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Management of asthma

​​​In 1999 the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN) agreed to jointly produce a comprehensive new asthma guideline.  This guideline was last updated in 2014 and provides recommendations based on current evidence for best practice in the management of asthma.

Visit the British Thoracic Society website for more information

There are several groups of medication and treatments used in the management of asthma.

  • Short acting bronchodilators
  • Long acting bronchodilators
  • Inhaled corticosteroids
  • Anti leukotrienes
  • Theophyllines
  • Antimuscarinics
  • Oral steroids
  • Anti IgE treatment
  • Bronchothermoplasty
  • Allergen avoidance
  • Weight reduction
  • Smoking cessation – avoid passive or active exposure to smoking
  • Breathing exercises – helps to reduce symptoms​

The Nebuliser Service

The Nebuliser Service is run by appointments only.

PLEASE DO NOT WALK INTO THE DEPARTMENT WITHOUT AN APPOINTMENT AS YOU MAY NOT BE SEEN DURING BUSY PERIODS.

The Nebuliser Service is part of the Respiratory Physiology Department, at the City
General Hospital.

We provide a number of services:
• Yearly loan nebulisers - a nebuliser is loaned to you for 12 months. This is the main service we provide.
• Provision of consumables lasting for 12 months to use with the nebuliser loaned to you.
• Holiday loan nebulisers on request - smaller portable nebulisers that can be used for holidays. Please ring us to arrange collection.

Please do not hesitate to ring us if you have
any questions about the service we provide.

YEARLY SERVICE APPOINTMENT

You will be sent a letter in 12 months time providing an appointment for you to bring the nebuliser back to us for its annual service. You will be loaned another nebuliser for another 12 months, along with all consumables, when you attend this
appointment.

The service appointment does not take very long and you do not have to attend the
appointment yourself—a relative or friend can return and collect the nebulisers on your behalf.

Please ring if you cannot attend your appointment or wish to re-arrange it.

Using Your Nebuliser

In your nebuliser you will find:

• 2x Sidestreams—these are the mouthpieces, and what turns your liquid medication into very small particles that you can then breath into your lungs. Each
individual Sidestream should last up to 6 months. It is important that these are kept clean.
• 1x Inlet Filter—this is the filter that cleans the air you breathe during your treatment.

They can get dirty over time. Each filter should be changed every 6 months. A
spare filter is attached on your machine with a date for changing (usually on the
inside of lid).

• Electric lead—Please do not forcefully push the lead into your nebuliser as this can
bend the electrical connectors.

WHEN YOU OR A FAMILY MEMBER NO LONGER REQUIRE THE USE OF A NEBULISER,
PLEASE RETURN IT TO US (ADDRESS CAN BE FOUND ON THE BACK OF THIS LEAFLET).

THERE ARE A NUMBER OF NEBULISERS IN THE COMMUNITY THAT HAVE NOT BEEN USED OR SERVICED FOR LONG PERIODS OF TIME— PLEASE HELP US TO HELP OTHER PATIENTS WHO MAY ALSO BENEFIT FROM NEBULISER THERAPY BY RETURNING MACHINES TO US.

Do’s + Don’ts

DO clean the machine and the mouthpieces every day. This is very important for your health and the nebulisers efficiency. The machine can be wiped with a damp cloth once a day. The mouthpieces should be washed in warm soapy water after each use and left to air dry.

DON’T put your machine on carpets or in dusty/smoky environments and try not to
cover the machine when being used.

DO follow your doctor’s instruction's on when to use your nebuliser, what edications to take and how many times per day you should be using it. If you are unsure then please ask—your own GP may be able to advise you also.

DON’T forget to attend your annual service loan appointments to ensure the nebuliser is working safely and efficiently!

Answer Machine Service

Please note that there may be some times when we are unable to answer the phone. Therefore, you will be given the option to leave a message. Please leave a clear message stating your name and hospital unit number if available, and your date of birth; and one of the team will ring you back as soon as possible.

We endeavour to return calls on the same day.

In Case of Emergency

If your nebuliser stops working for any reason during times when the department is closed and you require a nebuliser, you can go to Ward 222 (Main Building, Tel:01782 676222).

The Ward will loan you a machine to use temporarily until we are open again.

PLEASE DO NOT TAKE YOUR BROKEN MACHINE TO WARD 222.

On the next working day, please ring us to arrange a suitable time to bring in your broken machine and also the temporary loan from Ward 222 to us.

We will then loan you another annual loan nebuliser.

