Acute Services Division Asthma Action Plan and Education Name: Date:
Index What is Asthma? Page 4 Asthma Triggers Page 5 Peak Expiratory Flow Rate (Peak Flow) Page 6 Asthma Treatments Page 7 Asthma Action Plan Page 11-12 Useful Contacts Page 14
What is Asthma? Asthma is a common condition that affects the lungs. The exact cause of asthma remains unclear. When you breathe air travels in and out of your lungs through a network of tubes known as airways. These airways have an inner lining and are supported by an outer ring of muscles. In asthma the lining of the airways are more sensitive than usual and may become easily inflamed (swollen) when exposed to a wide range of provoking factors. This inflammation may cause: Swelling of the airway lining Production of sticky phlegm Spasm of the airway muscle As a result the airways become narrowed so there is less room for air to get in and out of the lungs. This can cause the signs and symptoms of asthma i.e. cough, wheeze, breathlessness, chest tightness, nocturnal wakening, peak flow falling. Taking your medicine regularly will help to prevent these symptoms.
Asthma Triggers A trigger is anything that causes airway inflammation and asthma symptoms to occur. These triggers vary from person to person. Some people may have more than one trigger. The following are common asthma triggers: Allergies e.g. house dust mite, pets or pollen. Exercise Infections e.g. colds and flu Irritants e.g. tobacco smoke or air pollution Changes in the weather e.g. extreme hot or cold Emotional changes e.g. excitement and stress It is important for you to know your triggers and to avoid or reduce exposure to them. Your Triggers are:
Peak Expiratory Flow Rate Peak flow is a measurement of how fast you can blow air out of your lungs. It shows how wide your airways are at the time of taking the test. Peak flow varies throughout the day and the morning reading is often lower than the evening. It is recommended during periods of good control you check your peak flow on occasion. This will establish your normal or best peak flow. When your airways become narrowed, readings will be lower and there will be greater variation between the morning and evening reading. How to use the Peak Flow Meter Peak flow should be measured early morning (before taking your inhalers), and late afternoon (4pm - 6pm if possible). Stand if you can. Make sure the mouthpiece is firmly in place and the marker is at zero. Hold the meter horizontally Breathe in deeply and then seal your lips around the mouthpiece Blow out as hard and as fast as you can Remove from mouth and make a note of where the marker stops. Place the marker back at zero. Repeat these steps until three readings are taken then record the highest of your three peak flow readings in your diary. Your best peak flow is: (this should be within the last 2 years)
Asthma Treatment Asthma can be treated with modern medicines. The aim is to keep you feeling well on the smallest possible does of medicine. The most effective treatments are inhalers which allow medication to be given directly into the airways. The medication prescribed will depend on how troublesome your asthma is and may be adjusted from time to time. Treatment will vary from person to person. It is important to have your inhaler technique checked at regular intervals by your asthma or practice nurse. There are three main types of treatment: Preventers, combination and reliever inhalers. Preventers (usually brown) These reduce and prevent the inflammation in the lining of your airways. These contain a steroid and may take up to fourteen days to build up the preventative effect. They do not bring any instant relief from symptoms of asthma and will not work unless they are taken every day. Even when your asthma symptoms are under control you must continue to take your preventer. It is also important to gargle with water after use to prevent hoarseness and thrush. Your Preventer is: Puffs:
Combination (usually purple or red) A combination of a steroid and a long acting reliever. These reduce and prevent inflammation in the lining of your airways and also keep the airway muscle open and relaxed. They are taken twice a day as they slowly release the medication over a period of time and it is important that you take this inhaler regularly as discussed. It is also important to gargle with water after use to prevent hoarseness and thrush. The drug you have been prescribed is: Puffs: Relievers (usually blue) These act quickly and for a short period by relaxing the ring of muscle surrounding the airways, opening them and allowing you to breathe easier. Relievers do not reduce or prevent inflammation. How often you use your reliever indicates how well your asthma is controlled. Your Reliever is: Device:
If Supplied with Oral Steroid Tablets (Prednisolone) At times your normal inhaled therapy may not control your symptoms and you may require a short course of oral steroids. These work quickly by reducing the inflammation in the lining of your airways. It is important to complete the course. If you are on frequent or continuous you will normally be supplied with a steroid card. It is important that you read the information on the card and carry the card on your person. It is important that you follow the instructions you have been given when you are taking these tablets. You must always take the tablets after you have eaten. If you are already on long term maintenance steroids follow the reducing course until you reach your maintenance dose. Dose of your oral steroid (Prednisolone: For. days If you are on any other oral asthma medication, continue to take these unless you have been directed otherwise.
