1 The Problem with Asthma Ruth McArthur, Practice Nurse/Trainer
2 Getting the diagnosis right!
3 Asthma or COPD? History taking is key Both are inflammatory conditions with different mechanisms & mediators Diagnostic tests help confirm the diagnosis in both
4 Sometimes patients don t fit in boxes They have more than one disease They have shared common risk factors They have shared presenting symptoms The patient has never read the textbook
5 Confirming the diagnosis
6 Treatment trials In adults a 6-8 week trial of 200mcg of inhaled beclometasone (or equivalent) twice daily Or In patients with significant airflow obstruction there may be a degree of inhaled corticosteroid resistance and a treatment trial with 30mgs of oral prednisolone for 2 weeks is preferred (rarely given in children) BTS/SIGN Guideline on the Management of Asthma, April 2014, revised edition : available from
7 The modern asthma paradox Greater understanding of pathogenesis Wide range of evidence based interventions Greater awareness of importance of prevention Proliferation of evidence based guidelines Improved health professional education Better educated patients and general public Undetected disease : case finding Poorly controlled and monitored disease Continued unacceptable levels of morbidity Unnecessary mortality Avoidable use of emergency care & hospital admissions crisis! Acute exacerbations still feature
8 Problems: The Health Care Professional Inadequate understanding of disease aetiology Not making the diagnosis early enough Inaccurate assessment of disease severity Poor or unstructured communication with patients Lack of time Holgate et al, 2006 BMC Pulmonary medicine 6(suppl 1):S2
9 Some possible explanations Patients and families not recognising symptoms of asthma Patients treat asthma as an acute episodic illness rather than a chronic disease HCPs assume patients will put aside their own beliefs, concerns & goals to follow the treatment plan Lack of emphasis on what really works in patient education: we frequently give information but concentrate less on how we deliver the messages.
10 Problems: The patient Underestimates symptoms Under usage of prophylaxis Tolerates poor symptom control Has low expectations of therapy Confused/lacks knowledge of correct drug Poor adherence. Holgate et al, 2006 BMC Pulmonary medicine 6(suppl 1):S2
11 Recognising symptoms Asthma symptoms are variable, patients and their family members, need to recognise symptoms and adjust medications at home according to the clinician and patient s assessment.
12 Worsening symptoms Needing more and more reliever treatment Waking at night with coughing, wheezing, shortness of breath or a tight chest Having to take time off work because of asthma symptoms Feeling that they cannot keep up with their normal level of activity or exercise
13 Symptoms on activity 3x week
14 Night symptoms x1 week
15 Reasons for poor asthma control Patients with asthma and rhinitis: treating allergic rhinitis lowers the risk of attending accident and emergency departments and of being hospitalized for asthma Cigarette smoking may reduce effectiveness of inhaled corticosteroids Exposure to allergens Treating allergic rhinitis in patients with co-morbid asthma: the risk of asth-ma-related hospitalizations and emergency department visits. Crystal-Peters J et al. J Allergy Clin Immunol 2002;109: Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma. Chalmers GW et al. Thorax 2002;57:
16 Assess asthma control RCP 3 Questions 1) Have you had difficulty sleeping because of your asthma symptoms (including cough)? 2) Have you had your usual asthma symptoms during the day (cough, wheeze, chest tightness or breathlessness)? 3) Has your asthma interfered with your usual activities (eg housework or work)? British Thoracic Society-Scottish Intercollegiate Guideline Network. British Guideline on the Management of Asthma. Revised April 2014
17 Asthma control test 1 During the past 4 weeks: 1. How often did your asthma prevent you from getting as much done at work, school or home? 2. How often have you had shortness of breath? 3. How often did your asthma (wheezing, coughing, chest tightness, shortness of breath) wake you up? 4. How often have you used your reliever inhaler? 5. How would you rate your asthma control?
