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The Primary Care Respiratory Society

Inspiring best practice in respiratory care


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The Primary Care Respiratory Society

Inspiring best practice in respiratory care

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This website is for healthcare professionals only

Conference Abstracts

The PCRS Respiratory Conference 2019

Scientific Research Abstracts

At this year’s conference the npj Primary Care Respiratory Medicine research stream is dedicated to showcasing the cutting edge of scientific research in respiratory primary care. Full details about scientific research abstract oral presentation sessions and the poster presentation session can be found on the conference programme. Abstract posters can be found in the Gallery of The International Centre, Telford.

Best Practice / Service Improvement Abstracts

Abstract posters can be found in the Gallery of The International Centre, Telford.


Authors: Christos VC, Tricia MM, Dominick ES
Institution: University of Nottingham
Presenter: Christos Chalistios
Allocation: Poster Presentation
Category: Scientific Research Abstract
A retrospective database study of oral corticosteroids and bisphosphonates prescribing patterns in England Christos V. Chalitsios, Tricia M. McKeever, Dominick E. Shaw Abstract Background Regular use of oral corticosteroids (OCS) is associated with an increased risk of osteoporosis and fracture. Guidelines state that all patients receiving regular OCS therapy should be considered for bisphosphonate (BP) use in order to prevent osteoporosis. Objectives To comprehensively assess prescribing and cost patterns, trends and variation of OCS and BP among General Practices (GPs) and Clinical Commissioning Groups (CCGs) in England. Methods A population study was performed using prescribing and cost data for all GPs and CCGs in England. We calculated the prescribing and cost patterns per 1,000 population between 1998 and 2018 and the annual ratio between OCS and BP prescriptions from 2015 to 2018. We also evaluated geographical variation patterns and examined factors associated with OCS and BP prescribing performing a mixed-effect negative binomial regression analysis across 2018. Results There was a rise in OCS and BP prescriptions of 55% and 1,200% respectively from 1998 to 2018. OCS and BP had respectively 140 and 120 prescribed items per 1,000 population at a cost of £920 and £101 per 1,000 population in 2018. By 2018 there were 1.16 OCS prescriptions for every BP. Higher OCS prescribing was associated with higher BP prescribing rate (IRR=1.82; 95%CI: 1.75-1.90; p <.0001). Better QOF score, comorbidities and advanced age were associated with higher both OCS and BP prescriptions. The more deprived the area where the GPs located, the less the medication is likely to be prescribed. Conclusion Although OCS and BP prescriptions are closely related, a variation among GPs and CCGs exists and is associated with multiple factors including patients and GP characteristics. Our results support the need to promote best practice in glucocorticoid-induced osteoporosis preventative prescribing.
Session: Scientific Research Abstract Poster Presentations and Discussion
Date / Time: Friday 20th September 14:45 - 15:30
Location: (Gallery)
Authors: Sanders MJ, Tran CH
Institution: Clement Clarke International Limited
Presenter: Mark Sanders
Allocation: Poster Presentation
Category: Scientific Research Abstract
Aim Clip-Tone E is an inhaler technique training tool for use during active Ventolin Evohaler (VE) administration, and is newly-reimbursed. The device fits to the actuator-top of the Evohaler: providing whistle guidance during inspiration, thereby improving co-ordination and establishing good inhaler technique on a repeated basis. Previous in vitro aerodynamic particle size distribution (APSD) research, at the 30L/min flow rate, with single, dual and triple pMDI therapies has shown that Clip-Tone does not affect drug delivery. We wished to understand the effect of the span of flow rates at which the training whistle sounds. Method Salbutamol APSD from VE (Control) and VE plus Clip-Tone E (n=5 per group) was evaluated at 20 and 48 L/min flow rates. Aerosol properties were studied using the Next Generation Impactor (Copley Scientific Limited, UK). Five actuations were delivered from each inhaler. Salbutamol deposition (µg, mean±SD) was quantified, using standard chromatographic analysis; from Clip-Tone, inhaler actuator, induction port (‘throat’) and all NGI stages. Key aerosol variables were determined. Results We also present the 30L/min data from Eur Respir J 2018; 52[suppl62]:PA4430 (10.1183/13993003.congress-2018.PA443). Fine particle fraction data (FPF %<5µm) at 20, 30 and 48 L/min for Control were 27.5±2.0, 48.9±1.3 and 43.8±2.9 respectively; for VE plus Clip-Tone: 30.0±1.7, 48.2±1.6 and 44.9±1.6. Similarly, fine particle dose data (FPD µg<5µm) were Control: 27.8±3.5, 39.8±1.9 and 46.3±7.1 and VE plus Clip-Tone: 31.0±2.0, 41.5±2.5 and 40.9±3.1. Summary APSD data were comparable (Figure). Conclusion Clip-Tone did not adversely influence salbutamol delivery at the range of flow rates that span whistle generation. Although FPF and FPD data differed between flow rates this was not unexpected or considered of clinical relevance, the dose of salbutamol being sufficient for clinical effect. Patients hearing the Clip-Tone whistle as they use their inhaler can expect to receive a clinically effective dose of salbutamol.
Session: Scientific Research Abstract Poster Presentations and Discussion
Date / Time: Friday 20th September 14:45 - 15:30
Location: (Gallery)
Authors: Aljahan A.
