assessed by spirometry or by PEF. Reduced lung function compared to previously recorded values may indicate current bronchoconstriction or a long term decline in lung function and should prompt detailed assessment. Patients with irreversible airflow obstruction may have an increased risk of exacerbations
  • exacerbations, oral corticosteroid use and time off work or school since last assessment
  • inhaler technique
  • adherence, which can be assessed by reviewing prescription refill frequency
  • bronchodilator reliance, which can be assessed by reviewing prescription refill frequency
  • possession of and use of self management plan/personal action plan (1).

Notes:

  • UK has one of the worst asthma death rates in Europe, with the rate of people dying from an asthma attack increasing by more than 20% in five years (2)
    • Asthma UK's analysis of the most recent Europe-wide figures from 2011 to 2015 found that:
      • rate of asthma deaths in the UK has increased by more than 20% in five years, with figures from 2015 showing 1,434 people died from an asthma attack
      • UK's average asthma death rate over five years is worse than countries such as Greece, Italy and the Netherlands - and it is almost 50% higher than the average death rate in the European Union

  • National Review of Asthma Deaths revealed two thirds of asthma deaths could have been prevented with basic asthma care (3)

Reference:


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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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