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Asthma Management Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides safe, effective, and person-centred care to people we support who have asthma. Asthma is a long-term respiratory condition that can cause severe breathing difficulties if not managed properly. This policy outlines the procedures for managing asthma symptoms, preventing exacerbations, and responding to emergencies. It ensures that all staff members are well-equipped to support individuals with asthma, reducing the risk of severe attacks and hospitalisations while promoting overall well-being and independence.

2. Scope

This policy applies to all staff within {{org_field_name}}, including carers, support workers, registered nurses, and management. It is relevant to all individuals who use our services and have a diagnosed asthma condition or who are at risk of developing respiratory issues. The policy covers daily asthma management, medication administration, environmental considerations, training requirements, and emergency response procedures. Additionally, it ensures compliance with Scottish health and social care regulations and best practices.

3. Related Policies

To ensure a holistic approach to asthma management, this policy should be read in conjunction with the following:

• Medication Management Policy – for procedures on medication administration and storage.
• Infection Prevention and Control Policy – to reduce environmental triggers related to infection and hygiene.
• Risk Assessment and Management Policy – for assessing environmental and personal risks associated with asthma.
• Emergency Response Policy – for guidelines on responding to severe asthma attacks.
• Personal Planning Policy – ensuring asthma care is tailored to individual needs and documented properly.

• Adult Support and Protection Policy – for responding to concerns where asthma care, medication support, neglect, self-neglect, missed visits, failure to seek medical advice, or unsafe practice may place a person at risk of harm.
• Record-Keeping and Confidentiality Policy – for maintaining accurate asthma care records, medication records, incident records, communication records and personal health information.
• Accident, Incident and Near Miss Reporting Policy – for recording asthma attacks, medication errors, delayed responses, emergency service involvement and lessons learned.
• Care Inspectorate Notification Policy – for ensuring notifiable events are reported to the Care Inspectorate within required timescales.
• Consent, Capacity and Supported Decision-Making Policy – for supporting people to make informed choices about asthma care, medication, emergency treatment and information sharing.
• Staff Training and Supervision Policy – for ensuring staff only carry out asthma-related support tasks where they are trained, competent and authorised to do so.
• Smoking, Vaping and Environmental Risk Policy, where held – for managing risks linked to smoke, vaping, aerosols, poor ventilation, damp, mould, pets, dust, pollen and other asthma triggers.

• Missed and Late Visits Policy – for responding where a missed or late visit could result in missed asthma medication, failure to observe deterioration, delayed emergency response, or increased risk of harm.
• Duty of Candour Policy – for responding openly and honestly where an asthma-related incident has caused or may have caused harm.
• Complaints Policy – for ensuring people supported, families, carers and representatives know how to raise concerns about asthma care, medication support, staff practice or emergency response.
• Health and Safety/Lone Working Policy – for managing risks to staff when supporting people in homes where smoke, poor ventilation, pets, damp, mould, aerosols, oxygen use or environmental hazards may affect asthma care or staff safety.

4. Legal and Regulatory Framework

This policy is written for Care at Home services in Scotland and must be read alongside current legislation, regulatory requirements, professional codes and clinical guidance. The service will comply with the following:

