The RCN Learning Zone is a FREE online service to help RCN members with their continuing professional development and professional portfolio management. The RCN Learning Zone can be found at www.rcn.org.uk/members/learningzone.php This practice profile is based on NS689 Hazeldine V (2013) Pharmacological management of acute asthma exacerbations in adults. Nursing Standard. 27, 33, 43-49. I care for many people with coexisting conditions, including asthma, in a nursing and residential care home. The CPD article helped me to change practice in this setting. Although the prevalence of asthma is slowly declining, it affects an estimated 3.8 million people in the UK. There have been advances in diagnosing and managing asthma, but exacerbations remain a problem, and early recognition of such exacerbations can save lives. Where I work, several service users experience asthma and other respiratory pathologies. All service users are monitored regularly using the National Early Warning Score (NEWS) observation chart, which includes temperature, pulse, blood pressure, respiratory rate, peripheral oxygen level and consciousness measurements. These parameters are measured routinely in the nursing and residential care home and recorded on clinical charts. It was interesting to read that the signs and symptoms of an acute asthma exacerbation can include cough, wheeze, dyspnoea, chest tightness and variable airflow obstruction. Patients with asthma and other respiratory conditions could be monitored more effectively using a peak expiratory flow (PEF) meter. PEF meters are low cost, portable, and easy to use. Using this meter, along with the NEWS observations, allows for greater monitoring of asthma and other respiratory conditions. Individuals with asthma ideally require a recorded PEF from within the last two years for comparison purposes. This would help nurses to determine if a service user was experiencing an acute asthma exacerbation. A series of PEF readings were taken for service users, initially only for those with asthma, to record baseline levels. PEF can be used with a traffic light system, and this is how it is used at the care home: Red (danger) – PEF less than 50% of the individual’s personal best indicates a medical alert. Advice should be obtained as soon as possible. At the care home, the service user’s GP or nurse practitioner responds as appropriate. Yellow (caution) – PEF 50-79% of the individual’s personal best indicates that the asthma is worsening. Medical review of the service user should be obtained. At the care home, the GP or nurse practitioner responds as appropriate. Green (safe) – PEF 80-100% of the individual’s personal best indicates that the asthma is under control and that the person should continue to be monitored. The rapid assessment of a service user during an asthma exacerbation is important. At the care home, individuals with asthma usually only develop exacerbations when they have an acute illness, such as a chest infection or pneumonia. Monitoring PEF and using the NEWS observation chart will help to improve the care I give NS