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Asthma control: The 10-point checklist

Some simple changes can go a long way to helping patients understand and manage their asthma. This article summarises 10 top tips from the experts at the Royal College of Physicians in London and the American Lung Association.

10 top tips to successful asthma management

If you find any other practice particularly useful, why not let us know , so we can extend the list and add your suggestions for better asthma management?

  1. Consider nominating an asthma care lead at your practice, who can look out for training opportunities and follow the latest in asthma diagnosis and management.1
  2. Encourage patients to work with you on their asthma plan, sometimes known as a personal asthma action plan, and to keep copies in key locations, such as school or places of work.1
  3. Help patients to note their personal triggers, such as pollen or pollution, their current treatment, how they can help prevent asthma relapse, and when and how to seek emergency help. Those with severe asthma could need their asthma plans updated regularly.1
  4. Helping patients to self-manage their asthma is important. Perhaps they need to increase medication dosage before the hay fever season, for example.1
  5. Open up the conversation at regular appointments to find out whether there are any problems with adherence and educate patients on the benefits of taking their medication as prescribed. Numbers are very helpful here and tracking their FeNO results is an easy way for patients to visualise their progress.
  6. Check patient understanding of their condition. Patient education is fundamental to asthma management. Greater understanding should lead to improved compliance, from knowing when medication is required to recognising a loss of control.1 There are courses for patients, such as the American Lung Association’s Asthma Basics, which can be accessed online.2
  7. Arrange appropriate patient follow-up at timely intervals. This will enable you to check adherence and asthma management. You might find medication dosage could be stepped up or down, for example.
  8. Take immediate action when a loss of control of a patient’s asthma is identified.1 This might be unexpectedly higher FeNO than the patient’s baseline, for example. The patient might need a change to their current treatment or onward referral.
  9. Consider introducing electronic prescribing surveillance. An alert when patients may be receiving too many short-acting reliever inhalers (SABA) or too few preventer inhalers could be vital; all patients who have been prescribed more than 12 SABA inhalers in a year should be invited for urgent review.1
  10. Did you know, it is now understood that up to 84% of asthma patients have Type 2 airway inflammation, one of the main causes of asthma exacerbations?3 FeNO testing is a great way to check inflammation levels at the point-of-care so do consider implementing FeNO testing into the clinical routine.

Why FeNO?

FeNO-guided asthma management has been proven to help reduce exacerbations by up to 50% and is recommended by most international guidelines.4-7 Studies have also shown that FeNO testing is a cost-effective way to improve patient outcomes.8-10

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The gold standard FeNO device is the NIOX VERO®, which makes testing safe and easy. Results are available at the point-of-care for immediate benefits too: in an 8,000-patient study, NIOX® helped show that the true level of inflammation in over 50% of participants had been incorrectly assessed using standard methods. As a result, physicians were able to optimise treatment for 30% of those patients.11

To see how FeNO fits into your practice, use our book a demo form to get started right away.

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References

1. Royal College of Physicians (RCP). Why asthma still kills: the National Review of Asthma Deaths (NRAD). 2014.
2. https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/asthma-education-advocacy/asthma-basics. Last accessed July 2022.
3. Heaney LG et al. Eosinophilic and noneosinophilic asthma: an expert consensus framework to characterize phenotypes in a global real-life severe asthma cohort. Chest. 2021;160(3):814-30.
4. Petsky HL et al. Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): a systematic review and meta-analysis. Thorax. 2018;73(12):1110-9.
5. Khatri SB et al. An official American Thoracic Society clinical practice guideline: use of fractional exhaled nitric oxide to guide the treatment of asthma. Am J Respir Crit Care Med. 2021;204(10):e97-e109.
6. Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC) et al. 2020 Focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020 Dec;146(6):1217-1270.
7. National Institute for Health and Care Excellence (NICE). NICE guideline. Asthma: diagnosis, monitoring and chronic asthma management. 2017.
8. Sabatelli L, et al. Cost-effectiveness and budget impact of routine use of fractional exhaled nitric oxide monitoring for the management of adult asthma patients in Spain. J Investig Allergol Clin Immunol 2017; 27(2): 89-97.
9. Arnold RJG, et al. Cost impact of monitoring exhaled nitric oxide in asthma management. Allergy Asthma Proc 2018; 39(5): 338-44.
10. Brooks EA, Massanari M. Cost-effectiveness analysis of monitoring fractional exhaled nitric oxide (FeNO) in the management of asthma. Manag Care 2018; Jul 27(7): 42-8.
11. Hanania NA et al. Measurement of fractional exhaled nitric oxide in real-world clinical practice alters asthma treatment decisions. Ann Allergy Asthma Immunol. 2018;120(4):414-418.