Respiratory

Bronchial thermoplasty for severe asthma

This is a new guideline on bronchial thermoplasty from NICE on bronchial thermoplasty for severe asthma. NICE advise that it can be used. This procedure reduces the smooth muscle mass lining the airways, making them less able to constrict. It is done under sedation or under GA. A catheter is inserted into the lungs and…
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Diagnosing and managing cystic fibrosis

This is a new guideline from NICE on diagnosing and managing cystic fibrosis. Most of this guideline will be much more relevant to secondary care, so I'm just covering the list of possible presentations (as I'd forgotten quite a lot of these) and also some of the different mucolytic treatments (as I was not aware…
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Nice | Tuberculosis (TB)

This is an updated guideline from NICE on managing tuberculosis. I guess the relevance will be largely related to where you work. There isn't any really big change here, but there are lots of things that I wasn't aware of, so I will do a general summary of the guideline. There is a lot more detail…
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Nice | Bronchiolitis in children

This is a new guideline from Nice on diagnosing and managing bronchiolitis. It really doesn't add much new as it mainly lays out criteria for referral and this is just around recognition of a sick child. I've outlined a few interesting points. Symptoms usually peak at 3 - 5d. 90% have recovered from the cough by…
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Nice | Diagnosis and management of pneumonia

Nice's latest guideline looks at the diagnosis and management of pneumonia. I was surprised by the stats here, so I'm including those. The 2 new things here are the use of CRP in deciding when to use antibiotics and use of the CRB65 score to give an idea of severity. Another useful aspect of this guideline…
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BTS/Sign | Asthma

This is an updated guideline from SIGN and the British Thoracic Society. There really isn't anything substantial that has changed for us in this guideline. The full guideline (page 47) has a useful section on various non-medication aspects of management, including lots of questions that parents and patients often ask (eg house dust mites). It can be useful to…
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Nice | Exhaled nitric oxide measurement in asthma

This new guideline from NICE looks at measuring exhaled Nitric Oxide (eNO) in asthma. I have never heard of this, so I'll just lay out the guidance and then give a bit more of an explanation as to what this is all about. NICE recommendations Measuring eNO is recommended as an option to aid diagnosis of asthma…
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Nice | Idiopathic pulmonary fibrosis

This guideline is mainly useful to us in terms of when to consider Idiopathic Pulmonary Fibrosis , but there was some information in here that I was not aware of that is important. When to consider Idiopathic Pulmonary Fibrosis: • Patients over age 45 • Persistent breathlessness on exertion • Persistent cough, with or without…
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Omalizumab in severe allergic asthma

This guideline advises that Omalizumab can be used in the treatment of asthma. It is a monoclonal antibody that binds to IgE and is given every 2 to 4 weeks subcut. We may start seeing patients treated with this, so worth knowing about it. Treatment is to be started and maintained by specialists only. Quite…
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Whooping Cough – HPA Guidance

Bordetella Pertussis from Sanofi Pasteur (flikr website) This is a summary of guidance from the HPA on how to manage Whooping Cough. A member forwarded this on to me and requested I pass on the information as it is so important - so please do the same if you have other stuff you think everyone should know! There is separate guidance for the management…
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