Among my practice responsibilities is included a •commitment to qualityê for asthma. I was interested, therefore, to read Dr John Haughneyês article on the new SIGN/BTS guideline1 (•New national guideline should raise standards of asthma careê, Guidelines in Practice February 2003 ).

The advice contained in the new guideline refines and improves on what has become standard practice. In addition, the guideline has highlighted for me several areas where improvements can be made relatively painlessly.

I am thinking in particular of the new advice on the doses of oral steroids that should be given in acute asthma, doses somewhat higher than have previously been customary (20mg for children under 5 years, 30-40mg for the over 5s and 40-50mg per day for at least 5 days in adults).

The question of whether we should invest in oxygen delivery equipment in our practice to drive nebulisers has now become an important issue.

I found the situations in which patients should be referred for a second opinion very clearly set out, as were the differential diagnoses to be considered when diagnosing asthma for the first time.

I shall incorporate the simple list of questions devised by the RCP for use during clinical review (see Box, below) immediately into regular practice.

The three RCP questions for use in clinical review*

In the last week or month:

  • Have you had difficulty sleeping because of your asthma symptoms (including cough)?
  • Have you had your usual asthma symptoms during the day (cough, wheeze, chest tightness or breathlessness)?
  • Has your asthma interfered with your usual activities (e.g. housework, work, school etc)?

* Applies to all patients with asthma aged 16 years and over. Use only after diagnosis has been established

A recent paper in the British Medical Journal2 has shown that routine reviews are conducted just as effectively by telephone as in face-to-face consultations. (See News in this issue.)

Not only were there no clinical disadvantages, but patient satisfaction was high, and telephone interviews, conducted by a trained asthma nurse, took less time than traditional appointments.

This paper and Dr Haughneyês article have contributed significantly to my understanding of asthma management. What is most pleasing is that they will both contribute to my •service provisionê too.

Dr Chris Barclay, GP, Sheffield

  1. Scottish Intercollegiate Guidelines Network/The British Thoracic Society. British Guidelines on the Management of Asthma: a national clinical guideline. Thorax 2003; 58 (Suppl 1). Also available at:
  2. Pinnock H, Bawden R, Proctor S et al. Accessibility, acceptability, and effectiveness in primary care of routine telephone review of asthma: pragmatic, randomised controlled trial. Br Med J 2003; 326: 477-9.

Guidelines in Practice, March 2003, Volume 6(3)
© 2003 MGP Ltd
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