1.2 Diagnosis and day-to-day management of uncontrolled asthma
The National Institute for Health and Care Excellence (2020) defines uncontrolled asthma as:
asthma that has an impact on a person’s lifestyle or restricts their normal activities. Symptoms such as coughing, wheezing, shortness of breath and chest tightness associated with uncontrolled asthma can significantly decrease a person’s quality of life and may lead to medical emergency.
Uncontrolled asthma is determined by having symptoms for three or more days per week, having to use a ‘short-acting beta antagonist’ (SABA) (reliever) inhaler such as salbutamol for three or more days per week or waking up from sleep once or more in a week. For an occasional wheeze or asthma that is considered ‘controlled’ (i.e. it does not meet these criteria), a SABA might be the only course of treatment required. Inhaled corticosteroid (ICS) (preventer) inhalers are recommended for children and young people if they meet these criteria or if they have had an asthma attack in the preceding two years (British National Formulary, BNF, 2019). Preventer inhalers build up asthma protection over time by reducing inflammation in the lungs.
Activity 3 Having asthma
Listen to Audio 1.
Look through the diagnosis and treatment sections of theand conduct your own internet search on the diagnosis and treatment of asthma. Remember, to avoid losing your place in the course, if you are studying on a desktop you should open the link in a new tab or window by holding down Ctrl (or Cmd on a Mac) when you click on it. If you are studying on a mobile device hold down the link and select to ‘Open in New Tab’. Then return here when you have finished.
Make sure you are familiar with the advice on managing an asthma attack and then complete the next part of this activity.
In the audio you heard a parent talking about their experience of having a child diagnosed with asthma and some of the day-to-day considerations. Using the clinical guidance and what you have found from your own internet search, indicate the type of advice you would provide to this parent for their son, whose usual peak flow is 120.
You might also find this asthma action plan from Asthma UK useful when completing this activity.
Outline of the diagnostic process
Everyday asthma care
When they feel worse
What to do in an asthma attack
This activity has allowed you to use clinical guidance to produce patient-facing information to help them manage their asthma.
For children under 5 with suspected asthma, treat symptoms based on observation and clinical judgement, and review the child on a regular basis. If they still have symptoms when they reach 5 years, carry out objective tests.
If a child is unable to perform objective tests when they are aged 5:
- continue to treat based on observation and clinical judgement
- try doing the tests again every 6 to 12 months until satisfactory results are obtained
- consider referral for specialist assessment if the child repeatedly cannot perform objective tests and is not responding to treatment.
Everyday asthma care:
- Personal best peak flow is 120
- ICS (preventer) such as beclomethasone (Clenil) – one puff twice daily
- SABA (reliever) such as salbutamol – take two puffs at a time
- They may use a spacer to administer their inhaler.
When they feel worse:
- My peak flow drops below 115 (you may have estimated this differently)
- ICS (preventer) – two puffs twice daily
- Take reliever inhaler up to 10 puffs every 4 hours (if they need to do this then it is likely they are having an asthma attack and need urgent attention). They should not exceed the daily maximum dose
- They may be prescribed a nebuliser.
What to do in an asthma attack:
- You should have noted the actions to take when someone is having an asthma attack
- If they are taking a maintenance and reliever inhaler in one (maintenance and reliever therapy, or MART) then it’s likely they will have been prescribed a reliever inhaler for use in emergency situations.
You will now explore what treatment is provided in hospital when someone has a severe exacerbation of asthma.