Asthma Education for Families and HCPs Sarah Latham Senior Paediatric Respiratory Nurse Specialist

Aim of asthma education To instill confidence in parents/children in how to manage their asthma To ensure child is on appropriate level of day to day treatment to lead a normal life

Aim of asthma education To try to instill confidence in parents/children in managing asthma To ensure child is on appropriate level of treatment to lead normal life

NRAD Inadequate inhaled corticosteroid (ICS) use Inadequate objective monitoring of asthma Inadequate follow-up Inadequate use of written asthma plans

NRAD Increased use of salbutamol reliever if ≥ 12 salbutamol inhalers prescribed over previous 12 months review needed Increased risk of death within a month of discharge from hospital following acute asthma attack follow-up at primary care essential

How long is an asthma attack? Most asthma attacks severe enough for eventual hospitalisation develop relatively slowly over a period of ≥ 6 hours In one study > 80% developed over 48 hours Kolbe et al Thorax 1998:53

When/where to deliver asthma education Acute asthma attack Follow up appointment Home visit School

Acute asthma attack BTS Asthma Care Bundle TAPES For adults and children from age 2 yrs admitted to hospital with acute asthma TAPES Technique and medication + Action Plan + Environment + Subsequent Care

BTS Asthma Care Bundle Inhaler technique check Medication check Written asthma action plan Triggers NB include smoking status Subsequent care

Follow-up Explore parental/child management of recent asthma attack prior to seeking medical help Reiterate salient points of asthma management, referring to written plan, inhaler technique Lung function/allergic status

Inhaler technique 30 % asthma patients have poor inhaler technique Poor inhaler technique associated with worse asthma outcomes Gilette et al 2016 77% patients with good inhaler technique in clinic had partially effective/poor technique at home Shields et al 2018

Home Visit Systematic evaluation required for children and young people with persisting symptoms of asthma on high dose treatment including identifying the mechanism of the persisting symptoms and assessment of adherence to therapy BTS Asthma Guideline 2016 home visits by specialist respiratory nurse key part of assessment

School Asthma education in schools led to improvements in symptom control and QOL but no impact on healthcare use Directly observed therapy (DOT) improved symptom control BTS/SIGN Asthma Guideline 2016

School Multifaceted intervention combining education of school children with additional training for their doctor led to improved symptom control, QOL and reduced ED attendance and hospitalisation Bruzzese et al 2010

determines the outcome Non-Concordance Patient’s expectation Doctor’s/nurse’s opinion The relationship determines the outcome Agreed management plan

Asthma education for HCPs Education for Health www.educationforhealth.org Tel. 01926 493313 Courses at levels 5, 6 and 7 cover both adult and childhood asthma Workshops “Introduction to Paediatric Asthma” 21st June 2019 15 places left!

Thank you!