Institution: University of Birmingham
Presenter: Abdullah Aljahan
Allocation: Poster Presentation
Category: Scientific Research Abstract
Abstract Title “The role of community pharmacist in improving adherence to inhaled medication among COPD patients” Background Inhaler medication is the most common pharmacological treatment for COPD, yet it is recognised that non-adherence is a significant problem, causing reduced quality of life and increased health care expenditure, morbidity and mortality. Inhaler non-adherence may relate to factors including inhaler type, dosing schedule, inhaler technique, patient characteristics and knowledge of COPD. Inhaler technique should be checked during annual COPD reviews at GP practices, but there may be insufficient time or knowledge to provide optimal training on this important issue Effective training of inhaler technique could benefit from an integrated approach using other healthcare professionals including community pharmacists, with evidence from other countries suggesting they contribute to the successful management and support of COPD patients. Aim Assess the knowledge, attitudes and skills of Community Pharmacists within the UK, and explore the potential gap between community pharmacists and other HCPs in relation to the education of optimal inhaler use for COPD patients. Method An online questionnaire will be designed with a mixture of 5-point Likert scale, categorical and binary response items as appropriate. Approximately 300 Community Pharmacists across the UK will be invited to complete the survey. Study invitations and information sheets will be sent via the Community Pharmacist Champion in West Midlands, it will sent through pharmacist networks. Pharmacists will be able to access study information on a web platform (https://www.onlinesurveys.ac.uk/) and complete the questionnaire if they agree to participate. The questionnaire will capture Pharmacist demographics, characteristics, knowledge, skills, attitudes and, views on potential interventions and communication with other health care practitioners. Analysis Basic descriptive analyses will be undertaken to produce summary scores that will be reported in narrative and graphical format. Stata Ver.15 will be used in statistical analysis. Dissemination Results will be published in a relevant scientific journal.
Session: Scientific Research Abstract Poster Presentations and Discussion
Date / Time: Friday 20th September 14:45 - 15:30
Location: (Gallery)
Authors: Sanders MJ, Waleed WA, Abdelrahim ME
Institution: Clement Clarke International Limited
Presenter: Mark Sanders
Allocation: Poster Presentation
Category: Scientific Research Abstract
Aim Many asthma and COPD patients exhibit poor inhaler technique despite extensive efforts at training and Guideline agency support. Training takes place predominantly in the clinic or pharmacy, and is a one-off event that may include demonstration, explanation and patient-participation. Inhaler use is an habitual process: formed by repeated action, reinforced by reward. For reliever medication, multiple actuations may contribute towards tangible relief but be misinterpreted as acceptable technique. We have looked at how habit formation and new skill acquisition might contribute to better technique. Method We deconstructed the features of inhaler training tools in terms of the aspect of training they address: checks of device coordination/preparation and correct flow, and app availability; and active inhaler/home use availability (habit-forming potential). In an on-going investigation we determined the inhalation duration (n=3 efforts) of subjects who received verbal pMDI instruction (VI) with/without the Clip-Tone device (Figure) fitted to the pMDI as an acoustic guidance aid (n=25 per group). Results Most training tools are unavailable for active inhaler or home use and are therefore unlikely to promote habit formation: some of the newer tools do, however, include features that could reinforce habit (Table). In VI subjects, inhalation duration ranged from 2.4–14.8 seconds, with 19/25 achieving the ≥5-second target, and 2/25 ≤3-seconds. VI group inter- and intra-subject variability (standard deviation) was 2.62 and 1.02, respectively. For VI plus Clip-Tone, duration was 3.0–11.3 seconds, with 21/25 achieving ≥5-seconds and none failing ≤3-seconds, with variability decreasing to 1.76 and 0.82, respectively. Conclusion Opportunities for healthcare provider training are scarce, and unlikely to build habit. Devices that can be practised at home or, better still, used continuously will potentially have stronger habit-forming characteristics. Preliminary data suggest that an on-[active]device guidance approach could improve technique and co-identify with the relief-reward; building habit based on good technique.
Session: Scientific Research Abstract Poster Presentations and Discussion
Date / Time: Friday 20th September 14:45 - 15:30
Location: (Gallery)
Authors: Ajepe TO, Ezeugwa CJ, Okafor UAC, Ehuwa OF
Institution: College of Medicine, University of Lagos
Presenter: Chidinma Ezeugwa
Allocation: Poster Presentation
Category: Scientific Research Abstract
ABSTRACT Correlation of Hand Grip Strength and VO2 Max in Active and Sedentary Individuals Okafor UAC, Ajepe TO, Ehuwa OF, Ezeugwa CJ 1. Department of Physiotherapy, College of Medicine, University of Lagos, Nigeria Aim: This study sought to determine the correlation between handgrip strength and VO2max in apparently healthy young adults living an active lifestyle and a sedentary lifestyle. Methods: Four hundred participants (171 males and 229 females), were involved in the study. They were apparently healthy young adults stratified into sedentary and active using the International Physical Activity Questionnaire (IPAQ). Handgrip strength was assessed using the digital hand grip dynamometer and VO2max was calculated using the formula 15(HRmax ÷HRrest). Resting heart rate was obtained using a heart rate monitor while the maximum heart rate was calculated by subtracting the age from 220. Independent t-test was used to obtain the difference between the parameters of sedentary and active participants. Relationship between VO2max and Handgrip Strength was obtained using Pearson’s correlation coefficient. Results: The mean resting heart rate in sedentary individuals was significantly higher than the active participants (p=0.001). All other parameters assessed (Handgrip strength and VO2max) were significantly higher among the active participants when compared with the sedentary participants. (p=0.001, p=0.001 respectively). Overall, a significant relationship exists between Handgrip strength and VO2max among all participants but when stratified into active and sedentary, there was significant relationship between Handgrip strength and VO2max in active participants, however, there was no significant correlation between the handgrip strength and VO2max in sedentary participants. The regression analysis showed that handgrip strength was significant predictor for VO2max in all the participants. Conclusions: Apparently healthy active participants had higher handgrip strength and VO2max with lower resting heart rate. There was significant relationship between handgrip strength and VO2max while Handgrip strength was found to predict VO2max in apparently healthy young individuals Keywords: Handgrip strength, VO2max, Active lifestyle, Sedentary lifestyle
Session: Scientific Research Abstract Poster Presentations and Discussion
Date / Time: Friday 20th September 14:45 - 15:30
Location: (Gallery)
Authors: James AJ, Davey C, Simpson J
Institution: Barts Health NHS Trust
Presenter: Aron James
Allocation: Poster Presentation
Category: Scientific Research Abstract
Introduction: Healthy Muslim adults are obligated to refrain from food and drink between dawn and sundown as one of the Five Pillars of Islam during Ramadan. Despite medical and religious advice, Muslim individuals with chronic respiratory conditions may feel impelled to fast and reduce their inhaler compliance, believing inhaler use breaks their fast. These individuals may be at risk of respiratory compromise, potentially leading to increased hospital admissions during this period. Aim: To review admission rates of Muslim patients with chronic respiratory conditions requiring inhaled medications during and after Ramadan. Of patients admitted, altered inhaler compliance was assessed to indicate whether this could have influenced the admission. Hypothesis: Reduced inhaler compliance will increase respiratory exacerbation admissions during Ramadan. Method: Using self-reported questionnaires, all Muslim patients admitted with exacerbations of asthma or chronic obstructive pulmonary disease to the Royal London Hospital were interviewed about their inhaler compliance and beliefs during Ramadan. The number of admissions were compared during and after Ramadan. Results: 12 male patients were admitted and therefore included (8 during Ramadan, 4 after). In this study it was unlikely that inhaler compliance beliefs contributed solely to the increased admission rates during Ramadan, and that gender-based multifactorial influences likely swayed the raised rate (100%). The majority felt inhaler use did not break fasts and adhered to their usual prescription, altering regime timing if able or necessary (87.5%). There exists a smaller population whose opposing beliefs may increase their risk of respiratory complications (12.5%). Conclusion: This small study indicated that the majority of Muslim patients felt that their usual inhaler compliance was acceptable during Ramadan. The increased number of respiratory admissions during Ramadan was likely due to multifactorial causes.
