National Asthma Guidelines Research Articles

Qualitative research influencing guideline and policy: An exemplar of the development of a national school asthma guideline in Malaysia.

Qualitative research influencing guideline and policy: An exemplar of the development of a national school asthma guideline in Malaysia.

Adherence to National Asthma Guidelines in the Acute Care Setting: A Retrospective Cohort Study.

Peak flow is a crucial but simple test used to categorize the severity of an episode of an acute exacerbation of asthma.It should be regularly done in all the patients who present with asthma acute exacerbation in the emergency department. The British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) guidelines stipulate peak flow use as one of the main tools to categorize acute asthma into moderate, severe, and life-threatening asthma. The BTS and SIGN guidelines also state peak flow is to be utilized in monitoring the disease and to guide in treating patients with acute asthma. This study aims to identify the adherence to BTS/SIGN guidelines around the use of peak expiratory flow rate (PEFR) in assessing the severity of patients presenting with acute exacerbation of asthma in a district general hospital. The retrospective cohort study involved collating data between October 2022 and February 2023 from our hospital electronic system. The data collected about the use of PEFR and whether the patients were being classified by severity in presentation following this was compared to the BTS/SIGN 158 asthma guidelines. Following this, the data analysis was done using IBM SPSS Statistics for Windows, Version 21.0 (Released 2012; IBM Corp., Armonk, New York, United States). Data from 92 patients were collated. PEFR was recorded for 29.3% (n=27) of patients and acute exacerbation of asthma severity was documented in merely 17.4% (n=16) patients. The results indicate a significant proportion of the patient cohort analyzed did not have peak flow readings, there is clear room for improvement, and further intervention is needed in order for the department to adhere to the gold standard guidelines (i.e., BTS/SIGN 158), and thus improve the management and monitoring of acute asthma exacerbations. Future directions can include departmental education, posters as a reminder, and prompts on the electronic system used to alert users to check PEFR when a diagnosis of acute asthma exacerbation is documented.

Asthma outcomes in pediatric patients with 30-day follow-up after an asthma hospitalization in a Medicaid-managed care program

Background National asthma guidelines recommend an outpatient follow-up after hospitalization for asthma. Our aim is determine if a follow-up visit within 30 days after an asthma hospitalization impacts risk for re-hospitalization and emergency department visits for asthma within the following year. Methods This was a retrospective cohort study of claims data of Texas Children’s Health Plan (a Medicaid managed care program) members age 1 to <18 years and hospitalized for asthma between January 1, 2012, and December 31, 2018. Primary outcomes were days to re-hospitalization and emergency department visit between 30 days and 365 days following the index hospitalization. Results We identified 1,485 children age 1 to <18 years hospitalized for asthma. Comparing those with a 30 day follow-up to those without, there was no difference in days to re-hospitalization (adjusted hazard ratio 1.23, 95% Confidence Interval (CI) 0.74–2.06) or emergency department visit for asthma (aHR 1.08, 95% CI 0.88–1.33). Inhaled corticosteroid and short acting beta agonist dispensing were greater in the group completing the 30 day follow-up (means of 2.8 and 4.8 respectively for those with follow-up, 1.6 and 3.5 respectively for those without, p < 0.0001). Conclusion Having a follow-up outpatient visit within 30 days of an asthma hospitalization is not associated with a decrease in asthma re-hospitalization or emergency department visit in the 30–365 day period following the index hospitalization. Non-adherence to regular use of inhaled corticosteroid medication was high in both groups. These findings suggest need for improvement in the quality and quantity of post hospital asthma follow-up.

Uncontrolled asthma in primary care: part 1

Uncontrolled asthma places patients at risk of asthma attack, hospital admission and death. Andrew Booth highlights strategies that may be used in primary care to identify these patients This article will help nurses to identify uncontrolled asthma in a primary care setting, and support the identification of people who may be at risk from asthma attack, hospital admission or death. Guideline-defined asthma control is covered, along with the appropriate tools used to measure asthma control. The difference between asthma severity, asthma control and risk of attack is discussed, with practical advice from national and international asthma guidelines. Strategies and interventions that may be of use in primary care are highlighted, and a look at how research is helping identify new ways of supporting people with uncontrolled asthma.

Landscape of short-acting beta-agonists (SABA) overuse in Europe.

