Respiratory

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.

Cystic Fibrosis: What do we need to know?

Cystic fibrosis (CF) is the most common inherited genetic disease in the UK.
Improvements in both diagnosis and treatment over the last 30 years have resulted in
increased survival with children born in the 1990s now likely to live into their forties.
Although much of the treatment is delivered in hospitals, healthcare professionals in
primary care should be aware of management principles and understand the impact of the
condition on patients and their families. This article provides an overview of CF and shows how
to support patients and families in primary care.

The breathless patient: Is it asthma or COPD?

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.

Back to Basics: Key steps in resuscitation

Treatments for Hayfever

Over the next few months practice nurses are likely to see many patients with hayfever
(also known as seasonal allergic rhinoconjunctivitis). Although it may appear to be a
minor complaint, hayfever can result in considerable suffering for the individual, who
may or may not seek professional help and advice. Practice nurses play an important
role in improving the management of this condition. In this article, we describe the impact of
hayfever on patients and provide a comprehensive review of the treatments currently available
for hayfever.

Respiratory causes of breathlessness

The development of shortness of breath (SOB) is an expected outcome of overexertion,
as normally occurs after strenuous exercise. SOB occurring at rest or during marginal
exertion is considered abnormal. Multiple organ systems are involved in the differential
diagnosis of SOB but for the purpose of this article, we concentrate on the pulmonary
system and include chronic obstructive pulmonary disease (COPD), asthma, pneumonia,
pneumothorax, interstitial lung disease, lung cancer and dysfunctional breathlessness. This is
the second in a series of three articles focusing on diagnosis of the breathless patient.

How can I measure airways inflammation in asthma?

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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