Session: Scientific Research Abstract Poster Presentations and Discussion
Date / Time: Friday 20th September 14:45 - 15:30
Location: (Gallery)
Authors: Uzzaman MN, Jackson T, Uddin U, Rowa-Dewar N, Habib GMM, Pinnock H
Institution: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
Presenter: Md. Nazim Uzzaman
Allocation: Poster Presentation
Category: Scientific Research Abstract
Aim COPD is currently the fourth leading cause of death in the world and projected to increase in coming decades. However, it is often under diagnosed and insufficiently managed by Primary Care Physicians (PCPs) in Bangladesh. Traditionally, training involves attending face-to-face study, but shortage of manpower in many areas of Bangladesh; it is difficult for a PCP to leave their practice to attend training courses of several days duration. We aim to: 1. assess the feasibility of blended learning on COPD for primary care physicians 2. explore participants’ perspectives towards the blended learning approach Methods We will use a mixed methods approach for this study: • Quantitative data: We will collect process data (e.g. on course completion) to inform the feasibility of the blended learning, and learning outcomes (e.g. practice adherence to COPD guidelines at one month after completion of the training) to inform a potential outcome for a future trial. • Qualitative data: We will use purposive sampling to recruit practitioners to two focus group discussions, and facilitators/ trainers will be interviewed. The topic guide will explore operational challenges and perceptions of participants. Focus groups and interviews will be recorded, transcribed verbatim and analyzed using thematic analysis. Results This would let more PCPs participate COPD training as it would mean less time away from their practice. This is really important in areas where there are lots of people with COPD and not enough doctors with COPD training. Patients with COPD would receive better quality treatment from their doctors which may improve their quality of life. Conclusion Policy makers would be interested in adopting blended learning approach for capacity building of physicians on COPD as well as other health conditions too in Bangladesh.
Session: Scientific Research Abstract Poster Presentations and Discussion
Date / Time: Friday 20th September 14:45 - 15:30
Location: (Gallery)
Authors: Ridgway CL, McClatchey K, Appiagyei F, Taylor O, Carter V, Morrow S, Taylor SJC, Price D, Pinnock H
Institution: Optimum Patient Care Global (OPC Global)
Presenter: Kirstie McClatchey
Allocation: Poster Presentation
Category: Scientific Research Abstract
Please see the abstract poster in the Gallery.
Session: Scientific Research Abstract Poster Presentations and Discussion
Date / Time: Friday 20th September 14:45 - 15:30
Location: (Gallery)
Authors: Micklewright KM, Farquhar M
Institution: University of East Anglia
Presenter: Carole Gardener
Allocation: Poster Presentation
Category: Scientific Research Abstract
Introduction Informal carers play a key supportive role for patients with Chronic Obstructive Pulmonary Disease. The care they provide also plays a vital role in relieving pressure on health and social services. However, caring can have a considerable impact on health and wellbeing and carers may have unidentified support needs that could be a target for intervention. Literature on the support needs of these carers has not been fully synthesized, and our knowledge of the comprehensiveness of the Carer Support Needs Assessment Tool (CSNAT) for these carers is limited. Methods English language studies published between 1997-2017 were identified against predetermined inclusion/exclusion criteria through searches of MEDLINE, CINAHL, EMBASE, CDSR, ASSIA, PsycINFO and Scopus. Further studies were identified through searching reference lists and citations of included papers. Papers were critically appraised and data extracted and synthesised by two reviewers. Identified needs were mapped to CSNAT items. Results 24 studies were included. Results suggest that carers have support needs in a range of domains including physical, social, psychological and spiritual. Many of these needs are unmet. Particular areas of concern relate to: prolonged social isolation, accessing services, emotional support and information needs. Findings also suggest additional CSNAT items may be required in order to encompass the full range of needs of this group, particularly relating to difficulties within patient-carer relationships and carer-clinician relationships. Conclusion Based on this review, there is evidence to suggest that COPD carers would benefit from identification and response to their support needs by healthcare professionals but to enable this the CSNAT requires additional items. Future planned work will develop these items with COPD carers.