This review article provides an overview of short-acting beta-agonist (SABA) use and prescribing trends in Europe, summarizing updated data on the results from the industry-funded SABINA program (SABA use IN asthma) and other studies on this matter. SABA use continues to increase worldwide. Overuse has been defined as ≥3 canisters/year. Almost a third of European patients with asthma, at all severity levels, overuse SABA. Guidelines recommend close monitoring of patients who overuse SABA and avoiding over-reliance on SABA monotherapy. SABA overuse is associated with increased risk of asthma exacerbations and mortality, increased use of health services and negative physical and mental health outcomes. Reliance on SABA monotherapy can be unsafe and therefore it is necessary to change asthma treatment approaches and policies. Changes in physician and patient behaviours towards SABA use are required to ensure that patients with asthma are not over-reliant on SABA monotherapy. Notwithstanding, the limitations of the studies on the use of SABA should be considered, taking into account that the prescription/purchase of medication canisters does not always represent the actual use of the medication and that associations between SABA overuse and poor asthma outcomes may not be directly causal. National health systems and asthma guidelines must align asthma management with global recommendations and adjust them to local needs.

Implementing Spirometry and Fractional Exhaled Nitric Oxide Testing in Childhood Asthma Management in UK Primary Care: An Observational Study to Examine Training and Implementation Cost and Impact on Patient’s Health Use and Outcome

National Asthma Guidelines are important to implement in the primary care setting to provide standardized and improved asthma care. This study was designed to evaluate the implementation and clinical outcomes related to the delivery of spirometry and fractional exhaled nitric oxide (FeNO) testing for children with diagnosed or suspected asthma in the primary care setting.The study included 27 clinical staff from 10 general practices and 612 children with asthma ages 5 to 16 years in a prospective observational cohort in the United Kingdom. Children with asthma were defined as those with the diagnosis of asthma or those suspected to have asthma who were prescribed asthma medications in the last 12 months.Training materials on spirometry and FeNO tests were developed and taught to 27 clinical staff to implement for the study patients. The cost of implementation was estimated based on time, cost of resources, and standard costs of care in the UK-based system. The study then compared this invested cost to the benefits, such as decreased unplanned healthcare utilization and the amount of oral corticosteroids used. Participants were given the 3 questionnaires: Asthma Control Test (ACT), mini Pediatric Asthma Quality of Life Questionnaire (mini PAQLQ), and Child's Health Utility 9D (CHU9D), which measure asthma control, asthmatic quality of life, and general health, respectively, at the time of review and 6 months later to measure the benefits.The overall cost for material development, training time, and purchase of equipment was about £58 317 ($75 171 US dollars). The study equipment included 2 spirometers and 2 FeNO machines that rotated between clinics; however, the spirometry machines were donated and therefore, did not contribute to the total costs. Healthcare utilization was reduced by a total of £26 064 ($33 596) or £43 ($55) per child in the subsequent 6 months after the asthma review. Following the asthma assessments, there was an increase in daily inhaled corticosteroids prescribed, and fewer children required prescribed oral corticosteroids. There was no significant difference in the number of short-acting β-agonist inhalers prescribed. Of the 612 children, only 226 however completed their follow-up surveys at 6 months. ACT scores for ages 5 and up improved significantly. The mini PAQLQ was not statistically significant and the CHU9D decreased significantly at follow-up.Overall, the cost to train the staff and implement spirometry and FeNO measurement practices in the primary care clinic was £95 per child ($123). The potential healthcare dollar savings and benefits demonstrated with improved outcomes are significant and worth consideration and investment.This study from the UK demonstrates how a $150 investment per asthmatic child could lead to fewer emergency department visits, better controller medication compliance, fewer oral steroids, and better healthcare dollar utilization overall. With training and implementation of asthma education using objective asthma data at the primary care provider level, these improved asthma outcomes can be achieved. A similar study based on the most recent EPR-4 guidelines and the American medical system would be beneficial to assess the translation and replication of cost-benefit analysis in the US healthcare system.URL: www.pediatrics.org/cgi/doi/10.1542/peds.10.1136.archdischild-2020-319310

Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis.

