11/13/24, 8\:17 PM Guide | Explaining asthma

Explaining asthma

Table of contents

Introduction

Being able to share information in a clear and concise way is an essential skill in all
simple explanations, such as why a blood test may be needed, to more complex situations, such as explaining a new diagnosis.
Often, sharing information with a patient occurs naturally during a consultation. However, providing clinical information may
also be the primary focus of an appointment, and in these situations, it is crucial to have a structured format in order to
communicate more e
This guide provides a step-by-step approach to explaining a diagnosis of asthma. You should also read our overview of how
to e

Structure

Explaining a diagnosis requires structure and adequate background knowledge of the disease. Whether the information
being shared is about a procedure, a new drug or a disease, the BUCES structure (shown below) can be used.
Explanation structure

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
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BUCES can be used to remember how to structure a consultation in which providing information is the primary focus. Before
explaining the various aspects of a disease, it is fundamental to have a common starting point with your patient. This helps to
establish rapport and creates an open environment in which the patient can raise concerns, ask questions and gain a better
understanding of their problem. After introducing yourself, it is important to take a brief history (this is the
structure)\:
What has brought the patient in to see you today?
What are their symptoms?
Are there any risk factors that can be identi
For example, an asthmatic patient may describe episodes of shortness of breath, wheezing and nocturnal cough. They may
have risk factors such as pre-existing atopy (e.g. eczema, hay fever) and a family history of asthma.
Tip\: Practice taking concise histories to get the timing right. In OSCE stations, timing is crucial and you do not want to spend all
your time taking a history when you are meant to be explaining a diagnosis! A rough guide would be to keep the introduction
and brief history between 1-2 minutes maximum.

What does the patient understand?

Following a brief history, it is important to gauge the patient’s knowledge of their condition. Some patients may have a family
member with asthma and therefore have a fairly good understanding of what the condition entails. Other patients may have
heard of asthma but only have a vague understanding of the important details. The patient sitting before you may not even
know at this point that they have asthma - you may be the
Due to these reasons, it is important to start with open questioning. Good examples include\:
" W h a t d o y o u t h i n k i s c a u s i n g y o u r s y m p t o m s ?"
" W h a t d o y o u k n o w a b o u t a s t h m a ?"
" W h a t h a s b e e n e x p l a i n e d t o y o u a b o u t a s t h m a s o f a r ?"
Open questioning should help you to determine what the patient currently understands, allowing you to tailor your
explanation at an appropriate level.
At this stage, primarily focus on listening to the patient. It may also be helpful to give positive feedback as the patient talks
(i.e. should a patient demonstrate some understanding, reinforce this knowledge with encouraging words and non-verbal
communication such as nodding).
Checking the patient’s understanding should not be solely con
throughout by repeatedly ‘chunking and checking’
.
Tip\: Try using phrases such as\:
" J u s t t o c h e c k t h a t I a m e x p l a i n i n g a s t h m a c l e a r l y , c a n y o u r e p e a t b a c k t o m e w h a t y o u
u n d e r s t a n d s o f a r ?"
. This is far better than only saying “ W h a t d o y o u u n d e r s t a n d s o f a r ?” as the onus is placed upon the quality
of your explanation rather than there being an issue with the patient’s ability to understand.

What are the patient's concerns?

The patient’s concerns should never be overlooked. A diagnosis of asthma can be a signi
of worries. Asking the patient if they have any concerns before beginning your explanation allows you to speci
is most relevant to the patient, placing them at the centre of the explanation. The “ICE” (ideas, concerns and expectations)
format, can provide a useful structure for exploring this area further.

ICE

Ideas\:
What does the patient think is causing their symptoms?
What is their understanding of the diagnosis?
Concerns\:
What are the patient’s concerns regarding their symptoms and diagnosis?
Expectations\:
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What is the patient hoping to get out of the consultation today?

Explanation

After determining the patient’s current level of understanding and concerns, you should be able to explain their condition
clearly. Asthma can be confusing to medical students and doctors, let alone patients. Avoid medical jargon so as not to
confuse your patient.
You should begin by signposting what you are going to explain to give the patient an idea of what to expect.
" I’ m g o i n g t o b e g i n b y t a l k i n g a b o u t h o w t h e l u n gs w o r k a n d t h e n m o v e o n t o d i s c u s s w h a t a s t h m a i s , w h a t c a u s e s i t a n d h o w
w e c a n m a n a g e i t t o g e t h e r .
"
Tip\: Use the mnemonic "Normally We Can Probably Manage" to help you remember the structure of explaining a disease.