Session: Scientific Research Abstract Poster Presentations and Discussion
Date / Time: Friday 20th September 14:45 - 15:30
Location: (Gallery)
Authors: Barnes S, Ewing G, Farquhar M
Institution: University of East Anglia
Presenter: Morag Farquhar
Allocation: Oral Presentation
Category: Scientific Research Abstract
Aim Breathlessness is distressing and disabling, and common in advanced cancer and non-cancer conditions. Informal carers (family/friends) provide unpaid support, but many lack knowledge and confidence in caring, experiencing anxiety, uncertainty, and helplessness. The Learning about Breathlessness programme (LaB) is addressing this. LaB1 identified six topics carers want to learn about breathlessness. LaB2 is working with carers, patients and clinicians to co-develop and test a prototype web-based educational intervention for carers on breathlessness. Content for five of the six topics was developed, but additional work was needed for the sixth topic, "What to expect in the future”, to ensure utility/sensitivity. Method Two disease-specific focus groups and six interviews were conducted with bereaved carers of people with breathlessness due to cancer or chronic obstructive pulmonary disease (COPD) (n=12). Data were sought on what carers would have liked to have learnt about the topic, and sensitive ways to present this for potentially co-present patients. Transcripts were analysed using content analysis, and validation sought from the Carer Advisory Group (CAG) and Study Advisory Group (SAG: includes clinical experts). Follow-on workshops with current carers and patients reviewed resulting draft webpages on this topic for utility and sensitivity. Results Carers learning preferences for “What to expect in the future” included support with: coping with symptom changes as a patient’s condition worsened, discussing “the future” with others, accessing care and support, administrative tasks (e.g. death registration), and bereavement. Findings were validated by the CAG and SAG. Current carers and patients provided valuable feedback on drafted webpages. Conclusion Co-developed webpages on the topic of “What to expect in the future” covered key content identified by bereaved carers as important. Their utility and sensitivity was confirmed by current carers and patients. Follow-on work is testing the full prototype website with carers, patients and clinicians to enable refinement.
Session: Winning Scientific Research Abstract
Date / Time: Saturday 21st September 09:37 - 09:52
Location: PCRS 1 (Ironbridge 1)
Authors: Watson JS, Jordan RE, Abab P, Greenfield S; Enocson A.
Institution: Anglia Ruskin University & University of Birmingham
Presenter: Jane Watson
Allocation: Oral Presentation (Long Oral)
Category: Scientific Research Abstract
Please see the abstract poster in the Gallery.
Session: Research Presentations: Pulmonary Rehabilitation
Date / Time: Saturday 21st September 11:25 - 12:10
Location: PCRS 3 (Wenlock Suite)
Authors: GM Monsur Habib1, Roberto Rabinovich2, Kalyani Divgi3, Salahuddin Ahmed1, Samir K Saha4, Sally Singh5, Aftab Uddin6, Nazim Uzzaman7, Hilary Pinnock1
1NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute of Population Health Science and Informatics, The University of Edinburgh. 2ELEGI/Colt laboratory, Centre for Inflammation Research, QMRI, The University of Edinburgh and Respiratory Department, Royal Infirmary Edinburgh, 3Chest Research Foundation, Pune, India, 4Dhaka Shishu Hospital, Bangladesh, 5Pulmonary and Cardiac Rehabilitation, Department of Respiratory Medicine (Acute Division), University Hospital of Leicester NHS Trust, 6International Centre for Diarrhoeal Disease Research, Bangladesh, 7Bangladesh Primary Care Respiratory Society.
Presenter: Dr Monsur Habib
Allocation: Oral Presentation (Long Oral)
Category: Scientific Research Abstract
Background: The increasing disability, reduced productivity, associated anxiety and depression from CRDs result in social isolation and economic hardship for patients and their families. Pulmonary rehabilitation (PR) is a guideline-recommended multidisciplinary and multifaceted intervention that improves the physical and psychological condition of people with chronic respiratory disease (CRD). However, PR services are under-provided and uptake is poor in LMICs, especially in low-resourced setting. Aim: We aimed to review the effectiveness, components and mode of delivery of PR in low-resource settings. Method: We systematically searched MEDLINE, EMBASE, CABI, AMED, PUBMED and CENTRAL from 1990 for clinical trials of adults with CRD (including COPD) comparing PR with usual care in low-resource settings. After duplicate selection process we extracted data on exercise tolerance and quality of life (QoL); component and mode of delivery. Results: From 7355 hits we included 13 studies. PR improved exercise tolerance significantly in all the studies and QoL in 12. In addition to exercise training PR services included education and breath retaining technique in most of the studies. Delivery was typically in home-based and in outpatient department with low cost services. Conclusion: PR can be delivered effectively in low resource settings, incorporating multifaceted components and employing a range of modes of delivery. PROSPERO: CRD42019125326 Funding: NIHR RESPIRE
Session: Research Presentations: Pulmonary Rehabilitation
Date / Time: Saturday 21st September 11:25 - 12:10
Location: PCRS 3 (Wenlock Suite)
Authors: R. De Vos, E. Lanning, J. Longstaff, H. Rupani, T. Brown, E. Heiden, T. Jones, D.
Neville, J. Winter, S. Begum, M. Mottershaw, C. Fogg, A. J. Chauhan
Institution: Portsmouth Hospitals NHS Trust
Presenter: Ruth De Vos
Allocation: Oral Presentation (Long Oral)
Category: Scientific Research Abstract
Please see the abstract poster in the Gallery.
Session: Research Presentations: Pulmonary Rehabilitation
Date / Time: Saturday 21st September 11:25 - 12:10
Location: PCRS 3 (Wenlock Suite)
Authors: R. De Vos, H. Rupani, T. Brown, J. Gates, D. Lodge, E. Heiden, M. Jones, A. J.
Chauhan
Institution: Portsmouth Hospitals NHS Trust
Presenter: Ruth De Vos
Allocation: Oral Presentation (Short Oral)
Category: Scientific Research Abstract
Please see the abstract poster in the Gallery.