18 Other indicators to assess control: Frequent prescriptions
19 NRAD A UK initiative, funded by NHS England Scottish Government Multi-disciplinary multi-agency steering group Run by Royal College of Physicians (London) Commissioned to an investigative team RCP Why asthma kills. Report of the NRAD May 2014
20 NRAD Report 2014 Range of people who died 4-97yrs 69% diagnosed > 15yrs Most common trigger of attacks: Respiratory tract infections, followed by hay fever/allergic rhinitis, and other allergic factors such as foods and drugs 6 of the patients who died had a history of anaphylaxis 41% had a history of allergy In children/young people age 10-19yrs 78% died between May and September supporting earlier research that most deaths occur during the summer months due to allergy
21 Key findings Can be sub-divided into Medical and professional care Prescribing and medicines use Patient factors, perception of risk of poor control
22 Medical and professional care Personalised Asthma Action Plans were held by 23% of those studied No review in the previous year in 43% of those studied Exacerbation risk factors documented in half of those studied Severe asthma present in 39%, moderate in 49%, mild in 9% (not always documented and likely to be inaccurate) Avoidable death if guidelines applied in 46% Divided into: lack of expertise (17%) lack of knowledge (25%) RCP Why asthma kills. Report of the NRAD May 2014
23 Prescribing and medicine use Excess reliever prescribing: 39% of those with accessible records had received >12 SABA in previous 12 months, 6 people >50 Under-prescribed preventers: 38% fewer than 4/12months, 80% fewer than 12 (or full dose) Inappropriate use of LABA: 14% of those studied were on LABA by single component inhaler, 5 people on LABA but no ICS RCP Why asthma kills.report of the NRAD May 2014
24 What is frequent use of a reliever? 2 or more canisters per month = >10-12 puffs OD, defined as a marker of poorly controlled asthma
25 Inhaled Corticosteroid use and the prevention of death from asthma ICS = Inhaled corticosteroid. Suissa S, et al. N Engl J Med. 2000;343:
26 NRAD Recommendations Every hospital and GP practice should have a designated named clinician for asthma services Better monitoring of asthma control, where loss of control is identified, immediate action is required, treatment change and follow-up Better education for nurses, doctors, patients and carers to make them aware of risks, the need to be able to recognise signs of poor control and know what to do during an attack All patients should be provided with a personal action asthma plan (PAAP), which helps them to identify if their asthma is getting worse and tells them what to do and when to access medical help.
27 Actions during a review Record triggers in the medical records and PAAP Review control at each asthma review Inhaler technique should be routinely undertaken and documented Non-adherence should be identified and monitored Smoking record should be documented and support for smoking cessation Urgent review for all with more than 12 short-acting reliever inhalers in the previous 12 months Patients should not be prescribed a long acting beta agonist alone (should be in combination with an inhaled corticosteroid Royal College of Physicians (2014) Why Asthma Still Kills The National Review of Asthma Deaths
28 Background Excellence in medical treatment is worthless if the patient doesn t take the medicine Compliance is closely linked to clinician communication and patient education Most clinicians believe they are good communicators, but most patients feel clinician communication and education is inadequate.
29 Impact on Patients There are discrepancies between expectations and patients satisfaction with the doctor/nurse-patient relationship: Patients would like to receive more clear explanations about possible side effects and risks of their medicines Patients would like to be consulted with regard to the choice of the inhaler device Partridge et al, Prim Care J,20011
30 Fears about asthma medicines Research from 445 families with a child with asthma: 39% Believe medicines are addictive 36% Believe medicines are not safe to take over a long period of time 58% Believe regular use will reduce effectiveness Wasilewski Y, Clark NM, Evans D, Levison MJ, Levin B, Mellins RB. Factors associated with emergency department visits by children with asthma and implications for health education. American Journal of Public Health, 86(10): , October 1996.
31 Address adherence as a routine part of care instead of waiting for your patients to fail! We need to view adherence along a continuum without a succeed or fail mentality If they feel more supported they will be more honest Agree coping strategies together that are achievable What systems do you have at home to help you remember to take your medicines? Have you been taking all your medicines?