• The Public Services Reform (Scotland) Act 2010, which provides the statutory basis for the regulation and inspection of care services by the Care Inspectorate.
• The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, including:
  • Regulation 3 – Principles, requiring the service to be provided in a way that promotes welfare, safety, dignity, independence, choice, privacy and respect.
  • Regulation 4 – Welfare of users, requiring providers to make proper provision for the health, welfare and safety of people using the service.
  • Regulation 5 – Personal plans, requiring a written personal plan to be prepared, implemented, reviewed and updated.
• The Social Care and Social Work Improvement Scotland (Applications and Registration) Regulations 2011, where applicable to registration, records and regulated service information.
• The Health and Social Care Standards: My support, my life, which set out what people should experience when using health, social care and social work services in Scotland.
• Care Inspectorate quality frameworks and adult services guidance, including current guidance on personal planning, records that must be kept, and notifications that must be made.
• The SSSC Codes of Practice for Social Service Workers and Employers 2024, which set out the standards of conduct, practice, employer responsibility, learning, supervision and safe care expected in Scottish social services. The 2024 Codes replaced previous versions from 1 May 2024.
• Adults with Incapacity (Scotland) Act 2000, where a person may lack capacity to make some decisions about asthma management, medication, emergency treatment or information sharing.
• Adult Support and Protection (Scotland) Act 2007, where asthma management concerns, missed medication, neglect, self-neglect, unsafe practice or failure to seek medical help may indicate an adult protection concern.
• Equality Act 2010, ensuring reasonable adjustments are made for disabled people and that people are not discriminated against because of protected characteristics.
• Human Rights Act 1998, including respect for private and family life, dignity, autonomy, bodily integrity and the right to make informed choices.
• UK GDPR and the Data Protection Act 2018, ensuring personal and health information is recorded, shared, stored and retained lawfully, fairly and securely.
• Health and Safety at Work etc. Act 1974 and associated health and safety duties, including safe working arrangements for staff supporting people in their own homes.
• BTS/NICE/SIGN Asthma: diagnosis, monitoring and chronic asthma management guideline NG245, and the related asthma pathway, which provide current UK-wide guidance on asthma diagnosis, monitoring, treatment and self-management.

Where legislation, Care Inspectorate guidance or clinical guidance changes, this policy will be reviewed and updated without waiting for the annual review date.

5. Understanding Asthma

Asthma is a chronic condition affecting the airways, causing inflammation and narrowing, leading to symptoms such as wheezing, breathlessness, coughing, and chest tightness. The severity of symptoms can vary from mild to life-threatening. It is essential to understand the following aspects of asthma:

• Triggers: Common triggers include dust, pollen, smoke, stress, cold air, respiratory infections, and physical exertion.
• Types of medication: Asthma treatment may include reliever inhalers, preventer inhalers, combination inhalers, AIR or MART inhalers, tablets, nebulised medication or other prescribed treatments. Staff must follow the person’s prescription, medication administration record, pharmacy label and personal asthma action plan. Staff must not assume that all people with asthma use a blue reliever inhaler, as some people may have a different prescribed emergency inhaler regime.
• Personalised Management: Each person experiences asthma differently, so care plans should be tailored to individual needs, focusing on symptom control and lifestyle adjustments.

6. Personal Planning and Risk Assessment

Each person supported who has asthma, suspected asthma, a history of asthma attacks, prescribed asthma medication, or respiratory symptoms requiring support must have asthma management information included in their personal plan. This must be developed with the person, and where appropriate their representative, family, carers, GP, pharmacist, asthma nurse or other relevant healthcare professional. The plan must be in place within 28 days of the person starting to use the service, reviewed at least every six months, and reviewed sooner where there is any change in asthma symptoms, medication, inhaler technique, triggers, hospital attendance, emergency service involvement, capacity, consent, or level of staff support required.

This should be developed in collaboration with healthcare professionals and should include:

• A comprehensive list of known asthma triggers.
• Daily self-management strategies, including peak flow monitoring if applicable.
• A medication schedule outlining dosage and frequency.
• Recognition of early warning signs and steps to take when symptoms worsen.
• Emergency contact details and an action plan for severe attacks.

The asthma section of the personal plan must also record:

• the person’s diagnosis, usual symptoms and how they describe breathlessness or distress;
• the person’s usual baseline, including peak flow readings where these are used;
• prescribed asthma medication, inhaler colour/name, dose, frequency, route and whether the inhaler is a reliever, preventer, AIR, MART or other prescribed treatment;
• whether a spacer is prescribed or recommended and where it is kept;
• what the person can do independently and what support staff must provide;
• the person’s consent and preferences about family, representative or carer contact;
• specific actions staff must take if symptoms worsen;
• when to contact the GP, NHS 24, the community pharmacy, the asthma nurse, 999 or other healthcare professional;
• how staff will support the person’s choice, independence and positive risk-taking while reducing foreseeable harm;
• any reasonable adjustments needed because of disability, communication needs, sensory needs, language, cognition, trauma, anxiety or capacity;
• the date of the last asthma review and the date the plan is next due to be reviewed.

