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- Volume 9 - Edition 9
News – September 2006
Contents
- BTS guideline highlights differences between acute and chronic cough
- Final guidance issued on Herceptin for early breast cancer
- News in Brief - Advisors appointed for COPD NSF
- News in Brief - New work programme topics referred to NICE
BTS guideline highlights differences between acute and chronic cough
The British Thoracic Society (BTS) has published evidence-based guidelines for the management of cough in adults. A clear distinction is made between acute cough and chronic cough, and the differences in management are detailed in the guidance.
Acute cough is defined by the following characteristics: it lasts less than 3 weeks; it is usually associated with a viral upper respiratory tract infection; it is normally self-limiting and benign; it is a common cause of acute exacerbations and hospitalizations with asthma and COPD; it is the most common new presentation in primary care.
In the absence of other significant symptoms, acute cough can be the first indication of a more serious condition.
Chronic cough is defined as follows: it lasts for more than 8 weeks; it is reported by 10%–20% of adults; it is most common in obese people and middle-aged women; it causes a similar detriment in quality of life to COPD.
Most types of chronic cough are indicative of an aggravant, such as asthma, drugs, or upper airway disease. However, the cause of 25% of chronic cough cases is unspecified.
The need for further research into 'undiagnosed' chronic cough is highlighted by the guideline: 'Chronic cough is a common condition which is currently under-researched. While an attempt is being made to understand the condition and create better diagnostic protocols and treatments, there are still a significant number of patients who we can't help with specific treatment,' stated Professor Ian Pavord, co-chair of the guideline development group.
Final guidance issued on Herceptin for early breast cancer
NICE has issued its final guidance to English and Welsh health service trusts on the use of trastuzumab (Herceptin) for the treatment of early stage breast cancer in women with HER2 positive disease who are free of heart disease.
The final guidance recommends that Herceptin is provided at 3-week intervals for 1 year, or until disease recurrence – whichever is sooner – following surgery, chemotherapy, and radiotherapy, if applicable. Cardiac function should be assessed before treatment starts, and repeated quarterly.
Herceptin should be avoided in women who have a left ventricular ejection fraction of 55% or less; a history of congestive heart failure; high risk uncontrolled arrhythmias; angina pectoris requiring medication; clinically significant valvular disease; evidence of transdermal infarction on ECG; or poorly controlled hypertension.
NICE Chief Executive Andrew Dillon stated: 'Our assessment of Herceptin shows that it is clinically and cost effective for women with HER2 positive early breast cancer.The guidance has been issued rapidly, to ensure consistent use across the NHS, and was produced in draft form just 2 weeks after the licence extension for Herceptin was granted. We plan to continue appraising certain technologies rapidly and close to when they are licensed.'
Advisors appointed for COPD NSF
The members of the external reference group for the new National Service Framework for COPD have been announced.The 19-strong team of advisors is drawn from primary care, secondary care, commissioning, the acute sector, physiotherapy, nursing, and PCT management.
The group will advise on the development of the framework, and ensure that the needs of patients are met. It will be jointly chaired by Professor Peter Calverley (President of the BTS) and Professor Sue Hill (Chief Scientific Officer at the DH).
Professor Hill stated: 'The COPD NSF gives us the opportunity to improve the care of people with this disabling condition and to take the lead internationally in the implementation of effective COPD services.'
Dr Rupert Jones and Dr Noel O'Kelly, both members of GPIAG, will provide the primary care perspective.
New work programme topics referred to NICE
The Secretary of State for Health has referred eight further public health topics to NICE in line with the Institute's widened remit to include the development of guidance that promotes good health, and prevents and treats ill health.Topics include strategies for reducing the harm from smoking, and sensible drinking information for schools.
Eleven technology appraisal topics have also been referred including drugs for refractory RA, and the treatment of sleep apnoea.
Andrew Dillon, NICE Chief Executive, has welcomed the referral of new topics across the NICE work programmes, and announced that detailed timetables will be available on the website shortly.
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Guidelines in Practice, September 2006, Volume 9(9) |