Asthma Care Plans in Belconnen: Your Guide to Effective Asthma Management

Asthma is a very common condition in Australia, and for people in Belconnen, the right support can be a very important element in managing asthma well. We want you to live a full and active life in Belconnen, and we at Belconnen General Practice believe asthma management should be individualized, easily accessible and personalized. This is a comprehensive guide to all you need to know about asthma care plans and what our GPs can do for you right today to take control of your asthma.

Know the types and triggers of Asthma

Asthma is a long-term respiratory condition that involves inflammation and narrowing of the airways in the lungs, which can result in problems breathing, wheezing, coughing and chest tightness. Knowing what kind of asthma you have is the first step to getting it under control.

Collaborative asthma care consultation session

Asthma comes in many forms

Allergic Asthma

The most common type is Allergic Asthma, which is caused by allergens, including pet hair, mold, dust mites, and pollen. If symptoms become worse in springtime or if you have been exposed to certain allergens, you could have allergic asthma.

Non-allergic Asthma

In cases of non-allergic asthma, the cause of the asthma is not an allergy, but rather a viral infection, exposure to cold air, exercise, or stress. Most patients have symptoms in the winter or when they catch a cold.

Occupational Asthma

Occupational asthma occurs when someone gets asthma for the first time, or gets worse as a result of their job-related exposures to chemicals, dust, or other environmental triggers. If symptoms improve on weekends and/or during holidays, occupational triggers may be present.

Exercise-induced Asthma

Exercise-induced asthma is asthma that develops during or immediately after exercise, and is often seen in cold, dry air. Most people can exercise without this form being a hindrance with proper management.

Determine Your Personal Triggers

Each individual with asthma will have their own set of triggers. Common triggers include:

• Allergens: Pollen, dust mites, mould, air pollution, cigarette smoke
  • Food allergies, Insect stings, and Pet hair
  • Infections: colds, flu and respiratory infections
  • Physical activity: In cold or dry air.
  • Changes in the weather, such as cold air, high humidity and thunderstorms
  • Excessive emotional stress: Anxiety and high emotions may provoke attacks.
  • Medications: Some drugs such as beta blockers or aspirin can have side effects.
  • Sulphites: Sulphites and food colorings may be problematic in some cases.

It is important to know one’s own triggers to manage asthma effectively. Maintain a symptom diary to look for patterns of symptom triggers and present the information to your GP when you come for your asthma review.

Obtaining a Proper Diagnosis: Testing and Assessment

A proper diagnosis is critical in the initiation of any asthma management plan. Belconnen General Practice physicians have a few diagnostic aids to help establish the diagnosis of asthma and determine its severity.

Diagnostic Tests

Spirometry

Spirometry is the best test to diagnose asthma. This is a simple, non-invasive test that determines the amount of air you are able to inhale and exhale and how fast you are able to empty your lungs. It aids in the confirmation of airway obstruction and provides baseline lung function assessment.

Peak Flow Measurement

Peak flow measurement is a simple test that you can do at home with a small handheld device. It is a measure of the fastest speed of air that you can blow out and can be used to track asthma over time.

Bronchial Challenge Tests

Bronchial challenge tests are tests that release increasing amounts of something that causes narrowing of the airways. These tests are useful as evidence to confirm the diagnosis of asthma when spirometry results are normal, but symptoms indicate asthma.

Allergy Testing

If allergic asthma is suspected, allergy testing might be suggested. Specific allergens that cause the symptoms are detected by either a skin prick test or blood test.

Initial Assessment

At the first appointment, your GP will talk with you about:

1. Your symptom history and frequency.
2. Family history of asthma or allergies.
3. Potential triggers.
4. Impact on daily activities and sleep.
5. Your past medical history and medications you are taking now.

This is a thorough evaluation that is the basis for your individualized asthma plan.

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Asthma Action Plans Explained

An asthma action plan is a written plan that you and your GP develop to help you control your asthma every day and what to do if your symptoms or asthma attack becomes more severe. This plan forms a key element in the asthma management of Belconnen.

