Summary
Asthma is a common respiratory disease in the UK with over 5 million sufferers. It a reversible airways disease characterised by bronchoconstriction, inflammation, oedema and mucus production. There is a wide spectrum of severity and asthma can be controlled effectively by pharmacotherapy. The British Guideline on the Management of Asthma provides the framework for treatment. Primary care nurses have been involved in the management of asthma for many years and a large number have undertaken asthma training courses. The asthma guidelines recognise the benefit of trained asthma nurses in the provision of care.
The revised General Medical Services contract rewards practices who provide asthma care under the Quality Indicators framework. Supplementary nurse prescribing allows nurses with appropriate training to prescribe asthma medication, providing the diagnosis of asthma is confirmed by a medical practitioner and a clinical management plan is used. Community pharmacists have an important role in the care of patients with asthma as well and some pharmacists have become supplementary prescribers. Their role will become more evident in the future.
The main asthma medications are bronchodilators and inhaled steroids, which should be used at the lowest dose to control symptoms. Caution should be exercised in young children where many asthma medications are used ‘off-label’. Their use can be justified when it is the most appropriate medication and is supported by evidence such as asthma guidelines.
All patients on asthma medicines should be monitored closely, not only to ensure control of symptoms but to monitor for adverse side effects. Sufficient knowledge of appropriate pharmacology is required by those involved in asthma management. Regular asthma review should be structured and include issues of adherence to medication, appropriate use, inhaler technique, current symptoms and effects on lifestyle. All patients should have an asthma action plan so they know how to manage their asthma. This action plan is agreed with the patient and the health professional. Appropriate asthma management and supplementary prescribing will enhance patient care.
