Asthma Review

Your Practice Name Here Logo


Key Points

- This secure form will allow you to provide the information your GP team needs to review your asthma.
- This includes some questions about key asthma symptoms.
- You will have the opportunity to submit your peak flow readings if you wish.
- Your answers may not be seen immediately meaning this service is not suitable for seeking urgent or emergency care.
- This form should only be used by someone over the age of 13.
- When you are ready to complete your review, click the "Review my Asthma" tab above.

Asthma Symptoms

Worsening of asthma usually refers to a recurrence of your symptoms especially if these symptoms interfere with day to day life. Exacerbations are sudden progressive worsening of your symptoms such as shortness of breath, wheezing, cough and chest tightness. Exacerbations often require additional treatment, such as steroid tablets or hospital treatment.

Worsening Asthma

Symptoms of worseing asthma include the following:
- Persistent symptoms (wheeze, tight chest, breathless, coughing)
- Waking at night
- Breathing interfering with daily activities
- Using reliever inhaler three times per week
- Peak flow drops to around 50-75% of your best

Asthma Exacerbations

Signs you may need an emergency appointment or to call 111 include:
- Needing your reliever inhaler more than every 4 hours
- Finding it difficult to walk or talk
- Finding it hard to breathe
- Getting very wheezy or tight chested
- Coughing much more than normal

Helpful Tips

- If your inhaler contains a steroid, brush your teeth or rinse your mouth with water and spit it out after every use to prevent mouth infections.
- It is recommended that everyone who uses inhalers for asthma, even if only occasionally, should consider using a regular preventer. If you would like to discuss this further you can let us know in the comment section at the end of this review.
- All used inhalers should be returned to a pharmacy to be disposed of safely.
- People with allergies need to be extra careful as attacks can be more severe if the trigger is an allergen.
- You can safely dispose of your inhalers by returning them to your local pharmacy

Asthma plan

This is an example of a typical asthma plan. It covers everyday care, feeling worse and a sudden asthma attack. If you'd like a copy of your plan after your review please contact the practice. Your review will cover each of these sections


Your Details:
DOB:
These questions relate to your general health.
How many Standard Drinks of alcohol do you have on average each week?
How much / what do you smoke each day (if anything)?
How would you like to enter your height and weight?
Your BMI is one indicator of a healthy weight.

Your BMI: Please provide your height and weight

These questions are about your asthma control

The questions for your asthma control depend on your age. They will appear once you enter your date of birth.

These questions are to help us formulate an asthma plan.

The following questions are about how you currently manage your Asthma currently when you are well, worsening and unwell. We will use these to create a plan which has been structured around the Asthma UK "Your Asthma Action Plan".

Do you already have an asthma action plan in place?
Are you currently under hospital care for your asthma?
What is your best peak flow meter reading (optional)?

Peak flow is a useful way to monitor your asthma. Peak flow meters are available on prescription or can be bought from most pharmacies. To see how to do a peak flow reading click the "show me how" button above.

People with asthma often know what triggers their symptoms. Avoiding these triggers and taking your asthma medicine each day will help prevent symptoms. What triggers your asthma (we suggest using bullet points)?
These questions are about your everyday asthma care
A preventer inhaler is a regular inhaler taken to prevent lung symptoms. Do you have a preventer inhaler?
These questions are about what you do when your asthma worsens
How do you manage if your asthma is much worse than normal (tick all that apply or leave blank if none apply)?
Increase preventer use
Preventer Inhaler
Separate reliever inhaler
Reliever Inhaler
Monitor peak-flow readings
Peak Flow
Start treatment course
Rescue Tablets
These questions are about sudden asthma exacerbations (attacks)
Exacerbations are sudden progressive worsening of your symptoms such as shortness of breath, wheezing, cough and chest tightness. Exacerbations often require additional treatment, such as steroid tablets or hospital treatment.
Have you had an exacerbation in the last year?
Are you happy for a clinician to see your responses and complete your review without further discussion (if appropriate)?

Questions, concerns or additional comments: