Asthma Information

For patients who are due an annual asthma review.

Please would you answer the questions on the form below and submit it to us.

If your symptoms are deteriorating or you have any concerns, please make an appointment with the Respiratory Nurse or a Doctor.

Historically most patients with asthma have been prescribed aerosol (MDI) inhalers, but for most patients this is not the best choice of inhaler and NHS Highland are recommending that we switch patients onto dry powder (DPI) inhalers. There are several advantages with these, more modern, inhalers.

1. They are activated by taking a quick breath in and so do not require co-ordination of pressing to activate the aerosol inhaler and breathing in at the same time.

2. They have a dose counter on them, so it is easy to see how many doses are remaining and when you need to reorder an inhaler.

3. Dry powder inhalers have a far lower carbon footprint than MDI inhalers.

The NHS is responsible for 5% of UK greenhouse gas emissions. The single biggest contributor to this is inhalers (more than NHS buildings or vehicles). It is the propellant gas in MDI (aerosol) inhalers that cause the problem. Some propellant gases are over 3000 times more potent as a greenhouse gas than carbon dioxide.

A single MDI inhaler has the equivalent greenhouse gas emissions of a 175mile car journey e.g., Dingwall to Dumfries.

A single dry powder inhaler has the equivalent greenhouse gas emissions of a 4-mile car journey e.g., Dingwall to Strathpeffer.

Based on this information, we are switching our patients currently on metered dose (aerosol) inhalers (MDIs) onto dry powder inhalers (DPIs).

Please see the link below for information on how to use a dry powder inhaler

https://www.asthmaandlung.org.uk/living-with/inhaler-videos/accuhaler

Asthma Review Questionnaire

Full Name(Required)

Date of Birth(Required)

DD slash MM slash YYYY

Email(Required)

Phone Number(Required)

Please complete the following questions to allow your health care professional to assess your asthma.

How often does your asthma cause symptoms during the day?(Required)

Never

1 to 2 times per month

1 to 2 times per week

Most days

How often does your asthma cause symptoms at night?(Required)

Never

1 to 2 times per month

1 to 2 times per week

Most days

How often does your asthma limit your activities?(Required)

Never

1 to 2 times per month

1 to 2 times per week

Most days

How many asthma exacerbations (attacked) have you had in the past year?(Required)

How many times have you attended Accident and Emergency Department since your last asthma review?(Required)

Inhaler Technique

Please select the types of inhalers that you use(Required)

Metered Dose Inhaler

Autohaler

Accuhaler

EasiBreathe Inhaler

Easyhaler

Turbohaler

Small Volume Spacer

Large Volume Spacer

My inhaler is not listed here

Please specify your inhaler(Required)

Lifestyle - Alcohol

How often do you have a drink containing alcohol?(Required)

Never

Monthly or less

2-4 times a month

2-3 times a week

4 times or more a week

How many units of alcohol do you drink on a typical day drinking?(Required)

1 - 2

3 - 4

5 - 6

7 - 9

10+

How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?(Required)

Never

Less than monthly

Monthly

Weekly

Daily or almost daily

Lifestyle - Smoking

Do you smoke?(Required)

Never smoked

Ex-smoker

Trivial smoker (less than 1 cigarette per day)

Light Smoker (1-9 cigarettes per day)

Moderate smoker (10-19 cigarettes per day)

Heavy smoker (20-39 cigarettes per day)

Very heavy smoker (40 or more cigarettes per day)

Do you use an e-cigarette?(Required)

No

Ex-user

Yes

Would you like help to quit smoking?(Required)

Yes

No

For further information, please see: nhs.uk/quit-smoking

Asthma Control Test Score

During the past 4 weeks, how often did your asthma prevent you from getting as much done at work, school or home?(Required)

All of the time

Most of the time

Some of the time

A little of the time

None of the time

How often have you had shortness of breath?(Required)

More than once a day

Once a day

3-6 times a week

1-2 times a week

Not at all

How often did your asthma symptoms (wheezing, coughing, chest tightness, shortness of breath) wake you up at night or earlier than usual in the morning?(Required)

4 or more times a week

2-3 nights a week

Once a week

Once or twice

Not at all

How often have you used your reliever inhaler (usually blue)?(Required)

3 or more times a day

1-2 times a day

2-3 times a week

Once a week or less

Not at all

How would you rate your asthma control?(Required)

Not controlled

Poorly controlled

Somewhat controlled

Well controlled

Completely controlled

Your Calculated Asthma score(Required)

Your score is less than 20.

Your asthma may not have been controlled during the past 4 weeks.

Your doctor or nurse can recommend an asthma action plan to help improve your asthma control.

Your score is between 20 and 24.

Your asthma appears to have been reasonably well controlled during the past 4 weeks.

However, if you are experiencing symptoms your doctor or nurse may be able to help you.

Your score is 25, well done!

Your asthma appears to have been under control over the last 4 weeks.

However, if you are experiencing any problems with your asthma, you should see your doctor or nurse.

Further Questions

I have the following information, questions or concerns that I would like to raise with my Asthma Nurse or Doctor

Phone

This field is for validation purposes and should be left unchanged.