I recently attended the European Respiratory Society (ERS) annual conference in Amsterdam and the Primary Care Respiratory Society UK annual conference in Northampton. There is so much excellent learning and new research to incorporate into practice.
What I learnt was that we should be personalising the care we give for the patient sitting in front of us no matter what their diagnosis. If the person has asthma, things are not as simple as just following the guidelines.
We can determine some information around phenotypes in asthma by taking a detailed history focusing on symptoms and exacerbations and response to previous treatments. We do not need to look at molecular endotypes – how could we in primary care?
So what lies behind the current buzz-words? What is the difference between an endotype and a phenotype?
The genotype is the set of genes in our DNA, which is responsible for a particular trait. The phenotype is the physical expression, or characteristics of that trait.When we refer to phenotypes we are referring to groups of patients defined by observable or measurable (biomarker) traits who share similar characteristics and who respond in similar ways to treatment.
What we do well in primary care is offer holistic care to our patients. We are also good at encompassing change and recognising complexity, diversity and co-morbidity. Therefore, offering personalised care is actually nothing new – we have been working in partnership with patients on personalised action plans for well in the excess of 15 years.
I attended the Asthma COPD Overlap Syndrome (ACOS) session at the ERS where the jury was out on whether we needed yet another diagnostic term at all, despite the Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) releasing a joint statement on ACOS in 2015.
As nurses working in primary care we need to offer our patients care that fits their disease and their lifestyle not simply the ‘one size fits all’ guidelines approach. Talking to patients about their symptoms, triggers, and response to previous treatments all hold clues to what is personal to the individual and which treatments are more likely to relieve the symptom burden. History taking skills take practice and are not taught routinely to nurses, but we excel at talking to patients – we just need to structure and direct the conversation.
If an accurate history can be endorsed by objective measurements, then all the better. FeNO (Fractional Exhaled Nirtic Oxide) testing, response to trials of treatment, improvement in symptom scores or lung function testing are all possibilities.
As well as the educational value, attending healthcare conferences is always an opportunity to network with others and share ideas that prove to be invaluable. Time away from practice also gives the precious opportunity to reflect on what we have learnt and how we might improve our practice as a result – a vital part of the impending revalidation process.
Disclaimer: Carol Stonham received payment to attend the European Respiratory Society (ERS) by Aerocrine, the manufacturers of NIOX VERO®,which uses Fractional Exhaled Nitric Oxide (FeNO) to measure airway inflammation.