A thorough risk assessment should be conducted to identify and mitigate environmental factors that could exacerbate asthma symptoms, such as household allergens, pet dander, or exposure to tobacco smoke. Regular reviews should be carried out to ensure the plan remains up to date.

Where a person declines aspects of asthma care, medication support, environmental advice or medical review, staff must respect the person’s rights and choices where they have capacity to make the decision. Staff must record the discussion, the information provided, the risks explained, the person’s decision, and any agreed risk-reduction measures. Where there is doubt about capacity, or where refusal may place the person at serious risk of harm, staff must escalate this to the manager and follow the Consent, Capacity and Supported Decision-Making Policy, Adults with Incapacity procedure and Adult Support and Protection Policy as appropriate.

7. Medication Management

Effective asthma management relies on the correct use of prescribed medications. Staff should be trained to:

• Understand the difference between reliever and preventer inhalers.
• Assist individuals with inhaler techniques, ensuring maximum efficacy.
• Recognise when a person requires medication based on their symptoms.
• Record medication use accurately in line with the Medication Management Policy.

• Record all asthma medication support on the medication administration record or agreed medication record, including administered doses, prompted doses, refused doses, omitted doses, PRN use, emergency inhaler use, and any concerns about availability, expiry date, storage, device function or inhaler technique.
• Where inhalers are prescribed for “as required” use, the person must have a clear PRN protocol or asthma action plan that explains when the inhaler should be used, how many doses may be taken, when to seek medical advice, and when to call 999.
• Staff must check, during visits where asthma support is part of the agreed care, that prescribed inhalers and spacers are available, clean, in date, labelled for the person and accessible in an emergency.
• Staff must not administer or prompt asthma medication unless this is included in the person’s personal plan and medication support arrangements and the staff member has been trained, assessed as competent and authorised to do so.

• Ensure medications are stored safely and easily accessible in emergencies.
• Monitor for side effects and report any adverse reactions to healthcare professionals.

Any suspected adverse reaction, medication error, missed asthma medication, unavailable inhaler, expired inhaler, incorrect inhaler technique, overuse of reliever medication, or repeated use of emergency asthma medication must be reported to the manager and recorded. The manager must decide whether medical advice, family/representative contact, adult protection action, duty of candour action, Care Inspectorate notification, commissioner notification or medication incident review is required.

8. Identifying and Managing Triggers

Minimising exposure to asthma triggers is key to preventing attacks. Staff should actively work with individuals to identify and manage common triggers by:

• Smoking and vaping: Staff must encourage a smoke-free and vape-free environment where this is part of the person’s agreed risk management plan. As people are supported in their own homes, staff must balance the person’s rights and choices with asthma risk, other household members’ safety and staff health and safety. Where smoke or vaping creates a risk to the person or staff, this must be recorded, risk assessed and escalated to the manager.

• Maintaining good indoor air quality – through ventilation, air purifiers, and regular cleaning.
• Reducing exposure to allergens – such as dust mites, pet dander, mould, and pollen.
• Where damp, mould, poor ventilation, pests, unsafe heating, air pollution, strong chemicals or household conditions appear to be worsening asthma symptoms, staff must record the concern and escalate it to the manager. With the person’s consent, the service should consider whether to contact the relevant housing provider, landlord, environmental health service, GP, community respiratory team, family, representative or commissioner.
• Avoiding strong fragrances and aerosols – which can irritate airways.
• Monitoring weather conditions – cold air and humidity changes can affect asthma, so precautions should be taken when going outdoors.

If an individual experiences worsening asthma symptoms due to environmental factors, staff must document the incident and take appropriate action to prevent future occurrences.

9. Emergency Response

Asthma attacks can escalate quickly and require immediate action. Staff must be able to identify the signs of an asthma attack and respond accordingly.

Symptoms of an asthma attack may include:

• wheezing, coughing, chest tightness or breathlessness that is worse than usual;
• the person needing their reliever inhaler more than usual;
• difficulty speaking, walking or completing usual activities because of breathlessness;
• rapid breathing, shallow breathing, exhaustion, agitation, fear or confusion;
• peak flow below the person’s agreed action level, where peak flow monitoring is used;
• symptoms not improving after reliever medication;
• blue, grey or pale lips, face or fingernails;
• drowsiness, collapse or reduced responsiveness.

