Patient discussions

Patients with a history of severe asthma exacerbations are encouraged to seek medical review early in the course of future exacerbations. Involvement of other healthcare workers, such as pharmacists, may be beneficial in some cases.[146]

Personalised asthma action plan:

All patients should have a personalised asthma action plan written by health professionals with expertise in asthma and should receive culture-appropriate education.[7][57]​​[147]

Written asthma action plans have been shown to improve asthma outcomes.[148][149]​​​ Symptom-based plans are superior to peak expiratory flow rate-based plans.[150][151]​​​ They should document appropriate weaning advice for medications given for the current exacerbation and should provide appropriate management steps for future exacerbations, detailing the use of bronchodilators and when to seek medical attention. The need for regular inhaled corticosteroid (ICS) or changes to existing preventive therapies should be considered. Cultural issues may need to be taken into account.[152] One study showed that the use of parent mentors reduced the rate of asthma exacerbation in children with asthma from minority racial or ethnic groups.[153]​ Parent-initiated oral corticosteroids may be appropriate for some patients, but do not appear to improve outcomes.[154][155]

Patient education:

Education is an integral part of asthma management. While education of children and carers presenting to the emergency department has been shown to reduce further emergency department visits, hospitalisation, and unscheduled medical reviews, this has not been reported in all meta-analyses.[156][157][158]​

Education should include discussion of the underlying pathophysiology, explanation of the role of reliever and preventer medications, the importance of adherence, and assessment of the patient's or parent's technique of medication administration.[159] Education should be culture-specific for minority racial or ethnic groups as this has been shown to improve asthma outcomes compared with standard education.[147]

Spacers and home nebulisers:

Spacers should be used when children are prescribed pressurised metered-dose inhalers, and are especially useful for young children (i.e., ≤5 years old), reducing the risk of transmitting infection (e.g., COVID-19), and reducing the adverse effects of inhaled corticosteroids.[7]​ Use a face mask for children aged <3 years and a mouthpiece for older children.

In the UK, home nebulisers are not recommended for the relief of acute symptoms in children and adolescents without medical supervision by a respiratory specialist. This is because their use may mask deterioration and has led to fatal delays in treatment.[160]

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