2. Asthma management across ages Acute asthma What is the difference between acute and brittle asthma??

3. Asthma management across ages Brittle asthma

4. Asthma management across ages Brittle asthma Its sudden No warning signs No time 

5. Asthma management across ages Brittle asthma  Very sudden sever attacks of asthma without the usual warning signs  Those who under-estimate their asthma, seeking doctor too late or not at all  Known as (Fulminant)

6. Asthma management across ages Brittle asthma Identify patients at risks of fulminant attacks  Those with previous fulminant attacks  Those with previous hospital admissions for acute asthma  Those who need regular courses of oral steroids

7. Asthma management across ages Brittle asthma Local arrangements are made for immediate hospital admissions in the event of acute attack Liaison between : Patient Patient's relatives PHC team Local A&E Dept. Local chest physician Very clear understanding of what to do and when for all those involved

8. Asthma management across ages Brittle asthma Underestimating asthma  People who do not seek medical attention  British Thoracic Association (Anonymous 1992) survey of 90 asthma deaths  21/36 dead or dying on GP arrival  2/3 out of 34 died in transit or soon after arrival hospital  13 patient no medical help  Delay in treatment is an important cause of asthma deaths

9. Asthma management across ages Brittle asthma Cause of asthma deaths?  Delay in treatment is an important cause of asthma deaths  Failure of patient to appreciate severity of attack  Adverse psychosocial factors in over 65% of deaths (Wareham et al 1993, Mohan et al 1996)

10. Asthma management across ages Brittle asthma Underestimating asthma Adverse psychosocial factors associated with risk of developing near fatal or fatal asthma  Non compliance with treatment  Psychological illness e.g. psychosis, depression  Alcohol or drug abuse  Childhood abuse  Social isolation  Domestic stress

11. Asthma management across ages Brittle asthma Underestimating asthma Patients at risk from their asthma:  Frequent asthma attendance at ER  Previous admissions from asthma in the last year  Use large amounts of bronchodilators  Require > 3 different types of asthma medications  Had near fatal episodes of asthma

12. Asthma management across ages Brittle asthma Underestimating asthma Health professional role:  Patient education  Identify high risk  Patients with severe asthma and have one or more associated psychosocial factors are at risk of asthma death (BTS/SIGN 2004)