The Joint Committee on Vaccination and Immunisation in the United Kingdom requested an evidence synthesis to investigate the relationship between asthma and coronavirus disease 2019 (COVID-19) outcomes. We conducted a systematic review and meta-analysis to summarise evidence on the risk of severe COVID-19 outcomes in people with uncontrolled asthma or markers of asthma severity. High-dose inhaled corticosteroids (ICS) or oral corticosteroids (OCS) were used as markers of asthma severity, following international or national asthma guidelines. Risk of bias was assessed using Joanna Briggs Institute tools. Adjusted point estimates were extracted for random-effects meta-analyses and subgroup analyses. After screening, 12 studies (11 in adults and one in children) met the eligibility criteria. Adults using high-dose ICS or OCS had a pooled adjusted hazard ratio (aHR) of 1.33 (95% CI 1.06-1.67, I2=0%) for hospitalisation and an aHR of 1.22 (95% CI 0.90-1.65, I2=70%) for mortality for COVID-19. We found insufficient evidence for associations between markers on COVID-19 mortality in the subgroup analyses. Adults with severe asthma are at increased risk of COVID-19 hospitalisation compared to nonusers. Our analysis highlighted the dearth of studies in children with asthma investigating serious COVID-19 outcomes.

The implementation of pediatric asthma guidelines including self-assessment of the level of confidence and accessibility of medical supplies necessary for asthma management from the perspectives of multidisciplinary care teams.

Asthma control in Thai children is not yet satisfactory. Direct observation of the clinical practice for health care professionals (HCPs) in asthma clinic is essential. To ascertain the implementation of asthma guidelines for Thai children, to assess the confidence level in general asthma management, and to determine the availability of medical supplies. A cross-sectional study was conducted in which HCPs were surveyed by questionnaire. The selection of pediatric asthma guidelines and self-assessment of their confidence level of their own asthma practice were assessed by using a score range between 1 (the lowest) and 10 (the highest). Reasons for low confidence were identified. The necessity and availability of medical supplies for asthma and its comorbidities were investigated in government hospitals in Chachoengsao province. A total of 245 participants from 11 hospitals were enrolled. There were registered nurses (38.0%), medical and nursing students (31.4%), physicians (28.2%), and pharmacists (2.4%). The Global Initiative for Asthma has been the most frequently used guideline followed by the Thai Asthma Guideline for Children 2015-2016 (56.3% vs. 52.7%; p = 0.45). The pathway for assessment and stepwise approach for adjusting treatment was the most regularly applied (61.4%). The mean overall level of confidence was 5.72 & 1.70-a moderate level. Only 2 of 11 (18.2%) surveyed hospitals had nebulized corticosteroids, and less than half of them (45.5%) had an allergic rhinitis checklist. To perfectly implement the national asthma guidelines, HCPs should be able to increase the level of confidence and procure necessary medical supplies.

Adherence to National Asthma Guidelines in a Pediatric Outpatient Clinic: Why Periodic Education Improves Adherence

A pre- post-chart audits of 50 asthmatics assessed provider documentation for asthma classification and treatment according to national guidelines. Once baseline electronic medical records (EMR) audit was conducted the healthcare providers and clinic staff received training on the use of asthma diagnosis and treatment national guidelines. A post-training EMR chart audit (3-months after the training) was conducted for a pre-post-training comparison.

Sensitization against Fungi in Patients with Airway Allergies over 20 Years in Germany

Background: Fungal spores are ubiquitous allergens. Severe forms of asthma are particularly highly associated with fungal sensitization. National and international asthma guidelines recommend the implementation of allergen immunotherapy if indicated. Thus, detection and treatment of relevant allergies are key components of primary care of these patients. Objectives: The aims of the study were (i) to investigate trends in the prevalence of sensitization to twelve fungi in central Germany over the last 20 years and (ii) to dissect specific sensitization patterns among the 3 most important fungi: Aspergillus, Alternaria, and Cladosporium. Methods: This single-center study evaluated skin prick test (SPT) results of 3,358 patients with suspected airway allergies over a period of 20 years (1998–2017). Results: While 19.2% of all study patients had positive test results to at least 1 of the 3 fungi (Alternaria, Aspergillus, or Cladosporium) in the first study decade, this rate increased to 22.5% in the second decade. Slight increases in sensitization rates to almost all fungi were observed over the 20-year period. In the last decade, polysensitization to Alternaria, Aspergillus, and Cladosporium increased significantly. Sensitization to fungi is age-dependent and peaks in the age-group of 21–40 years during the second decade. Conclusion: Fungi are relevant allergens for perennial and seasonal allergy symptoms. We currently recommend including Aspergillus, Alternaria, and Cladosporium in the standard series of SPTs for airway allergies.

Deep Learning Identification of Asthma Inhaler Techniques in Clinical Notes.

