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?
P-values: what are they?
Getting it Right: Asthma Devices in Children
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.
Asbestos and the lung
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.
Optimising nutrition in COPD
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.
Back to Basics: How do dry powder inhalers (DPIs) work?
The Null Hypothesis: There’s Nothing to it
Oral Allergy Syndrome
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.
Food Allergy in Childhood
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.
Anxiety in Patients with Respiratory Disease
Anxiety is a significant problem for many patients with respiratory disease and can have
a very negative impact on the disease course and prognosis. Practice nurses have an
important role to play in identifying anxiety and referring patients for appropriate
treatment. This article will focus on anxiety in such patients and aims to help you
understand what anxiety is, how anxiety affects patients, how to recognise symptoms of anxiety
and how to use the Hospital Anxiety and Depression Scale. A second article, to be published in
the next issue, will focus on management of anxiety.
Making the most of self-management plans in COPD
The Department of Health’s Expert Patient Programme recognises the role of selfmanagement
in many different disease areas and its report Self Care recommends the
concept of encouraging people with long-term conditions to self-manage where
possible. Diabetes management would never succeed without the active participation of
the person with the condition and asthma management plans have been advocated for some
time for people with asthma. What can self-management plans achieve in chronic obstructive
pulmonary disease (COPD)?
Back to Basics: Drugs for asthma – where and how do they work?
The Evaluation and Management of Cough in Adults
Cough as a symptom results in significant impairment of quality of life for patients. Its
wide and varied causes and presentations make diagnosis and management complex.
Many sets of guidelines have been produced to help clinicians in the evaluation and
management of acute and chronic cough. This article uses the British Thoracic Society
(2006) guidelines to provide a summary of the evaluation and management of cough.
