The British Thoracic Society (BTS) has published a new care bundle for use in adult patients (aged 16+) following an acute asthma attack. Building on the first Asthma Care Bundle produced in 2016, the new “Asthma 4” - Asthma Attack bundle is introducing a set of clinical interventions designed to improve outcomes for patients following an asthma attack.
Since the publication of the 2016 Bundle, a range of innovations have emerged in the field of asthma clinical practice, including biologic therapies, which have informed the development of this new resource. The new Care Bundle is designed for use when patients present with an asthma attack in any clinical setting - including primary, urgent and emergency care. Unlike the 2016 version, this document does not include considerations for paediatric patients.
The main aims of the new Care Bundle include:
- reducing the risk of further asthma attacks.
- reducing the number of patients who are readmitted to hospital following discharge.
- encouraging follow-up and appropriate onward referral (if necessary).
A key focus point of the document is the introduction of the ‘The Asthma 4’ framework, 4 impactful and measurable actions that healthcare professionals can undertake to help improve outcomes for people living with asthma.
The ‘Asthma 4’ is made up of the following actions:
- Medication review – Ensure all patients are prescribed an inhaled corticosteroid containing inhaler. All patients should be observed using their inhalers and coached to improve their technique as necessary. Adherence to inhaled corticosteroid containing inhaled should be assessed and importance of good adherence discussed.
- A personalised asthma action plan – All patients should receive a written (or electronic) self-management personalised asthma action plan that has been co-designed with the patient and is individualised for their situation, taking into account their health literacy, language and appropriate treatment.
- Tobacco dependence advice and support for current smokers – All current smokers should be given very brief advice on tobacco dependence and referred to specialist support. Those vaping should have a plan in place to eventually stop vaping.
- Clinical review within four weeks – Clinical review within four weeks by a healthcare professional trained in asthma care to confirm the diagnosis of asthma and review oral steroid requirement, biomarkers and the need for further follow-up.
On the Asthma Care Bundle, Dr Hitasha Rupani, Consultant Respiratory Physician and Chair of the BTS Asthma Advisory Group, said,
“The ‘Asthma 4’ has built on the previous asthma discharge bundle and aims to enhance clinical care and improve asthma outcomes by highlighting necessary and relevant components of the patient review and encouraging appropriate follow-up.”
