The incidence of asthma and allergy are on the rise with ever increasing understanding of the role of unique genetic changes to epithelial tissues and environmental impacts including nutrition and bacteria.[1]
But aside from the choices f intervention, asthma management is all about limiting the triggers managing the symptoms and helping to maintain function. Helping the individuals to avoid hospital visits, experience adverse effects of medication are also important.
You should keep in mind that there are a small number of steps that it is worth either undertaking directly with your patient or referring them to their GP or specialist.
Regular Assessment
If your patient with Asthma is not having a regular check up to explore their peak flow, then encourage them to do so. These objective findings may not always fall in line with their subjective sense of well-being and it is sensible to ensure that the two measures are kept in alignment through monitoring.
Determining Efficacy
Of course the effect of intervention and management needs to be recorded to ensure a suitable record or transfer notice is available. Memory is notoriously liable to bias and so recommended forms such as these should be employed. Check their peak flow records, spirometer readings and history of episodes.
- Asthma Control Test – Whilst this is a USA based questionnaire it is simple to do.
- Asthma Control Questionnaire This may be printed off
- Asthma Therapy Assessment Questionnaire This may be printed off
Review with the patient their records,
discuss their lifestyle and food choices as well as medication use. Discuss triggers and avoidance strategies, encourage relaxation and suitable nutrition that supports epithelial tissues and reduces the risk of aggravation. Look at their food diary and check for any likely food triggers. remind them of air pollution risks, and suggest they use the DEFRA air pollution map to determine the risk of outdoor activity.
Review Meds and Supplements
The GP should be managing the medicines, although some may be under the care of a specialist. Supplementation is likely to be your area of expertise along with food management. Whilst decisions concerning the correct drugs and their dose are the responsibility of the GP, asthma patients inevitably use a variety of decisions to determine dose and frequency. Referral back to the GP with a note may be required from time to time and review of supplemental dose in light of current data and food intake as well as stress management techniques are all to be considered and applied accordingly.
Reference
[1] Lloyd CM, Saglani S. Asthma and allergy: the emerging epithelium. Nat Med. 2010 Mar;16(3):273-4. No Abstract
