There are several different drug types used in the management of hypertension. This back to basics provides a useful summary of the different antihypertensive drug classes and how they act to regulate blood pressure.
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
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.
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.
To be able to effectively manage patients with
airflow obstruction in general practice it is
imperative that we can differentiate between
asthma and chronic obstructive pulmonary disease
(COPD). Although COPD and asthma share many
clinical features, they are different conditions with
different airway inflammation and parenchymal
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.