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Asthma - Management
What follow up is recommended after an exacerbation of asthma?

  • One week after an asthma exacerbation in all people:
    • Assess the exacerbation:
      • Ask about the duration and severity of the exacerbation compared with any previous episodes. Record the number of exacerbations and hospital admissions.
      • Identify possible trigger factors, such as exercise, work, or allergens.
    • Optimize treatment:
      • Ask about compliance with treatment before the exacerbation and review the person's inhaler technique (correcting problems).
      • Provide advice on lifestyle, vaccinations, diet, exercise, and smoking. If the individual or parent of the child smokes, advise them to stop.
      • Consider stepping-up treatment by increasing inhaled corticosteroids or adding in new preventive therapy.
    • Review self-management education and written action plan:
      • Review the person's understanding of how to recognize an exacerbation and what to do at the early signs of an exacerbation (increase beta2-agonist and start oral corticosteroids).
      • Reinforce understanding by updating the written action plan.
Clarification / Additional information
  • Some people may not need follow up during a mild exacerbation. However, if there are signs of deterioration, review is necessary to determine whether admission to hospital is appropriate.
  • Ideally, people should be seen within 1 week, but this may be impractical. Consider a telephone consultation to review the individual early, and schedule a clinic consultation for a later date to assess inhaler technique and perform an examination.
  • People who attended hospital do not require such an early follow up, as they will have received appropriate changes to medication and been given self-management advice. All people should receive a follow-up appointment with a respiratory specialist within 1–2 months following admission to hospital.
Basis for recommendation
  • These recommendations are based on the British Guideline on the management of asthma: a national clinical guideline [SIGN and BTS, 2009]. Many follow up studies have involved small numbers of people, mainly in a secondary care setting, and follow up was done by specialists using different methods. Evidence is scant on following up people who have not been admitted to hospital:
    • Follow up is necessary after an exacerbation, as the evidence suggests that more than 15% of people will have a relapse within 2 weeks [SIGN and BTS, 2009]. The follow up process should aim to identify a possible cause of the exacerbation so that strategies to prevent further exacerbations can be developed.
    • The evidence suggests that follow up after an exacerbation which involves providing self-management education and a written action plan may reduce hospital re-admissions and improve symptom control and self-management of asthma. Outcomes appear to differ little by the place or personnel involved [Bernard-Bonnin et al, 1995; Nathan et al, 2006].

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