Respiratory Theme Peer Group Discussion

Bronchiolitis

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

1. What aspects do you find most challenging when managing patients with bronchiolitis?
2. In your opinion, what are the main features that dictate how you will manage a patient with bronchiolitis?
3. Do you use an objective scoring system to assess severity or do you tend to rely on clinical judgement? If a scoring system is used, what is it and why?
4. What are some ways that you have found useful in your own practice to reassure parents that their child can be managed at home?

Managing adults with asthma in primary care

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

1. What are some of the most challenging aspects of managing asthma in adults?
2. Māori and Pacific peoples are more severely affected by asthma. How do you address ethnic inequalities in asthma management in your practice?
3. Have you used the Asthma Control Test in clinical practice? Was it helpful or not?
4. How do you normally address smoking cessation in patients with asthma? What techniques have you found most successful?
5. Do you routinely offer adults with asthma a printed “Asthma Action Plan”? If so, do patients find this useful? Do you update it when the patient’s treatment changes? If you don’t use an action plan for adults, would you reconsider after reading this article?

Inhaled corticosteroids for adults with asthma

Inhaled corticosteroids for adults with asthma

1. What factors do you base your decision on when considering whether to initiate an ICS?
2. What is your usual approach to initiating an ICS and following up patients to assess control?
3. What is your impression from your own practice regarding adherence to inhaled corticosteroids? How do you discuss, assess and improve adherence?

Adding a long-acting beta₂-agonist

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

1. If a patient taking an ICS at a standard dose is unable to achieve good control of their symptoms, it is recommended that, after checking adherence and managing co-morbidities, a LABA is added to their treatment regimen rather than increasing the dose of ICS. Does this reflect your current practice? What is your usual approach to escalating treatment?
2. When you add a LABA to a patient’s treatment regimen, there are two main strategies for doing this:
   • Change the ICS inhaler to a LABA/ICS combination inhaler and continue with the SABA inhaler; OR
   • Change the ICS inhaler to a LABA/ICS combination inhaler and use this as “single inhaler treatment”, discontinuing the SABA inhaler
   Do you have a preference when prescribing for either ICS/LABA inhaler with a SABA reliever or single inhaler treatment? What do you find that patients prefer?
3. The use of a single inhaler (ICS+LABA) as both preventer and reliever can sometimes cause confusion in patients accustomed to also using a SABA. What strategies have you found successful when helping patients transition to single inhaler treatment?

Pulmonary rehabilitation for people with COPD

Pulmonary rehabilitation for people with COPD

1. Before reading this article, were you familiar with the concept of pulmonary rehabilitation for patients with COPD? What is your understanding of what pulmonary rehabilitation is?
2. Were you aware that you could refer patients to pulmonary rehabilitation programmes? What has been your experience, if any, with these programmes? Have you had any feedback from patients?
3. Thinking about your practice population, can you come up with any strategies you could try for patients unable to attend a programme?
4. What are some of the barriers to exercising that patients with COPD may experience? How would you address these issues?
5. Have you ever taught a patient with COPD “The active cycle of breathing” techniques? If so, do you think this helped them? If not, would you feel confident explaining this method to patients?