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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.

The common chronic respiratory disorders diagnosed in primary care—asthma and chronic obstructive pulmonary disease (COPD)—are both characterised by airway obstruction. In asthma, this varies markedly with time and treatment, while in COPD, the airway obstruction is typically fixed and permanent. Some people have fixed obstruction with some degree of reversibility—the so-called asthma COPD overlap syndrome (ACOS).

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:

In this PCRS Podcast episode, Carol Stonham (Primary Care Nurse and PCRS Policy Lead) is in conversation with Amanda Roberts (PCRS Patient Reference Group and PCRS Education Committee Patient Representative) to delve into the positive and negative aspects of Amanda's asthma reviews of the past, discussing what could and should be better, and how a really good asthma review should be for both the patient and the healthcare professional.

This spring, Primary Care Respiratory Update comes to you with a new focus on asthma. Our contributor bring you pragmatic and succinct information that you can adopt in your practice to support early diagnosis, improved management, reduced reliance on short-acting bronchodilator inhalers and advice on managing patients with severe asthma.

In this one hour live webinar we will cover:

Originally presented at the PCRS Respiratory Conference 2020 Dr Glenis Scadding presents One airway: if they're wheezing, are they sneezing too?