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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 support to people with asthma who receive supported living services. This policy supports compliance with the Health and Social Care Act 2008, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, CQC Fundamental Standards, the Mental Capacity Act 2005, the Equality Act 2010, the Care Act 2014 safeguarding duties, the Human Medicines Regulations 2012, UK GDPR and the Data Protection Act 2018. It also reflects current CQC guidance, NICE/BTS/SIGN asthma guidance and recognised best practice for asthma self-management, medicines support, emergency response, record keeping and learning from incidents.

2. Scope

This policy applies to all staff, including permanent, temporary, agency workers, and volunteers, involved in the care and support of individuals with asthma. It covers asthma identification, medication management, emergency response, training, and monitoring procedures to minimise risks and promote well-being.

This policy applies only to asthma support that falls within the service’s role and assessed responsibility in supported living. It does not replace clinical assessment, diagnosis, prescribing or treatment by a GP, asthma nurse, pharmacist, respiratory specialist or emergency services. Staff must follow the person’s care plan, medicines support plan, risk assessment, Personalised Asthma Action Plan and any current instructions from prescribers or emergency services.

3. Related Policies

• Safe Care and Treatment Policy (SL11)
• Medication Management and Administration Policy (SL21)
• Risk Management and Assessment Policy (SL18)
• Health and Safety at Work Policy (SL16)
• Emergency and Business Continuity Plan (SL19)
• Safeguarding Adults from Abuse and Improper Treatment Policy (SL13)
• Mental Capacity Act and Deprivation of Liberty Safeguards Policy
• Consent to Care and Treatment Policy
• Equality, Diversity and Human Rights Policy
• Accessible Information and Communication Policy
• Duty of Candour Policy
• Incident Reporting and Investigation Policy (SL24)
• Infection Prevention and Control Policy
• Confidentiality, Data Protection and Record Keeping Policy
• Staff Training and Competency Policy
• Hospital Admission, Discharge and Health Appointments Policy

4. Policy Statement

{{org_field_name}} is committed to supporting people with asthma in a way that is safe, person-centred, dignified, rights-based and proportionate to assessed need. The service will ensure that asthma-related support is planned with the person, and where appropriate their family, advocate, representatives and relevant health professionals. Staff must know how to recognise signs of worsening asthma, how to support the person to follow their Personalised Asthma Action Plan, how to access prescribed reliever medication promptly, and when to call 999.

Asthma support must promote independence and self-management wherever possible. Where a person needs support with medicines, monitoring, appointments, inhaler technique prompts, trigger reduction or emergency response, this must be clearly assessed, recorded and reviewed. Staff must not diagnose asthma, alter prescribed treatment, advise a person to stop or change medication, or use another person’s medicine.

5. Understanding Asthma

Asthma is a long-term respiratory condition where the airways become inflamed and narrowed, causing variable breathing symptoms. Symptoms and triggers differ between people and may change over time. Common symptoms include:

• Wheezing
• coughing, especially at night or early morning
• chest tightness
• shortness of breath
• reduced ability to speak, move around or carry out usual activities during worsening symptoms

Common triggers may include viral infections, allergens, pollen, mould, dust, pets, smoke, air pollution, cold air, exercise, stress, occupational exposures, certain medicines, and changes in weather. Each person’s known triggers, early warning signs, prescribed treatment and emergency actions must be recorded in their care plan and Personalised Asthma Action Plan.

6. Asthma Management Procedures

6.1 Identifying Individuals with Asthma

• During pre-admission, initial assessment and ongoing review, staff must identify whether the person has asthma, suspected asthma, a history of asthma attacks, hospital admissions, allergies, smoking exposure, respiratory infections, known triggers or prescribed inhalers/nebulisers/oral steroids.
• The person’s care plan must record their diagnosis, usual symptoms, early warning signs, triggers, prescribed asthma medicines, level of medicines support required, communication needs, capacity and consent arrangements, and emergency response instructions.
• Each person with asthma must be encouraged and supported to obtain and maintain an up-to-date Personalised Asthma Action Plan from their GP, asthma nurse or respiratory professional. Where the person does not have a current plan, staff must escalate this to the Registered Manager so that support can be offered to contact the relevant health professional.
• Asthma risk assessments must consider the likelihood and impact of an asthma attack, access to prescribed reliever medication, inhaler technique, dose counters or remaining doses, expiry dates, spacer use, environmental triggers, smoking exposure, allergies, night-time symptoms, recent increase in reliever use, recent emergency treatment, and whether staff know what to do in an emergency.
• Risk assessments and care plans must be reviewed at least annually, after any asthma attack, after any hospital attendance, following medication changes, where reliever use increases, where staff identify concerns, or where the person’s needs, capacity, communication or environment changes.

