The Asthma + Lung UK helpline receives over 1,000 calls a month from people struggling with their asthma. Asthma is a common lung condition affecting 5.4 million people in the UK (Asthma + Lung UK, nd).
About half of these people have poorly controlled asthma, which the charity defines as needing oral steroids or six or more rescue inhalers in the past year.
“Lack of access to a structured asthma review is one of the most common reasons why our helpline callers misuse rescue inhalers”
Rescue inhalers save lives during asthma attacks, but do nothing to treat the inflammation of the airways that causes asthma symptoms and attacks in the first place. This is the role of preventive inhalers which, if taken every day, reinforce the protection of the lungs by suppressing inflammation.
However, new research from Asthma + Lung UK (2022) has found that over a million people misuse their reliever inhalers. This means they take more than six full inhalers a year, whereas someone with well-controlled asthma will need less than two (Primary Care Respiratory Society, nd). Overuse can be dangerous because, as rescue inhalers do not treat the causes of asthma, it can lead to an increased risk of asthma attacks, hospitalization and even death.
In April 2022, new incentives were introduced as part of the Investment and Impact Fund (IIF) for Primary Care through Primary Care Networks to optimize treatment and address symptoms of COVID-19. asthma – which have for too long been a neglected part of asthma care. Asthma+ Lung UK welcomes these incentives but cautions that they must be accompanied by appropriate optimization of treatment and a structured review.
Lack of access to a structured asthma review, where patients can be told the difference between their inhalers, is one of the most common reasons why our helpline callers misuse asthma inhalers. relief. In new research from Asthma + Lung UK (2022), two in three respondents said they did not feel they had received enough information to understand their condition or treatments. This is why the use of a structured review, such as the SIMPLES assessment, is so important (Ryan et al, 2013), as described below:
Ssmoking status – smoking can worsen asthma control. Ask patients if they smoke and if the answer is yes, offer support to quit smoking.
Iinhaler technique – explain and demonstrate how patients should use their inhaler. You can find Asthma + Lung UK videos useful. If patients are using a metered dose inhaler, provide them with a spacer to help them get their medicine into their lungs more effectively.
Mmonitoring – teach patients how to monitor their symptoms by taking a peak flow measurement and asking how their symptoms are affecting their life; for example, “Does my asthma wake me up at night?” If the answer is yes, this should encourage patients to check whether they have taken their preventive inhaler regularly and correctly.
Pharmacotherapy – patients do not always take their preventive medications, so discuss this at each examination. Try to remedy poor compliance by adapting the medication to their lifestyle. Some patients may have better compliance with a different type of inhaler, a different dose, or maintenance and reliever therapy (MART)
Lifestyle advice – ask questions and give advice on lifestyle, including diet, alcohol consumption and known triggers. It is also important to inquire about comorbidities such as gastroesophageal reflux disease and rhinitis.
Eeducation – make sure patients understand what asthma is, what to do in an emergency, and how to monitor their symptoms and take their medications. A written asthma action plan can help with that.
Ssupport – examining patients to ensure that their asthma control has improved and that their medications are suitable for them. Make sure they know who to contact if they develop poor control again.
Using the acronym SIMPLE when evaluating your asthma patients will help reduce asthma attacks and save lives by preventing them from overusing their reliever medications.
For more information on asthma management, visit asthma.org.uk.
Caroline Fredericks is a Respiratory Specialist Nurse at Asthma + Lung UK
Asthma + Lung UK (nd) Asthma data visualizations. Asthma.org.uk (accessed 3 May 2022).
Asthma + Lung UK (2022) Fight back: Transforming asthma care in the UK. Asthma + Lung UK.
Primary Care Respiratory Society (nd) Asthma Right Care slide rule. pcrs-uk.org (accessed 26 April 2022).
Ryan D et al (2013) ‘SIMPLE’: a structured primary care approach for adults with difficult asthma. Primary Care Respiratory Review; 22:3, 354-373.