Making Best Practice, Every Day Practice
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Asthma is a common condition in children, with approximately one in eight youngsters in
the UK receiving treatment for asthma at any given time. The British guidelines on the
management of asthma have separate pathways for children of different ages, for those
under 5 and for children aged 5-12 years. In this article, we review some of the
challenges of treating children with asthma, in particular, the best use of bronchodilators.
Oxygen therapy for patients with chronic obstructive pulmonary disease (COPD) has
recently been hitting the headlines, because major changes in its supply – using
independent contractors – introduced last year initially caused problems in some areas.
In this article, we review why some patients with COPD need oxygen therapy, when it
should be used and how to use it safely.
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.
P-values are commonly included in the results sections of randomised controlled trials (RCTs), but what is a p-value and
how should it be interpreted?
Asthma medications should routinely be delivered by a pressurised metered dose inhaler
(pMDI) and spacer system, with a facemask where necessary, in children under five,
according to the National Institute for Health and Clinical Excellence (NICE).1
For older children, aged 5-15 years, NICE has advised that a child’s therapeutic needs,
the ability to develop and maintain an effective technique, the suitability of a device for the
child’s and carer’s lifestyles (ie portability and convenience) and the likelihood of good
compliance are the factors that should govern the choice of device.2 Only once these factors
have been taken into account, should choice be made on the basis of cost minimisation.
Although the use of asbestos in this country has been tightly controlled for over 30 years
the incidence of asbestos-related lung diseases has increased dramatically over the
last few years. It is expected that this increase will continue during the next decade.
This article describes some of the different lung diseases caused by asbestos and their
management, and provides a useful clinical background to the issues for healthcare workers in
primary care.
Although principally an inflammatory respiratory disease, chronic obstructive pulmonary
disease (COPD) is now recognised as a complex disorder that also manifests in
extrapulmonary and systemic effects. Nutritional manifestations of the disease, notably
weight loss and obesity, have been recognised. However, the complexity of nutritional
problems in COPD has been poorly understood, and the consequences largely underrated. Now,
linked to increasing knowledge regarding systemic inflammation, it is becoming clear that poor
nutritional status is not only a manifestation of COPD but also a predictor of mortality and
healthcare utilisation.
Did you know…. that a large number of your hayfever patients may have a
condition known as oral allergy syndrome? In this article we explore what
causes oral allergy syndrome, why it occurs, the symptoms that patients may
suffer and how to manage the problem.
Milk, eggs and peanuts are the most common foods causing allergy in early childhood.
The prevalence of these allergies is on the increase. A thorough clinical history
together with an allergy test allows for a clear diagnosis and implementation of a
comprehensive management plan. This article outlines some of the key features in
diagnosing and managing childhood allergies.
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