6.2 Medication Management

• All asthma medicines, including reliever inhalers, preventer inhalers, MART/AIR inhalers, oral steroids, nebuliser solutions and spacers, must be prescribed, supplied, stored, administered or supported in line with the person’s prescription, medicines support plan, Personalised Asthma Action Plan and the Medication Management and Administration Policy (SL21).
• Staff must not use another person’s inhaler or any non-prescribed medicine. The person’s own prescribed reliever or MART/AIR inhaler must be available and accessible to them according to their care plan, including when they are away from home, attending activities, appointments or community settings.
• Where {{org_field_name}} supports a person with medicines, staff must maintain accurate MAR or medicines support records, including prompts, administration, refusal, missed doses, PRN use, rescue medication use and any concerns. Records must be completed as soon as possible after the support is provided.
• Where the person self-administers asthma medicines, this must be assessed and recorded. The assessment must consider whether they can identify the correct inhaler, use it correctly, monitor remaining doses, recognise expiry dates, store it safely, carry it when needed, understand when to seek help, and communicate if symptoms worsen.
• Staff must check, where this forms part of the assessed support plan, that prescribed reliever inhalers are in date, available, not empty, clean, and stored according to the manufacturer’s instructions. Where inhalers have dose counters, staff must support the person to monitor them if this is part of the care plan. Where inhalers do not have dose counters, staff must support the person to keep a suitable record of use where this is part of the care plan.
• Increased use of a blue reliever inhaler may indicate worsening asthma and must be escalated. Staff must support the person to seek a GP, asthma nurse, pharmacist or NHS 111 review if the person’s reliever inhaler use increases, if symptoms are waking them at night, if symptoms interfere with usual activities, or if the person’s Personalised Asthma Action Plan says review is required.
• Staff must not make clinical decisions to increase, reduce, stop or change asthma treatment. Any concerns about side effects, overuse, underuse, poor inhaler technique, missed preventer medication, repeated attacks or deteriorating symptoms must be escalated to the Registered Manager and relevant health professional.
• Medicines must normally be stored in the person’s own home in a way that meets their needs, preferences, risk assessment and the manufacturer’s requirements. Medicines must not be stored centrally unless this is clearly justified, risk assessed and lawful.

6.3 Consent, Capacity and Refusal

• Asthma-related care and medicines support must only be provided with the person’s consent, unless the person lacks capacity for the specific decision and action is taken lawfully in accordance with the Mental Capacity Act 2005 and the organisation’s MCA policy.
• Staff must provide information in a way the person can understand, including accessible formats, communication aids, interpreters, advocates or family involvement where appropriate and lawful.
• A person with capacity has the right to refuse asthma medicines, support, appointments or emergency advice, even where staff believe the decision may place them at risk. Staff must record the refusal, explain the risks in a way the person can understand, encourage the person to seek medical advice, and escalate concerns to the Registered Manager.
• Where a person appears to lack capacity to make a specific asthma-related decision, staff must follow the Mental Capacity Act 2005, complete or request a decision-specific capacity assessment, and act in the person’s best interests using the least restrictive option.
• In a life-threatening emergency, staff must call 999 and provide immediate support in line with the person’s care plan, known wishes, best interests and emergency services instructions.

