Avoidable factors play a part in up to two thirds of asthma deaths according to the National Review of Asthma Deaths (1). Along with excessive prescribing of reliever medication, in conjunction with under-prescribing of preventer medication, the NRAD panel found avoidable factors that were related to health professionals’ lack of specific asthma expertise and lack of knowledge of the BTS/SIGN guidelines (1). If asthma care is to be improved, education of primary care and secondary care professionals is critical.
Yet asthma education for nurses is fragmented and under-resourced. A recent survey of 184 practice nurses conducted by the journal Independent Nurse (2) and Napp Pharmaceuticals revealed that while 90% felt their asthma management was in line with local guidelines, 20% had not had any formal training on asthma themselves. NRAD also found poor or inadequate implementation of protocol and a lack of knowledge of guidelines as avoidable factors relating to asthma deaths in secondary care (1).
A survey of 184 practice nurses [...] revealed that while 90% felt their asthma management was in line with local guidelines, 20% had not had any formal training on asthma themselves.
Monica Fletcher, Chief Executive of Education for Health and Chair of the UK Inhaler Group, said she was unsurprised by these results: “Things have changed very little in the last decade; we commissioned a similar survey eight years ago that had the same result. It saddens me that in such an amount of time we haven’t made inroads" (3).
To address the needs gap, Education for Health have joined forces with Napp Pharmaceuticals to offer training in effective asthma management to nurses. This partnership between charity and industry is delivered via a unique training programme called the Napp Academy, which provides on-the-ground training with the aim of empowering nurses to drive improvements within their clinical setting.
Ms Fletcher comments that a more contemporary approach to training is needed in order to fit in with nursing priorities: “Education is changing: new technologies mean that the use of e-learning and scenario based training are on the move."
The offering from Napp Academy includes asthma masterclasses and accredited diploma level modules, which enable nurses to extend their knowledge and skills in all aspects of asthma management
Training sessions [...] provide a great opportunity to get out of our practice, network with others and share best practice.
Natalie Harper, a Respiratory Advanced Nurse Practitioner and an Education for Health Trainer on the Napp Academy programme said: “Our collaboration has enabled many Health Professionals to extend their understanding of asthma therapies and management techniques as well as the underlying disease itself, along with up-to-date national supporting documentation. Delegate feedback suggests this wider understanding of the asthma arena is crucial in today’s changing NHS.”
In addition to improved knowledge of asthma management itself, Napp Academy training offers wider benefits says Deirdre Siddaway, a nurse trainer and former delegate at the Napp Academy: “Training sessions help people ensure their methods are up to date – but they also provide a great opportunity to get out of our practice, network with others and share best practice.”
Improving inhaler technique
Inhaler technique is an important part of asthma management and, when asked, over 90% of nurses believed that their technique was good or very good (2).
This, however, does not tell the full story, as Monica Fletcher explains: “There was a piece of work by Baverstock, published in the journal Thorax, that quoted the same percentage, yet when those 90% were asked to demonstrate their technique – they actually did it incorrectly” (4).
For patients, this is not good news. Poor inhaler technique may lead to the belief that medication is not effective, reducing treatment compliance (5). Research has found that up to 40% of patients believe they are taking their asthma medication when they are actually activating an empty or nearly empty MDI (6).
Poor inhaler technique may lead to the belief that medication is not effective, reducing treatment compliance.
For that reason, the Napp Academy now includes an inhaler technique training session for nurses and other healthcare professionals that has been developed and is delivered by Education for Health at a local level. Over 40 training sessions have taken place across the UK this year, including sessions in Basingstoke and Southampton.
Carla Astles, Southampton Integrated COPD Team, Nurse Educator said: “We know poor inhaler technique is a cause of exacerbation and hospital admission in asthma and the need for professional healthcare training is highlighted in the national asthma guidelines and NICE quality standards for asthma care. However, recognised and locally-based, training for this can be difficult to find, so this opportunity was an important part of the respiratory education service across Southampton and will benefit our patients greatly."
Jane Butcher, a Respiratory Clinical Nurse Specialist who attended the training in Basingstoke, agreed the sessions played a valuable role in improving not only practice nurses’ inhaler technique but also their understanding of the role of secondary care colleagues. She explained: “The education provided from this training has helped encourage and enhance integration between primary and secondary care, and the community - ensuring that excellence in asthma care is supported across all specialities and thereby optimising therapy, enhancing quality of care and improving respiratory health and well being.”
In fact, feedback from delegates attending Napp Academy courses reveals integration is so vital to improving asthma care, there is now a national Integrated Care Approach workshop. The workshop is chaired by Dr. Stephen Gaduzo (GP and chair of the UK Primary Care Respiratory Society), with Professor Mike Morgan (National Clinical Director for Respiratory, NHS England) presenting as a member of the faculty. As part of the Napp Academy programme, local integrated care study days are also planned, alongside wider respiratory meetings aimed at all healthcare professionals working in primary care and networking events across the country.
Monica Fletcher comments: “Napp are ahead of the curve and think of interesting ways to engage healthcare professionals. It’s a great way to work because we operate in a genuine partnership with a common aim to improve the care of patients living with asthma.”
For more information on the Napp Academy please visit: http://napp.co.uk/our-responsibilities/education/commitment-to-educationnapp-academy-2/
1. Royal College of Physicians. Why asthma still kills. National Review of Asthma Deaths. Confidential enquiry report. May 2014. Available at: https://www.rcplondon.ac.uk/sites/default/files/why-asthma-still-kills-full-report.pdf
2. Spotlight on asthma training. Independent Nurse. 5 October 2015
Baverstock M, Woodhall N & Maarman V. 2010. Do healthcare professionals have sufficient knowledge of inhaler techniques in order to educate their patients effectively in their use?Thorax 2010;65:A117-A118. Available at:
5. Papi A, et al. Eur Respir J 2011;37:982-5.
6. Conner JB, et al. J Asthma 2013;50:658-63
Napp Pharmaceuticals Limited