Asthma

Accurate diagnosis is the fundamental principle underlying effective management of
any condition. Without a correct diagnosis it is not possible to recommend
appropriate treatments, provide relevant educational information or to establish
effective collaborative partnerships between health professionals and patients. In
this article, we provide a ‘how to’ guide to diagnosing asthma. Like a detective, you have to
piece together the clues – including history, lung function and response to treatment – to solve
the diagnosis.

Approximately one in every ten cases of adult-onset asthma is attributable to
occupational exposure. Unless occupation is considered, a diagnosis of occupational
asthma will be missed so it is likely to be underdiagnosed. An average practice with
around 6,000 patients will typically have approximately 600 adult patients with asthma,
of whom 60 may have occupational asthma if we assume 10% of cases are related to
occupational exposure. Can you think of 60 patients with occupational asthma in your practice?

UK primary care health professionals work under increasing demands and time
pressures. While a large proportion of their workload is demand-led (ie by patients
presenting with specific clinical problems), a significant amount of the work relates to
ongoing monitoring and care of patients with chronic illness. While most practices in
the UK achieve a high level of points in the Quality and Outcome Framework (QOF) for caring for
patients with asthma, the standard of the reviews for these patients may not reach a level
recommended in national and international guidelines. A structured approach may, therefore, be
helpful in ensuring quality of care for these patients. This article describes an approach to
reviewing patients with asthma, whether they present in surgery acutely, for follow-up of
uncontrolled episodes or for routine review.

Asthma affects more than 5 million
people of all ages in the UK today.
The vast majority of asthma is
diagnosed and managed in primary
care and most people with asthma rarely need
to see a hospital specialist. Until recently it
has been difficult to measure the level of
inflammation seen in asthma accurately in
general practice. However, new techniques
such as exhaled nitric oxide measurement are
now available for use and this article provides
GP and nurse perspectives on the potential of
such techniques in primary care.