There are significant variabilities in clinicians' guideline-concordant documentation in asthma care. However, assessing clinicians' documentation is not feasible using only structured data but requires labor intensive chart review of electronic health records. Although the national asthma guidelines are available it is still challenging to use them as a real-time tool for providing feedback on adhering documentation guidelines for asthma care improvement. A certain guideline element, such as teaching or reviewing inhaler techniques, is difficult to capture by handcrafted rules since it requires contextual understanding of clinical narratives. This study examined a deep learning based natural language model, Bidirectional Encoder Representations from Transformers (BERT) coupled with distant supervision to identify inhaler techniques from clinical narratives. The BERT model with distant supervision outperformed the rule-based approach and achieved performance gain compared with the BERT without distant supervision.

Providers' Adherence to Evidence-Based Asthma Guidelines in Pediatric Primary Care

BackgroundRegardless of existence of National asthma guidelines, adherence to major elements of guidelines among providers is suboptimal. The nonadherence contributes to poor clinical outcomes and quality of life of asthma patients. PurposeThis project aims to improve the standard of care of asthma patients with increased providers' adherence to asthma guidelines through provider education, and implementation of practice guidelines and evidence-based resources. MethodsA pre-post implementation retrospective design was adopted along with the provision of provider education sessions and implementation of pediatric asthma management practice guidelines and asthma resources in the pediatric practice in Southern, New Jersey. Data were collected via retrospective chart review among 41 patients four-months pre-implementation and 38 patients three months post-implementation to assess the improvement of providers' adherence to seven elements of asthma guidelines. Descriptive statistics and chi-square tests were computed to evaluate providers' adherence. ResultsResults showed improvement from pre- to post-implementation in utilization of six of the seven key elements of guidelines among providers that include, the assessment and documentation of asthma control (4.9% to 39.5%), medication adherence (20% to 87.5%), medication delivery technique (7.3% to 18.4%), environmental triggers (14.6% to 44.7%), asthma action plan (4.9% to 28.9%), and follow-up visits (48.8% to 76.3%). In addition, the chi-square test showed a significant association between environmental triggers assessment from baseline to post-implementation, χ2 (1, n = 79) = 4.29, p = .038. ConclusionProviding necessary resources and provider-focused education demonstrated a positive change in promoting best practice and facilitating providers' adherence.

Use of a validated asthma questionnaire to increase inhaled corticosteroid prescribing in the pediatric emergency department

Background Asthma guidelines recommend assessment of asthma control and treatment with an ICS when appropriate. Children seen for asthma in the ED often have poorly controlled asthma. Validated questionnaires are rarely used in the ED and ICS are prescribed at less than 5% of ED asthma encounters, leaving many children at risk for continued poor outcomes. Objective To determine if use of a validated asthma questionnaire can increase the proportion of children who receive an ICS prescription during an ED asthma visit. Methods We administered a validated asthma questionnaire (Pediatric Asthma Control and Communication Instrument-ED version [PACCI-ED]) to parents of children 2 − 17 years old presenting for asthma care at a large, urban, academic pediatric ED. Based on national asthma guidelines, the PACCI-ED results were used to determine ICS dose recommendations. ED physicians reviewed the PACCI-ED results and ICS dose recommendations and chose whether to prescribe an ICS upon discharge. ICS prescribing rates during the intervention period were assessed via medical record review and compared to historical controls. We also surveyed parents to examine the association of sociodemographic factors with receipt of an ICS prescription, and surveyed physicians regarding their prescribing decisions. Results Thirteen physicians and seventy-nine children participated. Historically, the ICS prescribing rate for asthma exacerbations discharged from the ED was 13%. The intervention increased ICS prescribing to 56% (p < 0.001). Children with ≥2 asthma exacerbations in the prior year (p < 0.02) and those with moderate-severe persistent asthma (p < 0.02) were more likely to receive an ICS prescription. There were no statistically significant differences in ICS prescribing by sociodemographic characteristics. Conclusion A validated asthma questionnaire increased ICS prescribing for children presenting for to the ED for asthma care. Additional strategies are needed to promote prescribing in this setting and ensure that all eligible children receive guideline-based asthma care.

Childhood Asthma: Low and Middle-Income Countries Perspective.