32 Patient acceptance: making the link1,2 Accepting they are an individual who requires medication may be difficult for some people and therefore: May avoid activities that bring on symptoms Think about the disorder and its treatment I don t think my asthma affects my ability to play sport... I just prefer playing in goal to running around the field 1. Juniper, 2003; 2. Rollnick et al, 2005
33 Patient acceptance: making the link1,2 Where the benefits of treatment are not immediate or obvious, patients can become ambivalent This is a particular problem for preventive treatment What s the point of taking my brown inhaler? 1. Juniper, 2003; 2. Elwyn et al, 2003
34 Patient involvement in decision making Patient involvement is particularly important for managing long-term conditions 1 Patient involvement increases the effectiveness of treatment and improves outcomes 2 4 Treatment should be based on negotiated agreement 4 1. Department of Health, 2006; 2. Weston WW. CMAJ 2001; 165: Towle A, Godolphin W. BMJ 1999; 319: ; 4. Elwyn et al, 2003
35 Time and other barriers Professionals trained in communication do not take significantly longer when seeing patients 1 Suggesting/providing resources and information increases likelihood of patient involvement 2 Poor control of asthma leads to increased emergency attendance and consultation time 3 Participants given appropriate education about their condition make more effective use of healthcare resources, requiring fewer consultations, A&E attendances and hospital admissions, and greater use of pharmacy services 4 1. Cabana et al. 2Department of Health, Self Care Barnes PJ et al. Eur Respir J 1996; 9: Commission for Healthcare Audit and Inspection. Clearing the air, 2006.
36 Concordance Four most important factors influencing compliance: Clinician/patient relationship Patients understanding of disease Current beliefs and perception of illness Active role in illness management Mork, Van Ganse, Osman, 2003 Primary Care Respiratory Journal
37 Poorly controlled asthma Check inhaler technique Eliminate triggers Compliance with therapy check computer prescriptions? Smoking status Review the diagnosis Step up therapy.
38 Vital variants in asthma The drug The device The patient treatment Important to get them all right!
39 Inhaler technique Up to 90% of patients show incorrect inhaler technique in clinical studies Techniques are significantly improved by brief instruction by trained HCP However, 25% of patients have never received verbal inhaler instruction Only 11% of patients receive follow-up assessment and education Basheti A et al, Patient Edu Councs 2008 Jul; 72 (1): 26-33
40 Examples of poor technique
41 Types of Inhaler Device? Think of inhalers in 2 categories: Aerosol: Liquid medication or Dry powder preparation Effectiveness of the inhaler depends on: Patient co-ordination Particle size Effect of resistance of inhaler device MDI < DPI Inspiratory Flow
42 So how would YOU inhale? Quick test of how you would inhale through commonly-used devices 1. MDI 2. Dry Powder Inhaler (DPI) Need to: 1. Simulate resistance of device 2. Measure speed of inhalation
43 How would you breathe in for these?
44 How about these?
45 Inhaler technique Check at each review Check before increasing medication
46 What makes a good asthma review Is asthma knowledge correct? Assess asthma control RCP OR ACT questionnaires Enquire about reliever/oral steroid use Enquire about associated symptoms and/or new triggers eg Rhinitis, house move, occupation Smoking status Check peak flow rate. - Compare with previous best
47 Asthma self management education and written action plans Cochrane review demonstrates use of patient education and self-management associated with: Reduction in unscheduled GP visits Reduction in number of patients who were hospitalised Reduction in number of days off work or school Reduction in nocturnal asthma Improvements in compliance and reduction in deaths also demonstrated Gibson PG, Couglan J, Wilson AJ et al. Cochrane Library 2000 Abramson MJ, Bailey MJ, Couper FJ et al. Am J Respir Crit Care Med 2001
48 Self management support will one size fit all? To be activated to be effective self managers our patients require a high level of knowledge, skills and confidence Around 40% of patients are likely to need additional support to self manage successfully By increasing activation step by step our patients can experience small successes and steadily build confidence in their ability to self manage Hibbard et al Health Serv Res 2005 Hellmans M abstract PCRJ 2012
49 Educate and support patients nd practice team to reduce risk of admission patients and
51 So that s the challenge... Do we know who our patients are? Do we tell them about their disease? Do we ask them about the impact of their disease? Do we know how best to treat them? Do we tailor their treatment to meet their individual needs? Do we encourage self management?
