Gemma Lambert, Editor of Guidelines in Practice, ponders the relationship between a wedding dress and an asthma action plan, and summarises the articles in the March 2019 issue

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When I’m not sat behind a desk with my Editor hat on, one of my hobbies is sewing (bear with me on this, it is loosely relevant). Last year, I embarked on my most ambitious project to date: I made my own wedding dress. One thing I learnt was how important it was to tailor the dress to my individual dimensions in order to get the perfect fit. This involved cutting up a number of commercial dress patterns and adapting them to suit my shape and the design I had created. So, what do a wedding dress and an asthma action plan have in common? To get the best results, they must be tailored to the individual.

Our new Pharmacist focus series continues with a piece on asthma. Garry McDonald describes a number of key reports that can be generated by practice-based pharmacists to assess the current state of asthma care at the local level, and explains how to carry out a structured, pragmatic annual asthma review. The annual asthma review should be patient-centred and focus on empowering patients to self-manage and monitor their asthma. All patients with asthma should have a written personalised asthma action plan detailing how to maintain asthma control, identify a lack of control, and act after an asthma event. The patient’s asthma action plan should be personalised to detail their trigger factors, typical ‘good’ peak flow, inhaler strength and dose, and spacer device usage. Educating patients about asthma and good inhaler technique is crucial, and as the author points out, ‘the best inhaler on the market today is the one that the patient can use, does use, and will use.

The range of available medications is continually growing and evolving, meaning that practitioners have ever more treatment options to present to patients. Since combined hormonal contraception (CHC) first became available more than 50 years ago, a variety of new formulations and types have come on to the market. Earlier this year, an updated guideline on CHC published by the Faculty of Sexual & Reproductive Healthcare (FSRH) made headlines when it highlighted that, for women using CHC there is no health benefit from the 7-day hormone-free interval. This means that women can safely take fewer, shorter, or no hormone-free intervals to avoid monthly bleeds, cramps, and other symptoms. Tailoring regimens in this way increases the range of options available and allows CHC to be further optimised to individual patients’ preferences.

Dr Katie Boog discusses the updated FSRH CHC guideline, detailing how CHC regimens can be tailored to reduce the frequency of, abolish, or shorten hormone-free intervals. Dr Boog also highlights that, although the risks associated with CHC are small, they are serious; a thorough medical history should be taken to assess that CHC is safe and effective for the individual. Multiple-choice questions are provided for you to test your knowledge after reading the article.

NICE states at the beginning of every guideline: ‘When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service.’ In December 2018, NICE published an updated guideline on post-traumatic stress disorder (PTSD). Guideline development group members Dr Jonathan Leach, Professor Neil Greenberg, and Dr Odette Megnin-Viggars highlight the key learning points for primary care. Some people who present to primary care with anxiety and/or depression may in fact have PTSD, so it is important to keep PTSD in mind during consultations. Co‑morbid health problems (such as depression, anxiety, and substance misuse) should be assessed and managed alongside PTSD.

Sad person looking out of the window

Key learning points: post-traumatic stress disorder

Dr Jonathan Leach, Professor Neil Greenberg, Dr Odette Megnin-Viggars

Depression and anxiety are also common co-morbidities in people with eating disorders. Eating disorders are under-recognised and can have a significant, long-lasting impact on physical health. People with eating disorders may have been ill for years before they first present, so it is important that referral is made at the earliest opportunity. Dr Dominique Thompson provides top tips for primary care on identifying, assessing, and managing eating disorders, including common presenting complaints (e.g. gastrointestinal upset, requests for allergy testing, and menstrual disorders), suggested questions to ask, and physical and mental health assessments.

Person at end of tunnel

Top tops: eating disorders

Dr Dominique Thompson

Regardless of the patient’s presenting condition or symptom, the best healthcare possible is that which is tailored to the patient’s individual needs.