Signs of Worsening Asthma It is very important for you to be able to recognise early when your asthma symptoms are deteriorating. By doing so you will know when to increase your treatment or contact your GP or practice nurse. You should not be waiting until your symptoms are so bad that you have to attend Accident and Emergency. Signs of worsening asthma are: An increase in symptoms i.e. cough, chest tightness, wheeze and breathlessness Overnight wakening with the above symptoms Increased use of reliever inhaler with reduced benefit Restriction on daily activities Reduced peak flow and a greater variation between the morning and evening reading. Asthma Care Take your Inhaled and oral medication regularly as discussed. Use your reliever inhaler as required. Record your peak flow and symptoms in the diary provided. Remember to avoid triggers that make your asthma worse wherever possible. Seek medical attention should your symptoms worsen.
Your Asthma Action Plan Your normal peak flow (best) is: Your typical asthma symptoms are: If you have a slight increase in your asthma symptoms you may be able to improve your inhaled therapy by:
Your Asthma is Much worse If using your reliever inhaler more frequently and it is not relieving your symptoms as it normally does. You are experiencing symptoms or disturbed sleep that you do not normally have during periods of well control. Your peak flow has fallen below: If this persists for 2 consecutive days Consult your GP or Practice Nurse. If you have a supply of oral Prednisolone at home for emergency use, take as directed. Always contact your GP if you have started your emergency supply of Steroids.
It is an Asthma Emergency It is an Asthma Emergency if: You have increased your reliever (blue inhaler) or have used your nebuliser and this is not helping. Your symptoms getting worse (cough, wheeze, breathlessness, chest tightness). Too breathless to speak. Your peak flow reading is below: If you are currently on oral Prednisolone and your symptoms deteriorate. Action Call 999 / NHS 24 Tel no. 08454 24 24 24. Take your reliever (blue inhaler) multi dose as directed or nebulise if you currently have one. You should be sitting upright and loosen tight clothing. Try to stay calm. Await ambulance / medical attention.
AFTER A BAD ATTACK / EXACERBATION If within 24hrs you experience an increase in asthma symptoms with no relief from your reliever inhaler (blue inhaler), or are struggling to speak in a sentence, then attend A and E or call 999 / NHS 24 no. 08454 24 24 24. Make an appointment to see your GP or practice nurse within 24-48 hours if you have been discharged from hospital or A and E (this may need to be an emergency appointment). If you have been discharged from hospital you maybe given an Asthma Clinic appointment within 4 weeks. Remember to bring your peak flow, diary, and current inhalers and prescription. Take your preventer medication /combination regularly as discussed. This may be an increased dose. Use your reliever inhaler as required. Record your peak flow and symptoms in the diary provided. Remember to take this to your GP or hospital appointment. If you have been prescribed prednisolone with or without an antibiotic, ensure that you finish the course even if you feel well. There are times when the course of predinsolone may have to be extended. Remember if on maintenance Prednisolone, return slowly to your normal dose as directed. Seek medical attention should your symptoms worsen. Your nurse or doctor should review your Asthma Action Plan with you. Take to appointment inhalers and any other medications prescribed. If your asthma is or becomes difficult to control, your care might be shared between your GP and the local hospital Asthma Clinic.
Smoking If you are a smoker it is highly recommended that you stop as smoking worsens asthma control and makes your preventer/combination inhaler less effective. Seek advice from your GP or smoking concerns. Useful contacts Asthma UK Helpline: Tel.: 0800 1216244 National Asthma Campaign 21 Coates Crescent Edinburgh EH3 7AF Tel.: 0131 226 2544 British Lung Foundation Scotland 0141 248 0050 Helpline: 08458 50 50 20 Smoking Concerns Tel.: 0141 201 9832 Website: www.smokingconcerns.com