52 Goals of asthma management No/minimal symptoms No/minimal serious attacks Require little reliever medication Have productive, physically active lives Have normal or near normal lung function
53 Thank You Why not study with us in Scotland? To find out details of Education for Health courses running near you, visit: Free-to-access online resources and elearning:
7 Asthma Asthma is a common disease in children and its incidence has been increasing in recent years. Between 10-15% of children have been diagnosed with asthma. It is therefore a condition that pharmacists
An Overview of Asthma - Diagnosis and Treatment Asthma is a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness,
COPD and Asthma Differential Diagnosis Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in America. Learning Objectives Use tools to effectively diagnose chronic obstructive
3 Respiratory conditions Asthma Condition A common disorder in which there is reversible bronchospasm of the bronchial airways, resulting in chest tightness and wheeze. Treatment options Inhaled short-acting
Management of exacerbations in chronic obstructive pulmonary disease in Primary Care Acute exacerbations of chronic obstructive pulmonary disease (COPD) are associated with significant morbidity and mortality.
Bulletin 61 February 2014 2.0 Leukotriene receptor antagonists: Montelukast and zafirlukast Across the PrescQIPP membership (20.2 million patients, November 2013), annual spend for the leukotriene receptor
Guidance to support the stepwise review of combination inhaled corticosteroid therapy for adults ( 18yrs) in asthma Important Complete asthma control needs to be achieved for at least 12 weeks before attempting
Medicines Use Review Supporting Information for Asthma Patients What is asthma? Asthma is a chronic inflammatory disorder of the airways. The inflammation causes an associated increase in airway hyper-responsiveness,
Clinical Practice Guideline for the Management of Asthma in Children and Adults Assessment: A critical aspect of the diagnosis and management of asthma is the precise and periodic measurement of lung function
Asthma Asthma is the term which describes a specific type of breathing problem that arises due to narrowing of the airways. This narrowing is caused when certain natural chemicals within the body are released,
Service Specification Spirometry in Primary Care Date: February 2011 Document Reference: Service Specification (V4.0) Contents: Section Page 1 Definition of service 3 2 Training 4 3 Reporting / Monitoring
ASTHMA DISCHARGE PLAN Information Leaflet Your Health. Our Priority. Page 2 of 6 Asthma When a child with asthma comes into contact with something that irritates their airways (an asthma trigger) the muscles
Background information Asthma Asthma is a complex disease affecting the lungs that can be managed but cannot be cured. 1 Asthma can be controlled well in most people most of the time, although some people
Key Components in Treating Asthma in Adults and Children Older than 5 Years: Diagnosis, Treatment and Referral Initial Asthma Assessment Critical to accurately diagnose asthma by: Identifying the presence
Asthma Diagnosis and Management Asthma is a condition characterized by narrowing and inflammation of the airways. This inflammation causes the airways to be very sensitive and react to a variety of stimuli
For public handouts Reslizumab for treating asthma with elevated blood eosinophils inadequately controlled by inhaled corticosteroids [ID872] 1 st Appraisal Committee meeting Clinical Effectiveness and
Dr GH Kaye-Eddie Helen Joseph Hospital Pulmonology Introduction Definitions Impact of Exacerbations Assessment of COPD Management of COPD Management of Acute Exacerbations Prevention of Exacerbations COPD
Table VI-14 Risk miminisation by safety concern: off-label use of SYMBICORT pressurised inhalation, suspension for the treatment of asthma, in children, adolescents, or adults Safety concern Routine risk
Breaking Down the Barriers - Masterclass training package and modules Assessment of a patient with urgent mental health needs in an emergency department Module 1 Module 2 Mental health awareness training
Asthma Care Quality Improvement Tool Instruction Guide (TPP SystmOne) PRIMIS development of the Asthma Care quality improvement tool has been funded by Boehringer Ingelheim. Boehringer Ingelheim has undertaken
Drugs Used in Asthma and COPD Charts 1 and 2 show trends in prescribing for asthma and chronic obstructive pulmonary disease (COPD). Although the recorded prevalence of asthma is higher (5.4% of registered
South Staffordshire Area Prescribing Group Asthma Prescribing Guidelines Adults and Children over 12 years Inhaler choices in this guideline are different from previous versions produced by the APG. It
TSANZSRS Gold Coast 2015 Can average outcomes in COPD clinical trials guide treatment strategies? Long live the FEV1? Christine McDonald Dept of Respiratory and Sleep Medicine Austin Health Institute for
Classifying Asthma Severity and Initiating Treatment in Children 0 4 Years of Age Components of Severity Symptoms Intermittent 2 days/week Classification of Asthma Severity (0 4 years of age) Persistent
NHS Forth Valley Guideline for the Management of Chronic in Adults Approved 07/05/2008 Version 1.1 Date of First Issue 18/11/2015 Review Date 18/11/2017 Date of Issue 07/05/2008 EQIA Yes 01/05/2008 Author
SEVERE ASTHMA understanding the professional guidelines This guide includes information on what the European Respiratory Society (ERS) and the American Thoracic Society (ATS) have said about severe asthma.