Asthma consultation in a modern clinic

There are three zones of an Asthma Action Plan

Green Zone (Doing Well)

• You do not have any symptoms or few symptoms
  • You can engage in usual activities unrestricted.
  • Take preventer medicines as directed
  • Keep an eye on your peak flow – it should be at normal levels,

Yellow Zone (Caution)

• Start to notice symptoms such as coughing, wheezing or chest tightness.
  • Your peak flow is between 50% and 80% of your best peak flow measurement.
  • Asthma symptoms can occur during the night.
  • Your plan outlines information about the reliever medicines you should use and when to get help from your GP.

Red Zone (Medical Alert)

• Symptoms are severe – difficulty breathing at rest, having trouble talking in sentences.
  • Peak flow: Less than 50% of personal best
  • Relief is not obtained from medications or relief doesn’t last longer than 4 hours
  • Your plan also shows when it’s time to go to the ER right away.

There are several benefits to having a written plan:

An “Asthma Action Plan” that has been documented:

• Guides you to manage your health
  • Explains how to take and give medications to you and your family/caregivers
  • Facilitates quick response to the signs of increased symptoms
  • Saves trips to the emergency department
  • Increases the overall control of asthma and quality of life

Your GP will check and review your asthma action plan every year or if there’s a big change in your symptoms.

Understanding inhaler types and how to use them correctly

The main route of asthma medications is by inhaler. Correct use of inhalers is vital for effective treatment and an understanding of the type of inhaler used and how to use it properly is essential.

Types of Inhalers

Reliever Inhalers (Rescue Inhalers)

Short-acting bronchodilators such as salbutamol are used in reliever inhalers (rescue inhalers). They are quick-acting drugs which loosen the muscles of the air passages in minutes, relieving the symptoms of asthma or an attack. Typically blue in colour, they should be used as needed.

Preventer Inhalers (Maintenance Inhalers)

Preventer Inhalers (Maintenance Inhalers) are inhaled medications that decrease inflammation in the airways and help prevent symptoms. They are typically brown, orange, or red, but they can be any other color, and they are used every day, whether or not they are causing pain.

Combination Inhalers

Combination Inhalers are for people who require additional control and include both long-acting bronchodilators and steroids.

Nebulizer

A nebulizer is a device used to breathe in medication that is turned into a fine mist. They are used for severe attacks and/or in young children who have difficulty taking their inhalers.

Proper Inhaler Technique

Wrong technique is very prevalent and greatly diminishes the effectiveness of the medication. The correct use of a metered dose inhaler (MDI):

1. Shake inhaler gently for 10-15 seconds (preparing the inhaler)
2. How to hold the inhaler: Hold the inhaler upright, with a thumb supporting the base.
3. Exhale: Expel all the air from your lungs.
4. Coordinate: As you start to inhale slowly and deeply, press down on the canister once
5. Hold: Breathe in after pressure, then take in a deep breath and hold it for 10 seconds (or as long as you can).
6. Wait 30-60 seconds before giving a second dose if given

A spacer or holding chamber will make medication delivery easier and more consistent, allowing you to better coordinate activation with breathing. We strongly recommend that a spacer be used, particularly for preventer medicines.

At your GP or practice nurse’s appointments, your GP or nurse can watch your technique to make sure you are using your inhaler properly. Technique reviews are beneficial for many patients at each visit.

Medications Explained: Preventers vs Relievers

It’s important to learn the distinction between preventer and reliever medications so that you can manage your asthma appropriately.

Reliever Medications (Short-Acting Beta-2 Agonists)

These drugs cause relaxation of the muscles in the airways immediately, giving quick relief of symptoms. They can be completed in 5-15 minutes and the effects will last for 4-6 hours. Use of relievers should be:

• Reserved for symptom relief, if necessary.
  • Taken before exercise if exercise causes asthma.
  • It may only be used occasionally in people with controlled asthma

Asthma is poorly controlled when people use their reliever inhaler regularly, and this is a sign that they should see their GP urgently.

Preventer Medications

Inhaled Corticosteroids

Inhaled Corticosteroids help prevent airway swelling and inflammation – the cause of asthma. They need to be used every day to be effective and cannot be used to relieve the symptoms. These include fluticasone, beclomethasone and budesonide.

