Your child’s difficult asthma assessment · Your child’s difficult asthma assessment For most children, asthma is easy to control with simple medications. However, for some children

A lifetime of specialist care

Your child’s difficult asthma

assessment

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What is difficult asthma? 3

What is a difficult asthma assessment? 3

Why does my child need this assessment? 3

What happens during the assessment? 3

How long does the assessment take? 4

Preparing for the assessment 4

If your child uses inhalers 4

What happens during the hospital visit? 5

The tests 6

What happens during the home visit? 7

Information about your child at school 8

What happens when the assessment is complete? 8

What else may happen? 9

Getting to the hospital 9

Who can I contact for more information? 10

Contents

This leaflet gives you general information about your child’sdifficult asthma assessment. It does not replace the need forpersonal advice from a qualified healthcare professional. Pleaseask us if you have any questions.

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Your child’s difficult asthma assessment

For most children, asthma iseasy to control with simplemedications.

However, for some childrenthis is not the case. Despite

taking medications, they sufferfrom a range of symptoms thatmay result in asthma attacksand generally affect theirquality of life. We describe thisas difficult asthma.

What is difficult asthma?

A difficult asthma assessmentis a way of finding out asmuch as possible about yourchild and his / her asthma.There are lots of differentreasons why your child mayhave asthma that is difficult tocontrol. During an assessment,we work in partnership with

you to identify possible causesso we can suggest the besttreatment for your child.

It is important that you readthis leaflet before theassessment begins so that youunderstand what it involves.

What is a difficult asthma assessment?

We think this assessment mayhelp your child. Once we havecompleted an assessment, wecan often suggest simple

things to improve your child’sasthma, without increasing the doses of medication.

Why does my child need this assessment?

First, we will ask you and your child to visit the hospital. You will meet one of ourrespiratory clinical nursespecialists and your child will

have some tests (see page 6).

After the hospital visit thespecialist nurse will arrange tovisit you at home.

What happens during the assessment?

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The hospital visit normallytakes two to four hoursdepending on the tests yourchild needs (the nurse will giveyou details when he / shearranges the assessment with you).

Both you and your child willhave the opportunity to get adrink or lunch during thehospital visit.

The home visit takes aroundtwo hours.

How long does the assessment take?

Please bring your child’smedications with you to the hospital. If your child takes antihistamine (allergy)

medication, please do not giveit to him / her for 48 hoursbefore the assessment unless itis really essential.

Preparing for the assessment

Your child should take his / herregular inhalers on themorning of the assessment,except for the blue inhaler(salbutamol).

We would prefer him / her notto take the blue inhaler in thefour hours before the

assessment as it will affect theresults of the spirometry test(see page 6). However, if yourchild finds it difficult to managewithout this inhaler, please useit and make a note of the time.Then, when you arrive at thehospital, tell us the time yourchild used the inhaler.

If your child uses inhalers

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Your child’s difficult asthma assessment

During the hospital visit we will:

• Ask lots of questions aboutyour child’s asthma. Forexample, how often doasthma attacks occur?

• Review your child’smedications.

• Check your child is using his / her inhaler correctly.

• Provide a device thatattaches to your child’ssteroid inhaler (called aSmartinhaler) to monitorhow often he / or she uses

it during a two-monthperiod. The device isexpensive, so please lookafter it carefully and return it when you nextvisit the clinic.

• Ask you and your child tocomplete questionnairesabout how asthma affectshis / her daily life and mood.

• We will ask your permissionto contact your child’sschool (see page 8 fordetails).

Your child will also have aseries of tests.

What happens during the hospital visit?

During the hospital visit, we will check your child’s inhaler technique

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• Spirometry – a breathingtest to check how well yourchild breathes. We use adevice called a spirometerto take the measurements.We will ask your child tobreathe in fully and toblow out as hard and fast as he / she can into the mouthpiece of thespirometer.

• Skin prick tests (allergytesting) – a safe way oftesting for allergies to

common substances, forexample: grass pollen andhouse dust mites.

These tests are not painful,but can cause an itchy rashthat lasts up to 30 minutes.

• Urine test – a sample ofyour child’s urine will showwhether he / she has beenexposed to environmentaltobacco smoke.

• Exhaled nitric oxide – abreathing test that

The tests

A child using a spirometer

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measures inflammation(swelling) in your child’sairways. We will ask yourchild to breathe in and outof a mouthpiece attachedto a special machine.

• Blood tests – to assess yourchild’s general health.

• Adrenal gland function tests– to check your child’sadrenal glands are workingeffectively. This is explained

in more detail in a separateleaflet. If you would like toknow more, please ask for acopy.

Note: Sometimes we arrangefor your child to have bloodand adrenal gland functiontests on a different day.

Also, if your child has had anyof the tests listed donerecently, we may not need torepeat them.