Summary Charts For Diagnosis And Management Of Asthma In Children And Adolescents In Family Practice Lee Bee Wah, Daniel YT Goh The following tables and flow charts have been developed and adapted from
ASTHMA IN INFANTS AND YOUNG CHILDREN What is Asthma? Asthma is a chronic inflammatory disease of the airways. Symptoms of asthma are variable. That means that they can be mild to severe, intermittent to
Prescribing for patients with asthma by general practitioners in England and Wales 1994 96 Azeem Majeed and Kath Moser, ONS The objective of this study was to examine trends in the management of asthma
Asthma in Older Adults: overcoming the challenges of diagnosis and management Jennifer Gonzalez McComb, MD, MPH, FACP Section Chief, Pulmonary and Critical Care Medicine UPMC Shadyside Hospital April 9,
Merck & Co., Inc. U.S. Human Health P.O. Box 1000 North Wales, PA 19454-1099 Dear Health Care Professional: Thank you for your interest in the enclosed attachment, Stepwise Approach for Managing, excerpted
Asthma and COPD This review will focus on the most recent evidence regarding the safety of currently recommended options for treating chronic asthma and exacerbations in chronic obstructive pulmonary disease
Childhood Asthma / Wheeze Symptoms Asthma causes a range of breathing problems. These include wheezing, feeling of tightness in the lungs/chest and a cough (often in the night or early morning). The most
Background: Asthma is a chronic inflammatory condition of the airways affecting nearly 23 million Americans (17 million adults and 6 million children). 1 Asthma exacerbations result in approximately 440,000
Getting the Vision Right: A multi-disciplinary approach to providing integrated care for respiratory patients Dr Noel Baxter, GP NHS Southwark CCG Dr Irem Patel, Integrated Consultant Respiratory Physician
The Annual Direct Care of Asthma The annual direct health care cost of asthma in the United States is approximately $11.5 billion; indirect costs (e.g. lost productivity) add another $4.6 billion for a
Inhaled Corticosteroid Audit AIM To enable practices to review their prescribing of inhaled corticosteroids (ICS) for both asthma and / or COPD To step down the dose of ICS where clinically appropriate
RESPIRATORY CLINICAL REFERENCE GROUP (RCRG) PROGRESS REPORT 1. Executive Summary The Purpose of this report is to provide the Wandsworth Clinical Commission Group Board with an update on the progress on
COPD PROTOCOL CELLO Leiden May 2011 1 Introduction This protocol includes an explanation of the clinical picture, diagnosis, objectives and medication of COPD. The Cello way of working can be viewed on
BACKGROUND Position Statement from the Irish Thoracic Society on the treatment of Idiopathic Pulmonary Fibrosis Idiopathic Pulmonary Fibrosis (IPF) is a rare, chronic and fatal disease characterised by
Integrated 24-hour children and young people s asthma service: reducing unnecessary hospital attendance Provided by: South Essex Partnership Trust Publication type: Quality and productivity example Sharing
