Hello everyone. Just had my first asthma review and it was bizarre. I have to go back a second time after talking to a doctor just to fix a typo in my prescription and it seems like a bit much to have three overall appointments for a review, because my asthma is well controlled. I don't need to see the nurse for a second time as far as I can tell.
What does a normal asthma review involve? What is the purpose of them? Would it cause any problems if I got the typo fixed and then just didn't go back for a second review?
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JazzySalmon
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I wouldn't know, it's 5 years since I had a review - and not by choice! In an ideal world and a good gp practice I'd like to build up relationships as I did at my old practice in Wimbledon for over 17 years, 9 years at this one in a Gloucestershire is *star . I need to transfer
My asthma review is simple. I see my GP asthma nurse, we have a chat, she checks peak flow and oxygen levels, and goes through the meds. The purpose for me is to do a long term check on the meds, as opposed to just carry on as you are, without thinking about it.
It is good, I normally only see my asthma nurse when my asthma is out of control, when speaking is difficult.
Re, your typo, at my GP surgery, reception would just sort it out by asking the asthma nurse to do it for me.
See, that sounds useful and a valuable service. She didn't do most of that. I wonder if she was so confused by the prescription that she didn't proceed with the rest of the review and that's why she wants me to go back.
I'm most concerned she can't alter a typo. If she can't do that, then what could she do if my inhalers actually needed changing? It seems like a total waste of everyone's time and I might as well just see a GP in the first instance.
The trouble is, if you do not go back, and she has something up her sleeve like changing your meds, she may just do it anyway.
For example I am on fostair 100, when my asthma settles, my asthma nurse says she will be under pressure to change it to luforbec, which I do not want. So, in a way, I have to do the reviews, if only to say my asthma is unsettled.
I hadn't thought about that, thanks. They tried to put me on Luforbec three months ago and it made my asthma so much worse I only took it for three days. I begged a pharmacist to give me a Fostair inhaler to tide me over and did an e-consult to get it into my repeat prescriptions. The nurse didn't believe me because "it's the same medication" 🙄 but not the same fillers!! So you may have a point about going back. This practice has messed up my inhalers six times in the last three months and I'm sick of going back and forth trying to get it all sorted out. Last thing I want is a rogue nurse deciding I'll be ok on Luforbec after all!
Your messages are raising questions for me. 🙂 I may be interpreting them incorrectly.
Did the asthma nurse make the typo? Why couldn't the GP alter it?
Do you have a prescription department at your surgery. I belong to a quite large practice and they have one with several pharmacists. I can also contact them online with any questions etc.. An alternative could be ringing your GP secretary.
I either fill in the form annually for my review or see the asthma nurse. But since my regular one, a nurse practictioner left, the quality of the review is not the same.
I make sure I respond annually as I was swapped back along, to DuoResp Spirimax without consultation and that previous nurse, wrote on my record that I have to stay on Symbicort as my symotoms worsened and I ended up needing prednisolone. My consultant also wrote it in the letter to the surgery. I want to ensure it doesn't happen again, as my asthma is not controlled all year round.
Regarding your inhaler errors, I would chase up in a big way and each time. I had a problem a few years ago. I was on two doses of Symbicort inhaler whilst reducing/changing over from 400/12 dose, 6 puffs a day, to Symbicort MART very slowly. They kept giving me the incorrect dose inhaler that I had requested, even though I would write in the comment section to highlight that I am on 2 different doses.
I was horrified as, I was trained to administer meds at work over many decades and checking the dose is absolutely essential, as are all of the other steps. I really questioned the training at the surgery of the prescription department. Fortunately, they have improved and brought in their own pharmacists also.
I think my surgery may be in something of a shambles at the moment, so I do hope they sort themselves out. I've been living abroad for a decade so my experience with the NHS before I moved was very different. I'm not sure how many of the issues are systemic to the NHS today, vs this practice vs individuals having a bad day. They certainly seem overworked.
The typo occurred when I signed up at the practice and went in to speak to a doctor to get my repeat prescriptions set up. My health situation has changed a lot in the last ten years, so none of my issues or prescriptions were in the system and I knew I needed to sit down and arrange everything in person. He added the Fostair Nexthaler, which I specifically told him I can't take twice during the appointment, and the wrong dose for my other inhaler. I spoke to reception, who asked the doctor to change it to Fostair spray as requested. They changed it to Luforbec, I nearly ended up in hospital, I asked them to change it to Fostair via e-consult, they changed it back to the Nexthaler, I spoke to reception again, GP changed it to Fostair spray with the wrong dose. So now both my inhalers are set to the wrong dose, and together they are far too high. I've just been taking it at the same rate that's worked for two years, ignoring their dose, but they're handing me twice as many inhalers as I need every time I pick up a prescription, and the Fostair expires.