Normal anatomy and physiology

" W h e n y o u b r e a t h e i n , a i r t r a v e l s f r o m y o u r m o u t h d o w n d e e p i n t o y o u r l u n gs t h r o u gh a s e q u e n c e o f s m a l l e r a n d s m a l l e r t u b e s
t h a t r e s e m b l e t h e b r a n c h e s o f a t r e e . W h e n t h e a i r r e a c h e s t h e s m a l l e s t o f t h e s e t u b e s , y o u r b o d y a b s o r b s t h e o x y ge n f r o m t h e
a i r i n t o y o u r b l o o d . O x y g e n i s t h e n u s e d t o p o w e r a l l o f t h e c e l l s i n y o u r b o d y .
"

What is asthma?

“ A s t h m a i s o n e o f t h e m o s t c o m m o n l u n g c o n d i t i o n s . P e o p l e w i t h a s t h m a h a v e s e n s i t i v e a n d i n
n a r r o w e r t h a n n o r m a l .
”
“ T h e m o s t c o m m o n s y m p t o m s i n c l u d e c o u gh i n g , w h e e z i n g , t h e s e s y m p t o m s a t t h e s a m e t i m e .
”
c h e s t t i g h t n e s s a n d s h o r t n e s s o f b r e a t h . Y o u m a y n o t h a v e a l l o f
“ T h e s y m p t o m s o f a s t h m a t e n d t o c o m e a n d g o , o f t e n i n r e s p o n s e t o s p e c i
”
“ I t i s i m p o r t a n t t o t a k e a s t h m a m e d i c a t i o n e v e r y d a y , s y m p t o m s o r b e c o m i n g u n w e l l .
”
e v e n i f y o u a r e f e e l i n g w e l l , a s t h i s r e d u c e s t h e c h a n c e o f y o u ge t t i n g

What is the cause of asthma?

“ W e d o n’ t k n o w t h e e x a c t c a u s e o f a s t h m a , a l t h o u g h s o m e t h i n g s m a k e p e o p l e m o r e l i k e l y t o ge t a s t h m a , a l l e r g i e s o r h a v i n g a f a m i l y h i s t o r y o f a s t h m a .
”
s u c h a s h a v i n g o t h e r
“ M o s t p e o p l e t e n d t o d e v e l o p a s t h m a a s a c h i l d , b u t i t c a n s t a r t i n a d u l t h o o d t o o .
”
“ T h e s y m p t o m s o f a s t h m a a r e c a u s e d b y i n t e r m i t t e n t n a r r o w i n g o f t h e s m a l l t u b e s w i t h i n t h e l u n gs . T h i s m a k e s i t h a r d e r f o r a i r
t o m o v e i n a n d o u t o f y o u r l u n g s , c a u s i n g y o u t o f e e l t i gh t c h e s t e d a n d s h o r t o f b r e a t h . S o m e t i m e s t h e n a r r o w e d t u b e s c a u s e
t h e a i r t o w h i s t l e a s i t m o v e s t h r o u g h t h e m , l i k e t h e w i n d i n a t u n n e l – t h i s i s c a l l e d a w h e e z e . T h e n a r r o w i n g o f y o u r a i r w a y s c a n
a l s o c a u s e i r r i t a t i o n , l e a d i n g t o a c o u g h .
”
“ T h e s e s y m p t o m s t e n d t o o c c u r i n r e s p o n s e t o s p e c i
i n c l u d e a l l e r g i e s ( e .g . t o p o l l e n , p e t s o r f o o d ) , i n f e c t i o n s , s t r e s s , s m o k i n g a n d s u d d e n t e m p e r a t u r e c h a n ge s . I t i s i m p o r t a n t t o t r y
a n d w o r k o u t w h a t t r i g g e r s y o u r a s t h m a , a s i t w i l l b e d i
m a n a g i n g a s t h m a .
”