Our aim is to review current asthma epidemiology, achievements from the last 10 years, and persistent challenges of asthma management and control in low-middle income countries (LMICs). Despite global efforts, asthma continues to be an important public health problem worldwide, particularly in poorly resourced settings. Several epidemiological studies in the last decades have shown significant variability in the prevalence of asthma globally, but generally a marked increase in LMICs resulting in significant morbidity and mortality. Poverty, air pollution, climate change, exposure to indoor allergens, urbanization and diet are some of the factors that contribute to inadequate control and poor outcomes in developing countries. Although asthma guidelines have been developed to raise awareness and improve asthma diagnosis and treatment, problems with underdiagnosis and undertreatment are still common. In addition, important social, financial, cultural and healthcare barriers are common obstacles in LMICs in achieving control. Given the high burden of asthma in these countries, adaptation and implementation of national asthma guidelines tailored to local needs should be a public health priority. Governmental commitment, education, better health system infrastructure, access to care and effective asthma medications are the cornerstone of achieving success. CONCLUSION: Asthma poses significant challenges to LMICs. Whilst there are ongoing efforts in improving asthma diagnosis and decreasing asthma burden in LMICs; reasons for inadequate asthma control are also common and difficult to tackle. Improving asthma diagnosis, access to appropriate treatment and decreasing risk factors should be key goals to reduce asthma morbidity and mortality worldwide.

Intravenous and intramuscular therapy in near fatal asthma. A response to Al-Shamrani.

The invited review by Al-Shamrani et al. (2020) [1] failed to address the management of a patient having an asthma attack who arrives in the Emergency Department with respiratory failure or in a moribund condition. The only route available for drug therapy in these patients is intravenously (IV) or intramuscularly in a final attempt to reduce bronchoconstriction. This could avoid tracheal intubation and lung ventilation, or make these procedures safer (Sellers, 2013; Williams et al., 1992) [2,3] for the patient if some bronchodilation occurs. Intubation and ventilation prevent coughing but tenacious mucus remains which blocks the bronchi. There are no randomised controlled trials or national asthma guidelines to inform practice at this stage of the disease, especially in under 18 year olds, so case report evidence, experience, common sense, and pharmacological principles must be engaged to save the patient’s life.

Improving Asthma Conditions for Children and Adolescents by Expanding the Statewide Learning Collaborative Model Through Health Homes.

Asthma is one of the most common diseases among children in the United States. Increasing provider adherence to national asthma guidelines and connecting patients to Health Homes can increase optimal asthma care. The objectives of this article are to report the results of an asthma learning collaborative and explore the role of Health Homes in contributing to its success. Quantitative and qualitative data were collected regarding the experiences of 14 pediatric primary care practices and 6 Health Homes participating in a 9-month learning collaborative. Practices exceeded process aims of 80% compliance with optimal asthma care and the use of an Asthma Action Plan among patients aged 2 to 21 years. Health Home care coordinators also reported improvements in self-management strategies for asthma conditions, including the presence of an Asthma Action Plan, medications, spacers, and proper spacing techniques. Providers and Health Home care coordinators identified role clarity, mitigation of environmental triggers, and management of asthma conditions as benefits of the experience. The results of this asthma learning collaborative increased provider adherence to national guidelines and significantly improved optimal asthma care for patients. This multipronged, holistic approach to asthma care proved successful for controlling and maintaining asthma conditions among patients.

Detection of Respiratory Syncytial Virus or Rhinovirus Weeks After Hospitalization for Bronchiolitis and the Risk of Recurrent Wheezing.

In severe bronchiolitis, it is unclear if delayed clearance or sequential infection of respiratory syncytial virus (RSV) or rhinovirus (RV) is associated with recurrent wheezing. In a 17-center severe bronchiolitis cohort, we tested nasopharyngeal aspirates (NPA) upon hospitalization and 3 weeks later (clearance swab) for respiratory viruses using PCR. The same RSV subtype or RV genotype in NPA and clearance swab defined delayed clearance (DC); a new RSV subtype or RV genotype at clearance defined sequential infection (SI). Recurrent wheezing by age 3 years was defined per national asthma guidelines. Among 673 infants, RSV DC and RV DC were not associated with recurrent wheezing, and RSV SI was rare. The 128 infants with RV SI (19%) had nonsignificantly higher risk of recurrent wheezing (hazard ratio [HR], 1.31; 95% confidence interval [CI], .95-1.80; P = .10) versus infants without RV SI. Among infants with RV at hospitalization, those with RV SI had a higher risk of recurrent wheezing compared to children without RV SI (HR, 2.49; 95% CI, 1.22-5.06; P = .01). Among infants with severe bronchiolitis, those with RV at hospitalization followed by a new RV infection had the highest risk of recurrent wheezing.