6.4 Staff Training and Competency

Staff who support a person with asthma must receive asthma awareness training appropriate to their role and the person’s assessed needs. Training must include:

• what asthma is and how it may affect the person
• common triggers and prevention measures
• recognising worsening asthma and asthma attacks
• the person’s Personalised Asthma Action Plan and care plan
• how to prompt or support correct inhaler and spacer use, where this is part of the care plan
• the difference between reliever, preventer, MART and AIR inhalers, where relevant to people supported
• safe medicines support, MAR records and PRN recording
• when and how to call 999, NHS 111, GP, asthma nurse or pharmacist
• consent, capacity, refusal and escalation
• incident reporting, safeguarding, Duty of Candour and CQC notification requirements

Staff must not provide asthma medicines support until they have completed relevant medicines training and have been assessed as competent, unless they are acting in a life-threatening emergency under emergency services instructions.

Competency must be assessed at induction, when a person’s asthma support needs change, following medication or device changes, after any asthma-related incident or medicines error, and at regular intervals set by the Registered Manager.

Training and competency records must be maintained and audited. Any staff member who is not competent must receive supervision, retraining and restricted duties where necessary to protect people from risk.

6.5 Recognising and Responding to Worsening Asthma or an Asthma Attack

An asthma attack is a medical emergency. Staff must follow the person’s Personalised Asthma Action Plan where available. Where the person’s plan gives different emergency instructions from the general guidance below, staff must follow the person’s plan unless emergency services advise otherwise.

Staff must treat the situation as urgent if the person:

• is very breathless, wheezy, coughing persistently or has chest tightness
• cannot speak in full sentences
• is becoming exhausted, distressed, confused, drowsy, pale, grey or blue around the lips
• has symptoms that are not improving after reliever medication
• does not have their prescribed reliever/MART/AIR inhaler available
• has a peak flow reading in the red zone, if peak flow monitoring is part of their plan
• asks for emergency help or staff are worried at any time

Emergency response:

1. Stay calm, stay with the person and call for assistance from another staff member if available.
2. Help the person sit upright. Do not make them lie down. Loosen tight clothing if this helps and the person consents.
3. Support the person to use their prescribed reliever inhaler, MART inhaler or AIR inhaler as stated in their Personalised Asthma Action Plan.
4. If the person uses a blue reliever inhaler and there is no different instruction in their plan, support them to take 1 puff every 30 to 60 seconds, up to a maximum of 10 puffs, using a spacer if prescribed or available.
5. If the person uses a MART or AIR inhaler and there is no different instruction in their plan, support them to take 1 puff every 1 to 3 minutes, up to a maximum of 6 puffs.
6. Call 999 immediately if the person feels worse at any time, does not improve after the maximum dose in their plan, does not have their inhaler, is unable to speak in full sentences, becomes exhausted or drowsy, has blue/grey lips or skin, collapses, or staff are worried.
7. Tell 999 that the person is having an asthma attack. Give the person’s name, address/location, symptoms, medicines already taken, known allergies, relevant medical history and any DNACPR/ReSPECT or emergency care plan if applicable.
8. If the ambulance has not arrived after 10 minutes and symptoms are not improving, repeat the inhaler steps in line with the person’s plan or emergency services instructions.
9. Continue to monitor and reassure the person until emergency services arrive. Do not leave the person alone.
10. After the incident, record the event, medicines used, times, actions taken, advice received, outcome and follow-up required.

6.6 Preventative Measures

• The person’s care plan and risk assessment must identify known asthma triggers and agreed actions to reduce avoidable exposure, while respecting the person’s tenancy, lifestyle choices, rights and preferences.
• Staff must encourage and support the person, where this is part of the care plan, to attend asthma reviews, GP appointments, asthma nurse appointments, annual reviews, medication reviews and post-attack reviews.
• Staff must encourage and support adherence to prescribed preventer, MART or AIR treatment where this is part of the care plan. Staff must escalate concerns if preventer medication is repeatedly missed, refused or unavailable.
• Staff must monitor and report signs of worsening asthma, including increased reliever use, night-time symptoms, reduced activity, frequent coughing, repeated chest infections, reduced peak flow if monitored, or repeated requests for emergency support.
• Staff must support smoking cessation, smoke-free environments, good ventilation, cleaning arrangements, reduction of dust or mould exposure, and avoidance of known allergens where this forms part of the person’s agreed support plan.
• Staff must not impose restrictions that are disproportionate, discriminatory or not agreed through assessment, consent or best-interest processes.

