Page 52 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 52
conventional approaches meet with limit- with the patient, gain understanding of their
ed success. At the same time they have to ap- hopes and fears and gain their confidence. A
severe asthma forum 1: severe asthma - basic and clinical views propriately consider the need to involve oth- further important nursing role, both initial-
er core members of the MDT in patient care ly and then longer term, is to support patient
including Nurse Specialist, Physiotherapist, understanding of their condition and the rel-
Psychologist, Dietitian and Speech Therapist. evant aggravating factors that need to be ad-
Furthermore, they need to consider any need dressed to aid their asthma management.
to refer to other specialists to address particu- These might include education on aeroaller-
lar comorbidities (e.g. Gastroenterologists and gen avoidance, smoking cessation, mitigat-
Otolaryngologists for example). ing exposures to other irritants and measures
such as weight loss and improved physical ac-
In addition to a good understanding of tivity. Another important function of the Spe-
asthma management, the Specialist Asthma cialist Nurse is to support patient manage-
Physician must have a good working knowl- ment by interlinking with other members of
edge of managing relevant comorbidities. the MDT including the Consultant, Physio-
A difficult asthma MDT would also benefit therapist, Psychologist, Speech Therapist, Di-
from having multiple Specialist Asthma Phy- etitian and Pharmacist as well as the patient
sicians in order to ensure resilient capacity during the course of the patient journey.
to meet the demands placed on that service.
That also offers the opportunity to create a Ensuring optimal inhaler technique, de-
Specialist team with a diversity of overlap- veloping sustainable self-management plans
ping clinical expertise which can then prove and achieving good adherence to both medi-
helpful in complex case management. In that cations and other aspects of that management
context having Physicians within the difficult plan are all activities that Specialist Nurses
asthma MDT who have added expertise in also are well placed to deliver. These should
Allergy, Bronchiectasis, COPD, Sleep Medi- be addressed at the outset but need regular
cine and ILO/VCD can significantly enhance reassessment and reinforcement over time as
the effectiveness of that MDT. improvements in these areas may wane over
time. In that regard, poor inhaler technique
The Asthma Nurse Specialist is commonplace among asthma patients, po-
tentially present to some degree in most pa-
Asthma Nurse Specialists sit at the core of any tients at some point, and remains an ongoing
difficult asthma MDT where they fulfil a va- issue that facilitates poor asthma control.44-47
riety of key roles at different stages of the pa- A Cochrane database review of studies assess-
tient journey as outlined in Figure 3. ing impact of strategies to improve inhaler
technique found some benefit for asthma con-
When a patient is first assessed in a diffi- trol and quality of life but generally did not
cult asthma service, the Specialist Nurse may result in consistent or important clinical bene-
undertake a supportive role with many of the fits.48 This may in part reflect the heterogene-
initial objective assessments. These might in- ity and inherent biases of studies assessed in
clude performing aeroallergen skin prick test- that review. Conversely a recent systematic re-
ing, blood sampling and FeNO testing to view of critical inhaler errors and their impact
inform asthma characterization as well as ad- on health outcomes did identify some stud-
ministering a range of questionnaires relat- ies that found beneficial impact of strategies
ed to both asthma control and relevant ag- to improve inhaler technique in relation to
gravating comorbidities. These actions are asthma outcomes.49 There is also a major role
time consuming. However, that time spent by for the Asthma Nurse Specialist in assessing
a Nurse Specialist with a new patient at the
outset of their Specialist Care can provide in-
valuable opportunity to establish a rapport
ed success. At the same time they have to ap- hopes and fears and gain their confidence. A
severe asthma forum 1: severe asthma - basic and clinical views propriately consider the need to involve oth- further important nursing role, both initial-
er core members of the MDT in patient care ly and then longer term, is to support patient
including Nurse Specialist, Physiotherapist, understanding of their condition and the rel-
Psychologist, Dietitian and Speech Therapist. evant aggravating factors that need to be ad-
Furthermore, they need to consider any need dressed to aid their asthma management.
to refer to other specialists to address particu- These might include education on aeroaller-
lar comorbidities (e.g. Gastroenterologists and gen avoidance, smoking cessation, mitigat-
Otolaryngologists for example). ing exposures to other irritants and measures
such as weight loss and improved physical ac-
In addition to a good understanding of tivity. Another important function of the Spe-
asthma management, the Specialist Asthma cialist Nurse is to support patient manage-
Physician must have a good working knowl- ment by interlinking with other members of
edge of managing relevant comorbidities. the MDT including the Consultant, Physio-
A difficult asthma MDT would also benefit therapist, Psychologist, Speech Therapist, Di-
from having multiple Specialist Asthma Phy- etitian and Pharmacist as well as the patient
sicians in order to ensure resilient capacity during the course of the patient journey.
to meet the demands placed on that service.
That also offers the opportunity to create a Ensuring optimal inhaler technique, de-
Specialist team with a diversity of overlap- veloping sustainable self-management plans
ping clinical expertise which can then prove and achieving good adherence to both medi-
helpful in complex case management. In that cations and other aspects of that management
context having Physicians within the difficult plan are all activities that Specialist Nurses
asthma MDT who have added expertise in also are well placed to deliver. These should
Allergy, Bronchiectasis, COPD, Sleep Medi- be addressed at the outset but need regular
cine and ILO/VCD can significantly enhance reassessment and reinforcement over time as
the effectiveness of that MDT. improvements in these areas may wane over
time. In that regard, poor inhaler technique
The Asthma Nurse Specialist is commonplace among asthma patients, po-
tentially present to some degree in most pa-
Asthma Nurse Specialists sit at the core of any tients at some point, and remains an ongoing
difficult asthma MDT where they fulfil a va- issue that facilitates poor asthma control.44-47
riety of key roles at different stages of the pa- A Cochrane database review of studies assess-
tient journey as outlined in Figure 3. ing impact of strategies to improve inhaler
technique found some benefit for asthma con-
When a patient is first assessed in a diffi- trol and quality of life but generally did not
cult asthma service, the Specialist Nurse may result in consistent or important clinical bene-
undertake a supportive role with many of the fits.48 This may in part reflect the heterogene-
initial objective assessments. These might in- ity and inherent biases of studies assessed in
clude performing aeroallergen skin prick test- that review. Conversely a recent systematic re-
ing, blood sampling and FeNO testing to view of critical inhaler errors and their impact
inform asthma characterization as well as ad- on health outcomes did identify some stud-
ministering a range of questionnaires relat- ies that found beneficial impact of strategies
ed to both asthma control and relevant ag- to improve inhaler technique in relation to
gravating comorbidities. These actions are asthma outcomes.49 There is also a major role
time consuming. However, that time spent by for the Asthma Nurse Specialist in assessing
a Nurse Specialist with a new patient at the
outset of their Specialist Care can provide in-
valuable opportunity to establish a rapport