RESPIRATORY DISEASE AND SMOKE EXPOSURE QUESTIONNAIRE COPDGene THIS FORM DOES NOT NEED TO BE COMPLETED IF THE SUBJECT IS WITHIN WINDOW FROM COPDGene VISIT 0a) Date... / / 0b) Initials... Instructions: This
Fostair Maintenance & Reliever Therapy (MART) for asthma Turnberg Building Respiratory Medicine 0161 206 3158 All Rights Reserved 2014. Document for issue as handout. Name: Date: Best peak flow recording
Global Strategy f the Diagnosis, Management and Prevention of COPD 2016 Clinical Practice Guideline MedStar Health These guidelines are provided to assist physicians and other clinicians in making decisions
Patient safety failures in asthma care: the scale of unsafe prescribing in the UK Complacency in asthma care can kill 2 3 Every ten seconds, someone is having a potentially life-threatening asthma attack,
South Staffordshire Area Prescribing Group COPD Prescribing Guidelines Inhaler choices in this guideline are different from previous versions produced by the APG. It is not expected patients controlled
National Learning Objectives for COPD Educators National Learning Objectives for COPD Educators The COPD Educator will be able to achieve the following objectives. Performance objectives, denoted by the
PATIENT INFORMATION ABOUT TREATMENTS FOR ASTHMA AND ALLERGIC RHINITIS, PRESCRIPTIONS & OVER THE COUNTER MEDICINE The content of this booklet was developed by Allergy UK. MSD reviewed this booklet to comment
Ambulatory Asthma Management Summary of Recommendations Algorithm Patient presents with symptoms of asthma Establish diagnosis and determine level of severity by H and P and spirometry. (A) Consider alternative
Skill Levels for Delivering High Quality Asthma and COPD Respiratory Care by Nurses in Primary Care September 2007 Revised December 2009, April 2014 Author: Ruth McArthur In conjunction with the PCRS-UK
PEDIATRIC ASTHMA UPDATE FOR PRIMARY CARE PROVIDERS SERIES EDITOR: KENAN HAVER, MD Tracking and treating asthma in young children ABSTRACT: The use of a signs-based diary can be a valuable tool for monitoring
Exploratory data: COPD and blood eosinophils David Price: 9.23-9.35am Blood Eosinophilia in COPD The reliability and utility of blood eosinophils as a marker of disease burden, healthcare resource utilisation
31 st Irish Association for Emergency Medicine (IAEM) submission to the National COPD Strategy 1 Introduction Chronic obstructive pulmonary disease (COPD) is an important disease for patients, the health
Asthma Basic Facts Staying safe and well with asthma For people with asthma and their carers Breathing Breathing is how we get air in and out of our body. We all need air to live. The lungs (inside your
Wandsworth Respiratory Clinical Reference Group Annual Progress Report 2014/15 April 2015 Dr Kieron Earney & Kate Symons Acknowledgements Dr Sarah Deedat Public Health Lead for Long Term Conditions 1 1.
