Clinical update

Asthma management: how nurses can help prevent attacks

British Thoracic Society and Scottish Intercollegiate Guidelines Network national guidance update

British Thoracic Society and Scottish Intercollegiate Guidelines Network national guidance update


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Essential info

Asthma is a common chronic lung condition that causes occasional breathing difficulties.

A total of 5.4 million people in the UK receive treatment for asthma, of which just over 1 million are children, according to Asthma UK. Every ten seconds, someone is having a potentially life-threatening asthma attack. 

The charity's recent analysis of Office for National Statistics data found that deaths in England and Wales from asthma attacks are the highest they have been in the past decade and have increased by more than 33% in that time. 

What’s new?

Asthma attack prevention is one of the key areas in updated national guidance on the management of asthma produced by the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN).

Health professionals should assess all patients with asthma for their level of risk of having a future asthma attack and tailor their monitoring, treatment and care accordingly, guidance states. 

Every asthma review should assess the key factors that greatly increase the risk of attack. 

When the National Institute for Health and Care Excellence (NICE) published guidance in 2017, the BTS said this differed from its guidance in quite a few areas, including aspects of diagnosis, treatment and management. In July, the BTS, SIGN and NICE announced that all future UK-wide guidance on asthma would be produced jointly by all three organisations.

Signs and symptoms

The most common symptoms of asthma are coughing, wheezing, chest tightness and breathlessness.

Symptoms can vary in severity and a patient may not experience all of them.

Causes and risk factors

Risk factors include having an atopic condition such as eczema, a family history of asthma or atopic conditions, having had bronchiolitis, childhood exposure to tobacco smoke, having a mother who smoked during pregnancy, being born before 37 weeks' gestation or with a low birth weight.

How you can help your patient

The BTS/SIGN guidance states:

  • Asthma reviews should take place at least once a year and consider factors that greatly increase risk of an attack. These are history of previous asthma attacks, poor current control of asthma, and overuse of reliever medication.
  • Be aware of factors that can moderately or slightly increase risk. In children these are having an allergic disease as well as asthma, younger age, obesity and exposure to environmental tobacco smoke. In adults, older age, female gender, reduced lung function, obesity, smoking and depression are markers of a slightly increased risk of future asthma attacks.
  • Do not routinely carry out FeNO (fractional exhaled nitric oxide) or sputum eosinophilia testing.
  • All patients whose asthma is not adequately controlled on recommended initial or additional controller therapies should be referred for specialist care.
  • Advise people with asthma and parents/carers of children with asthma about the dangers of smoking and secondhand tobacco smoke exposure, and offer support to quit.

When the NICE guidance was published in 2017, the BTS said it differed from its own guidance in quite a few areas, including aspects of diagnosis, treatment and management. In July, the BTS, SIGN and NICE announced that all future UK-wide guidance on asthma would be produced jointly by all three organisations.

Expert comment

Jane Scullion, respiratory nurse consultant at University Hospitals of Leicester NHS Trust, says: ‘This update is important for all nurses and commissioners, as people with asthma present in a wide range of settings.

'We still have high rates of asthma deaths, so the emphasis is on future risk. Nurses should be looking at indicators such as excessive short-acting beta agonists (SABA) use, poor control and previous attacks, which are all signs of poor management.

'Patient education and personal action plans are emphasised, as is tobacco control. This policy doesn’t change treatment guidance, with long-acting beta agonist (LABA) the first add-on to inhaled corticosteroid if there is poor control.

'Although this is still at odds with NICE recommendations, there is a commitment for SIGN, BTS and NICE to provide joint recommendations, which should avoid confusion over conflicting guidance.

‘Sometimes guidance does differ, which can be confusing, but remember they're guidelines not tramlines. What we need to do is the best for our patients with the knowledge we have, and we can always check our local guidelines too.’

 

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