The year is racing by – autumn is already upon us! It’s a time which fills me
with great expectations, with memories of starting a new academic year at
school or university. Many of you may still be experiencing this through your
children! I love the feeling of opening a clean ‘exercise book’! Some of you
may even be contemplating starting up studies again. The Education for Health
graduation ceremony is being held in October; it is one of the most thrilling
events in our academic calendar – seeing the smiles on the faces of the
mature graduates and their families as they attain awards that they never felt
would be possible! Let them be an inspiration to you all; it is never too late to
start! Our team here at Education for Health would be delighted to discuss any
programmes you might be interested in.
Editorial
The changing role of the community pharmacist: COPD and asthma clinics
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.
Back to Basics: Pharmacokinetics of inhaled drugs – where inhaled drugs go
Urticaria and angioedema
Allergic diseases such as hayfever and allergic asthma are becoming increasingly common
in westernised countries such as the United Kingdom, with an estimated 25% of the
population now suffering from some form of allergic condition. Urticaria and angioedema
are commonly thought of as allergic problems although in general only acute symptoms
are related to allergen exposure. Here we discuss the diagnosis and management of urticaria and
angioedema in primary care, with particular focus on identifying allergic triggers and managing
long-term symptoms successfully.
Rhinitis: Successful Diagnosis and Management
Runny, blocked noses are a common problem in the winter months, accounting for a
substantial number of general practice consultations. Successful treatment depends
on identifying the correct cause of the symptoms. In this article we give you key
information on rhinitis – what it is, how to diagnose it and how to treat it successfully.
How to Manage Sleep Apnoea in Primary Care
The NICE Technology Appraisal of continuous positive airway pressure (CPAP) published in
March 2008 has led to dramatically increased referrals for sleep apnoea in most areas.
Together with the National ‘Referral to Treatment’ (RTT) 18-week target, there is mounting
pressure on Primary Care Trusts to identify patients with obstructive sleep apnoea (OSA).
This article describes how OSA can be identified and diagnosed, and how CPAP can be managed in
primary care.
Diagnosing allergy in asthma and allergic rhinitis
Patients with allergic asthma, intermittent (seasonal) or persistent (perennial) allergic
rhinitis, represent a significant proportion of primary care consultations. There is
growing awareness of allergy and the possibility of an allergic component as the cause
of a wide variety of symptoms. It is important to understand how to diagnose atopy to
ensure appropriate management and care of our patients. Diagnosing allergy is initially about
asking the right questions, followed by confirming or refuting the diagnosis by objective testing.
In this article, we explore history taking and objective testing that will help us to manage and
advise patients appropriately.
The Challenges of Scoring QOF Points for Asthma and COPD
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.
Back to Basics: Mechanisms of allergy
Tuberculosis
Cases of tuberculosis (TB) have been increasing over the past few years, with recent data
from the Health Protection Agency showing a rise of 2% from 2005 to 2006 in England,
Wales and Northern Ireland, following a rise every year since the late 1980s. Although
London continues to account for the highest proportion of cases – 42% – there have
been outbreaks throughout the country. In this article, we review the cause, pathology, clinical
investigations, diagnosis and management of TB.
Respiratory Infections: How to Minimise the Impact
Accurate diagnosis of respiratory tract infection can be difficult in primary care,
particularly in older patients. Time constraints meaning that most consultations allow
less than six minutes to deal with patients’ clinical problems – with much of the time
devoted to achieving political and financially driven targets – can make it even more
difficult. In this article, we provide practical tips on how to recognise and treat common
respiratory infections.
How to do an asthma review
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.