Staff must remember that not every person wheezes during a severe asthma attack. Any sudden or severe breathing difficulty must be treated as urgent.

Steps to take during a suspected asthma attack

1. Stay with the person, reassure them and act immediately. Help the person to sit upright. Do not ask them to lie down.
2. Follow the person’s personal asthma action plan, where this is available and safe to do so.
3. Use the person’s prescribed reliever or emergency inhaler as directed.
   • If the person has a blue reliever inhaler, support them to take 1 puff every 30–60 seconds, up to 10 puffs, using a spacer where available.
   • If the person has an AIR or MART inhaler, support them to follow their personal asthma action plan. Where no different personal instruction is available, current NHS advice is 1 puff every 1–3 minutes, up to 6 puffs.
4. Call 999 immediately if:
   • the person feels worse at any point;
   • the person does not improve after the maximum dose in their asthma action plan;
   • the person does not have their reliever/emergency inhaler available;
   • the person is too breathless to speak, is becoming exhausted, drowsy, confused, blue, grey, pale, collapsed or unresponsive;
   • staff are worried about the person’s breathing or safety.
5. If symptoms are no better after 10 minutes and the ambulance has not arrived, repeat the inhaler treatment in line with the person’s asthma action plan or current emergency asthma advice. Contact 999 again immediately if the person remains no better or deteriorates.
6. Continue to monitor and reassure the person until emergency services arrive. Follow the instructions given by the 999 call handler.
7. After the incident, record the event, medication used, response, actions taken, professionals contacted, family/representative contact, outcome, and any follow-up action required.

Where a person has required 999, emergency inhaler treatment beyond usual day-to-day use, NHS 24 advice, GP urgent review, hospital attendance or admission due to asthma symptoms, the manager must review the person’s personal plan, risk assessment and medication support arrangements before the next planned review date. The manager must also consider whether the incident is notifiable to the Care Inspectorate and whether any other reporting is required.

10. Escalation, Notifications and Duty of Candour

Asthma-related concerns must be escalated promptly where there is actual or potential harm. Staff must inform the manager as soon as possible where:

• the person has an asthma attack;
• emergency services, NHS 24, GP urgent review or hospital care is required;
• asthma medication is missed, refused, unavailable, expired, incorrectly administered or used more frequently than expected;
• staff are concerned that the person’s asthma is deteriorating;
• environmental risks are contributing to worsening symptoms;
• there are concerns about neglect, self-neglect, missed visits, poor medication support or failure to seek medical advice;
• there has been any incident, error or omission that has caused or may have caused harm.

The manager must review the incident and decide whether action is required under the Medication Management Policy, Accident, Incident and Near Miss Reporting Policy, Adult Support and Protection Policy, Duty of Candour Policy, Complaints Policy, Care Inspectorate Notification Policy or commissioner reporting arrangements.

Where an asthma-related event is notifiable to the Care Inspectorate, the notification must be submitted within the required timescale and a record must be retained. The person, and where appropriate their representative or family, must be informed in an open, honest and compassionate way.

11. Training and Staff Responsibilities

To ensure the highest standard of care, all staff must undergo regular asthma management training, covering:

• How to recognise asthma symptoms and differentiate between mild and severe attacks.
• Safe administration of inhalers and the importance of correct inhaler technique.
• Emergency response procedures and how to provide immediate first aid.
• How to identify and manage environmental triggers.
• Understanding personalised asthma management plans and risk assessments.

Training must be completed during induction where staff may support people with asthma and refreshed at least annually, or sooner where guidance changes, a person’s needs change, a medication error occurs, an incident identifies a learning need, or the manager identifies a competence concern. Staff must not support asthma medication, inhaler use, peak flow monitoring or emergency asthma procedures unless they have received appropriate training, have had their competence assessed, and are authorised to carry out the task.

