IN 2019 it was highlighted that asthma deaths in the UK were rising, having increased by a third over the previous 10-year period. Not only was this concerning, but research by Asthma UK, one of the largest charities, demonstrated that many of these deaths could be prevented.

Issues raised included being seen multiple times by different healthcare professionals, for example in general practice and A&E, poor inhaler technique, a lack of understanding of the potential severity of the condition (not just by patients), and the absence of a Personalised Asthma Action Plan (PAAP).

A PAAP, either written or latterly electronic, is established as one of the gold standards in asthma management. It allows a person with asthma to know what to do on a good day, (green), one with moderate symptoms (amber), as well as warning signs of a potentially severe attack (red).

It is established that many do not take in sufficient information in a single consultation with a healthcare professional, so a PAAP, or a plan for any chronic condition is a useful aide memoire.

It is an interactive tool, in essence allowing the individual a greater ownership of their condition, rather than the paternalistic approach of old.

Consider the phrase “a person with asthma” as opposed to “the asthmatic” and therein lies the beauty of a PAAP. Those with a personalised asthma action plan are four times less likely to require hospital admission.

As one of the commonest long-term conditions, asthma affects up to one in five children, and 10 per cent of adults. Half of children thankfully grow out of their symptoms by adulthood, though it may recur later in life. Those who develop asthma as adults are more likely to have symptoms long term.

Classic symptoms of asthma are cough, chest pain, wheeze and shortness of breath. Multiple triggers may precipitate and exacerbate the condition, not just the stereotypical ones i.e., tobacco smoke, high pollen counts and extremes of temperature.

It has been noted that many chemicals which you might not necessarily consider harmful, such as those used in offices (for example cleaning fluids and even printing products), may precipitate asthma. You don’t need to work in a dusty environment.

There is a greater recognition that occupational asthma can occur in “white collar workers”. Many working from home during the pandemic have seen an improvement in their symptoms.

A cough at night, waking up coughing, and cough or wheeze on exercise should have you consulting with your regular GP at the earliest possible opportunity.

The pathology behind asthma is airways narrowing and swelling, with increased mucus production. As a consequence, the movement of air through these passages becomes disrupted and gas exchange, where oxygen crosses the delicate lining of the lungs into the blood stream, is reduced.

Diagnosis should be made on reported symptoms as well as breathing tests, (spirometry). Inhaling a reliever drug and the demonstration of an improvement in spirometry results (reversibility), points toward the diagnosis, whereas in chronic obstructive airways disease (COPD), reversibility is usually not present.

Treatment is a stepwise approach, the “asthma ladder”, stepping up and down the ladder in line with symptom control. Some may only require a reliever inhaler occasionally, but if you need this more than three times a week, or symptoms interfere with your life, a preventer inhaler will be needed.

Though there are those with brittle or very severe asthma, the crux of the matter is that individuals with only infrequent or mild symptoms can still suffer a life-threatening attack.

Everyone with a diagnosis should have a PAAP, and as a minimum, attend for yearly review with a suitably qualified healthcare professional to assess their symptoms and inhaler technique.

Initial Personalised Asthma Action Plans were able to fit on a single piece of A4, however with the recognition that over two thirds of 16–24-year-olds now carry a smart phone, (and spend a significant amount of time interacting on this medium) digital versions have been developed. These contain what to do in a green/amber/red situation, allow you to upload peak flow measurements, contain demonstrations on correct inhaler technique, and providing information on other useful aspects such as pollen count.

Not only is this far more attractive for the younger age group than an A4 sheet of paper, but data uploaded by the individual can be shared with their healthcare provider at routine assessments, as well as prompting the earlier recognition of deterioration in symptoms, and more urgent medical review.