Managing asthma – reviews and action plans

The aim of treatment for asthma is to get symptoms under control and to prevent further problems. The goal is to support and encourage people to manage their own condition, by recognising triggers, knowing what medicines to take and when to take them and what to do if symptoms change, get worse or flare up.

Key aspects of keeping asthma under control include:
  • Knowing what medicines to take and when to take them.
  • Reviewing symptoms and medicines with the doctor or asthma nurse regularly.
  • If necessary, using a preventer inhaler regularly.
  • Having experienced a severe attack in the past and wanting to prevent any further emergencies gave some people a strong motivation to keep their asthma well controlled.
Dee was diagnosed with asthma after a bad attack ‘I kind of got it into my head quite quickly that this was a serious thing and that it could take me if I didn’t take it first, sort of thing. So I kind of made it my business to get it under control’. Most people were keen to find ways to ensure that they could live their lives with minimum disruption Stephen, who was recently diagnosed, is motivated to keep control of his asthma because he has seen his mother experience chronic asthma and doesn’t want to become dependent, as she is, on medication.
A written asthma action plan can help people to know what to do if symptoms change or worsen, including details about the asthma medicines you are taking, how to tell when your symptoms are getting worse and what you should do about it, and emergency information on what to do if you have an asthma attack. It will usually tell you what your peak flow measurement should be, and that if it goes below a certain level you should seek help. Personal asthma action plans have been shown to be effective in improving asthma care by helping people manage their own condition.
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Not everyone we spoke to had a written plan, and not everyone wanted one. For example those who knew how to manage their relatively mild asthma with occasional use of a reliever inhaler did not necessarily feel they needed to have instructions written down. But some people who did not have an asthma action plan said they might find it useful if it were offered. Studies have shown few people with asthma have a written self-management plan, and health professionals do not always used them. Susan’s asthma plan helps her to feel justified in asking for help, because she has a written agreement about when she should do so.
An asthma review is recommended at least once a year (more frequently for those with severe asthma symptoms or children, who should be reviewed every six to 12 months). Regular reviews include: checking inhaler technique, monitoring peak flow measurements, prescribing add on therapies or changing inhalers for more effective or up to date ones, working out an action plan, passing on useful tips and information about how to manage asthma, or discussing lifestyle issues. Some people had regular reviews with the asthma nurse or GP, while others said they only visited when symptoms troubled them.

Stephen, though motivated to control his asthma, said he would find regular visits to the asthma clinic depressing. "It would feel like it’s getting a grasp on my life, you know. It would feel like it’s controlling me whenever I should be controlling it".
Once a regular treatment plan has been worked out, people sometimes find it helpful to be able to speak to the asthma nurse or GP on the phone for advice or reassurance, and which could be more convenient than waiting for an appointment and possibly having to take time off work to visit the surgery

Keeping in touch with the clinic means the nurse or GP will know you and how asthma affects you. Dee emphasised this point - ‘one of the things I’ve learnt is that it’s important to go back regularly to your asthma clinic, even if you think you don’t need to. Mostly because if you don’t know who they are and they don’t know you and you’re not familiar with it, then if you did get into difficulties it, that’s harder for you really’. Others also said they found it very helpful to build good relationships with the GP and asthma nurse.

Also see ‘Medication and treatment – inhalers’, ‘Medication and treatment – other treatments’, ‘Exercise, diet and other lifestyle issues’, ‘Triggers’, ‘Changing symptoms over time’, ‘Asthma attack and emergencies’ and ‘Dealing with health professionals’).


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