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Asthma - "Very positive results"

posted 31 Jul 2017, 00:52 by Hollie O'Connell   [ updated 16 Oct 2017, 02:32 ]
Corinne Clark 
Respiratory Specialist Nurse 


07 September 2017 


Many of Corinne’s patients suffer from severe asthma, which requires careful management to avoid asthma attacks that, in the most serious instances, can be life-threatening.  Corinne often worried about her asthmatic patients, specifically how well they were handling their condition, and wanted to do something about this.  Research suggests that patients who have a written asthma plan are 4 times less likely to be hospitalised due to asthma attacks.  Corinne enlisted the help of the health board’s TEC team to create an electronic Asthma Action Plan (eAPP) using Florence.

 There was certainly a cohort of asthma patients who I was losing sleep over!  I was worried about how they were self-managing their condition.  What we needed to do as healthcare professionals was really think outside the box: how we could get our patients to engage with us more effectively?  How do we best motivate patients to look after their condition through self-management?  And perhaps most importantly, how do we support patients to recognise when it is appropriate for them to seek urgent medical attention for their asthma? 


How do we use Flo? 
When I found out about Flo, I realised that she could really help to address some of the issues we’d been having.  We developed a protocol whereby Flo sends messages to the patient twice a day, asking for patient’s peak flow reading.  Flo records these readings, so I can map trends in their condition over the weeks and months.  This is really useful, as I can pick up on any points of concern, and then send them a text message directly via Flo from myself.  The patients we’ve identified as potentially benefiting from using Flo have all had previous admissions to hospital for acute exacerbation of asthma, or had been referred to the Respiratory Clinical Nurse Specialist (RCNS) by their GP or consultant.  In order for them to use Flo, these patients needed to have access to a mobile phone, and they were supplied with a peak flow meter and an emergency supply of rescue prednisolone.

The clever part of Flo for the patients is that she acts as an electronic asthma plan in the background for them.  When patients send their peak flow reading to Flo, the reading will fall into one of four zones, dependant on what their highest recorded peak flow reading is:
  • Zone 1 for readings above 80% of patient’s highest peak flow 
  • Zone 2 for readings between 60% and 80% 
  • Zone 3 for readings between 50% and 60% 
  • Zone 4 is for readings below 50% of the patient’s best peak flow 
So, depending on the patient’s reading sent to Flo, the patient will receive a confirmation message with advice that is appropriate to their current peak flow reading.

In addition, patients receive various support and information messages, and even reminders to book and attend their asthma reviews!  We do stress to our patients though that Flo isn’t an emergency response service – she’s a tool to help them to self-manage their asthma.  After all, patients are the ones that know their symptoms the best.


What differences has Flo made? 
When we first introduced Flo to our patients at the end of February 2016, we initially had 50 patients sign up, and this has now built up to a total of 88 patients so far.  A few patients have dropped out, either having opted out themselves, or being discharged from the service due to not sending their readings to Flo.

Amongst our active users we’ve seen some very positive results from using Flo.  Amongst the cohort we’ve seen only 4 acute admissions, all of which experienced exacerbations compounded with positive cultures of either influenza or pertussis.  In all of these cases however, the patients acted appropriately when there was deterioration in their symptoms and sought urgent medical attention in a timely manner. 

We also see that these patients have become more engaged with their own health and the specialist services on offer to them and importantly none of these patients have failed to turn up for their clinic appointments with their respiratory nurse specialist.  My colleagues across the country will tell you that asthma patients often don’t attend their clinic appointments, so for us to see such an improvement using Flo is wonderful.

From my perspective as a clinician, Flo is an amazing tool.  She allows me to monitor my patient’s remotely, and I find it reassuring to know that they are all managing their asthma well with Flo’s help.  Another benefit of being able to remotely monitor my patients’ readings with Flo is that they no longer have to attend as many appointments at the clinic.  Given how precious clinic appointments are, not having to see patients who are on Flo as often has really freed up some capacity for us. 

The feedback from patients so far has been very promising; they find Flo reassuring, and they’ve really noticed an improvement in the stability of their condition.  We have one patient, Kyle, who was regularly in hospital due to his asthma as he struggled to manage his condition.  Since he’s been using Flo though, he’s noticed that his breathing has improved, and that his peak flow readings are far more consistent.   

You can find out more about Kyle’s experience of using Flo to support his asthma management in this video


Comments from patients about Flo include:
  • After being in hospital I felt Flo was a support
  • Flo reminds me to check my peak flow.  I have a very busy job and I tend to forget to take my readings. 
  • I found it much easier to monitor my asthma on a daily basis 
  • I liked how I could keep a more accurate record of my peak flow 
  • Regular contact and advice
  • Easy and helpful 
  • For those who are unsure how to manage asthma, Flo provides simple, structured guidelines.  Flo provides the clinician with a clear overview for am and pm. 
  • Gets me to keep a check on my peak flow scores and be more aware of how my breathing is - whether it's zone 1 or zone 2 
  • It’s reassuring that even if my PF falls slightly due to a cold that I shouldn't be worried 
  • Reminded me to keep on top of my medication 
  • Consistent prompts for info makes me think about my health.  Reminders about changing treatment in response to data provided. 
  • Good monitoring, makes you complete your peak flows everyday.  Excellent that it can be monitored. 
  • Reminds you to check lung function and records function on phone.  You can look back 6 months if you want. Great! 
  • Flo lets me know when I need to change my medication 
  • Easy to use and understand 
  • Convenient helpful and easy to use
  • Flo shows you visually how your asthma is being managed and liaises with the hospital
  • Flo sends back information and records ups and downs, so finding further insight into illness is gained resulting in better control and treatment plans. 
  • I find that Flo keeps me looking at my PF when before I would not have checked it.
  • Reminds me morning and night to take my preventer inhaler (symbicort) because of the times I receive the text messages


Where are we headed?
We are currently in the process of having an external audit completed by an academic from Edinburgh University to look into both the clinical effectiveness and cost effectiveness of this specific Flo protocol.  This is using a number of sources, including Florence system reports, hospital and GP records, evaluation questionnaires and interviews with both the RCNS and patients, to find out what they really think about using Flo.  Although this is ongoing, early results are encouraging, and we hope that the final result will really allow us to shout about how good Flo is.

Earlier this year I submitted an abstract for consideration to the European Respiratory Society (ERS) around the asthma protocol.  I have recently been informed that my abstract has been successful and the ERS has invited me to give an oral presentation at their conference in Milan in September around Florence home health monitoring for asthma patients..... so exciting times!   "



For more information please contact corrineelaine.clark@nhs.net