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Registration Number: {{org_field_registration_no}}

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Asthma Management Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides safe, effective, person-centred and legally compliant care and support to service users with asthma. This policy supports compliance with the Regulation and Inspection of Social Care (Wales) Act 2016, The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, the Welsh Government statutory guidance for service providers and responsible individuals, CIW requirements, and current NICE/BTS/SIGN asthma guidance.

This policy sets out how {{org_field_name}} will identify asthma-related needs, include those needs in the person’s personal plan, support safe use of prescribed inhalers, spacers and nebulisers, respond promptly to asthma attacks, seek medical advice when required, maintain accurate records, notify relevant persons and agencies where required, and ensure staff are trained and competent to support service users safely.

2. Scope

This policy applies to all staff, including care workers, nurses, administrative personnel, and management, who are responsible for supporting service users with asthma. It covers:

• Recognising asthma symptoms and triggers.
• Managing medication, including inhalers and nebulisers.
• Emergency response procedures for asthma attacks.
• Staff training requirements to ensure competency in asthma care.
• Maintaining accurate records and communication with healthcare professionals.
• Ensuring asthma care is reflected in the service user’s provider assessment, personal plan, risk assessment and medication records.
• Supporting service users to self-manage their asthma where they are able and wish to do so.
• Responding to deterioration, increased reliever use, asthma attacks and post-attack follow-up.
• Escalating concerns to the GP, 111, 999, respiratory nurse, community pharmacist, emergency services, family/representative, commissioner and CIW where required.
• Ensuring asthma-related care is monitored through governance, audit, incident review and quality assurance processes.

3. Legal and Regulatory Framework

{{org_field_name}} will manage asthma care in line with the following legal, regulatory and best-practice framework:

• The Regulation and Inspection of Social Care (Wales) Act 2016.
• The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended.
• Welsh Government statutory guidance for service providers and responsible individuals, including requirements relating to personal plans, safe care and support, medication, staffing, records, notifications, monitoring and improvement.
• CIW requirements, including the requirement to notify CIW of relevant changes, incidents and events through CIW Online where required.
• NICE/BTS/SIGN guideline NG245: Asthma: diagnosis, monitoring and chronic asthma management.
• The BTS/NICE/SIGN asthma pathway, where relevant to diagnosis, monitoring, chronic management, difficult/severe asthma and acute asthma attack pathways.
• The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, where decisions about asthma treatment, self-administration or emergency care involve a service user who may lack capacity.
• The Equality Act 2010, including making reasonable adjustments for service users with communication, cognitive, sensory, physical or language needs.
• The organisation’s Medication Management and Administration Policy, Infection Prevention and Control Policy, Safeguarding Policy, Incident Reporting Policy, Duty of Candour Policy and Care Planning Policy.

4. Understanding Asthma

Asthma is a chronic respiratory condition that causes inflammation and narrowing of the airways, leading to symptoms such as:

• Wheezing
• Shortness of breath
• Coughing (particularly at night or early morning)
• Chest tightness

Asthma symptoms can be triggered by:

• Allergens (dust mites, pollen, pet dander)
• Airborne irritants (smoke, pollution, strong odours)
• Respiratory infections (colds, flu, chest infections)
• Physical activity
• Cold air or sudden temperature changes
• Stress and anxiety

Asthma may vary from mild and well controlled to severe, unstable or life-threatening. Some service users may have additional risks due to age, frailty, dementia, learning disability, communication difficulty, respiratory infection, smoking history, allergies, anxiety, reduced mobility or other long-term health conditions. Staff must never assume that wheeze will always be present during an asthma attack. Any sudden or worsening breathlessness, chest tightness, cough, reduced ability to speak, agitation, exhaustion, blue lips, collapse, or failure of the reliever inhaler to work must be treated as urgent.

The service will support service users to maintain asthma control, recognise deterioration early, and access timely medical advice. Where a service user’s asthma appears unstable, staff must inform the nurse in charge or senior staff member, record the concern, and seek advice from the GP, respiratory nurse, pharmacist, NHS 111 Wales or emergency services depending on severity.