Problems/complications of asthma

Asthma has the potential to be fatal, so outlining the potential complications is necessary so that the patient can recognise
problems early and take appropriate action. This information needs to be delivered in a sensitive manner, whilst ensuring the
patient is aware of the importance of treatment adherence and red
Acute asthma
“ S o m e t i m e s p e o p l e w i t h a s t h m a e x p e r i e n c e a w o r s e n i n g o f t h e i r s y m p t o m s t h a t m a y n o t i m p r o v e w h e n t h e y u s e t h e i r i n h a l e r s ,
t h i s i s c o m m o n l y c a l l e d a n “ a s t h m a a t t a c k” o r “ a s t h m a e x a c e r b a t i o n”
. I t i s i m p o r t a n t t o m a n a g e t h i s a p p r o p r i a t e l y a s t h e y c a n
p o t e n t i a l l y b e l i f e-t h r e a t e n i n g .
”
“ S i g n s o f a n a s t h m a a t t a c k i n c l u d e \: w h e e z i n g a l o t , h a v i n g a v e r y t i gh t c h e s t , c o u gh i n g a l o t ,
t o b r e a t h l e s s n e s s , b r e a t h i n g q u i c k l y o r y o u r r e l i e v e r i n h a l e r n o t h e l p i n g y o u r s y m p t o m s . Y o u m a y h a v e a l l o f t h e s e o r j u s t s o m e
o f t h e m , f o r e x a m p l e , y o u m a y n o t h a v e a w h e e z e .
”
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“ I f y o u a r e e x p e r i e n c i n g w o r s e n i n g s y m p t o m s a n d
i n h a l e r h e l p s y o u r s y m p t o m s , y o u s h o u l d c o n t a c t y o u r G P f o r a n u r g e n t r e v i e w o f y o u r a s t h m a . Y o u m a y n e e d e x t r a m e d i c a t i o n
t o t r e a t t h i s w o r s e n i n g o f s y m p t o m s , f o r e x a m p l e , a s h o r t c o u r s e o f s t e r o i d t a b l e t s t o h e l p s e t t l e t h e i n
”
Persistent symptoms
“ I t i s i m p o r t a n t t o t a k e y o u r a s t h m a m e d i c a t i o n e v e r y d a y , n o m a t t e r h o w w e l l y o u f e e l . T h i s i s b e c a u s e t h e p r o t e c t i o n b u i l d s u p
i n y o u r a i r w a y s a n d h e l p s t o p r e v e n t y o u f r o m e x p e r i e n c i n g s y m p t o m s o r a s t h m a a t t a c k s i n r e s p o n s e t o t r i gg e r s .
”
“ I f y o u e x p e r i e n c e s y m p t o m s f r e q u e n t l y d e s p i t e f o l l o w i n g y o u r t r e a t m e n t p l a n y o u s h o u l d s e e k a r e v i e w f r o m y o u r G P o r
a s t h m a n u r s e , w h o m a y a l t e r y o u r m e d i c a t i o n s t o t r y a n d i m p r o v e y o u r s y m p t o m s . Y o u s h o u l d a l s o m a k e s u r e t o s e e k a r e v i e w
i f y o u r d a i l y a c t i v i t i e s a r e b e i n g a
y o u r p e a k
”
“ A s m a l l n u m b e r o f p e o p l e w i t h a s t h m a w i l l h a v e s e v e r e a s t h m a a n d m a y e x p e r i e n c e f r e q u e n t s y m p t o m s t h a t a r e h a r d t o
c o n t r o l , b u t t h e m a j o r i t y o f p e o p l e w i l l
”

Management

Aims of asthma management
The aims of asthma management include\:
No daytime symptoms
No night-time waking due to asthma
No asthma attacks
No limitations on activity including exercise
Minimal side e
Example
" T h e p r i m a r y a i m o f t r e a t i n g y o u r a s t h m a i s t o m i n i m i s e t h e i m p a c t o f t h e c o n d i t i o n o n y o u r d a y t o d a y l i f e . I f a s t h m a i s
m a n a g e d a p p r o p r i a t e l y , w e w o u l d e x p e c t y o u t o h a v e n o s y m p t o m s d u r i n g t h e d a y o r a t n i gh t . W e w o u l d a l s o e x p e c t y o u t o
n o t f e e l l i m i t e d w h e n e x e r t i n g y o u r s e l f d u r i n g e x e r c i s e . F i n a l l y , w e w o u l d w a n t t o m i n i m i s e a n y s i d e e
y o u r e c e i v e .
"
Overview of asthma management
Provide information about asthma triggers
Initiate treatment at a step which is appropriate for the severity of the patient’s symptoms
Provide the patient with a personalised asthma plan and appropriate education to ensure good compliance
Ensure the patient is up to date with all necessary immunisations
Provide advice about weight loss and smoking cessation if relevant

