Optimising Asthma Control Audit

    
 
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Are you optimising your patientís asthma control?

Asthma guidelines recommend that patientsí asthma should be controlled as well as possible, in order to ensure their current wellbeing and also to reduce future risk of exacerbations. There are a number of different methods for assessing asthma control; one of these is the GINA Control Tool (www.ginasthma.org)[1,2]. Using this tool, asthma control is assessed by establishing the presence (or absence) of asthma symptoms, utilization of rescue medication for asthma and determining whether the patientsí lung function indicates current variable airflow obstruction. In this way three levels of asthma control are derived: controlled, partly controlled and uncontrolled. Another commonly used method for assessing asthma control in the United Kingdom, is the so called Royal Collage of Physiciansí 3 Questions (RCP 3Qís) as stated in the Scottish Intercollegiate Guideline Network/British Thoracic Society Guidelines (SIGN/BTS).[3,4]. These three questions are very similar to the three symptom questions in the GINA guideline.

The latest version of the GINA guidelines emphasizes the need to assess and gain asthma control in order to minimize future risk. In a study, which aimed to evaluate the effect of current Asthma control on future risk, Bateman et al[5] concluded that:
  • The better the patientsí asthma is currently controlled the lower the risk of an uncontrolled week
  • The probability of a future exacerbation is related to the level of current control
  • Current asthma control predicts future risk of instability and exacerbations

goals_of_asthma_management.jpg (28,164 bytes)

This audit

All asthma guidelines suggest that patients asthma should be well controlled as best as possible. This audit provides a tool for assessing asthma control, during the consultation. The health professional can record details of the patients management (anonymously) and then compare their actions with other health professionals. This audit of the management and assessment of patients who consult for an asthma review, and is based upon the GINA asthma control tool. (www.ginasthma.org)

This audit on asthma control has been developed with advice from Dr Helen Reddel, and the programming was part sponsored by an unrestricted educational grant from GlaxoSmithKline, UK.

Aim of the audit

To determine what action the health professional takes after performing an asthma review with a patient, in particular, in relation to gaining and maintaining the patients asthma control.

Standards

For the purpose of this audit, it is assumed that all patients attending for asthma review have an assessment of their control.

Standard 1: 100% of patients should have their inhaler technique assessed during the review.

Standard 2: 100% of patients who cannot use their inhaler device should be prescribed a different device.

Standard 3: 60% of patients who are well controlled should have their medication reduced.

Standard 4: If their inhaler technique is good, 70% of patients with partly controlled asthma should have their medication increased.

Standard 5: If their inhaler technique is good, 100% of patients with uncontrolled asthma should have their medication increased.

Standard 6: 70% of patients with partly or poorly controlled asthma who also have Allergic Rhinitis, should be on treatment for their allergic rhinitis.

Further Reading
  1. GINA Report, Global Strategy for Asthma Management and Prevention (www.ginasthma.org)
  2. Thomas M, Kay S, Pike J, Williams A, Rosenzweig JRC, Hillyer EV, Price D. The Asthma Control TestTM (ACT) as a predictor of GINA guideline-defined asthma control: analysis of a multinational cross-sectional survey. Prim Care Resp J 2009;18(1):41-49. DOI: http://dx.doi.org/10.4104/pcrj.2009.00010
  3. British Thoracic Society, Scottish Intercollegiate Guidelines Network. British Guideline on the Management of Asthma. Thorax. 2008;63((Supplement 4)):iv1-iv121. Available from: http://dx.doi.org/
  4. Pearson MG, CE B, editors. Measuring clinical outcome in asthma : a patient-focused approach London: Royal College of Physicians; 1999.
  5. Bateman ED, Reddel HK, Eriksson G, Peterson S, Ostlund O, Sears MR, et al. Overall asthma control: The relationship between current control and future risk. Journal of Allergy and Clinical Immunology. 2010;125(3).
 

 


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