5. Identifying and Managing Asthma Triggers

To reduce the likelihood of asthma exacerbations, staff must:

• Identify and document known asthma triggers for each service user.
• Implement environmental control measures, such as reducing dust accumulation and ensuring good ventilation.
• Monitor and record any changes in symptoms to identify new or worsening triggers.
• Educate service users and their families about asthma management and trigger avoidance.

6. Individual Asthma Care Plan and Personal Plan

Every service user with asthma must have their asthma-related needs recorded in their provider assessment, personal plan, risk assessment and medication records. The asthma care information must be person-centred, accessible to staff who need it, and reviewed whenever the person’s needs, symptoms, medication or risks change.

The asthma care plan must include, where applicable:

• The service user’s asthma diagnosis and relevant respiratory history.
• Known triggers, allergies and environmental risks.
• Usual asthma symptoms and early warning signs of deterioration.
• Current prescribed asthma medicines, including inhaler name, colour, dose, frequency, route, spacer use, nebuliser use and whether the medicine is regular, PRN, reliever, preventer, MART or AIR therapy.
• The person’s usual level of asthma control and any known peak flow readings or personalised action thresholds, where provided by a healthcare professional.
• The person’s personalised asthma action plan, where available.
• Whether the service user self-administers, needs prompting, needs assistance, or requires staff administration.
• How inhalers and spacers must be stored so they are secure but immediately accessible in an emergency.
• What staff must do if symptoms worsen, reliever use increases, the inhaler is not effective, or the person has an asthma attack.
• When to contact the GP, respiratory nurse, pharmacist, NHS 111 Wales, emergency services, family/representative and commissioner.
• Communication needs, mental capacity considerations, consent, best-interest decisions and any reasonable adjustments required.
• Post-attack follow-up arrangements.

7. Medication Management

Asthma medicines must be managed in line with the service user’s prescription, personal plan, medication administration record, personalised asthma action plan and healthcare professional advice. Asthma treatment may include:

• Short-acting reliever inhalers, commonly blue inhalers such as salbutamol, used when asthma symptoms occur or during an asthma attack.
• Preventer inhalers, including inhaled corticosteroid-containing inhalers, used regularly to reduce airway inflammation and prevent symptoms or attacks.
• Combination inhalers, including inhalers used as maintenance treatment.
• MART therapy, where a prescribed combination inhaler is used for both maintenance and reliever treatment, according to the prescriber’s instructions.
• AIR therapy, where a prescribed anti-inflammatory reliever inhaler is used according to the prescriber’s instructions.
• Spacer devices, where prescribed or recommended, to improve inhaler delivery.
• Nebulisers, only where prescribed or specifically advised by a healthcare professional.

Staff must not change asthma medicines, doses, frequency or inhaler technique instructions unless this has been authorised by an appropriate healthcare professional and recorded in the medication records and personal plan.

7.1 Administration and Support with Inhalers

• All staff administering or supporting asthma medication must follow the Medication Management and Administration Policy, the service user’s MAR chart, prescription label, personal plan and any personalised asthma action plan.
• Staff must be trained and assessed as competent before administering, prompting or assisting with inhalers, spacers or nebulisers.
• Service users who can self-administer must be supported to do so safely, in line with their risk assessment and personal plan.
• A self-administration risk assessment must consider the person’s capacity, dexterity, cognition, vision, understanding, ability to recognise symptoms, ability to use the inhaler correctly, and ability to request help.
• Reliever inhalers must be stored securely but must remain immediately accessible in an emergency. The storage location must be clearly recorded in the personal plan and communicated to relevant staff.
• Inhalers must not be locked away in a way that delays emergency access.
• Staff must check that inhalers are in date, labelled for the correct person, clean, available, not empty, and stored according to the manufacturer’s instructions.
• Staff must record administration, prompting, assistance, refusal, omission, dropped doses, medication errors or concerns in accordance with the Medication Management and Administration Policy.
• Increased reliever inhaler use, repeated requests for reliever medication, night-time symptoms or reduced response to reliever treatment must be treated as deterioration and escalated to a nurse, senior staff member, GP, respiratory nurse or pharmacist as appropriate.
• Where a service user is prescribed a MART or AIR inhaler, staff must follow the specific prescriber instructions and not automatically apply the blue reliever inhaler procedure unless this is the person’s prescribed emergency plan.

