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8 - Monitoring skills

Published online by Cambridge University Press:  10 January 2011

By
Trisha Weller
Edited by
Molly Courtenay  and
Matt Griffiths
Foreword by
June Crown
Molly Courtenay
Affiliation:
University of Surrey
Matt Griffiths
Affiliation:
University of the West of England, Bristol
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Summary

Part a – Asthma

Asthma is common in the UK, with over 5.2 million people with asthma, and more than 3 million receiving current treatment (National Asthma Campaign (NAC) 2001). Approximately 2.6 million people with asthma still have serious symptoms, mostly due to a failure of asthma management (Asthma UK 2004). The prevalence of asthma has risen over the last 30 or more years (British Thoracic Society (BTS) 2001) and the majority of asthma patients are cared for within primary care.

Asthma – the disease

Asthma is a reversible airways disease characterised by bronchoconstriction, inflammation, oedema and mucus production; more recent descriptions also include airways hyper-responsiveness. Asthma is reversible either spontaneously or with anti-asthma treatment.

The estimated prevalence rate of asthma in young children varies from 12.5% to 15.5%, while in adults current symptomatic asthma is reported by 7.8% of people (NAC 2001). There is a wide spectrum of disease severity, and treatment requirements vary. Control of asthma is assessed against a standard of (BTS/Scottish Intercollegiate Guidelines Network (SIGN) 2008):

  • No daytime symptoms.

  • No night-time awakening due to asthma.

  • No need for rescue medication.

  • No exacerbations.

  • No limitation on activity including exercise.

  • Normal lung function (in practical terms, forced expiratory volume in one second (FEV1) and/or peak expiratory flow (PEF) more than 80% predicted or best).

Nurse involvement in asthma management

Primary care-based nurses have been involved with asthma management since the General Medical Services contract (Department of Health and Social Security (DHSS) 1990) and the Health of the Nation White Paper (Department of Health (DoH) 1992).

Information

Type
Chapter
Information
Independent and Supplementary Prescribing
An Essential Guide
 , pp. 86 - 106
Publisher: Cambridge University Press
Print publication year: 2010

