Asthma is one of the most common chronic conditions in the UK, affecting an estimated 5.4million people.
But just because asthma is prevalent, it does not mean we can be complacent about treatment. Patients too must be aware of the importance of sticking to their treatment regime to keep their asthma under control.
Every day the disease kills three people, according to statistics from Asthma UK.
The first widespread investigation into asthma deaths in the UK found two-thirds of deaths from the condition could have been avoided with better routine care. (1)
But there is momentum in the drive to enhance asthma care for patients. NICE released new guidelines last year recommending the use of Fractional Exhaled Nitric Oxide (FeNO) tests to help diagnose asthma in adults and children when diagnosis is unclear. The guidance also recommended FeNO testing to help manage asthma in patients who continued to have symptoms despite being prescribed inhaled corticosteroids.
Further NICE guidance is expected to be released within weeks. Draft guidelines (2) highlighted that asthma is both over and under diagnosed, meaning that people with asthma may be walking around without treatment, and up to a third of patients diagnosed with asthma do not have clear evidence of the disease.
The full guidelines are designed to pinpoint the best way to effectively diagnose asthma to prevent misdiagnosis along with determining the best monitoring strategy for optimum asthma control. They will recommend that asthma should not be diagnosed on clinical symptoms or spirometry alone, or by a trial of steroids. Use of spirometry will be recommended as a first line of investigation and that a FeNO test should be offered if a diagnosis of asthma is being considered in adults and young people over the age of five.
We’ve been carrying out FeNO testing for a number of years at our practice (Minchinhampton Surgery) and I could not imagine not being able to use the test. Diagnosing and managing asthma is difficult, particularly because symptoms can be shared with other conditions such as chronic obstructive pulmonary disease (COPD), bacterial lung infections and a myriad of other similar respiratory conditions.
FeNO testing gives us the ability to identify Th2 driven inflammation in the lungs, providing us with vital information to help in both the accurate diagnosis of asthma and in monitoring the effectiveness of asthma medication.
The test is easy to carry out, using a small handheld device, which works like a breathalyser. A patient blows steadily into the device for around 10 seconds and a nurse can interpret the results on-the-spot, making it ideal for primary care settings.
Much research has been released recently showing the effectiveness of FeNO testing. Studies have found that measuring how inflamed patients’ airways were by carrying out FeNO tests and adjusting treatment accordingly, could cut down the number of asthma exacerbations suffered by as much as half. (3,4)
An interesting study in one centre showing the impact of FeNO on treatment decisions resulted in the practitioner changing their treatment decision 36% of the time after carrying out a FeNO test. (5)
With an increasing body of research as well as new NICE guidance, it’s likely that more commissioners will invest in FeNO devices, giving more nurse practitioners like me another tool to use in the diagnosis and ongoing care of asthma patients.
Carol Stonham is the expert blogger for the Nursing in Practice respiratory resource centre. She is a senior nurse practitioner working at Minchinhampton Surgery in Stroud, which is part of Goucestershire CCG. She has worked for many years as a practice nurse specialising in respiratory care and is also the nurse lead for the Primary Care Respiratory Society UK, a UK wide society for primary care health professionals keen to deliver high value patient-centred respiratory care.
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