7.2 Use of Spacers and Nebulisers

• Spacers must be used where prescribed, recommended by a healthcare professional, or included in the person’s asthma action plan.
• Staff must know which spacer belongs to which service user. Spacers must not be shared.
• Staff must be trained in the correct spacer technique for the individual, including tidal breathing/multiple-breath technique where this is the person’s recommended method or where the person cannot hold their breath effectively.
• Staff must check that the inhaler and spacer are compatible and that the spacer is clean, intact and available.
• Spacer cleaning, replacement and storage must follow manufacturer’s instructions and infection prevention requirements.
• Nebulisers must only be used where prescribed or specifically directed by a healthcare professional.
• Staff must receive training and competency assessment before supporting nebuliser use.
• Nebuliser masks, mouthpieces, chambers and tubing must not be shared between service users.
• Cleaning, maintenance, filter changes and replacement of nebuliser parts must be recorded and completed according to manufacturer’s instructions and infection prevention guidance.
• Any concern about nebuliser function, contamination, infection risk or treatment effectiveness must be escalated immediately to the nurse in charge, senior staff member, GP, respiratory nurse, pharmacist or emergency services as appropriate.

8. Emergency Response to an Asthma Attack

An asthma attack is a medical emergency. Staff must act promptly and must not leave the service user alone unless this is unavoidable in order to summon emergency help.

A service user may be having an asthma attack if they have any of the following:

• Symptoms are quickly getting worse, including cough, breathlessness, wheeze or chest tightness.
• The reliever inhaler is not helping as much as usual or is needed more often.
• The person is finding it difficult to walk, talk, eat or drink because of breathlessness.
• The person is distressed, frightened, exhausted, drowsy, confused, pale, clammy or has blue lips.
• The person’s peak flow is much lower than usual, where peak flow monitoring is used.
• Staff are worried about the person’s breathing or general condition.

Immediate action – blue reliever inhaler, such as salbutamol

Where the service user’s asthma plan confirms use of a blue reliever inhaler:

1. Help the service user to sit upright and try to keep them calm. Do not ask them to lie down.
2. Help them take one puff of their blue reliever inhaler every 30–60 seconds, preferably through a spacer where available and appropriate, up to a total of 10 puffs.
3. Call 999 immediately if the person feels worse at any point, does not feel better after 10 puffs, does not have their reliever inhaler, staff are worried, or the person has severe symptoms.
4. Tell the 999 call handler that the person is having an asthma attack.
5. If the ambulance has not arrived after 10 minutes and symptoms are not improving, repeat one puff every 30–60 seconds up to another 10 puffs while waiting for the ambulance.
6. If symptoms are still no better after repeating the reliever inhaler and the ambulance has not arrived, contact 999 again immediately.
7. Continue to monitor breathing, responsiveness and colour until emergency help arrives.
8. Be prepared to start basic life support if the person becomes unresponsive and is not breathing normally, in line with staff training.

Immediate action – MART or AIR inhaler

Where the service user’s asthma plan confirms use of a MART or AIR inhaler as reliever treatment:

1. Help the person sit upright and try to keep them calm.
2. Follow the person’s prescribed asthma action plan.
3. If the plan states MART or AIR reliever use, help the person take one puff every 1–3 minutes up to the maximum number of puffs stated in the plan or prescription.
4. Call 999 if the person feels worse at any point, does not improve after the maximum reliever doses in their plan, does not have their inhaler, staff are worried, or the person has severe symptoms.
5. If the ambulance has not arrived after 10 minutes and symptoms are not improving, repeat the action plan instructions if advised within the plan or by the 999 call handler.

Staff must call 999 immediately without delay if:

• The person has no reliever inhaler available.
• The reliever inhaler is not helping.
• The person is too breathless to speak, eat or drink.
• The person is becoming exhausted, drowsy, confused or less responsive.
• The person’s lips or face appear blue or grey.
• The person collapses or becomes unconscious.
• Staff are concerned at any point.