Session: Research Presentations: Pulmonary Rehabilitation
Date / Time: Saturday 21st September 11:25 - 12:10
Location: PCRS 3 (Wenlock Suite)
Authors: Stanescu SC, Ainsworth B, Kirby SE
Institution: University of Southampton
Presenter: Sabina Stanescu
Allocation: Oral Presentation (Long Oral)
Category: Scientific Research Abstract
Aim: To assess acceptability of a mindfulness intervention in primary care patients with asthma using quantitative and qualitative methods and to explore participants’ representations of their asthma and quality of life (QoL). Method: Ninety-eight participants were given access to the Headspace mindfulness app. They completed demographic, psychological and asthma measures at baseline, six weeks and three months. Twenty-seven participants completed semi-structured interviews 6 weeks after entering the trial. T-tests were used to asses changes in QoL, asthma control, illness perceptions and anxiety/depression. Correlations were further used to explore relationships between psychological factors. Interviews were analysed with inductive thematic analysis. They addressed the experience of living with asthma, and the relevance and usefulness of non-pharmacological interventions for people with asthma, and costs/benefits of digital interventions for asthma. Results: QoL and asthma control significantly improved both at six weeks, QoL significantly improved at three months, psychological inflexibility and depression decreased, and people reported feeling more mindful in relation to their condition. Participants qualitatively described quality of life mainly in terms of activity limitation, and anxiety about specific activities triggering asthma attacks, and they reported QoL as a meaningful outcome for all interventions. However, anxiety did not significantly change after using Headspace, despite participants reporting and increase in overall wellbeing. Participants viewed their condition as significantly less threatening and easier to control at follow-up, particularly as they appreciated the newly-acquired awareness of their breathing, the routine nature of the meditation, as well as the accessible nature of the digital intervention. Finally, participants valued non-pharmacological interventions but noted that they would prefer asthma-specific apps or websites (rather than general mindfulness or anxiety-reducing). Conclusion: Our findings have important implications for the development of future digital interventions for people with asthma that target quality of life, highlighting the need for disease-specific components to ensure interventions are engaging and acceptable.
Session: Research Presentations: Asthma Management
Date / Time: Saturday 21st September 08:50 - 09:35
Location: PCRS 3 (Wenlock Suite)
Authors: 1 Marsh V, 1 Last R, 2 McClatchey K, 3 Steed E, 3 Taylor SJC, 2 Pinnock H

1 Education for Health
2 Universityof Edinburgh
3 Queen Mary University London
Institution: Education for Health
Presenter: Viv Marsh
Allocation: Oral Presentation (Long Oral)
Category: Scientific Research Abstract
Aim: Successful implementation of supported self-management requires attention to patient resources, professional training, and prioritisation by organisations. The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) programme is developing a theoretically informed whole-systems implementation strategy that will improve implementation of supported self-management in routine primary care practice. The IMP2ART programme aimed to develop an educational package that targets barriers to implementation and develops professionals' skills in delivering tailored supported self-management. Method: A multidisciplinary team (educationalists, clinicians, academics, health psychologists) built on contemporary understanding of effective adult learning and behaviour change theory, robust clinical evidence, and existing practice routines to design a team-based educational package. A professional focus group of clinicians working in general practice (n=10) was held via webinar to provide insights on the initial design approaches. Results: Evidence from implementation research, and analysis using the theoretical domains framework, identified the importance of role identity, teamwork and perceived barriers to implementation (patient, health care professional and organisational) and barriers of practice routines. These themes, endorsed by the focus group, informed the content which will be divided into two distinct modules: 1. A facilitated team-based introductory module to raise awareness of supported self-management and increase engagement, motivation and commitment to supporting self-management to become a priority across the practice team. 2. An individual on-line module to skill key professionals providing asthma reviews to use behaviour change strategies in general practice to facilitate supported self-management. Conclusion: Practice-based testing using a ‘think-aloud’ method will be conducted to pilot the modules and suggested changes and recommendations will be incorporated. The modules will be integrated with the patient and organisational components of the IMP2ART implementation strategy for piloting (n=12 practices). A UK-wide cluster-RCT (n=144 practices) will follow, to evaluate the impact and cost-effectiveness of the IMP2ART implementation strategy on unscheduled care and ownership of action plans.
Session: Research Presentations: Asthma Management
Date / Time: Saturday 21st September 08:50 - 09:35
Location: PCRS 3 (Wenlock Suite)
Authors: Toor S, Crawford E, Aslam T, Sanders M
Institution: Clin-e-cal Ltd
Presenter: Elizabeth Crawford
Allocation: Oral Presentation (Short Oral)
Category: Scientific Research Abstract
Aim An approved smartphone app (Rafi-Tone) is available to help parents/carers encourage young children to use their asthma inhaler-spacer to better effect, incentivising with game-playing cartoon characters. Currently the app is linked to the Able Spacer whistle mask. We wished to understand if the app had any effect on treatment-distress, general asthma and healthcare services. Method Nurses, asthmatic children (n=112, 1-11 years) and their parents/carers from 13 General Practices within the Salford Clinical Commissioning Group took part in the research. Detailed questionnaires were completed by parent/carer and, using Likert images (score 1-5), by children before and after 6-10 weeks’ use of the app and spacer (Figure). Cost data were inferred from Unit Costs of Health and Social Care 2017. Results At baseline >50% of children became upset (every time, usually, sometimes), when using their spacer. Use of Rafi-Tone/Able Spacer reduced this to 22%, with 70% never becoming upset, alongside a significant improvement (mean change 3.4 to 4.2, p<0.001) in the child’s reported feelings about inhaler use. This was concurrent with an increase in every-time spacer use (59% to 71%) and frequency of daily preventer use (55% to 81%). Difficulty in sleeping, daytime and activity-interfering symptoms all improved (32% to 12%, 53% to 21%, 34% to 11%, respectively). Patient use of GP and emergency services in the previous month decreased from 22 to 5 occasions. An increase in nurse appointments (22 to 33) was due mainly to review appointments but the overall cost of these decreased by 42%. 95% thought their children were likely to engage with an asthma game-based app and nurses reported the app easy to use. Conclusion This survey has shown potentially important clinical and economic benefits from the use of the combination of Rafi-Tone and Able Spacer to help engage young children with their inhaled asthma treatment.