Inhalers

Reliever (e.g. salbutamol inhaler)
Explain what a reliever inhaler is and when it should be used\:
“ Y o u w i l l b e g i v e n a r e l i e v e r i n h a l e r , t h e m o s t c o m m o n o n e i s s a l b u t a m o l a n d i t i s t y p i c a l l y b l u e . T h i s i s u s e d t o h e l p r e l i e v e
a s t h m a s y m p t o m s a n d a s t h m a a t t a c k s . I t w o r k s b y h e l p i n g t o r e l a x t h e a i r w a y s w h e n t h e y b e c o m e n a r r o w .
”
“ I f y o u r a s t h m a i s w e l l -c o n t r o l l e d y o u s h o u l d n’ t n e e d t o u s e t h i s m o r e t h a n t h r e e t i m e s a w e e k . t h a n t h i s y o u s h o u l d r e q u e s t a r e v i e w o f y o u r a s t h m a w i t h y o u r G P .
”
I f y o u a r e n e e d i n g t o u s e i t m o r e
“ Y o u s h o u l d t a k e t w o p u
”
Preventer (e.g. beclomethasone inhaler)
Explain what a preventer inhaler is and when it should be used\:
“ Y o u w i l l a l s o b e p r e s c r i b e d a p r e v e n t e r i n h a l e r . T h i s h e l p s i n t h e l o n g-t e r m t o r e d u c e t h e i n
m a k e s t h e m l e s s l i k e l y t o n a r r o w i n r e s p o n s e t o t r i gg e r s .
”
“ Y o u s h o u l d i n h a l e …( x p u
”
“ Y o u s h o u l d a l s o m a k e s u r e t o r i n s e o u t y o u r m o u t h a f t e r u s i n g t h i s a s y o u c a n s o m e t i m e s d e v e l o p a s o r e , i n
w h e n t a k i n g i t .
”
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For more information, see the Geeky Medics guide to inhaler technique.

Other treatment

Explain that sometimes people may require other medications or referrals to specialists\:
“ M o s t p e o p l e
”
h o w e v e r , s o m e p e o p l e r e q u i r e m o r e
“ I f y o u c o n t i n u e t o h a v e r e g u l a r s y m p t o m s y o u s h o u l d r e q u e s t a r e v i e w o f y o u r a s t h m a w i t h y o u r G P a s y o u m a y r e q u i r e m o r e
m e d i c a t i o n s , f o r e x a m p l e , t h e r e a r e t a b l e t s t h a t c a n a l s o b e u s e d t o t r e a t a s t h m a . O r y o u m a y b e r e f e r r e d t o a l u n g s p e c i a l i s t
w h o c a n r u n m o r e d e t a i l e d t e s t s a n d m a y u s e d i
”

Peak

Explain what a peak
“ W e w i l l a l s o g i v e y o u a d e v i c e c a l l e d a p e a k
b l o w a i r o u t o f y o u r l u n g s .
”
“ A s a s t h m a c a u s e s n a r r o w e d a i r w a y s i t c a n m a k e i t h a r d e r t o b l o w a i r o u t o f y o u r l u n gs , s o w h e n p e o p l e a r e h a v i n g a s t h m a
s y m p t o m s o r t h e i r a s t h m a i s p o o r l y c o n t r o l l e d t h e i r p e a k
”
“ Y o u c a n w o r k o u t a p r e d i c t e d p e a k
w h a t y o u r p e r s o n a l b e s t i s , t h i s i s b e c a u s e s o m e p e o p l e m a y h a v e p e a k
Y o u r p e r s o n a l b e s t p e a k
n u m b e r s a n d s y m p t o m s .
”
“ W h e n s t a r t i n g o r c h a n g i n g t r e a t m e n t y o u s h o u l d c h e c k y o u r p e a k
W h e n y o u r r e a d i n g s h a v e s t a b i l i s e d y o u s h o u l d c h e c k i t i f y o u f e e l y o u r s y m p t o m s a r e ge t t i n g w o r s e o r i f y o u a r e c o n c e r n e d
a b o u t y o u r a s t h m a .
”
For more information, see the Geeky Medics guide to recording a peak expiratory .

Personalised asthma management plans

Explain why a personal asthma management plan is bene
“ I t i s r e c o m m e n d e d t h a t a n y o n e w i t h a s t h m a h a s a p e r s o n a l m a n a g e m e n t p l a n . I t t e l l s y o u a n d o t h e r p e o p l e w h a t y o u r n o r m a l
a s t h m a m e d i c i n e s a r e , w h a t t o d o i f y o u r s y m p t o m s a r e ge t t i n g w o r s e a n d w h a t t o d o i n a n e m e r ge n c y s i t u a t i o n .
”
“ A m a n a g e m e n t p l a n i s h e l p f u l b e c a u s e i t gi v e s y o u m o r e c o n t r o l o v e r t h e m a n a ge m e n t o f y o u r a s t h m a a n d c a n h e l p t o
p r e v e n t a s t h m a a t t a c k s f r o m h a p p e n i n g.”
“ Y o u s h o u l d b o o k a r e v i e w a p p o i n t m e n t w i t h y o u r G P o r a s t h m a n u r s e i n a c o u p l e o f w e e k s t o c o m p l e t e y o u r m a n a g e m e n t
p l a n . Y o u c a n
”

