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Asthma (12 years +) 

Key Considerations

- Patients should have a yearly asthma review at minimum. 

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- All patients should have a written asthma control plan 

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- Frequent prescribing of relievers can indicate uncontrolled asthma â€‹â€‹

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- Dry powder inhalers may be unsuitable for patients:

    - with uncontrolled asthma or

    - who cannot breathe in through their mouth quickly and deeply

  This usually includes: 

  • frail, elderly patients

  • very young patients

  • those with muscle weakness

Other Considerations

- Patient preference should be factored in when making a decision on choosing which inhaler(s) to prescribe

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- Montelukast can be especially effective in patient's who suffer with allergies. However the patient should be informed of the risk of neuropsychiatric reactions. 

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- Patient's should be advised to rinse out their mouth with water after using ICS inhalers to help reduce risk of oral thrush

When to titrate up?

- Asthma is regarded as completely controlled when :

   Patient has an ACT score of 20-25

   no night-time/early morning symptoms

   Use of reliever maximum 2 times a week 

   No limitations to activities due to asthma 

   Normal lung function (in practical terms FEV1 and/or PEF>80% predicted       or best)

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If all of the above criteria are not met, then it is suggested to titrate up 

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You should review the patient 4 weeks after titrating up to check for inhaler technique, adherence to treatment and to repeat the ACT

asthma

If asthma is still not controlled, refer to specialist 

MART therapy can be considered as an alternative to the LABA + ICS combo & SABA. 

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Benefits of MART therapy can be: 

  • a reduction in the likelihood of asthma attacks and the need for hospitalisation,

  • increased adherence to asthma treatment,

  • requiring people with asthma to learn just one inhaler technique and pay for one inhaler

When to titrate down? 

Complete asthma control needs to be achieved for at least 12 weeks before attempting to step patients down

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Do not step down if in the past 6 months pt has had:

 - an exacerbation

 - an oral steroid course

 - a GP/hospital visit due to worsening asthma

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You should stop or reduce the dose of medicines in an order that considers:

  - the clinical effectiveness 

  - side effects

  - the patient's preference

Inhaler Technique

Please see link to videos which show the correct inhaler technique for different inhaler types​

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how to:

use a pMDI inhaler
use a Accuhaler inhaler
use a Spiromax inhaler
use a NEXThaler
use a Ellipta inhaler
use all other inhalers

Spacer devices 

- Should be prescribed to patients who find it difficult to use the correct inhaler technique  

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- A new spacer should be cleaned before it is used for the first time, then once a month afterwards.

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- Warm water and a detergent, such as washing-up liquid should be used for cleaning 

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- The spacer should be air-dried as this helps to reduce static and prevents the medicine sticking to the inside of the spacer. 

Safety netting 

You should safety net all patient's on what to do in case of an asthma attack/exacerbation.

 

   1. Sit up - try to keep calm.

   2. Take one puff of your blue reliever inhaler every 30-60 seconds up to 10 puffs.

   3. If you feel worse at any point OR you don’t feel better after 10 puffs, call 999 for an ambulance.

   4. If the ambulance has not arrived after 10 minutes and your symptoms are not improving, repeat step 2.

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If the patient is on MART therapy then advise the following. 

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  1. Sit up straight - try to keep calm.

  2. Take one puff of your MART inhaler every 1 to 3 minutes up to six puffs.

  3. If you feel worse at any point OR you do not feel better after six puffs call 999 for an ambulance.

  4. If the ambulance has not arrived after 10 minutes and your symptoms are not improving, repeat step 2.

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FAQ's
 
When should steroids be prescribed? 

Steroids are usually prescribed for acute exacerbations of asthma.

 

They are sometimes prescribed to patients in advance if they tend to have frequent exacerbations or are at a high risk of complications.

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In patients aged 12 years and above, prednisolone 40–50 mg once daily for at least 5 days should be prescribed.

What are the considerations for older adults?

Arthritis, muscle weakness, impaired vision, and inspiratory flow should be considered when choosing inhaler devices for older adults

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