9. After an Asthma Attack

After any asthma attack, staff must:

• Continue to monitor the service user until they are stable and appropriate medical advice has been obtained.
• Record the symptoms, suspected trigger, time of onset, inhaler doses given, spacer use, observations, persons contacted, advice received, 999/111 contact, ambulance attendance, hospital transfer and outcome.
• Inform the nurse in charge, senior staff member and Registered Manager.
• Inform the GP or respiratory nurse as soon as possible.
• Inform the family/representative where appropriate and in accordance with consent, best interests and confidentiality requirements.
• Update the personal plan, asthma care plan, risk assessment and medication records.
• Review whether the person’s asthma control, inhaler technique, triggers, medicines, self-administration arrangements or environmental controls need reassessment.
• Complete an incident form and consider whether the incident requires safeguarding, commissioner notification, CIW notification or duty of candour action.

10. Staff Training and Competency

All staff who support service users with asthma must receive training appropriate to their role. Staff must not administer, prompt or assist with asthma medicines unless they have been trained and assessed as competent in line with the Medication Management and Administration Policy.

Training must include:

• Understanding asthma and common symptoms.
• Recognising early deterioration and signs of an asthma attack.
• Understanding individual asthma care plans and personalised asthma action plans.
• Correct use of inhalers, spacers and nebulisers relevant to service users in the home.
• Safe storage, access, recording and administration of asthma medicines.
• Supporting self-administration and recognising when self-administration arrangements need review.
• Emergency response, including blue reliever inhaler procedure, MART/AIR plans where applicable, when to call 999, and what to record.
• Infection prevention and cleaning requirements for spacers and nebulisers.
• Mental capacity, consent, best interests and reasonable adjustments where relevant.
• Duty of candour, incident reporting, safeguarding escalation and CIW notification awareness.

Training must be refreshed at least annually, or sooner where guidance changes, a staff member’s competency is questioned, a service user’s needs change, a new device is introduced, or an asthma-related incident identifies a learning need. Competency checks must be recorded.

11. Communication and Record-Keeping

{{org_field_name}} will maintain accurate, up-to-date and secure records relating to asthma care. Records must be clear enough to show what care was planned, what care was delivered, what changes occurred, what action was taken and whether escalation was appropriate.

The following must be recorded where applicable:

• Asthma diagnosis and relevant respiratory history.
• Asthma care plan and personalised asthma action plan.
• Triggers, allergies and environmental controls.
• Inhaler, spacer and nebuliser arrangements.
• Medication administration, prompting, assistance, refusal, omission, error or concern.
• Self-administration assessment and review.
• Changes in symptoms, increased reliever use or deterioration.
• Contact with GP, respiratory nurse, pharmacist, NHS 111 Wales, 999, ambulance service, hospital, commissioner, family or representative.
• Asthma attacks, emergency treatment given, outcome and follow-up.
• Staff training and competency.
• Audits, incidents, lessons learned and actions taken.

Any asthma-related change must be communicated promptly to staff who support the person. Where the change is significant, the personal plan, risk assessment and medication records must be updated. Where the person’s needs can no longer be met safely, the Registered Manager must escalate this to the relevant healthcare professional, commissioner, family/representative and service provider as required.

12. Infection Control and Hygiene Measures

• Inhalers, spacers, nebuliser masks, mouthpieces, chambers and tubing must not be shared between service users.
• Staff must follow hand hygiene and PPE requirements before and after assisting with inhalers, spacers or nebulisers.
• Spacers and nebuliser parts must be cleaned, dried, stored and replaced according to manufacturer’s instructions and infection prevention guidance.
• Cleaning and maintenance of nebuliser equipment must be recorded.
• Equipment must be checked for visible contamination, damage, expiry or malfunction before use.
• Any suspected respiratory infection, increased sputum, fever, worsening cough, wheeze or breathlessness must be reported to the nurse in charge or senior staff member and escalated to a healthcare professional where required.
• Clinical waste must be disposed of safely in line with the Infection Prevention and Control Policy and local arrangements.