Use of National Asthma Guidelines by Allergists and Pulmonologists: A National Survey

Little is known about specialist-specific variations in guideline agreement and adoption. To assess similarities and differences between allergists and pulmonologists in adherence to cornerstone components of the National Asthma Education and Prevention Program's Third Expert Panel Report. Self-reported guideline agreement, self-efficacy, and adherence were assessed in allergists (n= 134) and pulmonologists (n= 99) in the 2012 National Asthma Survey of Physicians. Multivariate models were used to assess if physician and practice characteristics explained bivariate associations between specialty and "almost always" adhering to recommendations (ie, ≥75% of the time). Allergists and pulmonologists reported high guideline self-efficacy and moderate guideline agreement. Both groups "almost always" assessed asthma control (66.2%, standard error [SE] 4.3), assessed school/work asthma triggers (71.3%, SE, 3.9), and endorsed inhaled corticosteroids use (95.5%, SE 2.0). Repeated assessment of the inhaler technique, use of asthma action/treatment plans, and spirometry were lower (39.7%, SE 4.0; 30.6%, SE 3.6; 44.7%, SE 4.1, respectively). Compared with pulmonologists, more allergists almost always performed spirometry (56.6% vs 38.6%, P= .06), asked about nighttime awakening (91.9% vs 76.5%, P= .03) and emergency department visits (92.2% vs 76.5%, P= .03), assessed home triggers (70.5% vs 52.6%, P= .06), and performed allergy testing (61.8% vs 21.3%, P < .001). In multivariate analyses, practice-specific characteristics explained differences except for allergy testing. Overall, allergists and pulmonologists adhere to the asthma guidelines with notable exceptions, including asthma action plan use and inhaler technique assessment. Recommendations with low implementation offer opportunities for further exploration and could serve as targets for increasing guideline uptake.

Parental perception of a picture-based chronic asthma care management tool in an urban pediatric emergency department

Background National asthma guidelines recommend use of an asthma action plan (AAP) as part of chronic asthma care. Unfortunately, AAPs have not been tailored for use in acute care settings, where many patients at risk for poor chronic asthma care are seen, including those who are non-English-speaking or have low literacy levels. We previously developed a picture-based medication plan (PBMP), a unique type of AAP for use in an ambulatory setting and designed to increase patient use and understanding. However, little is known about how parents seeking emergency department (ED) asthma care would perceive the PBMP. Objective To assess parental attitudes toward an asthma PBMP in the largest pediatric ED in Los Angeles County. Methods We surveyed a consecutive sample of English- or Spanish-speaking parents of children 2-17 years seeking ED asthma care. Parents used a 5-point Likert scale for various statements regarding their perceptions of the PBMP. Responses were analyzed by sociodemographics, asthma control, and health literacy using Chi-squared and t-tests. Results 90 parents provided feedback on the PBMP. The majority of parents endorsed the PBMP. Endorsement was 20%-30% higher among Spanish-speaking parents and those who did not complete high-school compared to English-speaking parents and parents with a high school education or higher (p < 0.05 for both comparisons). Conclusion Spanish-speaking parents and parents with less than a high-school education overwhelmingly endorsed the PBMP. It may be useful to consider incorporating the PBMP as part of patient-centered chronic asthma care strategies for populations seen in ED settings.

Prescribing inhaled therapy in asthma: health professionals' habits and beliefs

National and international asthma guidelines provide the evidence base for prescribing growing array of different inhaled therapies. However, the advice given is generic. The influence of nurses in prescribing inhaled therapy continues to grow, yet there is little published to help understand how and why nurses prescribe or advise on the prescribing of inhaled therapy in asthma. The aim of the study was to gain a better understanding of how health professionals make prescribing decisions in inhaled therapy, which was done by taking a survey. The survey gathered data of the habits and beliefs on prescribing inhaled corticosteroid/inhaled long-acting B2 agonist therapy in asthma, from 100 primary healthcare professionals. As a result of the study, patient preference, dose counter and maintenance and reliever therapy were reported to be considered the most important elements by health professionals. The device was considered more important than the drug, and there is an ongoing need for further education of health professionals in this area. Comparing responses from this study with similar responses from people with asthma may bring together the thinking of patients and professionals.