6.7 Accessible Information and Health Inequalities

{{org_field_name}} will provide asthma-related information in a way the person can understand, taking account of disability, communication needs, language, culture, sensory impairment, learning disability, autism, mental health, literacy and digital access. Where needed, staff will support the person to access easy-read asthma plans, translated information, interpreters, advocates, family support or health professional explanations. Staff must take reasonable steps to reduce barriers to asthma care, including support to book and attend appointments, obtain prescriptions, understand treatment changes and communicate concerns to health professionals.

6.8 Nebulisers and Specialist Equipment

Where a person is prescribed a nebuliser or other asthma-related equipment, this must be recorded in their care plan, medicines support plan and risk assessment. Staff must only support use of nebulisers where this is prescribed, included in the person’s plan, and staff have been trained and assessed as competent. The plan must include cleaning, maintenance, infection prevention, storage, replacement parts, electrical safety where relevant, and what to do if the equipment fails. Staff must not set up or administer nebulised medicines unless this is within the agreed care plan, prescription instructions and staff competency.

7. Documentation and Record-Keeping

Each person with asthma must have accurate, up-to-date and accessible records proportionate to their needs, including:

• diagnosis and relevant medical history
• Personalised Asthma Action Plan
• asthma care plan and risk assessment
• known triggers and early warning signs
• prescribed asthma medicines and devices
• medicines support plan and MAR/PRN records where applicable
• inhaler/spacer/nebuliser support requirements
• self-administration assessment where applicable
• consent, capacity and best-interest records where applicable
• communication needs and accessible information requirements
• emergency contacts, GP, asthma nurse, pharmacy and relevant professionals
• records of asthma attacks, near misses, 999 calls, NHS 111 calls, GP contacts, hospital attendances and follow-up actions

Asthma-related incidents, medicines errors, missed doses, unavailable inhalers, expired inhalers, repeated reliever use, emergency service calls and hospital admissions must be recorded, escalated, investigated and reviewed in line with the Incident Reporting and Investigation Policy.

Where an incident meets CQC notification thresholds, the Registered Manager must notify CQC without delay in accordance with the Care Quality Commission (Registration) Regulations 2009.

Records must be accurate, complete, contemporaneous, securely stored and available to staff who need them to provide safe care.

Learning from asthma-related incidents must be shared with relevant staff and used to update care plans, risk assessments, training and systems.

7.1 CQC Notifications and Duty of Candour

The Registered Manager must review all asthma-related incidents to determine whether they require external reporting, including safeguarding referral, commissioner notification, CQC notification, RIDDOR reporting, GP or health professional escalation, or police involvement.

Where an asthma-related incident results in death, serious injury, prolonged pain, prolonged psychological harm, hospital treatment to prevent death or serious injury, abuse or allegation of abuse, police involvement, or any event that threatens the safe running of the service, the Registered Manager must consider whether a CQC notification is required and must submit it without delay where the threshold is met.

Where an asthma-related incident is a notifiable safety incident under Regulation 20 Duty of Candour, {{org_field_name}} must act in an open and transparent way, provide a truthful account of what is known, apologise, explain what further enquiries will be made, keep records, and provide reasonable support to the person and/or relevant representative.

8. Responsibilities

8.1 Registered Manager

• Ensures this policy is implemented, monitored and reviewed.
• Ensures people with asthma have appropriate care plans, risk assessments, Personalised Asthma Action Plans and medicines support plans.
• Ensures staff receive relevant asthma awareness, medicines, emergency response, MCA, safeguarding, Duty of Candour and record-keeping training.
• Ensures staff competency is assessed before staff provide asthma-related medicines support.
• Ensures asthma-related incidents, medicines errors, emergency calls and hospital admissions are reviewed, investigated and used for learning.
• Ensures concerns are escalated to GPs, asthma nurses, pharmacists, NHS 111, emergency services, commissioners, safeguarding, CQC or other agencies as required.
• Ensures CQC notifications and Duty of Candour requirements are completed where thresholds are met.
• Ensures audits are completed on asthma care plans, medicines records, inhaler availability, training compliance, incidents and follow-up actions.

