Asthma UK is reviewing its asthma attack advice to make sure that it is easy to understand and in line with what people with asthma are told by their healthcare professional. If you are a person with asthma or a parents/carer we want to hear from you!
Currently our advice to people with asthma is to:
1. Take your reliever inhaler (usually blue)
2. Sit up and loosen tight clothing
3. If no immediate improvement, continue to take one puff/dose of reliever inhaler every minute for five minutes
4. If your symptoms do not improve in five minutes – or if you are in doubt – call 999 or a doctor urgently
5. Continue to take one puff of your reliever inhaler every minute until help arrives
We want to know:
- What you think of our advice – is it clear enough?
- Is it the same as the advice you receive from your doctor or asthma nurse?
- Has your doctor or asthma nurse given you a copy of Asthma UK’s asthma attack card or Personal Asthma Action Plan or something similar?
If i have an asthma attack im recommened to take 10 puffs of my inhaler (blue) as they say this is equivalent to a nebuliser. I've been advised to do this up to 3 times before seeking help as well as taking symbicort as a preventer. I akways take this through a spacer and think maybe that should be put in the advice as taking a normal MDI during an attack is pretty difficult and leaning forward also helps.
I've never been given any kind of written advice as to what to do during an attack or been given an action plan. Also doctors seem to have very differnt differnt views on when you should seek help, one doctor in a and e suggested i should be in after 5 puffs - which for me would be silly!
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I pretty much follow the advice that asthma uk give. But if I ahve no improvement after the first couple of puffs of inhaler I take 10 puffs of inhlaer through a spacer or use my neb (but i know not everyone has these) but as a first aider and if someone has an attack i use the ten puffs through a spacer alot and find it very effective.
I think the adive is very clear that AUK gives.
I am not sure the asthma attack cards are distrubted enough. I ahve had asthma for 22 years and last year was given my fiorst asthma attack card and this was by someone who works for AUK who i met at a charity event! otherwise I would still probably not ahve one!!!
I ahve never been given a personal asthma action plan. I think drs take it for grnated that we know what to do. I had an experience of this today when I went to the gp with my asthma worse and he said to do my usual steps for it getting worse. the problem is is that I tend to go by instinct alot of the time. I think this is because I am followed closly at the hospital by my consultant and often the information between consultant and gp is not that effective.
Even though I ahve had asthma for so long I think it would be very useful for me to ahve my action plan written for me.
I wonder if there is the possibilty of AUK producing a card like the asthma attck card which can have blanks to fill in as an action plan???
Olive
Would be good add on the cards not all asmatics weeze as with a bad attack can hardly talk and not get words out and cards come in handy in your purse xxx
I think the basic instruction card is Good and applies to the majority of Asthmatics.
It should be kept simple so as not to confuse or conflict.
However, a larger card with spaces to fill in would be good to guide people along with their Asthma personal action plan.
I have all my details on a treatment protocol ( 2 sides of A4) as the asthma PAP card would not really be much good to me as I am in the red for PFs most of the time! Also not much room on there for my own emergency treatment guidelines.
Perhaps an A5 or A6 size card for a personalised card for mild to moderate ( & perhaps severe asthmatics too) that is easily recognisable to all esp medical staff!
Kate
PS Olive! No PAP??
nope Kate non PAP as such. I am going to adress it with con when I see him in a few weeks. I think it is because i dont have much room for maneouver meds wise. I can only really increase pred (and I hate doing that) or upping my nebs to 2hourly but by that stage i really need to be in hospital.
If you dont mind me asking what is your PAP? can you inbox me it if possible. I ahve never had one even when I wasnt as bad as I am now.
Olive
Never had a visit to A&E for my asthma nor am I under a consultant.
Only by really pushing my asthma nurse the other day, did she fill in a Personal Action Plan - my first.
Seems to me that if you seem remotely sensible, then it is presumed that you know everything about your condition. Only by coming on here, did I learn about PAPs in the first place.
An episode a week or two back had me wondering if I should be heading off to A&E. I'm not a wheezer just dry cough that doesn't stop.
Several things stopped me from phoning 999.
1. Middle of the night and didn't want to be a bother in case symptoms stopped half way there.
2. Would A&E recognise my cough for asthma when chest clear and no wheezing. This last one mainly because I've had that symptom for nigh on ten years - coughing fit to burst and short of breath on exercise - and its only in the last year, identified as asthma.
In the event followed advice as far as sitting up and taking reliever then once every five minutes. 12 puffs in all and it had calmed down.
Confess, did give me a scare. Perhaps something to the effect that its better to go along than sit at home worrying could be writ in big letters.
I was only discussing this with my friend (whose dad has severe asthma like me) when she visited me in hospital the other day!
