Asthma
Feature
RUTH MORROW
VIRTUAL ASTHMA AND COPD REVIEWS Ruth Morrow, advanced nurse practitioner, provides an overview of virtual consultations in the Covid-19 era Asthma and COPD are two conditions which are ideal for virtual consultations. Both conditions have been the subject of many research studies over the last 20 years to address the issues of non-attendance at both primary and secondary care level appointment. “Every asthma consultation is an opportunity to review, reinforce and extend both the patient’s knowledge and skills. It is important to recognise that education is a process and not a single event” (BTS/SIGN 2019). Ryan et al 2013 proposed a universal structured approach to a primary care asthma review “SIMPLES”. SIMPLES is an acronym for Smoking, Inhaler technique, Monitoring, Pharmacotherapy, Lifestyle, Education and Support. It can be adapted to the current situation where face to face in person reviews may not be possible or even necessary for the majority of those with asthma. It allows an increased patient focused approach whilst gathering the required information. Anecdotally, healthcare professionals have noticed that patients are more relaxed and more honest during a virtual consultation as they are away from the clinical environment and have not been waiting in a packed waiting room. This article will address the finer points for undertaking virtual asthma and COPD reviews. It will also provide the GPN with a number of resources
36 SEPTEMBER-OCTOBER 2020
which can be used throughout the virtual consultation. Undertaking an effective asthma review: ▸ Identify how you will deliver the remote review, eg, will It be through video consultation or telephone? ▸ In preparation for the consultation, briefly gather information from the medical record and prescribing data to assess morbidity and compliance, looking at short acting bronchodilator use (SABA). You can assess the patient’s reliance on SABA using the Asthma Slide Ruler (Figure 1). This ruler can also be downloaded from: https://www.pcrsuk.org/resource/asthma-sliderule ▸ At the time of booking the appointment for the virtual asthma review, check If the patient has an Asthma Action Plan and if they are using it. If the patient doesn’t have an Asthma Action Plan, this can be completed by the practice nurse/GP in advance of the appointment and posted to the patient. Inform the patient that you will be referring to it and discussing it during the consultation (Figure 2). ▸ Start off with an introduction and establish if the patient has access to the Internet as this will be useful to signpost them to edu-
cational resources and support, both during (where appropriate) and/or after the consultation. Ask how the patient has been since their last review. ▸ Assessing asthma control - use the Asthma Control Test (Figure 3) and/or the GINA Assessment of Asthma Control to monitor the patient’s asthma. The ACT can be sent to the patient (or text a link to https://www.asthma. com/) beforehand so it can be discussed during the consultation. An ACT score of less than 19 (scored out of 25) indicates uncontrolled or poorly controlled asthma. If the patient has a peak flow meter, you can ask them to carry out the test and you can work out their percentage. ▸ Explore key triggers that make their asthma worse, including where appropriate, smoking which is a key element. Ask if there are any occupational or seasonal triggers which impact their asthma control, and whether avoidance or reduction of these is