Patient NHS COPD - Education for Patients and Carers Integrated Care Pathway Date ICP completed:. Is the patient following another Integrated Care Pathway[s].. / If yes, record which other Integrated Care
December 3, 2015 Prevention of Acute COPD exacerbations George Pyrgos MD 1 Disclosures No funding received for this presentation I have previously conducted clinical trials with Boehringer Ingelheim. Principal
The optimal management of patients with COPD Part 1: The diagnosis 12 Chronic obstructive pulmonary disease (COPD) affects approximately one in seven New Zealanders aged over 40 years, 1 and is the fourth
Chapter 31 Drugs Used to Treat Lower Respiratory Disease Learning Objectives Describe the physiology of respirations Compare the physiologic responses of the respiratory system to emphysema, chronic bronchitis,
INHALED CORTICOSTEROIDS FOR ASTHAMA IN ADULTS AND CHILDREN OVER TWELVE YEARS In both adults and children over 12 inhaled corticosteroids are the most important treatment for chronic asthma. This is because
YOU VE BEEN REFERRED TO AN ASTHMA SPECIALIST... ...HERE S WHAT TO EXPECT You have been referred to an allergist because you have or may have asthma. The health professional who referred you wants you to
Population Health Management Program Program (formerly Disease Management) is dedicated to improving our members health and quality of life. Our Population Health Management Programs aim to improve care
Virginia Tech Departmental Policy 27 Sports Medicine Key Function: Review: Yearly Director of Athletic Training Title: Management of Asthma in Athletes Section: Treatment S-A Safety POLICY STATEMENT: This
ASTHMA POEMs Asthma POEMs Patient Orientated Evidence that Matters Developed by the Best Practice Advocacy Centre Level 8, 10 George Street PO Box 6032 Dunedin Phone 03 4775418 Fax 03 4772622 Acknowledgement
Confirming Diagnosis Through Spirometry Shirley F. Jones, M.D., FCCP I have no conflicts of interest Instructional Objectives At the end of this session, learners will be able to: Select individual patients
New inhaled drugs for asthma & COPD: integration into UK practice Hasanin Khachi Lead Pharmacist - Respiratory Medicine Joint Chair UKCPA Respiratory Group Barts Health NHS Trust 30 th September 2014 Outline
GCE AS/A level 1661/01A APPLIED SCIENCE UNIT 1 Pre-release Article for Examination in January 2010 JD*(A09-1661-01A) 2 BLANK PAGE 3 Information for Teachers The attached article on asthma is based on some
Asthma Intervention 1. Primary disease education Member will have an increased understanding of asthma and the classification by severity, the risks and the complications. Define asthma Explain how lungs
Anxiety and are common in people with asthma. The good news is that there are effective treatments both for asthma and for anxiety and. With careful management, the symptoms of anxiety and can be treated
Differentiating Asthma from COPD: Role of History, Physical Examination, Laboratory Studies, and Lung Function Testing Stephen P Peters, MD, PhD, FAAAAI Professor of Medicine, Pediatrics and Translational
STRIVERDI RESPIMAT (olodaterol) Inhalation Spray is a long-term, once-daily prescription medicine for adults that controls symptoms of chronic obstructive pulmonary disease (COPD) and can help you breathe
New Australian asthma guidelines The National Asthma Council 2014 Australian Asthma Handbook has important changes that every pharmacist should be aware of. Some of the key changes in the Australian Asthma
COPD PATIENT SUPPORT What is COPD? This piece has been reviewed by COPD Support Ireland. COPD & Me Chronic obstructive pulmonary disease (COPD) is a very common lung disease. If you have been diagnosed
MEDICAL POLICY STATEMENT Original Effective Date Next Annual Review Date Last Review / Revision Date 06/15/2011 02/15/2017 03/09/2016 Policy Name Policy Number Xolair/Nucala SRx-0013 Policy Type Medical
SPIRIVA Respimat is approved for use in asthma in the EU, Japan, the USA and many other countries. The label varies by country. Please refer to the local product information ONCE-DAILY TIOTROPIUM RESPIMAT
ASTHMA NHLBI GUIDELINES Stephen Kurachek, MD CRCCS Children s Hospitals and Clinics of Minnesota Gillette Children s Specialty Hospital CentraCare Health System Essentia Health Today s Topics NHLBI Guidelines
Breathe With Ease Asthma Disease Management Program MOLINA Breathe With Ease Pediatric and Adult Asthma Disease Management Program Background According to the National Asthma Education and Prevention Program
Understanding the Risks and Benefits of Stepping Down Asthma MedicaDons 4813 Workshop: Stepping Down Asthma MedicaDons: Benefits and Risks Monday March 3, 2014 4:45 pm to 6:00 pm AAAAI 2014 John B. Hagan,
Illness such as gastroenteritis and upper respiratory tract infections, along with injuries caused by accidents in the home, are the leading causes of attendances at Accident & Emergency and hospitalisation
Lothian Guideline for Domiciliary Oxygen Therapy Service for COPD This document describes the standard for clinical assessment, prescription, optimal management and follow-up of patients receiving domiciliary