The asthma attack advice asthma UK is fine for mild/moderate asthmatics but it is really difficult for people who following the normal advice would be ending up in A + E on a daily/ weekly basis. Also if some of us followed the advice it might have adverse consequences. Would it be possible to get separate attack cards for more severe cases that could only be distributed by consultants/Clinical nurse specialists? Then you could fill them in together. Also these cards could be used to raise awareness of more dangerous signs to look out for i.e symptoms of hypoxia (how you can appear to be getting better/ calmer because you oxygen levels are dropping). This was the case with my friend's dad who thought he was fine because he was so confused and so ended up in ITU (and her mum is still cross 15 years later!). But how are people supposed to know these things if know one tells them! I am lucky as everyone in my family is a doctor.
I second the no-wheezing comment! I never wheeze -which caused problems when we turned up at a hospital here in Thailand where they had NEVER seen an acute asthma attack before let alone heard of non-wheezing.
I'm on home nebs. told if nebs not lasting 4 hours to seek medical attention.
I think that the asthma attack cards are very good because you can tick what symptoms you get. Maybe re wording the symptoms part. Putting something along the lines of when a person is suffering an asthma attack they could suffer from one or more of the following. This would show that when a person is having an asthma attack they are not guarenteed to get all the symtoms.
I like what they say - altho personally i do not fit it at all but in general i think it is very good. I think adding that people can have 10 puffs of ventolin through a spacer while waiting for an ambulance would be a good idea because you can improvise with a desposable cup if they dont have a spacer.
I think it maybe worth consider having two asthma attack cards, one for general asthamtics that use inhalers and one for severe asthmatics that use nebuilsers, ie
1. Give person there nebuilser
2. Loosen tight clothing and ensure sat down
3. If the medication does not work call 999 while ensuring they use another nebuilser.
I know nebuilsers are rarely used but i do think there are enough people that use one to benefit from an asthma attack card been produced for them.
If i think of anything else i will edit this post.
Plumie
Edit:
I have never been given a personal action plan until i got a respiratory nurse and now she is adapting one for me because i cannot use the asthma uk one as there is not enough space on it for all my asthma medication. Again it is designed for mild asthmatics, there is nothing out there for severe asthmatics which i am not complaining about just pointing out.
I know the suggestions about two different cards is a good ideabut there are thigns that would make this not work.
How do you define someone who has severe asthma. What is severe to one person may not be severe to another and therefore they may be issued the wrong card.
Also you need to remember the majority of asthmatics are not at the severe end of the spectrum. I know the foirum here appears to ahve alot of severe asthmatics but this does not reflect the whole asthma population as a whole. I dont think it would be cost effective for the production of two cards.
Also promoting the use of a nebuliser on an asthma attack card may not be a good idea as many people rely on nebs too much before seeking help and i know now a and e and dr's dont like giving out nebs so they are very rare for home nebs now.
Alot of people with severe asthma or who have done the difficult asthma protocol will have a written protocl from their consultant so a severe astham attack card is not really needed as we carry this letter about with us.
I think it maybe a good idea to produce a balnk one for people to fill in but on the whole the asthma attack card is really good.
Olive
Olive 86 i disagree GP's would know who to give the severe cards too and it would also prevent severe asthmatics staying at home too long as they would know that if one nebuilser didnt work then they needed to get help.
Interesting reading people's opinions! I didn't think about how you would defined 'severe' asthma! but surely anyone under a consultant would be a case of a 'special card'. If 2 cards helps people even if it costs more, I think it would be worth it.
I have never had a personal action plan (seen several consultants over the years). I have an appointment with a new consultant next week (I've moved back to Aberdeen) and I will insist on an action plan!
Ok Plumie,
One GP's perception of severe asthma maybe different from another. I know alot of people one here who think they have severe asthma but may not actually have severe asthma but their GP's ahve said they ahve severe asthma but in the broad specturm it is pretty moderate asthma.
Also consider it that the number of deaths caused by asthma are often with people who dont have severe asthma at all.
I think it is kind of scaremongering giving a severe asthma card and a not severe asthma card. an asthma attack is an asthma attack whther it is in a sevre asthmatic or a mild asthmatic it can still be life threatening no matter what.
Olive
Olive86, I agree with everything you've said, so won't repeat it. ANY asthma attack can be life-threatening. I would say the most important thing is that whatever card there is, it is very simple and easy to read telling particularly helpers/onlookers exactly what to do. The person having the attack should know what to do (or this can be given in more detail in other leaflets they can read in their own time when not having an attack) - the card needs to be something that can be given to someone if help is needed. It should not have superfluous information nor is it the place to educate more deeply about asthma. It needs to say ""I'm having an asthma attack, do/help me do this..."". I think the current card achieves this quite well in most cases, and as others have said, the 'special cases' amongst us have written letters from our consultants which we carry around anyway.
Maybe what I'm getting at is that there should be more detailed asthma attack advice in leaflet form not intended for use in an emergency situation but to educate (both the person with asthma and their family/carers) - this could also talk about the importance of having a PAP. Then there should be a very clear, concise credit-card sized card for use in an emergency situation and aimed at telling someone else (who may well be very anxious about not knowing how to help) in a simple step-by-step way what they should do.
