North London Partners in health and care

The Three Pillars of Asthma Management

Dr Shubhasree Mukherjee FRCPCH
Dr Shubhasree Mukherjee FRCPCH, Consultant Paediatrician with interest in Respiratory and Medicine and Allergy, Royal Free London NHS Foundation Trust

The Three Pillars of Asthma Management

Asthma is one of the commonest long term medical conditions affecting 1 in 10 children and young people (CYP) in United Kingdom. It affects the airways leading to wheeze, shortness of breath, cough and chest tightness. Asthma is not curable but with the correct management we can definitely improve the quality of life of those affected.

As healthcare professionals we need to continue reminding carers that asthma is a chronic condition, it can cause death and needs to be treated daily with a preventative inhaler.

The three pillars of asthma management are inhaler technique, annual asthma review and personalised asthma action plan (PAAP) which when adhered strictly will reduce unwanted hospital admissions and risk of death from asthma.

Undoubtedly the most important part of asthma management, the Inhaler Technique should be checked at every visit with the health care. The young person should also be offered the choice of inhalers without spacers like dry powder inhaler (DPI) as they might find it easier to carry and adhere to. In our efforts to reduce carbon foot print of health services we need to encourage more uptake of DPIs which have ten times less carbon foot print compared to the more widely used metered dose inhalers.

Personalised Asthma Action Plan

All children and young people with asthma should have an up-to-date PAAP, one for home and one for school. Taking a picture in the mobile is another easy way of carrying it around. PAAP provides a summary of inhalers and the doses, trigger factors for asthma and how to identify and treat a mild/moderate/severe asthma attack.

The primary and secondary care health care professionals working together should review the child / young person post discharge from hospital after an asthma attack within 48 hours in primary care and around 4 weeks in secondary care. With pollution being an additional trigger we should keep reminding families to check pollution forecast, avoid busy roads, take the preventative inhaler daily and always carry the rescue inhaler.