General practice nurses (GPNs) are well placed to ensure that patients with respiratory conditions receive high quality, safe, effective, evidence-based care. The National Review of Asthma Deaths (NRAD) (Royal College of Physicians [RCP], 2014) found that two out of three asthma deaths could have been prevented with better routine care. The key components of good asthma care, including the importance of correct inhaler technique, were highlighted by this landmark report. Poor inhaler technique is known to adversely impact upon control of respiratory disease and its symptoms. In 2013, the National Institute for Health and Care Excellence (NICE) published Asthma Quality Standards. However, NRAD found that despite the existence of such solid recommendations and guidance there were potentially avoidable factors related to the implementation of national guidelines in 46% of the deaths that were reviewed. Most recently, the Chronic Obstructive Pulmonary Disease (COPD) Quality Standard was added as an update to COPD guidance (NICE, 2016). Both documents include quality standards around inhaler technique.
Spirometry is very easy to do, and very easy to get wrong (Martin, 2010; personal communication). Not only is quality
assured spirometry dependent on the effort exerted by the patient, and the technical ability of the spirometer operator,
but also on the understanding of the results by the person interpreting them.
Interpretation of the results is essential if any meaningful decision is to be made about the patient’s care.
Respiratory disorders, in particular asthma and chronic obstructive pulmonary disease (COPD), have been recognised for many years and remain among the most common chronic long-term conditions that are seen in primary care. Despite the development of guidelines, standards and effective treatments, both diseases continue to carry a high morbidity and mortality, a significant societal cost in terms of lost school and work days, and high consultation and admission rates.This article follows the development of our knowledge of these common disorders and looks at how far we have progressed in our diagnosis, knowledge and treatments, as well as what the future may look like in terms of care management and treatment options.
Asthma is a common long-term condition affecting adults and children. Despite a number of evidence-based guidelines for treatment and new medications and inhaler devices, mortality rates remain static. Key findings from the National Review of Asthma Deaths (Royal College of Physicians [RCP], 2014) highlighted the importance of personalised asthma action plans (PAAPs) in good asthma care. This article looks at how healthcare professionals need to work with adults and children with asthma, involving them throughout the process, to produce a meaningful, useful plan that has been developed with the person, and parents or carers. The plan should be used as an educational tool to help understand how, when and why asthma medication should be used, what is meant by asthma control, and recognition of when control is slipping.
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