People with well-controlled asthma:
- have no or minimal symptoms both during the day and at night
- need little or no as-needed medication
- can participate in physical activities without restriction
- have normal or near-normal lung function
- avoid serious asthma exacerbations, including the need for hospitalisation.
Effective self-management of asthma requires patients and their whānau to have a good understanding of asthma and how it is managed. People who are unaware of what good asthma management looks like are more likely to normalise and accept sub-optimal asthma control. Healthcare professionals have a valuable role in improving this understanding, supporting patients/whānau and improving outcomes by embedding asthma education into their practice.4
Asthma education should be tailored to the patient/whānau. Poor asthma literacy is associated with reduced self-efficacy and decreased use of asthma medicines and is likely to contribute to asthma disparities. Always ensure asthma information is communicated in a way that aligns with patient/whānau health literacy, and check for understanding.4 The Health Quality and Safety Commission’s “Three steps to meeting health literacy needs” has been developed in the context of achieving equitable health outcomes for Māori and maintaining cultural safety. It provides a useful framework for assessing patient/whānau asthma knowledge, allowing existing information to be reinforced and gaps in understanding or misconceptions to be corrected.
Once a patient’s level of asthma knowledge has been established, it can be built on step by step – with a focus on expanding one aspect in the understanding of asthma at every point of contact.4
When in discussion with patients be sure to use appropriate language, not jargon, and try to adopt terms the patient or their whānau has used, thereby building a common language. For example, use “puffer” if the patient refers to their inhaler in this way. Avoid overloading patients with too much information at a time – start with the most important point. Be creative when trying to increase understanding – use illustrative analogies, and “what-if” scenarios where patients describe how they would manage a situation likely to result in asthma.
Offer targeted resources for patients to take away; check with asthma service providers for availability of these. A map providing a directory of local asthma societies with contact details is available from the Asthma and Respiratory Foundation NZ. ARFNZ has a variety of asthma resources, with some offered in te reo Māori, and in Samoan, Tongan and Chinese languages.
Asthma action plans
Everybody with asthma should be encouraged to have a personalised asthma action plan. These provide direction to patients on when and how to adjust treatment over the short term in response to worsening symptoms, and when to access additional medical care. They have been shown to improve health outcomes and reduce hospitalisations.3,4 Plans should be updated annually, and be appropriate for treatment level, asthma severity, health literacy, culture and self-management ability.
Action plans come in a range of formats – written, pictorial, electronic, app – with adult and child asthma action plans available in te reo Māori, Samoan, Tongan and English. They can be downloaded from the ARFNZ website, ordered in print and are available on the My Asthma App (see Asthma resources at the end of this article). The foundation also provides adult asthma action plans as interactive PDFs; these can be customised by the health professional and emailed to the patient.
Action plans may be based on symptoms with or without peak flow measurements and are either three or four-stage depending on both patient and health professional preference. The four-stage plan has an extra step giving patients the option of increasing the dose of ICS up to four-fold, by increasing the frequency of use and/or the dose.3
Asthma management is a cycle of ongoing assessment, treatment and review. Remember, when discussing asthma management with patients/whānau, personal goals should be included and documented as shared goals of care.