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References

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,Department of Health (1992). The Health of the Nation: A Strategy for Health in England, London: HMSO.Google Scholar
,Department of Health (2003). Investing in General Practice: The New General Medical Services Contract. London: DoH.Google Scholar
,Department of Health and Social Services (1990). General Practice in the National Health Service. A New Contract. London: HMSO.Google Scholar
Dickinson, J., Hutton, S., Atkin, A. et al. (1997). Reducing asthma morbidity in the community: the effect of a targeted nurse-run asthma clinic in an English general practice. Respiratory Medicine 91: 634–640.CrossRefGoogle Scholar
Fleming, D.M., Sunderland, R., Cross, K.W. et al (2000). Declining incidence of episodes of asthma: a study of trends in new episodes presenting to general practitioners in the period 1989–1998. Thorax 55(8): 657–661.CrossRefGoogle Scholar
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,Royal College of Paediatricians and Child Health (2003). The use of unlicensed medicines or licensed medicines for unlicensed applications in paediatric practice. In: Medicines for Children (second edition). London: RCPCH Publications Limited, pp. xvi–xviii.Google Scholar
Todd, G., Dunlop, K., McNaboe, J. et al. (1996). Growth and adrenal suppression in asthmatic children treated with high-dose fluticasone propionate. Lancet 348: 27–29.CrossRefGoogle ScholarPubMed
Todd, G.R.G., Acerini, C.L., Buck, J.J. et al. (2002). Acute adrenal crisis in asthmatics treated with high-dose fluticasone propionate. European Respiratory Journal 19: 1207–1209.CrossRefGoogle ScholarPubMed
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,British Thoracic Society (2001). The Burden of Lung Disease. A Statistics Report from the British Thoracic Society. London: BTS.Google Scholar
,British Thoracic Society/SIGN (2008). British Guideline on the Management of Asthma. Revised ed. Thorax 63(Suppl IV).Google Scholar
,Committee on Safety of Medicine/MCA (2002). Extension of the Yellow Card Scheme to Nurse Reporters. London: CSM/MCA.Google Scholar
,Department of Health (1992). The Health of the Nation: A Strategy for Health in England, London: HMSO.Google Scholar
,Department of Health (2003). Investing in General Practice: The New General Medical Services Contract. London: DoH.Google Scholar
,Department of Health and Social Services (1990). General Practice in the National Health Service. A New Contract. London: HMSO.Google Scholar
Dickinson, J., Hutton, S., Atkin, A. et al. (1997). Reducing asthma morbidity in the community: the effect of a targeted nurse-run asthma clinic in an English general practice. Respiratory Medicine 91: 634–640.CrossRefGoogle Scholar
Fleming, D.M., Sunderland, R., Cross, K.W. et al (2000). Declining incidence of episodes of asthma: a study of trends in new episodes presenting to general practitioners in the period 1989–1998. Thorax 55(8): 657–661.CrossRefGoogle Scholar
Hawkins, G., McMahon, A.D., Twaddle, S. et al. (2003). Stepping down inhaled corticosteroids in asthma: a randomised controlled trial. British Medical Journal 326: 1115–1118.CrossRefGoogle ScholarPubMed
,Medicines Control Agency (2002). Proposals for Supplementary Prescribing by Nurses and Pharmacists and Proposed Amendments to the Prescription Only Medicines (Human Use) Order 1997. MLX 284. London: MCA.Google Scholar
,National Asthma Campaign (2001). Out in the open. Asthma Journal 6(3) (suppl): 1–14.Google Scholar
,Royal College of Paediatricians and Child Health (2003). The use of unlicensed medicines or licensed medicines for unlicensed applications in paediatric practice. In: Medicines for Children (second edition). London: RCPCH Publications Limited, pp. xvi–xviii.Google Scholar
Todd, G., Dunlop, K., McNaboe, J. et al. (1996). Growth and adrenal suppression in asthmatic children treated with high-dose fluticasone propionate. Lancet 348: 27–29.CrossRefGoogle ScholarPubMed
Todd, G.R.G., Acerini, C.L., Buck, J.J. et al. (2002). Acute adrenal crisis in asthmatics treated with high-dose fluticasone propionate. European Respiratory Journal 19: 1207–1209.CrossRefGoogle ScholarPubMed
Weller, T., Booker, R., Walker, S. (2001). Declining incidence of episodes of asthma: letter. Thorax 56(3): 246.Google Scholar
Allender, S., Peto, V., Scarborough, P. et al.(2008). Coronary Heart Disease Statistics. London: British Heart Foundation.Google Scholar
Allender, S., Scarborough, P., Peto, V. et al. (2008). European Cardiovascular Disease Statistics. Brussels: European Heart Networks.Google Scholar
,Antithrombotic Trialists' Collaboration (2002). Collaborative meta-analysis of randomised trials of antiplatelet therapy for the prevention of death, myocardial infarction and stroke in high-risk patients. British Medical Journal 324(7329): 71–86.CrossRefGoogle Scholar
Baigent, C., Keech, A., Kearney, P.M. et al. ,Cholesterol Treatment Trialists' (CTT) Collaborators (2005). Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90056 participants in 14 randomised trials of statins. Lancet, 366: 1267–1278.Google ScholarPubMed
,Blood Pressure Lowering Treatment Trialists' Collaboration (2005). Effects of different blood pressure-lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized trials. Archives of Internal Medicine 165(12): 1410–1419.CrossRefGoogle Scholar
,Clinical Knowledge Summaries (2008). Antiplatelet treatment, http://www.cks.nhs.uk/antiplatelet_treatment (accessed 31 December 2008).
,Department of Health (1994). Nutritional Aspects of Cardiovascular Disease. Report of the Cardiovascular Review Group of the Committee on Medical Aspects of Food Policy. London: HMSO.Google Scholar
,Department of Health (2000). National Service Framework for Coronary Heart Disease. London: Department of Health.Google Scholar
,Department of Health (2004). Health Survey for England 2003. London: The Stationery Office.Google Scholar
,Diabetes UK (2008). Diabetes prevalence 2008, http://www.diabetes.org.uk/Professionals/Information_resources/Reports/Diabetes-prevalence-2008/ (accessed 31 December 2008)
Doll, R., Peto, R., Boreham, J. et al. (2004). Mortality in relation to smoking: 50 years' observations on male British doctors. British Medical Journal, 328: 1519–1527.CrossRefGoogle ScholarPubMed
,Joint British Societies (2005). JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart, 91(Suppl 5): v1–v52CrossRefGoogle Scholar
,Joint Health Surveys Unit (2008). Health survey for England 2006. Cardiovascular disease and risk factors. Leeds: the Information Centrehttp://www.ic.nhs.uk/webfiles/publications/HSE06/HSE%2006%20report%20VOL%201%20v2.pdf (accessed 30 December 2008).Google Scholar
,National Institute for Health and Clinical Excellence (2006). Public health intervention guidance no.1. Brief interventions and referral for smoking cessation in primary care and other settings. March 2006, http://www.nice.org.uk/nicemedia/pdf/SMOKING-ALS2_FINAL.pdf (accessed 1 January 2009).
,National Institute for Health and Clinical Excellence (2008). Lipid modification. Cardiovascular risk assessment: the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. Clinical Guideline 67. May 2008, http://www.nice.org.uk/nicemedia/pdf/CG067NICEGuideline.pdf (accessed 1 January 2009).
,National Prescribing Centre (1999). Signposts for prescribing nurses – general principles of good prescribing. Liverpool: National Prescribing Centre, http://www.npc.co.uk/nurse_bulletins/sign1.1.htm (accessed 31 December 2008).Google Scholar
,Royal College of Physicians Tobacco Advisory Group (2005). Going smoke-free. The medical case for clean air in the home, at work an in public places, http://www.rcplondon.ac.uk (accessed 31 December 2008).
Schildkraut, J.M., Myers, R.H., Carrison, R.J. (1989). Coronary risk associated with age and sex or parental heart disease in the Framingham Heart Study. American Journal of Epidemiology, 64: 555–559.Google ScholarPubMed
,Scottish Intercollegiate Guidelines Network (2007). Risk estimation and the prevention of cardiovascular disease, http://www.sign.ac.uk/pdf/sign97.pdf (accessed 30 December 2008).
Stead, L.F., Perera, R., Bullen, C. et al. (2008). Nicotine replacement therapy for smoking cessation (Cochrane Review). The Cochrane Library.John Wiley & Sons, Ltd, http://www.thecochranelibrary.com (accessed 1 January 2009).Google ScholarPubMed
,UK Prospective Diabetes Study Group (1998). Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 352(9131): 854–865CrossRefGoogle Scholar
,WeMeReC (2005). Type 2 diabetes important aspects of care. WeMeReC, http://www.wemerec.org/Documents/ Bulletins/ Diabetes_bulletin.pdf (accessed 30 December 2008).
,World Health Organization (2003) Diet, Nutrition and the Prevention of Chronic Diseases. Geneva, WHO,http://whqlibdoc.who.int/trs/who_TRS_916.pdf (accessed 30 December 2008).Google Scholar
Yusuf, S., Hawken, S., Ôunpuu, S. et al. ,on behalf of the INTERHEART Study Investigators (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet, 64: 937–952.CrossRefGoogle Scholar

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