As many as 4,498 nurses working with patients with respiratory disease may not be providing appropriate care or treatment for their patients, according to a survey conducted by the charity Education for Health.
The national survey into the roles and training of respiratory nurses in 389 general practices in the UK found 20% of asthma nurses and 52% of COPD nurses with an advanced role (autonomously conducting diagnostic and follow-up consultations) had no accredited asthma training. It also revealed that between 41% and 45% did not have immediate access to a GP should they require one.
Of the 52% of COPD nurses with an advanced role and no accredited COPD training, 92% of these had no accredited spirometry training. Spirometry is the main diagnostic tool for COPD and is important for confirming a diagnosis of asthma.
Samantha Prigmore, chairperson of the Association of Respiratory Nurse Specialists, voiced concerns that: ‘Inadequate training and support could result in a misdiagnosis and inappropriate treatment being commenced.’
Education for Health launched a Patient Charter for patients with long-term conditions at the House of Lords on 10 October. This can be viewed at www.educationforhealth.org.uk
Fears of child asthma raise A&E attendance
Passive smoking, damp homes or poor routine asthma care does not explain high rates of inner-city use of A&E in children with asthma, according to researchers in the UK.
A case-controlled study including 1,018 children who attended A&E for asthma over 12 months and 394 children who had not attended A&E for asthma over the previous year showed risk factors including having a parent who felt panic or fear when their child had asthma symptoms.
Parents also attended A&E, thinking they would be seen faster than at a GP surgery. There was a reduced risk of this when they were confident the GP could treat asthma attacks.
The authors suggest appropriate settings for treating children with asthma attacks need to be identified and patients made aware of them.
Forbes, L. et al (2007) Risk factors for accident and emergency (A&E) attendance for asthma in inner-city children. Thorax; 62: 10, 855–860.
Antibiotic use does not reduce the risk of URTI complications
The use of antibiotics cannot be justified to reduce the risk of serious complications associated with upper respiratory tract infections (URTIs), sore throats or otitis media, according to research published in BMJ online.
However, the authors of the research concluded that antibiotics substantially reduce the risk of pneumonia after chest infection, particularly in older people who are at greater risk of this complication.
The retrospective cohort study used data from the UK General Practice Research Database on 3.36 million episodes of respiratory tract infection.
Peterson, I. et al (2007) Protective effects of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK general practice database. BMJ online. DOI:10.1136/bmj.39345.405243.BE.
Scottish seal of approval for omalizumab
Omalizumab (Xolair) has been approved by the Scottish Medicines Consortium for the treatment of severe asthma.
The drug is used as an ‘add-on therapy’ in a fortnightly injection for adults and adolescents (12 years and above) with asthma that is severe, persistent and allergic.
Therapy must be started and monitored by hospital physicians experienced in diagnosing and treating severe, persistent asthma. It is restricted to patients who are prescribed chronic systemic steroids and in whom all other treatments have failed.
The consortium advises that the patient’s response to omalizumab should be assessed at 16 weeks and treatment should be discontinued in those who have not shown an improvement in overall asthma control.
Stop smoking services receive guidance
Stop smoking services should aim to treat at least 5% of their local population of smokers in the course of 2007–2008. This is one of the key challenges in updated guidance from the Tobacco Programme.
The guidance suggests that services need to focus on increasing access to services for manual workers and black and minority ethnic groups with high smoking rates. It also recommends that services provide repeat interventions to those who are motivated to make a quit attempt following a relapse. Stop smoking services should also be developed for pre-operative patients and in partnership with acute trusts.
The guidance is intended for everyone involved in managing, commissioning or delivering NHS stop smoking services.