Guidance and Best Practice

In an ideal world, asthma review appointments will be between 20 to 30 minutes in duration. But we are not living in an ideal world. Staff shortages due to ill health, burnout, and workforce issues are compounding an already pressured system, and in many practices, the maths doesn’t stack up; there are simply not enough hours in the year to see everybody in the recommended time. If practices are struggling to recruit staff to do the reviews, the time allocation for asthma reviews may be reduced to 10 minutes.

The Medicines and Healthcare Products Regulatory Agency (MHRA) has for the first time approved the use of a dual (ICS/beta-agonist) combination treatment to be prescribed as a reliever therapy for people aged 12 and over with the therapy choice situated early in the asthma treatment pathway as an alternative to its current use as a preventer therapy sitting later in traditional treatment pathways.

To consider how and when we use FeNO testing, we need to go to the definition of asthma. Both BTS/SIGN1 and GINA2 define it as a predominantly inflammatory disorder of the airways with airway hyperresponsiveness and variability in symptoms. Nitric oxide is a gas involved in the respiratory process and is present in the atmosphere in very small amounts (parts per billion). It can be easily measured in exhaled breath using a fractional exhaled nitric oxide (FeNO) test.

Asthma is a long-term condition characterised for the vast majority by trigger induced eosinophilic airway inflammation resulting in wheeze, breathlessness, cough, and chest tightness. Before embarking on any treatment for asthma, it is essential to ensure that you, as the prescriber, can describe to the person with asthma:

According to the Global Initiative for Asthma (GINA) asthma control is assessed in two domains: symptom control and risk of adverse outcomes.  Poor symptom control is budensome to patients and increases the risk of exacerbations, but patients with good symptom control can still have severe exacerbations.[1]

Resources from the Academic Health Science Network (AHSN) Programme

This pragmatic guide on the identification, referral and ongoing management of adults and children with severe asthma has been developed by an expert group led by Dr Steve Holmes, a GP based in Shepton Mallet, Somerset and including Will Carroll, University Hospital of the North Midlands, Stoke-on-Trent, Fiona Mosgrove, Clinical Lead Grampian Respiratory Improvement Programme, Angela Pugh of the University Hospital of Llandough Cardiff & Vale University Health Board and Robert Stone, Taunton and Somerset NHS Foundation Trust.

Blowing away the myths and facts around asthma management.