Asthma / Consultation template
Asthma review
The routine review, ordered so that control, technique and adherence are settled before anyone reaches for the next inhaler.
- 1Daytime symptoms
- 2Night waking due to asthma
- 3Reliever use
- 4Activity limited by asthma
- 5Asthma control questionnaire score
- 6Oral steroid courses
- 7Unscheduled care, A and E or admission
- 8Time off work or school
- 9Current inhalers
- 10Prescription collections in the last 12…
- 11Inhaler technique observed today
- 12Spacer
- 13Smoking or vaping
- 14Nasal symptoms or polyps
- 15Reflux symptoms
- 16Weight and BMI
and 15 more, in the block below.
Asthma review. Control since last seen: Daytime symptoms: [days per week] Night waking due to asthma: [nights per month] Reliever use: [doses per week] Activity limited by asthma: [yes or no] Asthma control questionnaire score: [ACQ or ACT, and which] Attacks since last review: Oral steroid courses: [] Unscheduled care, A and E or admission: [] Time off work or school: [] Treatment: Current inhalers: [drug, device, dose, doses per day] Prescription collections in the last 12 months: [preventer and reliever] Inhaler technique observed today: [adequate, or the specific error seen] Spacer: [in use, replaced or not needed] Anything making it worse: Smoking or vaping: [] Nasal symptoms or polyps: [] Reflux symptoms: [] Weight and BMI: [] Occupational or home exposures: [] Beta blockers, aspirin or NSAIDs: [] Measurements: Peak flow [] L/min ([]% of best, best []) FEV1 [] L ([]%) FeNO [] ppb Blood eosinophils [] x10^9/L Impression: [controlled on current treatment, or uncontrolled with the reason] Plan: 1. Treatment: [unchanged, stepped up to, or stepped down to] 2. Inhaler technique rechecked: [] 3. Action plan reviewed and reissued: [yes] 4. Vaccination: [influenza, COVID-19, pneumococcal as indicated] 5. Review in [] months, sooner if [specific trigger to come back]
How to use it
Escalation before the basics is how someone ends up on triple therapy for a disease that was never uncontrolled: check technique, check collections, and check that the preventer is being taken at all before adding to it. The guideline is equally clear in the other direction — asthma that has been controlled for two to three months should be stepped down, and the step-down conversation only happens if something in the template asks for it. Record reliever use as doses per week rather than "as required": three or more canisters of short-acting reliever in a year is a marker of risk that the word "occasional" hides. Reissuing the action plan is not paperwork; it is the one intervention with a mortality signal behind it.
Why it says that
None of this is in the copied text. It is here so you can check the block against its source, and change it when the source changes.
- NICE/BTS/SIGN NG245 - Asthma: diagnosis, monitoring and chronic asthma management Monitoring at review with symptoms, attack history, inhaler technique and adherence; step down when control has been maintained for two to three months; refer if uncontrolled on moderate-dose MART after trials of a leukotriene receptor antagonist and a long-acting muscarinic antagonist.
- GINA global strategy for asthma management and prevention Assessment of control, future risk and modifiable risk factors as three separate questions rather than one impression.
- National Review of Asthma Deaths (RCP, 2014) Excessive reliever use and under-collection of preventers were repeatedly visible in the records before death, and repeatedly not acted on.
Trials behind it
- MANDALA 2022 Adding budesonide to the albuterol reliever cut severe exacerbations by a quarter
- SYGMA 2 2018 As-needed ICS/formoterol matched daily ICS for exacerbations on a quarter of the steroid dose
- START 2003 Low-dose daily budesonide nearly halved severe exacerbations in mild asthma
Records on respiratorytrials.org.