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Monitoring adult asthma in primary care

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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