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BPJ 79 September 2017

Best Practice Journal

Managing adults with asthma in primary care: the four-stage consultation

The New Zealand adult asthma guidelines were released by the Asthma and Respiratory Foundation of New Zealand in November, 2016. In the first of a series on adult asthma, this resource outlines the four-stage consultation, which is a framework for managing patients with asthma in primary care (an appendix in the Guidelines). View Article

Inhaled corticosteroids for adults with asthma

A key decision in asthma management is when to initiate an inhaled corticosteroid (ICS). It is clear that patients with weekly asthma symptoms are likely to benefit from ICS treatment. However, emerging evidence suggests that patients with less frequent symptoms, e.g. monthly, will also benefit from ICS treatment, although adherence is often low in this group. It is recommended that clinicians offer an ICS to patients according to their treatment goals. View Article

Adding a long-acting beta2-agonist (LABA) to asthma treatment for adults

If a patient using an inhaled corticosteroid for asthma has symptoms which are not adequately controlled, clinicians should consider adding a LABA to their regimen in the form of a combined ICS/LABA inhaler. Use of an ICS/LABA inhaler as both reliever and preventer treatment is preferred for patients at high risk of exacerbation, known as single inhaler treatment. View Article

Pulmonary rehabilitation for people with COPD

Pulmonary rehabilitation is a behavioural intervention for patients with chronic obstructive pulmonary disease (COPD) that improves symptom control and quality of life, reduces hospital admissions and teaches self-management skills. There are a variety of pulmonary rehabilitation programmes available, all of which offer supervised exercise and education to motivate patients and promote sustainable behaviour change. Health professionals in primary care can raise awareness of pulmonary rehabilitation, refer patients to programmes, recommend personalised exercise for those unable to attend formal programmes and provide ongoing support to patients who have completed programmes to help them maintain the benefits they have gained. View Article

Bronchiolitis: when to reassure and monitor, and when to refer

Bronchiolitis is a lower respiratory tract infection, most often caused by Respiratory Syncytial Virus (RSV). In severe illness it is associated with increased respiratory effort, difficulty feeding, dehydration and cyanosis. Bronchiolitis typically affects infants aged under 12 months, with young infants or those born premature at greater risk of severe illness. For infants with mild illness and without risk factors for deterioration, caregivers can be reassured that conservative treatment is appropriate. Infants with more severe symptoms or underlying conditions which predispose them to deterioration may require referral to hospital. View Article

The bpacnz antibiotic guide: 2017 edition

The 2017 edition of the bpacnz antibiotics guide; "Antibiotics: choices for common infections", is now available online. There are several new features of this guide, along with some changes in advice. The release of the guide is also an opportunity to revise recommendations for prescribing in respiratory tract infections, including strategies for managing patient expectations. View Article

4% dimethicone lotion: a subsidised treatment for head lice

From 1 May, 2017, 4% dimethicone lotion can be prescribed fully subsidised for the treatment of head lice, which adds another treatment option to the currently subsidised 0.5% phenothrin shampoo. Lice are unlikely to develop resistance to dimethicone lotion as it is not an insecticide and instead kills lice by suffocation. Head lice infestation is a perennial problem in New Zealand, mainly affecting children. An infestation can easily spread to other members of the household, friends or classmates. Head lice often cause itching or irritation of the scalp, which may result in discomfort and disruption of sleep. In some children with a heavy infestation, scratching of the scalp can result in bacterial skin infection.1 View Article