Session: Research Presentations: Asthma Management
Date / Time: Saturday 21st September 08:50 - 09:35
Location: PCRS 3 (Wenlock Suite)
Authors: J. Suggett1, M. Nagel1, V Avvakoumova1, and A Bracey 3
1Trudell Medical International, London, Ontario, Canada N5V 5G4.
2 Trudell Medical UK, Basingstoke, UK, RG24 8AG
Institution: Trudell Medical UK
Presenter: Amanda Bracey
Allocation: Oral Presentation (Short Oral)
Category: Scientific Research Abstract
RATIONALE: The gold standard for the treatment of underlying inflammatory disease associated with asthma in children, is inhaled corticosteroid medication. Large volume valved holding chambers (VHCs) have capacities greater than can be emptied in a single breath, especially for children and small infants. The behaviour of widely prescribed large and small volume VHCs for the delivery of pMDI-delivered fluticasone propionate (FP) were compared. METHODS: The large and small volume VHCs (n = 3 devices/group) were represented by the 750-mL Volumatic*-infant facemask (GSK plc, UK) and 149-ml antistatic AeroChamber*Plus-child facemask (TMI, London, Canada). Each VHC was connected to a breathing simulator (ASL 5000, Pittsburgh, PA) mimicking a tidally breathing small child (tidal volume = 155-mL, rate/min = 25; inspiratory: expiratory ratio 1:2). An aerosol filter collected the medication delivered at the exit of the chamber-on-test. 1-actuation of FP (50 µg/actuation) was delivered to the chamber-on-test, and the mass collected on the filter after 1 complete breathing cycle (n = 5 replicates) was assayed by HPLC-UV spectrophotometry. RESULTS: Performance measures (mean ± S.D.) are summarized in Table 1. Very little FP was delivered from the Volumatic* VHC for the first five breathing cycles, and only 2.0 ± 0.6 µg/actuation was obtained after 10 cycles. In contrast, even after the first breathing cycle, 6.4 µg 0.7 µg/actuation was delivered by the smaller AeroChamber* Plus antistatic VHC, which plateaued at around 9 µg/actuation from 3 breathing cycles. CONCLUSIONS: Although other factors such as VHC materials and facemask fit might be contributing to the reported large differences in drug delivery performance, clinicians should be aware that the internal capacity of a VHC has a marked effect on the delivery of medication. An effective VHC should maintain the availability of medication for inhalation in cases where multiple inhalations may be required to empty, especially in children
Session: Research Presentations: Asthma Management
Date / Time: Saturday 21st September 08:50 - 09:35
Location: PCRS 3 (Wenlock Suite)
Authors: A Ramanathan
J Sheringham
Institution: Royal Free VTS/NIHR
Presenter: Agalya Ramanathan
Allocation: Oral Presentation (Short Oral)
Category: Scientific Research Abstract
Aim Our aim was to identify contextual factors which have been discussed in existing literature which influence adoption of self-management strategies in primary care settings. This work will add to existing literature by summarising the currently discussed contextual factors and identifying gaps in the evidence-base regarding their impact. 1) We will use the list of contextual factors to inform the development of a ‘practice profile’ - contextual information on all IMPART practices that will be used in the trial for randomisation, facilitator allocation, by facilitators and by evaluators – to understand what contextual factors might have influenced effectiveness 2) Summarise contextual factors relating to innovation in this field to help inform future implementation strategies. 3) Identify gaps in research. Method A search was conducted of the PUBMED database and SCOPUS databases in March 2019 to identify literature about implementation of self-management in primary care, particularly regarding asthma (or other chronic diseases) and digital tools. A total of 2566 papers were identified; 261 via the SCOPUS database and 2305 on PUBMED. After reading abstracts, the number of titles identified for full paper screening was reduced to 224 papers (56 from the SCOPUS database and 168 from PUBMED). A second reviewer further narrowed down the number of abstracts according to our inclusion criteria. Papers were also excluded based on year of publication, i.e. those included in a recent systematic review by Lau et al were excluded. For the purpose of this review article, we selected studies which looked at multiple/wide-ranging interventions and review articles. Papers which were protocols were removed as they would not give significant information about contextual factors. We used a narrative synthesis approach as all the papers were all heterogeneous in nature to identify key themes from the literature in order to answer our questions. A total of 168 papers were identified for full text screening. Results This is a work in progress; papers have been summarised according to research methods used, disease investigated and key contextual factors identified. The total number of papers will be categorised into types of contextual factors discussed and key contextual factors will be identified by the number of papers they are discussed in, and any significant findings. Key contextual factors influencing implementation of self-management tools in primary care will be discussed in further detail. Conclusions The conclusion will cover key contextual factors and identify how they can be used to design further research. The conclusion will also cover how these factors will influence the practice profile, which will be used as part of the IMPART asthma self-management trial, to recruit practices and guide the approach of facilitators. Any unexpected findings, as identified from previous literature, will also be discussed.
