Making Best Practice, Every Day Practice
About asthma and allergies
Asthma and allergies result in multiple long term consultations with an estimated 1 in 12 adults and 1 in 11 children in the UK. Sadly death rates remain stubbornly high will an average of three deaths a day.
Currently asthma costs the NHS about £1 billion p.a. and results in about 80,000 hospital admissions.
Allergy is affecting an increasing number of British adults and today they affect up to 44% of the population. Most allergies are not life threatening but in severe cases they cause anaphylaxis which may be fatal.
These resources include:
Explanations of the etiology of asthma and triggers of acute asthma attacks
The spectrum of asthma medications including inhaled corticosteroids, long-acting beta agonists (LABAs), leukotriene modifiers and inhalers combining a corticosteroid and a LABA
Reviews of recent asthma management guidelines and their application in primary care
Techniques and guidance to improve inhaler technique in children and adults
Articles also discuss common allergies such as allergic rhinitis and urticaria and the safe use of antihistamines
Beta agonists are the only class of drugs that is recommended for the management of
asthma at every level of current guidelines, including those from the British Thoracic
Society (BTS). This means that they are used across the spectrum of severity of
asthma, from mild intermittent disease (step one) to severe asthma symptoms (step
five). In this article, we take you through the key things that you – and your patients – need to
know about these drugs.
We continue our series on the changing role of the community pharmacist, with an article
from Alpana Mair in Edinburgh describing the work of a pharmacist in COPD and asthma
clinics based on her experience.
The Quality and Outcomes Framework (QOF) is now well into its third year and continues
to expand boundaries of quality domains within chronic disease management. In this
article we review some of the challenges in QOF indicators for asthma and COPD and
suggest some tips to make the requirements easier to achieve in daily clinical practice.
Breathlessness is a very common problem in the patients we see in general practice, and
there is a range of possible causes. In this article – the first in a series of three looking
at how to diagnose what’s wrong with a breathless patient – we explore how to
distinguish between two of the commonest respiratory causes of breathlessness,
asthma and chronic obstructive pulmonary disease.
Good self-management is obviously a central part of achieving effective control of any
chronic condition. It is particularly important in asthma to help patients manage
exacerbations, which can sometimes develop with little warning and with serious
consequences. This article provides a step-by-step guide to developing effective selfmanagement
plans for patients with asthma by providing practical solutions to key questions
underpinning the process.
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.
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