Long-acting beta-2 agonists (LABA)

Long-acting beta-2 agonists (LABA) are airway-relaxing drugs with a duration of action of 12 – 24 hours. They do not stand alone, but are always used with corticosteroids in a combination inhaler.

Leukotriene receptor antagonists

Leukotriene receptor antagonists prevent the activity of certain chemicals that cause inflammation, primarily in allergic asthma.

Immunomodulatory drugs

If severe allergic asthma is caused by certain allergens, then immunomodulatory drugs may be used.

Why Preventers Matter

Many patients discontinue preventer inhaler medications once they feel better. However, preventer medications:

• Minimize airway inflammation, even if not present in the symptoms.
  • Decrease the frequency and severity of asthma attacks
  • Try to limit use of reliever medicines
  • Improve exercise tolerance
  • Protect against permanent airway damage due to chronic inflammation.

The backbone of good asthma control is consistent use of the preventer.

Trigger Identification and Avoidance Strategies

In addition to medicines, knowing and avoiding your individual asthma triggers is key to managing your asthma in Belconnen.

Making ‘Your own Trigger Diary’

Record the following for 2 weeks:

• Symptoms are present at a specific time of day
  • Activities you were doing
  • Affected by the environment (weather, air quality, location)
  • Proper nutrition and beverage intake.Eating or drinking properly.
  • Emotional state
  • Medications taken
  • Sleep quality

There will be patterns that begin to emerge which will enable you and your GP to work out what the triggers are.

Common Avoidance Strategies

• If you are allergic to dust mites: Cover your bed and any other soft furnishings with allergen-proof bedding covers, wash bedding in hot water every week, reduce soft furnishings and keep humidity levels under 50%.
• For pollen allergies: Avoid opening windows on days of high pollen count, shower after being outside, and hang clothes indoors on days of high pollen count.
• Pets: If at all possible, keep pets away from the bedroom; if keeping pets, bathe weekly and use HEPA filters.
• If triggers are in the workplace: Discuss with your workplace safety representative the ways to reduce exposures, or make changes to the job or use protective equipment.
• If exercise causes asthma: Take your reliever inhaler 10 minutes before exercising, warm up slowly and do the exercise in humid conditions if possible.
• If you have asthma triggered by stress: Use stress reduction exercises such as mindfulness, exercise, sufficient rest and professional counselling (where appropriate).

Environmental Control

Many ways of improving the quality of the air in the home will have a significant effect on asthma:

• Clean with vacuum cleaners and air purifiers equipped with HEPA filters. Clean with vacuum filters or air purifiers that have HEPA filters.
  • Provide adequate ventilation, particularly in kitchens and bathrooms
  • Don’t use strong chemical cleaners; try using natural ones;
  • Avoid having second-hand smoke indoors; this can make asthma feel a lot worse.
  • Control mold by repairing leaks and keeping the humidity level in check.

Identifying poorly controlled asthma

However, for some, the asthma will not be well controlled even after trying their best. The following are signs of asthma that is not being well controlled:

• Daily symptoms: over 2 times a week (usually during the day) or more than once a month (usually at night)
  • Limited activities: Can’t play sports, exercise or do normal activities because of asthma
  • Reliever use more than two times a week (apart from using it before exercise)
  • Asthma-related sleep disruption: Waking more than once a month from symptoms of asthma
  • Less than normal peak flow: less than 80% of personal best
  • Exacerbations: over 2 attacks of asthma per year that do need oral cortisone

If you are having any of these symptoms, seek advice from your GP straight away. The treatment plan may need to be adjusted, or further investigation may be needed.

If you think you need emergency care, do so right away.

If you have seen the following signs and symptoms of illness, go straight to the Emergency Room of a medical centre:

• A condition of extreme difficulty in breathing while at rest.
  • Difficulty in using whole sentences.
  • Cyanosis – blue hands and feet.
  • Chest complaint or tightness in the chest.
  • Excessive worry or fear related to breathing.
  • After 10 minutes, no improvement with reliever inhaler.
  • Reliever use without peak flow < 50%

In Australia, dial 000 for emergencies. But do not wait for symptoms to get better on their own; emergency asthma attacks can be serious.

GP Monitoring and Review Schedule: Continuous Support

Asthma management is not a one-off task; it needs to be monitored and adjusted regularly.

