Justines Asthma pages

The aims of asthma care in the comunity etc is to reduce asthma-related morbidity and mortality, reduce the symptoms, reduce absence from work or school and to promote effective education and self-management for people with asthma. The objectives are to: Recognise the symptoms of asthma and initate appropriate treatment. To encourage compliance with theraphy and good inhaler technique. To invite all patients with active asthma for at least a once yearly check up to an asthma clinic. Also to keep and maintain an asthma register, and a seperate one for patients with severe asthma and finally encourage the use of self written managment plans by all patients, paticularly those patients with severe asthma. All asthma clinics should have this policy as it seems to be very effective.

Diagnosis of asthma in children is usually based on a recurrent history of wheeze, upper respiratory tract infections, persistant coughs, or exercise induced coughs and wheeze. In adults besides a history, it is necessary to obtain some evidence of airway obstruction. This may be done by the patient keeping a peak flow reading and a trial of inhaled or oral steroids. 

Once the diagnosis of asthma is made, patients are red-coded and entered on the asthma computer register. Patients on treatment are systematically invited to the Asthma clinic. The other register of severe asthmatics on nebulisers and recurrent hospital admissions or on oral steroids, are kept an closer eye on and watched for symptomatic deterioration. Please make sure you keep all appointments with Asthma clinics and hospitals.

A record is made of the following details: Age of asthma diagnosis, family history, personal history of eczema, hayfever, urticaria or wheezy bronchitis, enviromental factors, including occupation, bedding and pillows, animal contacts or smoking, present clinical state, presence of wheeze, nocturnal wheeze or cough. A peak flow reading is taken. An appropriate inhaler is selected and demonstrated. The distinction between prophylatic and releif medication is explained. Also a self management plan is discussed and he or she is encouraged to try and achieve an optimal level of control and self management and also awareness of deterioration in health.

All patients with active asthma (with regular symptoms within the past twelve months) will be offered at least a once-yearly review at an asthma clinic. All patients with sub-optimal control of asthma, especially those with nocturnal symptons and with nebuliser or steroid medications will be invited to the asthma clinic and offered regular reviews until symptoms are controlled. Frequency of follow ups depend on the severity of the asthma symptoms. Patients who have not had active asthma will not be invited to the asthma clinics. Stepping down of asthma medications will be considered when appropriate to the patient.

The purpose of self management plans are as follows: To enable patients with asthma to achieve better control of their condition and step up treatment without always seeing a doctor or nurse. Also to improve patient understanding and compliance of treatments. They are most likely to be used properly if adequate time is spent in educating patient at time of diagnosis. Education booklets are available to asthmatics on (better control). The initial aim for doctors is to make sure that patients have a good understanding and be able to self manage. These are a few things you should expect when you go along to clinics. Except nothing less than this.