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24min module
Asthma Monitoring
with June Roberts
This module provides an overview of asthma monitoring in patients, including:
- methods and tools for asthma monitoring,
- patient self-management,
- inhaler technique, and
- the role of asthma control questionnaires
No advice given in this module is intended to be a substitute for your own professional judgment in the clinical management of your patients.
Let's get started
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The simplest form of asthma monitoring is the recognition of key symptoms and the need for reliever inhalers. How many prescribed short-acting beta agonist (SABA) inhalers in the previous 12 months would mean a patient requires an urgent review?
Fewer than 3
Between 3 and 10
More than 12
Correct!
More than 12. That’s right. A patient prescribed more than 12 SABA inhalers in the previous 12 months should be invited for urgent review as this could indicate poorly controlled asthma.
Incorrect
Not quite. More than 12 SABA inhalers prescribed in the previous 12 months would mean a patient requires an urgent review.
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What should be checked at every asthma review?
PEFR, amount of amount of reliever inhaler used, including a check of the prescription record
Time off work or school due to asthma, amount of reliever inhaler used, including a check of the prescription record, number of courses of oral corticosteroids, admissions to hospital or attendance at an emergency department due to asthma
Inhaler technique, amount of reliever inhaler used, including a check of the prescription record
FeNO, number of courses of oral corticosteroids, admissions to hospital or attendance at an emergency department due to asthma
Correct!
That’s right. It is important to supplement questions about symptoms and reliever use with specific checks about time off work or school due to asthma, amount of reliever inhaler used, including a check of the prescription record, number of courses of oral corticosteroids, admissions to hospital or attendance at an emergency department due to asthma.
Incorrect
Not quite. While it is important to assess symptoms, inhaler technique, reliever inhaler use (including checking the prescription record), and, where available, FeNO to indicate airway inflammation, these checks should be supplemented with specific questions about time off work or school due to asthma, the number of courses of oral corticosteroids, and any admissions to hospital or attendances at an emergency department due to asthma. Routine measurement of PEFR is not recommended unless there are person-specific reasons for doing so, such as poor symptom recognition.
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Who should be offered a personalised asthma action plan according to BTS/SIGN guidelines?
Adults, young people and children aged 5 years or older with a diagnosis of asthma, and their families and carers if appropriate
Only patients with severe or difficult to control asthma
Only people with asthma 12 years and older
Only those recently hospitalised for an asthma attack
Correct!
That’s right. BTS/SIGN 2024 recommends that adults, young people, and children aged 5 years or older with asthma are offered a self-management programme including education and a personalised action plan, with families or carers involved where appropriate. Plans may be symptom- or peak flow–based in adults, usually symptom-based in children, and can also be considered for carers of children under 5.
Incorrect
Not quite. Although personalised action plans are especially important for people with severe or difficult-to-control asthma, those aged 12 years and older, or those recently hospitalised with an asthma attack, BTS/SIGN 2024 recommends that all adults, young people, and children aged 5 years or older with asthma are offered a self-management programme. This should include education and a documented personalised action plan, involving families or carers where appropriate. Plans may be symptom- or peak flow–based in adults, usually symptom-based in children, and can also be considered for carers of children under 5 with suspected or confirmed asthma.
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Which of the following statements best describes the use of validated asthma control questionnaires in clinical practice?
They are optional tools with no established role in monitoring asthma control
They replace objective rests such as PEFR and FeNO in monitoring asthma
They help standardize assessment of symptom control to guide management decisions
They are only used in research settings and are not recommended in routine care
Correct!
That’s right. Validated asthma control questionnaires help standardize assessment of symptom control to guide management decisions. Use of tools such as ACT and ACQ are well validated, have paediatric versions, and are recommended to be used routinely at asthma reviews for patients aged 5 years and older (BTS/SIGN and GINA) .
Incorrect
That’s not quite right. Validated asthma control questionnaires help standardise assessment of symptom control and guide management decisions. Tools such as the ACT and ACQ are well validated, have paediatric versions, and are recommended by BTS/SIGN and GINA for routine use at asthma reviews in patients aged 5 years and older. They do not replace objective tests such as PEFR or FeNO but can be used alongside them, particularly in patients with poor symptom recognition.
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