I asked the asthma nurse if she could change the dose to the correct one, to avoid the massive waste of me throwing away inhalers I never needed in the first place, but she can't alter dosages apparently, even though she can see it's far too high. I'm honestly at the point of just accepting the waste because if I'm afraid they'll change it back to the incorrect one, or Luforbec if I call or try e-consult! If it was just asthma I was dealing with I wouldn't mind so much, but I basically have a full time job dealing with other health issues at the moment, and this feels like such an unnecessary burden on top of it all. I'd also like to relax some time haha.
It's very destabilising to not know if you'll get the right medication every time you request a repeat, and it's wearing that I've been working on this for four months. I've been up there 4 times for this, and my husband has had to walk up about 8 times on his lunch break, bless him. Plus phone calls, e-consults, and now they're wanting two more in-person visits and I'm really not sure I can limp up there again unless they'll let me at their computer system to enter the right dose myself haha. I do feel for the NHS workers, I know they're overworked and underpaid but it's a nightmare.
This sounds awful and unacceptable! The Practice Manager is the person to go to with all of these errors. I would definitely see a different GP if you can also. The Practice Manager is the top person. I have never gone this far, but my sister has once and had an immediate phone call from hers for other problems.
You could do it informally at first or an official complaint I believe. If it continues, are you able to change to another surgery that is a similar distance? These mistakes worry me for people who are not so attentive to details when prescribed meds and assume no errors are made. I would definitely have your communication to the Practice Manager in writing, email or letter, if you decide to go down that route.
Regarding medication waste, can you request the inhaler less frequently? Or communicate you have given some back to the pharmacist, if that needs to be done. And tell the surgery in writing each time.
I know you can check a surgery's inspection rating online too. I believe it's CQC inspections. Might be worth checking.
I've contacted a practice manager about a different matter before (much worse than this!) and they were frankly more insulting than the doctor. This is a different practice, so it might work out better and it's certainly worth trying.
I am moving again soon (hopefully into somewhere permanent this time!) and won't be at this practice for too long, but it does worry me about other patients.
I discovered recently that the system my surgery uses can’t see any note added when requesting repeats online, so it’s possible they’re simply not seeing your comment (yes, I think it’s daft too, it just might explain what’s happening). If I have a prescription problem, I find the most effective solution is to go in to reception and explain in person - very old-fashioned, but it seems to work!
That is interesting. I know it wasn't happening for me as the surgery pharmacist I spoke to, that finally sorted it by emailing the whole team, to educate them, confirmed she could see I had done everything right my end by highlighting it in the comments. It doesn't surprise me though with the NHS technology. At least I can see with my surgery, they are doing a lot to change things that are not right. I think as long as I can see things improving, I'm happy.
Hi JazzySalmon, we must be going to the same surgery! Mine keep doing the same thing even though I've had it written in my notes several times that I cannot use Luforbec.
I don't bother, only had one phone appt. and she wanted to change my meds, I refused coz they work and if it ain't broke don't fix it! I don't bother with peak flow thing either, mine is so low it's irrelevant. If things change I'll get onto dox but only if I'm desperate as have so many conditions they just leave me to it and I tell them what I want. Have even recently educated new locum! 😂 I guess it helps some people esp. those badly affected or who haven't yet found a regime that helps them but for me it's just a tick box exercise. 🤷♀️
For me a review is just a tick box exercise and to try to reduce or change medication. If I ask the nurse any questions that they haven’t got the answers to on screen they don’t know and will have to ask the doctor and make another appointment just to answer my question. Better of just asking on this forum get more sense. Plus not had f2f appointment since 2019, when I speak to the receptionist they say it’s just a review so can do it over the phone.
I had my asthma review only this morning. I have one annually with the practice's asthma nurse, and I find it very helpful. She asks some questions to work out how well controlled my asthma is, how often I'm using Ventolin, if there are any areas of life where I feel asthma is limiting me etc, so that we can make sure my asthma is as well-controlled as possible before I get into the months that are the hardest for me.