8.2 All Staff

• Follow this policy, the person’s care plan, risk assessment, medicines support plan and Personalised Asthma Action Plan.
• Promote the person’s independence, dignity, choice and self-management.
• Recognise asthma symptoms, worsening asthma and asthma attacks.
• Support access to the person’s own prescribed reliever, MART or AIR inhaler in line with their plan.
• Never use another person’s medicine or a non-prescribed inhaler.
• Record medicines support, refusals, PRN use, missed doses, incidents and concerns accurately and promptly.
• Escalate concerns about increased reliever use, unavailable or expired inhalers, poor inhaler technique, repeated symptoms, missed preventer treatment or deterioration.
• Call 999 immediately where the person’s plan, symptoms or staff concern indicate emergency help is needed.
• Respect consent and follow MCA procedures where capacity is in doubt.
• Report safeguarding concerns, medicines errors, incidents and near misses without delay.

8.3 The Person Receiving Support

Where the person has capacity and chooses to be involved, they will be encouraged and supported to:

• understand their asthma and known triggers
• keep their Personalised Asthma Action Plan available and up to date
• carry or have access to their prescribed reliever, MART or AIR inhaler as agreed
• take prescribed medicines as directed
• attend asthma reviews and medication reviews
• tell staff if symptoms worsen or medicines are unavailable, expired or not working
• make informed choices about their health, lifestyle and support

9. CQC Compliance

This policy supports compliance with the following CQC requirements:

• Regulation 9: Person-Centred Care – asthma support must be based on the person’s needs, preferences, Personalised Asthma Action Plan, communication needs and desired level of independence.
• Regulation 10: Dignity and Respect – staff must support asthma care respectfully, protect privacy and promote independence.
• Regulation 11: Need for Consent – asthma support, medicines support and information sharing must be based on consent unless lawful MCA best-interest processes apply.
• Regulation 12: Safe Care and Treatment – asthma risks must be assessed and mitigated; medicines and equipment must be managed safely; staff must respond appropriately to emergencies.
• Regulation 13: Safeguarding Service Users from Abuse and Improper Treatment – failure to respond to serious asthma symptoms, neglect of medicines support, or disregard of a person’s needs may create safeguarding concerns and must be escalated.
• Regulation 17: Good Governance – accurate records, audits, incident reviews, risk monitoring and quality improvement systems must be maintained.
• Regulation 18: Staffing – staff must be suitably trained, competent, supported and supervised to provide asthma-related support safely.
• Regulation 20: Duty of Candour – the service must be open and transparent when a notifiable safety incident occurs.
• Regulation 20A: Requirement as to Display of Performance Assessments – where applicable, the provider must comply with CQC display requirements.
• Care Quality Commission (Registration) Regulations 2009, Regulation 18 – notifiable incidents must be reported to CQC without delay where thresholds are met.

9.1 Legislation and Guidance

This policy should be read alongside the following legislation and guidance, as amended or replaced:

• Health and Social Care Act 2008
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
• Care Quality Commission (Registration) Regulations 2009
• Care Act 2014
• Mental Capacity Act 2005 and Code of Practice
• Equality Act 2010
• Human Medicines Regulations 2012
• UK GDPR and Data Protection Act 2018
• CQC guidance for providers on Regulations 9, 10, 11, 12, 13, 17, 18, 20 and Registration Regulation 18
• CQC guidance on managing medicines in supported living
• NICE/BTS/SIGN NG245 Asthma: diagnosis, monitoring and chronic asthma management
• NHS and Asthma + Lung UK emergency asthma attack advice
• MHRA drug safety advice on short-acting beta-2 agonists, including salbutamol and terbutaline

10. Policy Review

This policy will be reviewed at least annually, or sooner where there are changes to legislation, CQC guidance, NICE/BTS/SIGN asthma guidance, MHRA safety alerts, local authority or commissioner requirements, organisational practice, or learning from asthma-related incidents, complaints, safeguarding concerns, medicines errors, audits or CQC feedback.

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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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