Training and competency records must evidence that staff understand:

• asthma symptoms, triggers and early warning signs;
• the difference between preventer, reliever, AIR, MART and other prescribed asthma treatments;
• safe prompting, assistance and administration of inhalers, including use of spacers where applicable;
• how to follow a person’s asthma action plan and personal plan;
• how to recognise deterioration and when to call 999;
• how to record PRN and emergency medication use;
• how to escalate medication concerns, missed visits, environmental risks and deterioration;
• consent, capacity, confidentiality and information sharing;
• Care Inspectorate notification and internal reporting routes;
• their own limits of competence and when to seek advice.

12. Communication and Collaboration

Effective asthma care requires coordination between individuals, families, carers, and healthcare professionals. Staff should:

• Maintain clear communication channels with GPs, pharmacists, and asthma specialists.
• Educate individuals and their families on self-management techniques and symptom monitoring.
• Regularly review personal asthma plans to ensure they remain effective and reflect current health conditions.
• Encourage shared decision-making, ensuring individuals have a voice in their care.
• Communication must be accessible and suited to the person’s needs. Staff must use the person’s preferred communication method and provide support where the person has sensory needs, cognitive impairment, mental health needs, anxiety, trauma-related needs, language needs or reduced capacity. Where appropriate, the service must involve representatives, independent advocates, families or carers, while respecting consent, confidentiality and legal authority.

13. Documentation and Record-Keeping

Accurate and detailed record-keeping is essential for tracking asthma symptoms and medication use.

Staff must document, where relevant:

• date, time and duration of the visit or contact;
• asthma symptoms observed or reported;
• possible triggers or environmental concerns;
• medication prompted, assisted or administered, including dose, time, route and inhaler/device used;
• PRN or emergency inhaler use and the reason it was required;
• whether a spacer was used, where applicable;
• the person’s response to medication and support;
• peak flow readings, where these are part of the person’s plan;
• advice sought from GP, pharmacist, NHS 24, asthma nurse, emergency services or other professionals;
• contact with family, representative, commissioner or other relevant people;
• refusals of medication, declined support or difficulty accessing medication;
• any medication error, missed medication, missed visit, late visit, incident, near miss or deterioration;
• whether Care Inspectorate notification, adult protection referral, duty of candour action or complaint action was considered or completed;
• updates required to the personal plan, risk assessment or asthma action plan.

Records must be clear, accurate, factual, dated, timed and signed or electronically attributable to the staff member making the record. Records must be completed as soon as possible after the event and must be stored securely in line with UK GDPR, the Data Protection Act 2018 and the Record-Keeping and Confidentiality Policy. Where electronic care planning or medication systems are used, staff must follow system procedures and report any access or recording issue immediately.

14. Quality Assurance and Audit

The manager must monitor asthma-related care as part of the service’s quality assurance and self-evaluation arrangements. This will include, where applicable:

• review of asthma-related personal plans and risk assessments;
• checks that asthma plans are person-centred, current, accessible and reviewed at least six-monthly;
• audit of medication records, PRN records and emergency inhaler use;
• review of incidents, near misses, hospital admissions, emergency service involvement and complaints;
• checks that staff training and competency records are current;
• review of environmental risk actions, including smoke, vaping, damp, mould, ventilation and allergens;
• evidence that learning from incidents is shared with staff and used to improve practice;
• feedback from people supported, families, carers, representatives and staff.

Where improvement is required, the manager must record the action to be taken, who is responsible, the timescale for completion, and how the service will check that the improvement has been effective.

15. Policy Review

This policy will be reviewed at least annually and sooner if there are changes in legislation, Care Inspectorate guidance, Health and Social Care Standards, SSSC Codes of Practice, asthma clinical guidance, medication safety guidance, organisational practice, or the needs of people supported by the service.

The policy must also be reviewed following any serious asthma-related incident, repeated medication errors, emergency service involvement, hospital admission, Care Inspectorate requirement or recommendation, complaint, adult protection concern, duty of candour event, or audit finding that indicates the policy is not effective.

The registered manager is responsible for ensuring that the policy remains current, that staff are informed of changes, and that training, competency and practice are updated where required.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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