The 2WHAM questions can be adapted for asthma patients and used during a MUR and when giving other medicines-related advice:

• Who is it for? (Continue if it is for the person you are talking with)
• What are you using the SABA for? Asthma or COPD? (If for asthma, continue)
• How many inhalers/canisters have you been prescribed in the last 12 months? How many puffs of SABA have you taken during the past seven days? Are any night-time and/or day-time symptoms present? Use the ‘asthma slide rule’ to indicate the number of SABA puffs per year and the potential number of breathless moments. For example, six SABA canisters = 1,200 puffs per year, which could mean 600-1,200 breathless moments (1 dose = 1-2 puffs of SABA).²
• Actions: Monitor the ratio of ICS and SABA usage in the past 12 months (e.g. 2 ICS:12 SABA = urgent referral. A ratio of 12:2 is an indicator of good control. Re-check inhaler technique, ask for a spacer if applicable, consider possible referral for temporary ICS dose step-up and adjust the PAAP if required
• Medication: Is the patient on any other medication (e.g. NSAIDs, beta blockers) or exposed to triggers (e.g. tobacco smoke, damp, pollen) that can make the medication less effective?