Indication for consultant referral Diagnosis unclear. Failure to control symptoms at Step 4. Consideration for home nebs or home oxygen. Acute severe exacerbations. Troublesome drug side effects or complications of Rx/asthma. Suspected occupational asthma At repeat medication re-authorisation doctors must look at: Beta 2 agonist over usage arrange GP or asthma review? – Spacer on repeat script? Check when last issued. Steroid card needed? Has it been issued? Oral steroid/high dose inhaled steroid usage and need for osteoporosis prophylaxis. Correct Read H33 Read coding & is it in the Problem page? Annual review in date Other News: Relvar Combined ICS/LABA. Once daily. Fluticasone furoate (not proprionate). High potency steroid, so only for BTS step 4 + Vilanterol. Little experience/safety/evidence of superiority. A not yet drug? Tiotropium. Now licensed in adult asthma. Respimat device. Option at step 4. DTB point out limited evidence. SIT (single Inhaler Therapy) regimes are sometimes used. Idea is to use ICS/LABA combo as reliever as well as preventer. Only works with rapid onset of action of LABA eg. Formoterol ( in Fostair, Symbicort) From October 2014 schools have been allowed to purchase a of salbutamol MDIs and spacers for emergency use. Bronchial thermoplasty- 2o care treatment offered to severe adult asthmatics to reduce excessive smooth muscle. Omalizumab. An anti-IgE monoclonal antibody in a few centres. Costly. QOF 2017/18 AST001 asthma register AST002 variability at diagnosis (8 and over) AST003 annual review incl MRC 3 questions AST004 19yrs smoking status recorded annually – References
Indication for consultant referral Diagnosis unclear. Failure to control symptoms at Step 4. Consideration for home nebs or home oxygen. Acute severe exacerbations. Troublesome drug side effects or complications of Rx/asthma. Suspected occupational asthma At repeat medication re-authorisation doctors must look at: Beta 2 agonist over usage – arrange GP or asthma review? Spacer on repeat script? Check when last issued. Steroid card needed? Has it been issued? Oral steroid/high dose inhaled steroid usage and need for osteoporosis prophylaxis. Correct Read H33 Read coding & is it in the Problem page? Annual review in date Other News: Relvar Combined ICS/LABA. Once daily. Fluticasone furoate (not proprionate). High potency steroid, so only for BTS step 4 + Vilanterol. Little experience/safety/evidence of superiority. A not yet drug? Tiotropium. Now licensed in adult asthma. Respimat device. Option at step 4. DTB point out limited evidence. SIT (single Inhaler Therapy) regimes are sometimes used. Idea is to use ICS/LABA combo as reliever as well as preventer. Only works with rapid onset of action of LABA eg. Formoterol ( in Fostair, Symbicort) From October 2014 schools have been allowed to purchase a of salbutamol MDIs and spacers for emergency use. Bronchial thermoplasty- 2o care treatment offered to severe adult asthmatics to reduce excessive smooth muscle. Omalizumab. An anti-IgE monoclonal antibody in a few centres. Costly. QOF 2017/18 AST001 asthma register AST002 variability at diagnosis (8 and over) AST003 annual review incl MRC 3 questions AST004 – 19yrs smoking status recorded annually References
Asthma%20for%20BRS%20CDM%202017.docx