Asthma affects 5.4 million people in the UK, around 8 in every 100 people. According to the NHS, it accounts for up to 3% of all primary care appointments, plus 60,000 hospital admissions per year, so most members of the nursing team will care for people with the condition at some point. While most people can control their asthma using medications, it can be life-threatening, with 4 people suffering a fatal attack every day in the UK. Yet 2 out of 3 deaths are preventable, says the charity Asthma and Lung.
You can play a part in reducing risks, helping patients to live well. Here’s what you need to know.
What is asthma?
Asthma affects a person’s airways, causing them to become inflamed and therefore narrowed, so less air gets into and out of the lungs. Symptoms include wheezing, breathlessness, a tight chest, and coughing. These can sometimes worsen quickly, leading to an asthma attack.
It may start in childhood, but adults can develop it too, says La Toya De Freitas, who has been a general practice nurse since 2017, and is a member of the RCN’s General Practice Nursing Forum. A passionate interest in asthma was sparked after her involvement in a project working with people in more deprived areas of Stoke-on-Trent to ensure they received optimum care for the condition.
Asthma facts
- Risk factors. Allergies (such as eczema, hayfever or an animal allergy), a family history, childhood respiratory problems, smoking or second-hand smoke, a premature birth and low birth weight, air pollution, occupational risks, and obesity.
- Triggers. These are individual but may include allergens (such as dust mites or pollen), pollution, smoke, exercise, or even changes in the weather.
- Variations. Asthma can fluctuate throughout the year and over time. Some patients might not experience symptoms for weeks or even months at a time.
“There’s a lot of hypotheses at the moment about why we’re seeing more late-onset asthma,” says La Toya. “It may be that the person has lived with some degree of asthma for a while. As humans, sometimes we have symptoms, but we don’t seek help. That’s why it’s so important to get a good clinical history.”
Awareness has also improved over the last 5 years or so, says Callum Metcalfe-O'Shea, RCN Professional Lead for Long Term Conditions. “Patients with symptoms might have tried many other treatments over a long period of time with limited improvement, so sometimes asthma is considered after other conditions are ruled out,” he says.
What role can nursing staff play in managing asthma?
Initial diagnosis can be a challenging time for patients, says Callum. “It’s a long-term condition, so there can be quite a psychological impact,” he says. “Suddenly you’re required to have continuous therapy, annual reviews and frequent check-ups. It’s a lot to take in. Nursing staff are integral to ensuring there’s support there.”
In the longer-term, nursing staff have a critical role in providing reviews and working alongside patients to help them self-manage their condition, says La Toya. “Basic care involves a personalised action plan,” she says. “This ensures the patient is on the right medication, they understand how to take it and what it does, and when they should seek follow-up from a health care professional.”
Every nurse should understand the roles of different kinds of inhalers, says La Toya, so they can explain how they work to their patients. Education can also help patients avoid side-effects, reducing the risk of non-compliance. “Patients can get a sore throat or oral thrush,” she says. “But they can reduce their risks by washing their mouth out thoroughly each time they use their inhaler.”
Mastering inhaler technique
Any member of nursing staff could encounter a patient with asthma, so ensuring you can support patients with their inhaler technique is a vital skill, says Callum. “Even if asthma is not your background, there are opportunities to support patients in any clinical setting,” he says. “Having a good understanding of how and when to use inhalers can really make the difference between good and poor management.”
During the pandemic, patients weren’t usually seen face-to-face, making checking techniques difficult. “We’re trying to catch up with that now,” says La Toya. “I always ask patients to bring their inhaler with them, so I can see for myself how they’re using it. If they’re not using it correctly, they won’t get the benefit of the medication.”
Different types of device may have different techniques, which can be especially tricky for patients when the design of theirs changes, or they’re prescribed a new type. Asthma and Lung provides advice, including videos, on all types of inhalers.
Finding out what’s important to a patient can motivate them to maintain their medication regime, La Toya believes. “Each person is different, but once I know what someone’s goals are, I can help them,” she says. “Total control is possible and people can live very full lives, with the right treatment, but it comes down to education.”
Nursing staff should know what someone’s action plan says, recognising when their symptoms are deteriorating and an attack is likely, or when they might need to escalate, Callum adds.
“Getting someone’s symptoms stable is key,” he says. “It’s really important we remind our patients that asthma can still be life-threatening, without unnecessarily alarming them. When people are feeling well, they often ask, do I need to continue with my inhalers. But it’s about preventive therapy. The aim is for them to remain symptom-free.”
Find out more about asthma care
- The e-asthma programme provides foundation level learning for health care professionals who are not specialists in this field, including practice, community and emergency nurses.
- The National Institute for Health and Care Excellence (NICE) has guidance on asthma diagnosis, monitoring and management.
- The Primary Care Respiratory Society offers a range of asthma resources, including guidance on best practice, podcasts and webinars.