Session: Research Presentations: Asthma Management
Date / Time: Saturday 21st September 08:50 - 09:35
Location: PCRS 3 (Wenlock Suite)
Authors: Ansari A, Yassin E, Shahid M, Ansari S
Institution: Ripple Road Medical Centre, 364-370 Ripple Road, Barking IG11 9RS (Barking and Dagenham CCG)
Presenter: Adeel Ansari
Allocation: Poster Presentation
Category: Best Practice / Service Improvement Abstract
Asthma effects 1.1 million children in the UK. The number of deaths from asthma in the UK has not reduced significantly from around 1,200/year for many years, even though it is widely accepted that there are preventable factors in 90% of deaths (1). It is essential to recognise children with asthma that are ‘high risk’. Potential barriers in primary care 1) Clinician: Education/understanding 2) Patient/ family: education/understanding (practical skills) 3) Lack of continuity of care(multiple clinicians), communication with secondary care/ community services 4) Social determinants of health Overcoming the potential barriers (what have we done): 1) Education: clinician education, non-clinical awareness 2) Named lead 3) Specific policy/protocol and ‘EMIS’templates for: a. Routine asthma review–holistic approach b. Acute exacerbation of asthma- read code for vitals/history/examination, link to BTS guidance c. 48-hour post-exacerbation review –assessing potential reason for exacerbation and identifying at-risk (previous exacerbations/hospital attendance/compliance) 4) Coding: clinician/admin education a. Coding exacerbations b. Coding A+E-asthma attendance c. Coding hospital-asthma admissions 5) 48-hour post-exacerbation/hospital attendance review: clinician, admin-staff, and patient education. Monthly audit to identify patients with exacerbation that have not had a follow-up review 6) PAAP/action plan: easy access from templates, easy access in emis documents, ‘F12’ 7) Keep ‘at-risk register’: multiple exacerbations, poor compliance, hospital admissions 8) Asthma Summary-tab in emis: trend in PEFR, date of last exacerbation and last admission 9) 3 monthly Audits: a. Review ‘at risk patient’ register b. Children with asthma issued 2 or more prednisolone courses in last 12 months: review for referral to secondary care/asthma specialist c. >3 SABA in 3 months-review d. >12 SABA in 12 months-review 10) Identify primary and secondary care non-attendance: keep register, work with social care where needed References: (1) NRAD. Royal college of physicians. 2015 (2) Asthma.NICE Guideline[NG 80]. November2018. (3) Guidance on management of asthma. BTS/ SIGBN.2016
Session: Presentation of Best Practice / Service Development Abstracts
Date / Time: Saturday 21st September 08:50 - 09:35
Location: PCRS 2 (Atcham)
Authors: Underhill L, Thompson S, Shearer R, McClaren S
Institution: North of England Commissioning Support (NECS)
Presenter: Liz Underhill
Allocation: Poster Presentation
Category: Best Practice / Service Improvement Abstract
Aim - The aim of the Wallsend Respiratory hub was to deliver quality assured spirometry, improve asthma management and assess the value of FeNO testing. Method - Patients were seen for spirometry, FeNO testing, reversibility and offered counselling on inhaler choice and technique. Patients on high dose inhaled corticosteroids were reviewed to assess potential for dose reduction. Results - We have not gained sufficient data to provide quantitative results yet, but have qualitative data in the form of 4 cases. 1- Spirometry showed likely asthma diagnosis. FeNO 104 and Clenil inhaler was started. On review, FeNO 20 and Montelukast was commenced. Further review showed FeNO remained consistently low and ACT improved. GP - ‘FeNO is a very exciting and new concept to Primary care. We found that patients like FeNO and it helps compliance ‘ 2 - Normal spirometry and peak flow variability. FeNO 49, suggestive of asthma. Clenil inhaler was started and advise given Nurse - ‘this has dramatically changed the way we think about asthma’ 3- On high dose Seretide Evohaler but poor compliance. ACT 21and FeNO 27. Switched to high dose Fostair inhaler and encouraged TWICE daily use. On review ACT was 25 and FeNO 19. ICS dose was reduced to medium dose 4- On high dose Seretide Accuhaler ACT 18, FeNO 13 . Switched to Duoresp Spiromax and ICS dose stepped down Patient - ‘I really like this new test, it’s so easy and quick’ Conclusion- FENO testing is not just about diagnosis, but tailoring the treatment to the patient to give the best individualised care, with a cost saving and reduced steroid burden. FeNO is a useful tool for behavioural change in patients and prescribers, providing an extra bit of the jigsaw and giving confidence around optimising treatment. References -NICE NG 80, Asthma. 2017
Session: Presentation of Best Practice / Service Development Abstracts
Date / Time: Saturday 21st September 08:50 - 09:35
Location: PCRS 2 (Atcham)
Authors: Razak,Y, Oyston M, Stone M, McGuire M, Garner R & Elkin SL
Institution: Imperial college NHS Trust
Presenter: Sarah Elkin
Allocation: Poster Presentation
Category: Best Practice / Service Improvement Abstract
Baseline data showed unwarranted variation across NeoHealth Practices in COPD diagnostic rates, outcomes data and COPD reviews. After the Grenfell tragedy it became apparent that COPD patients could receive better support if primary care were upskilled and care plans were more goal-orientated. Once the investment and approach were approved by the CCG, a project team was formed comprising of General Practice, Integrated respiratory team, commissioner and GP Federation staff. Our project involved working with our local partners to develop clearer diagnostic and management pathways with the aims of improving outcomes for our COPD population and improved staff experience, focussing on: • COPD Pathway redesign • Improving relationships, integrating local clinical teams in primary care, community respiratory, smoking cessation, community nursing & palliative care • Investment into up-skilling of staff & support systems, with utilisation all levels of skill mix within the PCN • Quantifiable improvement in care & patient experience, looking to long term benefit in outcomes and system change Results . - A standardised cross sector COPD care plan & new pathways have been co-designed with stakeholders. To date,154 enhanced care plans have been put in place. - New diagnosis pathways are completed including the use of group consultations at diagnosis and ensuring correct onward referrals including Pulmonary rehabilitation - Upskilling via practical workshops(videoed for shared use) including care alongside practice visits by specialist teams for Virtual registry reviews. - The number of COPD patients who had Influenza vaccinations during the 18-19 flu season increased from 70% to 99%. - The number of COPD patients who are current smokers who received smoking cessation advice increased from 44% to 89% Conclusion: As relationship building across our community support networks have grown, understanding COPD quality care will continue through templates, referral & diagnostic pathways, advice and guidance.
