Asthma management across ages Acute asthma
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Transcript of Asthma management across ages Acute asthma
Asthma management across agesBrittle asthma
Brittle asthma
Very sudden sever attacks of asthma without the usual warning signs
Those who under-estimate their asthma, seeking doctor too late or not at all
Known as (Fulminant)
Asthma management across agesBrittle asthma
Identify patients at risks of fulminant attacks Those with previous fulminant attacks Those with previous hospital admissions for acute
asthma Those who need regular courses of oral steroids
Asthma management across agesBrittle asthma
Local arrangements are made for immediate hospital admissions in the event of acute attack
Liaison between : Patient Patient's relatives PHC team Local A&E Dept. Local chest physician
Very clear understanding of what to do and when for all those involved
Asthma management across agesBrittle asthma
Underestimating asthma People who do not seek medical attention British Thoracic Association (Anonymous 1992) survey
of 90 asthma deaths
21/36 dead or dying on GP arrival 2/3 out of 34 died in transit or soon after arrival hospital 13 patient no medical help
Delay in treatment is an important cause of asthma deaths
Asthma management across agesBrittle asthma
Cause of asthma deaths?
Delay in treatment is an important cause of asthma deaths
Failure of patient to appreciate severity of attack
Adverse psychosocial factors in over 65% of deaths (Wareham et al 1993, Mohan et al 1996)
Asthma management across agesBrittle asthma
Underestimating asthma Adverse psychosocial factors associated with risk of developing near fatal or fatal asthma
Non compliance with treatment Psychological illness e.g. psychosis, depression Alcohol or drug abuse Childhood abuse Social isolation Domestic stress
Asthma management across agesBrittle asthma
Underestimating asthma
Patients at risk from their asthma:
Frequent asthma attendance at ER Previous admissions from asthma in the last year Use large amounts of bronchodilators Require > 3 different types of asthma medications Had near fatal episodes of asthma
Asthma management across agesBrittle asthma
Underestimating asthma
Health professional role:
Patient education Identify high risk Patients with severe asthma and have one or more
associated psychosocial factors are at risk of asthma death (BTS/SIGN 2004)