The respiratory team recommend diagnosis is made based on the BTS guidelines which suggest the diagnosis of asthma is made predominantly clinically by the presence of symptoms (wheeze, breathlessness, chest tightness, cough):
Asthma control test: https://www.asthmacontroltest.com/en-gb/welcome/
Spirometry(>5 years)– An obstructive picture (FEV1/FVC <70%)
Peak Flow (possible over 8yrs)– either 2 week history of diurnal variation or historical record of low PEFRs during symptomatic episodes compared to asymptomatic periods. (PEFR variability of 20% strongly suggestive of asthma)
FeN)– (If available) - adults over 17yrs or consider children 5-17yrs if diagnostic uncertainty e.g normal spirometry/peak flow
Consider referral for child/young person – If symptoms suggestive of asthma but all investigations negative. Or obstructive spirometry but no bronchodilator reversibility and normal FeNO.
QOF diagnosis – requires spirometry and one other objective test (e.g. FeNo or diurnal variability)
SIGNS OF UNCONTROLLED ASTHMA:
(again assess asthma control using asthma control test >20 is good control)
- 3 or more days a week with symptoms
- 2 or more days a week requiring SABA for symptomatic relief
- 1 or more nights with awakenings due to asthma
- High number of repeat SABAs: 6 SABAs/year = 3.3 reliever doses/day. 12 SABAs/year = 6.6 reliever doses/day2
PRIMARY CARE MANAGEMENT (before referral):
- Cornwall & IoS Adult Asthma Prescribing Guidelines: Simple asthma should be managed via the Cornwall and IoS guideline here. (Please also see BTS chart and guidance below).
- Please use DPIs in preference to MDIs in over 7s where possible (due to huge climate impact of MDIs). See https://youtu.be/vCqW9DmXTxc
- Referral is appropriate after ‘additional controller therapies’ step of BTS step pathway.
- STEP UP: if using SABA more than 3 times per week
- Montelukast should be trialled and benefit evaluated, stop if no benefit to patient.
- Always check inhaler technique & adherence/ script pick up prior to increasing treatment
- All patients should have a written Personal Asthma Action Plan (https://www.asthma.org.uk/advice/manage-your-asthma/action-plan/)