Table 4

Recommendations for the care of asthma patients

Follow BTS guidelines16 for prescription of regular anti inflammatory medication, specialist referral and follow up, and recognition and treatment of severe asthma.
• Check and record peak flow every GP consultation for asthma (even if patient is charting their peak flow at home).
• Many patients with asthma and certainly all patients with severe asthma should have an agreed written management plan and their own peak flow meter with regular checks on inhaler technique and compliance.
• Ensure Practice (Asthma) or Clinic Nurse or Doctor contacts asthmatics who do not attend their appointments.
Always try to involve a close relative, including in adults, in education and understanding about asthma and share the agreed management plan.
• Never prescribe beta blockers, including eyedrops, to patients with asthma.
• In patients presenting with worsening symptoms always agree plan of care with patient, ideally based on peak flow recordings and symptoms to include appropriate use of inhaled or oral steroids. Always arrange and ensure an early follow up appointment.
• Make register of patients “at risk” of developing severe or fatal asthma available to all partners and out of hours emergency doctors.
Patients “at risk” of developing severe or fatal asthma are those:
• With psychiatric morbidity, behavioural difficulties, especially denial, and socio-economic deprivation (recognise denial or anger by non attendance, unwillingness to comply with therapy or monitoring, unwillingness to accept the diagnosis or the need to take regular medication)
• Ever admitted with their asthma
• Requiring emergency steroids and/or nebulised treatment
• Calling for GP, or attending Surgery, or A & E Department with emergency deterioration
• Requiring courses or regular oral steroids
• Requiring high dose inhaled steroid
• Whose peak flow falls below 50% of their best or predicted value
• Requiring two or more bronchodilator inhalersmonthly
Discuss these issues frankly with the patient and their relatives
  • Reproduced from Mohan et al 39 with permission.