13. Mental Capacity, Consent and Best Interests

Service users must be supported to make their own decisions about asthma care wherever they have capacity to do so. This includes decisions about self-administration, accepting inhaler support, using a spacer, seeking medical help and involving family or representatives.

Where there is reason to believe a service user may lack capacity for a specific asthma-related decision, staff must follow the Mental Capacity Act 2005 and the organisation’s Mental Capacity and Deprivation of Liberty Safeguards Policy. Any best-interest decision must be decision-specific, proportionate, recorded, and involve relevant persons where appropriate.

Where a service user refuses asthma medication, inhaler support or emergency care, staff must assess the urgency of the situation, seek senior advice, consider capacity, record the refusal, and escalate to healthcare professionals or emergency services where there is risk of serious harm.

14. CIW Notification, Safeguarding and Duty of Candour

The Registered Manager and Responsible Individual must consider whether an asthma-related event requires notification to CIW, the commissioner, safeguarding team or other relevant body. This includes, but is not limited to, serious injury, death, hospital admission, significant medication error, avoidable delay in emergency response, equipment failure, safeguarding concern, or any event that affects the safety and well-being of a service user.

CIW notifications must be completed through CIW Online where required and without delay. CIW states that registered services must notify CIW of relevant changes or incidents at the service, and failure to do so may mean the service is operating illegally.

Where an asthma-related incident causes harm, has the potential to cause harm, or indicates that something has gone wrong in care or treatment, {{org_field_name}} will act openly and transparently in line with the duty of candour. This includes explaining what happened, offering an apology where appropriate, informing the service user and/or representative, recording the discussion, investigating the incident, sharing outcomes where appropriate, and taking action to reduce the risk of recurrence.

15. Compliance and Monitoring

The Registered Manager is responsible for ensuring this policy is implemented effectively. The Responsible Individual is responsible for maintaining effective oversight of the service, including assurance that asthma care is safe, person-centred and compliant with legal and regulatory requirements.

Monitoring arrangements will include:

• Audit of asthma care plans and personal plans for service users with asthma.
• Audit of inhaler, spacer and nebuliser records, including availability, expiry dates, storage and cleaning records.
• Medication audits, including PRN use, omissions, refusals, errors and increased reliever use.
• Review of asthma-related incidents, ambulance call-outs, hospital admissions and near misses.
• Review of staff asthma training and competency records.
• Review of whether post-attack follow-up was completed.
• Review of CIW notifications, safeguarding referrals, duty of candour actions and commissioner notifications where applicable.
• Environmental checks where triggers such as dust, smoke, odours, damp, mould, poor ventilation, extreme temperatures or allergens may affect service users.
• Evidence that learning from asthma-related incidents is shared with staff and used to improve practice.

The outcome of audits and incident reviews must be reported through the service’s governance and quality assurance systems. Actions must be recorded, allocated to a responsible person, given a timescale, and followed up until complete.

16. Related Policies

This policy should be read alongside:

• CHW11 – Safe Care and Treatment Policy
• CHW16 – Health and Safety at Work Policy
• CHW17 – Infection Prevention and Control Policy
• CHW21 – Medication Management and Administration Policy
• CHW36 – Initial Assessment and Care Planning Policy
• Safeguarding Adults and Children Policy
• Incident Reporting and Management Policy
• Duty of Candour Policy
• Mental Capacity and Deprivation of Liberty Safeguards Policy
• Records Management and Confidentiality Policy
• Staff Training, Supervision and Competency Policy
• Self-Administration of Medication Policy, if separate from the Medication Management and Administration Policy
• Emergency First Aid and Basic Life Support Policy
• Notification to CIW and External Agencies Policy
• Risk Assessment and Positive Risk-Taking Policy

17. Policy Review

This policy will be reviewed at least annually, or sooner where there are changes to legislation, Welsh Government statutory guidance, CIW requirements, NICE/BTS/SIGN asthma guidance, medication safety guidance, infection prevention guidance, the organisation’s statement of purpose, or following any asthma-related incident, complaint, safeguarding concern, audit finding or identified learning need.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
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