Asthma Action Plan…in Action

In retrospect, the warning signs were there.   My patients had been bringing it up all week in clinics, how they noticed they were back on their inhalers.

Then, I woke up early hours of the morning to hear a tiny, dry, persistent cough from the next room from 4 y.o. C. He had a mild viral thing from the preschool but now it had triggered his:

Asthma.

By school run time, 4 y.o. C. had had A LOT of Ventolin.  By 10.30am, I rang the GP.

I’m an asthmatic myself.  I’m a doctor. I’ve been through asthma with my boys before.

So, what makes me ring the GP?

• We had already activated C’s Action Plan from last winter and he wasn’t any better.

• Breathlessness – he was getting out of breath with normal non-vigorous play.

• Persistent dry cough.

• Faint wheeze, not relieved by inhalers.

• Working hard to breathe. Children working hard to breathe with asthma will muscles in their neck and chest moving that usually don’t when they are breathing.

• Logistics: I’ve found a problem early in the day.  If I let the GP surgery know earlier rather than later that I have a worry, it is more likely that they can help me during daytime hours and prevent an ED visit later. Worst case, if he gets better while I’m waiting for that urgent GP visit or call back, I can always let them know it’s settled.

So, how do I do it?

• I give fair warning to C. that we are going to go to the GP [for more on this, see last week’s blog!] and ask him to pick out one of his favourite stuffed animals to take along. He’s not a big fan of doctors.  We did a quick antigen test as a courtesy to other patients and the GP, considering C. is going to be coughing everywhere when we go in.

• I make sure he’s had all his Action meds before we go. I know that my colleagues will take it into account.

• I played with C. in the waiting room and remind him what happens when we are at the doctor (“remember he’s going to listen to your chest with the stethoscope like last time”)

• Once the doc has seen C. and made a new plan to add an inhaler and short course of steroids, I asked: what should I look for next?  When should I worry?  GP listed out what we should look for over next 24 hours, what should prompt me to take him to ED if out of hours, and if we need a 24 hours review.   Before we left, GP reminded me to book in to make a non-urgent appointment to make a new Action Plan for C.

There is A LOT of misinformation about asthma.  Best sources of information is Asthma Society of Ireland website https://www.asthma.ie/about-asthma/learn-about-asthma/managing-your-asthma/asthma-action-plan  and your GP. Working with your chemist or GP practice nurse can really help get a better understanding of your medications and how to use them, including inhaler technique.   For example: did you know that if you are struggling with inhaler technique – at any age – a spacer device can really help.  One of my patients discovered this after years of asthma this week!

To see archived discussion on asthma and mythbusting, try:  https://emdoc.ie/2022/07/23/asthma/