An Introduction Into Core Asthma Guidelines
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British guidelines on the management of asthma provide healthcare professionals with a core diagnostic pathway and guidance for the diagnosis, treatment and monitoring of asthma. Read on to find out how these can help you to manage your own asthma condition.
Asthma can be a hard burden to live with. From the initial diagnosis to various forms of medication and self-care management, anyone who has been newly diagnosed will undoubtedly have many questions surrounding how best to look after their condition.
With an estimated 5.4 million people receiving treatment for asthma in the UK, and 4.5 million of these people being residents in England, there is a need for core guidelines as a way to help manage the condition.
Based upon guidelines developed by asthma experts at both the Scottish Intercollegiate Guidelines Network (SIGN) and the British Thoracic Society, the purpose of these is to help with the workload for GP’s, hospital outpatient clinics and inpatient admissions.
It is helpful if you suffer with asthma, as you’ll need to apply a careful management programme, working with your doctor or nurse to look at any triggers, ensure correct diagnosis and monitor this long-term condition to the best ability.
These guidelines help healthcare professionals to do so.
So, what key areas should you be aware of?
ASTHMA PREVENTION
It’s important to firstly look at at the potential prevention of asthma.
And there are a few steps that can be taken to help with this:
- Breastfeeding may have a potential protective effect against childhood asthma.
- There is some evidence to show the the introduction of fish oil, selenium and vitamin E in pregnancy as a way to help prevent your baby developing early childhood asthma and wheeze.
There is evidence to show maternal smoking in pregnancy (MSP) being a modifiable risk factor for asthma and infant wheezing.
SECONDARY PREVENTION
In addition to primary prevention, there is also a level of What it known as secondary prevention.
This is essentially a way to manage existing asthma in order to help avoid attacks. This is what the World Health Organisation; WHO have to say:
“Early detection of occupational asthma is vital to prevent further progression and to ensure cost-effective management. Programmes for early detection of COPD have been suggested but their cost-effectiveness have yet to be fully evaluated. Although long term decline in lung function may not be reversible, effective management including smoking cessation, pulmonary rehabilitation and reduction of personal exposure to noxious particles and gases can reduce symptoms, improve quality of life, and increase physical fitness.”
The following factors have been shown to have an effect on existing asthma:
- Air pollution has been shown to aggravate asthma and a lot of research has been done in this area, particularly into the impact of indoor air pollution.
- Food allergies, pet dander, and the household dust mite can have an effect on the condition. In fact, Asthma UK’s annual survey showed a whopping 64% of people with dust as a trigger for their symptoms. The guidelines state that a
“raised specific IgE to wheat, egg white, or inhalant allergens such as house dust mite and cat dander, predicts later childhood asthma.”
- Smoking and exposure to cigarette smoke can have a significant negative impact in regards to lung function and long-term control of asthma. The guidelines state that
“Parents and parents-to-be should be advised of the many adverse effects which smoking has on their children including increased wheezing in infancy and increased risk of persistent asthma.”
DIAGNOSIS
Various tests are carried out as a way to try and help diagnose asthma. Ranging from lung function to evidence of inflammation in patients.
But it’s crucial to know that there is not one single objective test to diagnose it.
As per the NICE 2017 Guidelines, below is a list of types of test used to diagnose the condition:
Lung function tests
Spirometry
Spirometry should be offered to adults, young people and children aged 5 and over.
This involves looking at a forced expiratory volume in 1 second – FEV1 vs forced vital capacity – FVC. This ratio needs to be less than 70% (or below the lower limit of normal) as a positive test for obstructive airway disease.
Bronchodilator reversibility
A BDR test should be offered to adults aged 17 and over, along with an obstructive spirometry test.
This can also be considered as worthwhile test in children and young people aged 5 to 16 alongside a obstructive spirometry. An improvement in FEV1 of 12% or more is seen as a positive test.
Peak expiratory flow variability
Peak expiratory flow variability is used to determine average daily variability in lung expiratory flow. It should be used for 2 to 4 weeks in adults aged 17 and over if there is diagnostic uncertainty after initial assessment and a FeNO test, and the patient has either:
- normal spirometry or
- Spirometry and a positive BDR BUT a FeNO level of 39 ppb or less.
- NICE point out that a value of more than 20% variability is seen as a positive test.
MANAGEMENT
The NICE guidelines continue to state that there are various forms of management asthma patients should be adopting when it comes to looking after their condition.
These are as follows:
Self-management
The BTSSIGN guidelines show the importance of self-management as a tool to be adopted by patients to effectively help manage their asthma.
Personalized Asthma Action Plans
“PAAP”
Research has shown that when managed well, symptoms can be improved, making asthma attacks much less frequent. You can create your own asthma action plan to help you to manage your condition.
An action plan can also help to reduce hospital visits. Download your own action plan from Asthma UK.
As per these guidelines, there is evidence that educational interventions that were supported by a written PAAP and regular professional review were more effective than less intensive regimes.
Adherence
“Communication between doctors and patients is essential for the involvement of patients in decisions about medicines and for supporting adherence.”
There is help and guidance available for managing non-adherence to medicines in people with asthma. The NICE guideline offers more information on medicines adherence HERE.
TREATMENT
Pharmacological treatment
For adults over the age of 17
Short-Acting Bronchodilator Inhalers or SABA should be offered as a reliever therapy to adults with newly diagnosed asthma and those who have infrequent, short-lived wheeze and normal lung function
For children and young people aged 5-16
SABA should be offered with reliever therapy in for new diagnosis, and for patients who have infrequent, short-lived wheeze and normal lung function.
Maintenance and reliever therapy
“MART”
Maintenance and reliever therapy, (also known as MART) is a form of combined Inhaled Corticosteroids or ICS and Long-acting Reliever Inhalers or LABA treatment. These combine into one single inhaler, and used for both daily maintenance therapy and the relief of symptoms as required.
Another pioneering approach to monitoring and management can be seen in the Safey Health Smart Inhaler. Delivering a fresh breath of air into asthma care, this inhaler is able to measure the quality of your dose, providing reassurance and support for patients.
Syncing data with our app and healthcare providers via Bluetooth or SIM Card, it provide important updates, providing you with piece of mind. If this sounds like something you’d like further information, get in touch with us today to find out just how the Safey smart inhaler works.