However, my nurse is able to make changes to prescriptions which then just have to be signed off by the GP - who never seems to challenge anything she does. It sounds as if yours is either much less sure of her role or that the practice does not allow the asthma nurses to do much at all.
I hopefully managed to get my inhalers set up right this afternoon. They had a practice pharmacist call me and he seemed to think it was all straight forward. I'll keep my fingers crossed until my next repeat prescription becomes due!
There are two types of review - one is a routine annual review and the other is a post-attack review. In my opinion the most important one is the post-attack review . The post attack review has two purposes- I) to check and see if the attack is over - if it has not resolved you may need more meds or even hospital admission; and ii) this review aims to identify modifiable risk factors that caused the attack and which could be fixed by optimising your care.
The reason why the post attack review is so important is because if you have an asthma attack ( also called an exacerbation) that means something serious has gone wrong and that urgent action is needed to identify why you had the attack, identify modifiable risk factors, and to optimise your care to prevent another attack. ( modifiable factors include : too much blue reliever ( you should only need one a year if your asthma is treated properly); too little or no inhaled corticosteroid; poor inhaler technique; other medical conditions such as acid reflux, allergic rhinitis, COPD which may need treatment. So after an attack your symptoms, ability to use your inhaler, your adherence to medical advice - are you taking your inhaled corticosteroid? - should be checked and your self management plan should be revised or issued. This review should be done by someone trained in asthma care within a few days or max a week of the attack.
The routine annual review should include an assessment of your asthma control ( ie both symptoms at the time AND whether you had any attacks in the last year - as above - an attack means something has gone wrong and modifiable factors should be identified and fixed. Your concerns about your asthma should be addressed - do you know how and when to use your meds - can you use your inhaler - this should be checked whenever you see a doctor or nurse in my view because if you can’t use your inhaler correctly it can’t work. You should be issued with a self management plan ( so you know how to recognise poor asthma control and emergency need for help and what to do when this happens.
Key thing is that a review must be done by someone trained to do so - they need to be trained to recognise danger signals and what to do to optimise your care or even to get emergency medical assistance when appropriate - so do ask the person doing the review whether they have been trained on asthma care - ideally a diploma level trained asthma nurse.
I agree 100% with what you say - your comments are straight out of the best practise asthma guidance.
However, the reality for most asthmatics (in these days where the NHS is absolutely on its knees) is something completely different!
Ftf asthma reviews, follow up appts and even some emergency appts are a thing of the past.
My surgery doesn’t even have an asthma nurse.
I’ve been hospitalised x4 this year and I’ve never seen an asthma nurse either in or out of hospital and had no follow up.
I am not complaining and am very grateful to the NHS for patching me up and keeping me alive. However, I am under no illusion about what I can realistically expect from NHS asthma care in 2024 and beyond.
From what you have said in all your replies, while you call it a "typo", it's not. It's, in your belief, and that of your asthma nurse, the right medication, but the wrong dose. You appear fed up because of the medical practice 's desire to change you from Fostair to Luforbec. You say that you are wasting inhalers, because you're using a lower dose than prescribed, but I ask why you are requesting inhaler prescriptions every four weeks, when you should only request them when you need them. If you are taking half the prescribed dose, they will last 8 weeks, so should be requested at the start of the 7th week.
I've never been prescribed any of the inhalers you use. I was prescribed DuoResp Spiromax 320/9, some years ago, to help cut NHS costs, and it works much better than the inhaler that I had been using.
You will need a GP or practice pharmacist to alter the dose.
I have to take my inhalers and peak flow to my asthma review. Peak flow tested, best of 3. The nurse reminds me of correct technique. She also watches me take my inhaler, again to check my technique. She weighs me (😒) then conversation about losing weight. She asks what daily exercise I'm doing, then conversation about doing more exercise. Discussion around treatment options. Updates asthma plan. If necessary, second appointment in several weeks in order to check progress on any changes to treatment. Best asthma nurse I've had.
I had a review last Wednesday, my asthma nurse has retired so it was good to get to know my new one. Though she's pregnant so we'll see how that goes. She didn't test my peak flow but weighed and measured my height for my osteoporosis. She has given me a spacer to use, first time with one. Showed me how to use it, I'm still getting used to it. I'd follow up with your nurse and that way she will get to know you and your symptoms. My new one told me to see her if I need to use my reliever more than 2 or 3 times, but that's probably because I've only needed it once this last 3 - 6 months. I had a good relationship with my last nurse, I think that's important, with asthma.
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