The same specialist nurse youmet at the hospital willarrange to visit you at home ata convenient time. This giveshim / her an opportunity tomeet you again and tounderstand more about yourchild’s asthma.

There is no need for your childto be at home during the visit,so if the visit is during termtime, please send him / her toschool.

Asthma can be caused bytriggers (things that irritateyour lungs) in the homeenvironment. We may be able

to identify those triggers andgive you advice on how bestto tackle them.

The nurse will identify anyproblems in your home thatmay be affecting your child’sasthma. For example, if youlive in social housing and yourhome has mould and isovercrowded, we may be ableto help you by supporting yourapplication for re-housing.

Please do not make anyspecial preparations for thenurse’s visit to your home. Thenurse needs to see what yourhome is like on a normal day.

What happens during the home visit?

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It is useful to find out howasthma affects your child atschool. During the hospitalvisit, we will ask for yourpermission to contact theschool.

We will ask the school forinformation about your child’sattendance, asthma symptomsand whether he / she is ableto take part in physicaleducation (PE) lessons.

This information will help uscomplete our assessment.

We will check the school hasan asthma action plan foryour child and offer supportin managing his / hercondition at school. Ifneeded, we will also visit theschool to provide asthma caretraining or attend meetingsabout your child’s healthneeds.

Information about your child at school

When the assessment iscomplete, all the healthprofessionals involved in yourchild’s asthma care will meetto discuss the results. We callthis a multidisciplinarymeeting. Doctors, specialistnurses and pharmacists attendthe meeting. Together, we willmake recommendations abouthow to manage your child’sasthma.

We will discuss the resultsand our recommendations

with you at a hospitalappointment and send yourGP and consultant at yourlocal hospital a summary ofthe assessment. You will get acopy of the summary.

Most of the time, we findways to help improve yourchild’s asthma withoutincreasing his / hermedication or doing moreassessments. If we needfurther assessments, we willdiscuss them with you.

What happens when the assessment iscomplete?

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Your child’s difficult asthma assessment

During or after the assessment:

• We may ask aphysiotherapist to assessyour child’s breathingpattern. The physiotherapistcan provide advice aboutbreathing control exercisesfor your child. These canhelp ease the asthmasymptoms, especially duringan attack.

• We may refer your child toa specialist asthmapsychologist, if we feel thatanxiety and stress areaffecting your child’sasthma. A psychologist canprovide treatment to helpyour child manage his / herasthma and cope with theemotional impact of havingthe condition.

What else may happen?

Your appointment will be inFulham Wing. You need tomake your own way to andfrom the hospital. Please beaware that there is little or nocar parking available.

By busBuses 14, 211 and 414 all stopoutside the Fulham Wingentrance to the hospital.

Buses 49 and 211 stop outsidethe Sydney Street entrance, afive-minute walk to FulhamWing.

Buses 11, 19, 22 and 319 alltravel along the King’s Road

and stop near the corner ofSydney Street, which is lessthan 10 minutes’ walk fromFulham Wing.

By tubeThe nearest tube station isSouth Kensington on theCircle, District and Piccadillylines. It is a 10-minute walkfrom the hospital. The 49 bustravels from South Kensingtonstation to the hospital. Taxisare also available.

By railThe nearest mainline trainstations are Victoria stationand West Brompton station.

Getting to the hospital

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If you have concerns about any aspect of the service you havereceived in hospital and feel unable to talk to those peopleresponsible for your care, call PALS on:

• Royal Brompton Hospital – 020 7349 7715

• Harefield Hospital – 01895 826 572

You can also email [email protected]. This is a confidential service.

Both have good tube and busconnections to the hospital.

By car If a family member is drivingyou in by car, they can dropoff or pick up at the mainhospital entrance in SydneyStreet. There are no places tostop outside Fulham Wing.

Parking for patients andvisitorsRoyal Brompton Hospital is ina pay-and-display parkingmeter zone (street parking).

There is a small public car park

three minutes' walk away onSydney Street, near King'sRoad.

Parking for disabled badgeholdersA small number of disabledparking spaces are available in:

• Cale Street

• Foulis Terrace

• Sydney Street (near themain hospital entrance).

Remember to display yourdisabled badge.

If you need to cancel or rearrange your appointment / homevisit, or want further information, please contact the children’srespiratory nursing team:

Tel: 020 7351 8714 (direct line)

Email: [email protected]

Who can I contact for more information?

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Your child’s difficult asthma assessment

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Royal Brompton HospitalSydney StreetLondonSW3 6NPtel: 020 7352 8121textphone: (18001) 020 7352 8121

Harefield HospitalHill End RoadHarefieldMiddlesexUB9 6JHtel: 01895 823 737textphone: (18001) 01895 823 737

Website: www.rbht.nhs.uk

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© Royal Brompton & Harefield NHS Foundation Trust June 2016

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