Monitoring

Your Organisational Guidance

ebpracticenet urges you to prioritise the following organisational guidance:

Astma bij volwassenen: diagnose en monitoring in de eerste lijnPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2020Asthme chez l’adulte : diagnostic et surveillance en soins de santé primairesPublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2020

The patient's symptoms should be assessed and recorded on at least an annual basis in a clinical review by a healthcare professional with appropriate training in asthma management. These reviews can be undertaken in primary and/or secondary care according to local availability and clinical need.[55]

  • Regular review gives the opportunity to monitor current symptom control and the impact asthma is having on the patient's daily activities and quality of life, to assess future risk of asthma attacks, and to link these to management options.[55]

  • Reviews should take place more frequently for more severe asthma, to determine medication compliance and the patient's ability to monitor and control symptoms.

The core components of an annual asthma review are:

  • Current symptom control: bronchodilator use; validated symptom score; time off work due to asthma[55]

    • When assessing the patient's symptoms, use specific questions, such as the Royal College of Physicians' '3 Questions' (RCP3Q):[55]

      • 'In the last month, have you had difficulty sleeping because of asthma symptoms (including cough)?'[93]

      • 'Have you had your usual asthma symptoms during the day?'[93]

      • 'Has your asthma interfered with your usual activities (e.g., housework, work, etc.)?'[93]

    • Positive responses to RCP3Q should prompt further assessment with a validated questionnaire to measure symptomatic asthma control, for example the Asthma Control Questionnaire (ACQ) or Asthma Control Test (ACT).[2][55][56][94] [ Cochrane Clinical Answers logo ]

  • Future risk of attacks: past history of asthma attacks; oral corticosteroid use; prescription data: frequent short-acting beta agonist (SABA) and infrequent inhaled corticosteroid (ICS); exposure to tobacco smoke[55]

  • Tests: lung function (spirometry or by peak expiratory flow [PEF])[55]

    • Patients are recommended to self-monitor at home on a daily basis by checking and recording their peak expiratory flow (PEF) using a peak flow meter. Use the patient's PEF results, alongside their asthma action plan, to discuss adjustment of medication use as appropriate.

    • PEF monitoring becomes life-saving for the group of patients who are unable to sense worsening of their asthma. PEF is not, however, as accurate a measure of pulmonary obstruction as is the forced expiratory volume at 1 second (FEV₁) and the FEV₁/forced vital capacity (FVC) ratio.

  • Management: inhaler technique; adherence (self report, prescription refill frequency); non-pharmacological management (trigger avoidance, breathing exercises); pharmacological management (consider multimorbidity and polypharmacy)[55]

  • Supported self-management: education/discussion about self management; provision/revision of a written personalised asthma action plan[55]

    • The use of a written, personalised asthma action plan should be strongly encouraged.[1][55][56][147] Asthma and Lung UK: adult asthma action plan Opens in new window The asthma action plan can help your patient to recognise when their asthma is deteriorating and how to respond appropriately: for example, increasing usual reliever and controller treatment, and determining when to seek medical help.[1][85] [ Cochrane Clinical Answers logo ] [ Cochrane Clinical Answers logo ]

Peak flow measurement animated demonstration
Peak flow measurement animated demonstration

How to use a peak flow meter to obtain a peak expiratory flow measurement.

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