Using Your Nebuliser

1. Unscrew the top of the Sidestream (blue part) and check that both arts are clean, not cracked and there are no foreign objects in it.

2. Put the prescribed amount of medicine into the Sidestream (clear part).

3. Firmly screw the top back on connecting the white mouthpiece to the top of the Sidestream (blue part); and attach the tubing to the bottom of the Sidestream (clear part). Make sure the other end of the tubing is firmly attached to the machine.

4. Keep the Sidestream upright to prevent any spillage.

5. Plug the machine into the power supply, place on a hard surface such as a table, and switch on. Do not place the machine on the floor, as it may take in dust, or overheat on the carpet.

6. Sit down, put the mouthpiece in your mouth and breathe as normally as possible while you are using your nebuliser. It will take several minutes for all the medicine inside the chamber to be used up. A tiny drop of liquid is always left at the bottom of the unit.

7. After use, turn the machine off and unplug the power supply. Disconnect the tubing from the machine and unscrew the Sidestream. Then wash the Sidestream out in warm soapy water, rinse and leave to air dry or dry with a lint free cloth. THIS
SHOULD BE DONE AFTER EACH USE. By doing this, your risk of catching a chest infection is considerably reduced. It also helps to keep the whole nebuliser unit working efficiently.

8. The machine should be wiped clean with a damp cloth a few times per week.

If you need any help or have any questions, please do not hesitate to contact The Nebuliser Team or your own doctor/practice nurse will also be able to assist you.

 

Asthma reviews
It is an important aspect of asthma management to attend an annual asthma review at the GP surgery.  It will help you to make sure you're on the right asthma plan.  Everyone with asthma should have an asthma review at least once per year – those with severe asthma should have one more often.  You should go, even if you feel well – it is your chance to make sure your asthma stays well managed so that you can get on with doing the things you enjoy. 

To complete an Asthma Control Test questionnaire click on the link- Asthma control test

Medication
The best way to stay on top of your asthma is to remember to take your prescribed medication as directed by your GP/Practice nurse or Asthma team. If you develop any side effects from the medication, please make an appointment at your GP surgery for a review.  It is crucial to continue to take your preventer medication every day to control your asthma.  If you need to use your reliever medication three times per week or more on a regular basis, you should seek a medical review.  If you have severe asthma and your reliever medication does not relieve your symptoms for four hours, you should seek an immediate medical review.

To obtain information about prescription costs and/or purchase a prepayment certificate (it could save you money!) visit the NHS Choices​ website.

Personal Asthma Action Plan (PAAP)
You should have a written plan of action, including peak flow readings, so you will know what to do if your asthma gets worse, or if it gets better.  Your personalised plan can be completed by your GP, practice nurse or hospital asthma team.  Try and remember to take your management plan to all of your asthma appointments so that it can be reviewed or updated as necessary.

  • To tell what is going on in your lungs, rather than guessing by how you feel
  • To find out if your medicine is working or if you need to change the amount you're taking
  • To keep a record of how well you've been and show this to your GP or asthma nurse
  • Act quickly if your peak flow tells you it's an asthma emergency

Click to download -  Peak flow diary

You can talk to your GP or asthma nurse about having the flu vaccination.  This usually happens in the autumn.  You can also talk to them about the pneumococcal vaccination which protects you from pneumococcal infection. The GP or practice nurse may/ may not give you your vaccinations if you are taking prednisolone at the time.

Smoking can make asthma medicines less effective, increase the risk of an asthma attack and permanently damage your airways.  Stopping smoking can be difficult, but it will have a massive impact on your asthma.  You can ask your GP or asthma nurse for advice about smoking cessation services and nicotine replacement therapy.

People wanting to quit or find out more can contact the NHS Time to Quit service on 0800 043 4304 or visit the NHS Time to Quit service website.

NHS 111 – the non-emergency care number

Sometimes, you might need to call for help when it's not a life-threatening emergency.  The NHS 111 service is available 24 hours per day, 365 days per year.  Calls from landlines and mobile phones are free, just like 999.  NHS 111 is staffed by a team of fully-trained advisors, supported by experienced nurses who will assess your symptoms and then put you directly in touch with the people who can help.

You should call 111 if:

It is not a 999 emergency

  • You think you need to go to A&E or another NHS urgent care service
  • You don't think you can wait for an appointment with your GP
  • You don't know who to call for medical help

For less urgent health needs, you should still contact your GP in the usual way.  For IMMEDIATE, LIFE-THREATENING EMERGENCIES, you should continue to call 999.