Other aspects of asthma management

Explain the other aspects of asthma management that are important, such as annual reviews and vaccinations\:
“ Y o u s h o u l d a i m t o h a v e a r e v i e w o f y o u r a s t h m a w i t h y o u r G P a t l e a s t o n c e a y e a r , e v e n i f y o u a r e c o m p l e t e l y w e l l . T h i s w i l l
m a k e s u r e t h a t y o u r a s t h m a i s w e l l c o n t r o l l e d , a n d y o u k n o w w h a t t o d o i f y o u r s y m p t o m s ge t w o r s e . I f y o u a r e h a v i n g
p r o b l e m s w i t h y o u r a s t h m a , y o u m a y n e e d r e v i e w i n g m o r e r e g u l a r l y t h a n t h i s .
”
“ I t i s a l s o r e a l l y i m p o r t a n t t o m a k e s u r e y o u a r e u p t o d a t e o n y o u r v a c c i n a t i o n s a n d t h a t y o u g e t y o u r
p a t i e n t w i t h a s t h m a , y o u a r e e n t i t l e d t o t h i s f o r f r e e . T h i s i s i m p o r t a n t a s t h e
s y m p t o m s a n d p e o p l e w i t h a s t h m a c a n b e c o m e v e r y u n w e l l w i t h
”
If the patient is a smoker then you should also o
guide to smoking cessation counselling.

Closing the consultation

Summarise the key points back to the patient.
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“ W e h a v e d i s c u s s e d q u i t e a l o t t o d a y , i n c l u d i n g w h a t a s t h m a i s , t h e s y m p t o m s y o u m i gh t e x p e r i e n c e a n d h o w t h e c o n d i t i o n i s
m a n a g e d . I r e a l i s e t h i s i s a l o t o f i n f o r m a t i o n t o t a k e i n a n d t h e r e f o r e I h a v e a l e a
d i s c u s s e d . Y o u w i l l r e q u i r e r e g u l a r c h e c k s t o e n s u r e y o u r a s t h m a c o n t i n u e s t o b e w e l l c o n t r o l l e d . I t i s a l s o i m p o r t a n t t h a t y o u
s e e k a r e v i e w i f y o u n o t i c e y o u r s y m p t o m s w o r s e n i n g . I f y o u b e gi n t o f e e l v e r y s h o r t o f b r e a t h , d e s p i t e u s i n g y o u r t r e a t m e n t s ,
y o u s h o u l d c a l l a n a m b u l a n c e .
”
“ G o i n g f o r w a r d , i t i s i m p o r t a n t t h a t f o l l o w i n g t h i s a p p o i n t m e n t y o u a t t e n d a n i n h a l e r c h e c k a p p o i n t m e n t w i t h a s p e c i a l i s t
a s t h m a n u r s e t o m a k e s u r e y o u r i n h a l e r t e c h n i q u e i s c o r r e c t . Y o u w i l l a l s o n e e d a n a p p o i n t m e n t t o c o m p l e t e a n a s t h m a
m a n a g e m e n t p l a n . I t i s v e r y i m p o r t a n t t h a t y o u s t i c k t o t h e a s t h m a p l a n a n d u s e y o u r p r e v e n t e r i n h a l e r e v e n w h e n y o u a r e
f e e l i n g w e l l i n o r d e r t o g e t t h e f u l l b e n e
”
Ask the patient if they have any questions or concerns that have not been addressed.
" I s t h e r e a n y t h i n g I h a v e e x p l a i n e d t h a t y o u’ d l i k e m e t o g o o v e r a ga i n ?"
" D o y o u h a v e a n y o t h e r q u e s t i o n s b e f o r e w e
Direct the patient to further information about the condition using websites and lea
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.

References

NHS.uk. A s t h m a o v e r v i e w . Available from [LINK].
NICE Clinical Knowledge Summaries (CKS). A s t h m a-n e w l y d i a g n o s e d . Available from [LINK].
Asthma + Lung UK. H e a l t h a d v i c e . Available from [LINK].
Source\: geekymedics.com
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