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News – October 2005

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Updated BTS/SIGN guideline aims to raise awareness of occupational asthma

GPs should consider a diagnosis of occupational asthma in patients who present with adult onset asthma or a reappearance of childhood asthma, according to the latest guidance from the BTS and SIGN.

The second annual update of the British guideline on the management of asthma is due to be published electronically later this month.

Adults with airflow obstruction should be asked whether they are better on days away from work or on holiday.

Patients who give positive responses should be investigated for occupational asthma, the guideline says.

“Surveys suggest that up to 15% of adult onset asthma cases may have an occupational cause for their symptoms yet routine identification is rare – indeed in primary care many clinicians will struggle to remember when they last diagnosed occupational asthma,” said GP Dr Hilary Pinnock, a member of the guideline development group.

“Perhaps the most important message for primary care clinicians is the need to consider occupational causes for asthma starting, or recurring in, adult life,” she told Guidelines in Practice.

Serial peak flow measurements are recommended to confirm the diagnosis, with at least four readings a day.

“Although specific bronchial provocation testing is considered to be the gold standard diagnostic test, serial peak flow measurements offer good specificity and sensitivity and can be carried out in general practice,” explained Dr Pinnock.

Recommendations on the use of inhaler devices have also been revised. The updated guideline recommends that patients of all ages, including fants, with mild and moderate exacerbations of asthma should be treated by pMDI plus a spacer with doses titrated according to clinical response.

The updated guideline contains further evidence that patients with milder asthma will also benefit from asthma action plans.

The national evidencebased guideline is produced jointly by the British Thoracic Society and the Scottish Intercollegiate Guidelines Network. The two organisations have pioneered the concept of a ‘living guideline’ i.e. a guideline that is continually updated to keep track of the evidence.

Fast-developing areas of the guideline are subject to a rolling programme of appraisal and review, and the on-line version is updated each year.

The updated version should be published on the BTS and SIGN websites (www.brit-thoracic.org.uk and www.sign.ac.uk) at the end of October.

Northern Ireland GPs achieve highest QOF scores

The average practice score in Northern Ireland was 989 out of a maximum of 1050 points in the first year of the nGMS contract (1 April 2004 – 31 March 2005), figures released last month have shown. Data published earlier this year revealed an average score of 971 for practices in Scotland compared with 959 for England and 949 for Wales.

NICE launches guideline to improve detection of depression in children

GPs and other healthcare professionals dealing with children in the community should receive training to detect symptoms of depression and assess children who may be at risk, according to the latest guidance from NICE.

The evidence-based guideline, published last month, contains an algorithm on recognition, detection and referral and another on assessment and management.

Around 1% of children and 3% of adolescents suffer from depression each year.

“Depression in children is more common than many people realise and often goes unrecognised,” explained Professor Peter Fonagy, chair of the guideline development group.

“It can lead to a greatly increased risk of mental health problems in adult life and can dramatically increase the lifetime risk of suicide, from 1.3% to 6%,” he added.

Dr Alan Cohen, Director of Primary Care, Sainsbury Centre for Mental Health, welcomed the guideline. “Detecting depression is always challenging and especially so in children. The NICE guideline is helpful and will improve GPs’ confidence in making an effective assessment,” Dr Cohen told Guidelines in Practice.

Children and young people with moderate to severe depression should be offered psychological therapy as first-line, treatment, the guideline states. It recommends treatment with cognitive behavioural therapy, interpersonal therapy or family therapy for at least 3 months.

“The evidence supporting these treatments is robust and it is vital that the NHS provides psychological therapies to ensure everyone who needs these treatments can access them rapidly,” commented Dr Tim Kendall, Joint Director of the National Collaborating Centre for Mental Health.

His view was echoed by Dr Cohen. “While I believe that most GPs will welcome the fact that it is explicit that talking therapies are effective as a first-line intervention, access to the service is variable throughout the country.

“It will be interesting to see if the current NHS re-organisation and the advent of practice-based commissioning, will improve the situation,” he added.

Copies of Clinical Guideline 28. Depression in children and young people. Identification and management in primary, community and secondary care can be downloaded from the NICE website: www.nice.org.uk.

Quick reference guide on pressure ulcers

NICE has published a concise guide on the prevention and management of pressure ulcers in the form of an algorithm. The new guide, developed by the RCN, summarises the existing NICE guideline on pressure ulcer prevention and incorporates the key recommendations from the RCN guideline on the management of pressure ulcers in primary and secondary care, published in September. Copies of Clinical Guideline 29. The prevention and treatment of pressure ulcers can be downloaded from the NICE website: www.nice.org.uk.

BNF for Children published

A paediatric version of the BNF was launched last month.The handbook contains prescribing information on medicines for children from the neonatal stage through to adolescence. The British National Formulary for Children will be updated annually to include the latest evidence and innovative treatments.

Guidelines in Practice, October 2005, Volume 8(10)
© 2005 MGP Ltd
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