This essay is written as a case study, exploring the assessment and management of a patient who has been diagnosed with asthma from the local area of practice within primary care setting. The Nursing and Midwifery Council (NMC) code of conduct, lays down a duty on nurses to protect the privacy and confidentiality of patients (NMC, 2018) therefore, and to aid the flow of writing, the patient name has been changed to Pip and the area of practice has been omitted. Pip attended her routine asthma review and the important elements that are part of the asthma reviews such as: assessment of asthma control, concordance and inhaler technique will be analyzed. The pharmacological management options, patient education, self-management and the Personalized Asthma Action Plan (PAAP) will also be explored, discussed and analyzed as an overall patient centred assessment and management. There are several asthma guidelines available across the world. The Global Initiative Asthma (GINA) provides a global strategy (GINA, 2014), the National Institute of Clinical Excellence (NICE), the NICE Asthma: diagnosis, monitoring and chronic management guideline (NICE, 2017), although both of the above will be considered, the main evidence-based care will be provided based on the British Thoracic Society and Scottish intercollegiate guideline Network (BTS/SIGN) guidelines for asthma management (BTS/SIGN 2019) (appendix A).
Pip is 35 years old, diagnosed with asthma since childhood in another country. Both her parents had history of asthma and she has no siblings. Pip has emigrated to the United Kingdom 10 years ago, after her parents passed away. she is single, has a small short hair dog, whom she has had for 10 years, works as an industrial cleaner and is a non-smoker. She regularly attends her annual asthma review. During the initial clinical assessment, she presented with, observations baseline of; body mass index of 35, saturation of 96 percent, blood pressure 129/83 and a PEAK expiratory flow rate of 385 as her personal best. To assist assessing current asthma symptom control, Pip was asked to complete the Asthma Control test. This test is a well validated symptomatic asthma control measurement tool (BTS/SIGN, 2019). It has five direct questions about symptoms, reliever use, and overall control over the last four weeks prior to annual review. The control test provides patients with a snapshot of how well controlled their asthma is within a period of 4 weeks and gives a visual score and guidance.