Session: Presentation of Best Practice / Service Development Abstracts
Date / Time: Saturday 21st September 08:50 - 09:35
Location: PCRS 2 (Atcham)
Authors: Jayaraajan K, Waheed B
Institution: Imperial College London
Presenter: Burhan Waheed
Allocation: Poster Presentation
Category: Best Practice / Service Improvement Abstract
Introduction Evidence suggests that pulmonary rehabilitation (PR) enables patients to better manage their symptoms and improve their quality of life1. However, despite its benefits, there remain many barriers to patients attending and adhering to PR contributing to poor uptake and completion rates. As 3rd year medical students during our GP placement, we witnessed patients unable to attend sessions for multiple reasons including time constraints, travel and limited self-efficacy to participate in the programme alongside others, which is reflected in the literature. By creating a home exercise programme, we hoped to overcome these barriers, so that patients are not sent home empty-handed and are empowered to take active steps in managing their condition. This would eventually lead them to engage with PR services. Project Delivery After liaising with and observing physiotherapists deliver a PR session with 20 patients, a patient booklet was produced with accompanying YouTube tutorials to demonstrate what home exercises to perform. To mitigate patients overexerting themselves, each exercise was kept at a low intensity and recovery tips and positions were outlined. The booklet was further refined after our pilot study of 10 patients and 80% of these patients informed us that they would utilise this programme at home. Conclusion After presenting our work to the GPs of Kingston Health Centre, the practice integrated this within their new COPD clinical guidance. We hope that through enabling patients to do the exercises in the comfort of their own home, we empower and encourage them to be more active, less breathless and more independent. With more time, we hope to measure the efficacy of our intervention by following them through with time. References 1. Charlotte E Bolton et al. BTS Guideline for the Pulmonary Rehabilitation in Adults. Thorax. 2013;68(2): 6-10. Available from: https://www.brit-thoracic.org.uk/document-library/guidelines/pulmonary-rehabilitation/bts-guideline-for-the-pulmonary-rehabilitation-in-adults/ [Accessed 28th of June 2019]
Session: Presentation of Best Practice / Service Development Abstracts
Date / Time: Saturday 21st September 08:50 - 09:35
Location: PCRS 2 (Atcham)
Authors: Lewis P, Hughes D, Birchall J, Ramachandran A

Institution: Interface Clinical Services
Presenter: Jack Birchall
Allocation: Poster Presentation
Category: Best Practice / Service Improvement Abstract
Tameside & Glossop CCG has a COPD prevalence of 2.9%, the highest in Greater Manchester and amongst the highest in the UK.(1) This service aimed to support practices in improving COPD management through a proactive assessment of all patients with a diagnosis of COPD. Patients were stratified according to recorded symptoms and exacerbations. At baseline, 23% of the total COPD population (1171 patients) were recorded as having high levels of both symptoms and exacerbations. Following discussion with the lead GP in each practice appropriate patients were invited to GSK sponsored, Interface pharmacist-led clinics. 1133 patients were seen in 123 pharmacist-led clinics across 29 practices. Pharmacists assessed patients’ inhaler technique using an In-Check device and symptoms using MRC and CAT Test scoring. Based on these assessments, pharmacists were then able to recommend appropriate pharmacological and non-pharmacological interventions for GP approval. 58% of patients who had their inhaler technique checked in clinic (667) were found to have sub-optimal inhaler technique despite 537 of them having a recent record of ‘good technique’. As a result, 214 patients were provided with a spacer device and of those patients maintained on their current level of therapy 301 were recommended a change in inhaler device. 41% of patients seen (466) presented with high levels of symptoms and exacerbations and pharmacists recommended an increase in current pharmacological management for 29% of these patients (135). Although a further 29% of these patients already had an appropriate level of pharmacological treatment pharmacists recommended a change in device based on inhaler technique or rationalisation of current regimen. By recommending appropriate non-pharmacological interventions and ensuring patients are prescribed the optimal level of pharmacological treatment in an inhaler device they are best able to use, pharmacist-led programmes such as this can contribute to reducing symptoms and future risk of exacerbations. 1. https://fingertips.phe.org.uk/
Session: Presentation of Best Practice / Service Development Abstracts
Date / Time: Saturday 21st September 08:50 - 09:35
Location: PCRS 2 (Atcham)
Authors: Philip KEJ, Gaduzo S, Rogers J, Laffan M, Hopkinson NS
Institution: National Heart and Lung Institute, Imperial College London
Presenter: Keir Philip
Allocation: Poster Presentation
Category: Best Practice / Service Improvement Abstract
Aim: The British Lung Foundation COPD Patient Passport www.blf.org.uk/passport was developed as a resource to help patients with the condition and clinicians to consider the care they had received and to identify essential omissions. We aimed to use the online data collected to evaluate the delivery of COPD care in the UK from a patient perspective. Method: Each patient passport consists of 13 questions relating to key aspects of COPD care including: spirometry confirmation of diagnosis, understanding their diagnosis, support and a written management plan, vaccinations, smoking cessation, physical activity, exercise, eating well, pulmonary rehabilitation, exacerbations, medications, and yearly reviews. Data were presented as proportions with an answer representing good care, and plotted over time to identify trends. Results: After removing duplicates, data from 41,769 entries, completed online between November 2014 and April 2019, were available (Table 1). Only 24% reported receiving support to manage their care and a written action plan; only 53% could spot the signs of an acute exacerbation; only 34% had discussed pulmonary rehabilitation. A quarter reported not receiving flu vaccination and a third of COPD smokers were not offered support to quit smoking. Even the strongest areas including a spirometry-confirmed diagnosis, and knowing the importance of being active and eating well, achieved only around 80%. Most responses remained stable over time or got slightly worse (Figure 1). Only checking of inhaler technique has improved, though remaining poor with only about two thirds giving a positive response in 2019. Conclusion: Analysis of response to the BLF COPD Patient Passport identifies substantial gaps in the delivery of care. There is little evidence that there has been improvement over the 5 years covered by the data. This highlights the need for new approaches if the ambitions set out in the NHS Long Term Plan are to be met.
Session: Presentation of Best Practice / Service Development Abstracts
Date / Time: Saturday 21st September 08:50 - 09:35
Location: PCRS 2 (Atcham)