Annual Asthma Reviews

All people with asthma should have the following:

Annual review appointment where your GP will:

1. Review how well your asthma is under control.
2. Check your asthma plan of action.
3. See if your inhaler technique is correct.
4. Talk about the factors that could trigger him/her and anything you’re concerned about
5. Update Medicines if necessary
6. Set up the spirometry if appropriate
7. Take notes in written form to bring home

If the student has not mastered the standard, more frequent reviews are recommended:

• Asthma attack in the past year;Past year asthma attack;
  • You are using reliever inhalers more than twice a week
  • You suffer from poorly-controlled symptoms.
  • Recently taken a new prescription drug. You’ve just started a new prescription medicine.
  • Occupational asthma occurs when you have asthma that is triggered by the workplace.
  • You’re pregnant
  • You have been diagnosed as a kid or a young person with asthma.

Between-Appointment Support

Don’t wait for your annual review if symptoms worsen. If you experience any of the following, please see your GP as soon as possible:

• Symptoms get worse a lot.
  • Reliever inhalers are being used more frequently
  • There are new triggers that build up during this period.
  • The drugs you are taking at the moment do not appear to be working.
  • You experience side effects

Preventing an emergency and hospitalization is done by early intervention.

Co-ordination with Respiratory Specialists

If your asthma is more complex or severe, your GP may refer you to a respiratory specialist (pulmonologist). This referral is part of our holistic strategy to chronic disease management and provides access to expertise.

If recommended, Specialist Referral involves:

• Despite best asthma treatment, asthma is not well controlled
  • Diagnosis is uncertain
  • Your asthma is so bad that you need to take high doses of asthma meds
  • If you have occupational asthma, it needs to be investigated in detail.
  • Special testing or procedures are needed.
  • You have asthma and other medical conditions

Your GP and respiratory specialist share the responsibility – your GP is responsible for primary healthcare and for coordinating your care.

Asthma in Schools and at Workplaces: Asthma management

School Asthma Management

Parents should ensure:

• You have a copy of your child’s asthma action plan in school
  • Teachers are aware of the triggers and symptoms of your child.
  • Reliever inhalers and a spacer are on hand at school.
  • Your child is familiar with how to use their inhalers
  • The physical education teacher is given notice of any exercise limitations, if applicable
  • There is up-to-date emergency contact info.

Workplace Asthma Management

Asthma sufferers should:

• Let supervisors know of your condition
  • Have your asthma Action Plan at work.
  • Work out what triggers your problems with your eyes and tell your employer about it.
  • Cooperate with safety representatives with exposure reduction
  • Carry reliever inhalers around during working hours.
  • Understand emergency care procedures
  • If needed, make changes in the workplace

Open communication and planning are beneficial for both settings.

Living Well with Asthma: Your Path Forward

Asthma is a controllable disease. An effective asthma action plan, medications, avoiding triggers and regular GP monitoring will allow most people with asthma to live normal active lives with minimal restrictions.

The following are some key points to keep in mind when managing asthma:

Understand the type of asthma and individual triggers

• Have an asthma action plan from the GP. 
• Take it with you to the appointment
• Follow the use of preventer inhalers as directed
  • Understand correct inhaler use (using a spacer)
  • Avoid or minimize your personal triggers
  • Make sure to attend asthma reviews annually
  • Only use reliever inhalers to treat symptoms, not for prevention.
  • Go to the emergency room for serious attacks
  • Ensure close working relationships with GP and respiratory team

Keep your asthma under control!

Don’t let asthma limit your life. If you are just starting to be diagnosed with asthma, having difficulty managing it, or just want to get the most out of asthma management, the team at Belconnen General Practice can help you.

Have a personalized asthma action plan with your GP in Belconnen to make sure your asthma is well controlled. Please make an appointment for a thorough asthma evaluation or review today. Our expert GPs are dedicated to helping you enjoy a life of activity and good health, and breathe easy.

Asthma care is included in our comprehensive care programme for chronic diseases, using evidence-based, personalized treatment plans designed to meet your particular needs, as described in our chronic disease management guide.

Are you ready to get control of your asthma?

Please call Belconnen General Practice to make an appointment for your Asthma consultation. Get more information on chronic disease management.