One part of the advice I have always wondered about on the current card is where it says 'call 999 or a doctor immediately'. I wonder if this should just be changed to 'call 999' because a)the person helping may not be able to get the doctor's number from the person having the attack, b)it currently has a choice and the person helping may not know which choice to make - I know a lot of people worry about calling 999 unnecessarily - if it says do this on the card, they may be less reluctant, c)I don't know about others' experiences, but calling a doctor immediately isn't going to get help very quickly and they are likely to advise calling an ambulance - that time lag could be avoided if an ambulance had been called in the first place.
I Think a card would help but I wear a medical id talisman and good idea if your asthma is realy bad and on lots of meds.
I know what you mean about keeping cards simple and even mild asthmatics have severe attacks.But I do find one difference which may mean 2 different types of cards. My asthma is mild but I recently had a severe attack with near heart attack, so this follows in event of an attack.....
My Son has brittle asthma type 2 so can seem really fine but goes down hill really quickly sometimes with very little warning and sometimes gets better really quickly but then without warning gets really ill again within minutes but this is often overlooked by the medical profession. I have a letter but a card would be fab stating;If he starts to deteriorate this can proceed very rapidly. These factors need to be taken into consideration when treating him.
Rattles,
I caqn understand you point of view here. I also suffer from brittle asthma and can go down hill very quickly but when you are a charity producing these type of cards how cost effective is it. But also with brittle asthma every single person is different in the way they present with attacks etc so I think it is probably best to customize you own one or make a complete new one and laminate it with what happens for your son?
I am sort of thinking from both sides. AUK is a charity and unless we start paying for individual cards it is not going to be cost effective for the charity to start producing loads of different cards to suit different asthmatics needs!!!
Olive
I carry one of the asthma attack advice cards in my wallet and I have just given one to school today as well for my son. They are simply and straight to the point and because you have the white boxes on the cards I have ticked the ones that are relevant to my son. I also added on the back that if he has another attack with-in 1 hour of coming out of an attack then no matter what dial 999 as he will reqire medical assistance as thsi should not happen. I can't think of anything else that can be added to an asthma attack advice card as I feel they need to be simply and straight to the point. Th eonly thing that I can really think of that col dbe changed is instead of putting the number of puffs on the inhaler and the colour leave that space blank for people to fill in themselves with the details that they are adviced to do by there GP or asthma nurse. This way the card you already have will be 100% universal for everyone no matter how bad or what colour their relieve inhaler is
I have carried the asthma attack card in my wallet for a number of years. I think it gives the basic advice required for an emergency situation. While some people are reluctant to ring 999 I think it must be stressed that asthma can be life threatening.
I have just had my asthma action plan re-written by my consultant. This is a much more detailed document which gives clear guidance on treating my asthma. When to step up the medication and when and how to step down the medication. It also give the clear instruction to call an ambulance and go to the nearest A&E when necessary.
Unfortunately I have had two emergency admissions ( ambulance with blue lights and sirens) already this year. Fortunately I had quick access to treatment and recovered fairly quickly. Hopefully that is it for the year.
John
Good point asthma family - not everyone has a blue inhaler, the SMART inhaler is red, i think putting a gap for you to write what your personal reliver is, is an excellent idea, it would make the asthma card applicable for all whether mild, moderate or severe.
As i said before i love the tick part where you can tick your personal symtoms.
Also i like where some one wrote about taking off ring a doctor and just put ring an ambulance i think this is also an excellent idea, as the doctors surgery would just tell you to ring an ambulance i know that from personal experience even the a and e staff say forget doctors just come to us we prefer to send you home as you are ok than anything else.
This discussion has been so interesting.
Olive 86 i understand what you are saying and i think what asthma family are saying would be a good way to get round it and would also stop people saying asthma was a blue inhaler condition.
plumie
Hi All
Thanks so much for your replies so far. Very interesting reading!
We are updating the Personal Asthma Action Plan and asthma attack card this year so your comments are so useful. We are also right in the middle of our Severe Asthma Research Project so when we come to look at the outcomes and how Asthma UK can improve our services for people with severe asthma I will make sure to include the points you've raised.
Keep your comments coming - I'm especially keen to hear about any asthma attack advice that your doctor/asthma nurse has given you.
Hi Kim, please can you make sure that in the severe action plan that people are made aware that not all asthmatics wheeze, this is a huge point of life and death for some of us sufferers as we get overlooked when being treated and sent home, when really more tests and hospital care are desperately needed, (plummie has raised this issue before)
Thanks so much for your help
Kate x
Maybe it is time to look again at memory stick thing again to go along with a basic card. I have a card I did myself that says if you are given this please call 999 tell them you are with an asthmatic who is unable to speak, make sure I have and am using my nebuliser (I have instructions on how to use it with the nebuliser), get out my epipen and read and follow instructions. Please stay with me until the ambulance arrives and give the ambulance crew your detials I will want to know who to thank when I am better.
Bex
Hi Kim,
as my daughter's asthma was so severe the consultant at our local hospital made a card for her to carry with her at all times saying she required frequent life support for her attacks and was on oral theophyllines. This had the her hospital number on it and her cosultants name and her photograph. My daughter could go off very quickly and without warning.I hope this is of some help to you. LIZ x x
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