Diagnosis, management and monitoring of chronic asthma: New guidance

New ways to diagnose and manage asthma can improve care, says NICE in new guidance

This latest NICE guideline covers diagnosing, monitoring and managing asthma in adults, young people and children. It aims to improve the accuracy of diagnosis, help people to control their asthma and reduce the risk of asthma attacks.

NICE is recommending objective tests, which include spirometry and FeNO, to help confirm a diagnosis of asthma. This, they suggest, can achieve more accurate diagnosis and therefore more effective treatment

The new guidelines released yesterday recommend:

  • GPs and PNs should use an objective test to diagnose asthma, not symptoms alone.
  • Patients should be treated immediately if they are acutely unwell at presentation and objective tests for asthma should be performed if the equipment is available.
  • Check for possible occupational asthma. Refer those with suspected occupational asthma to an occupational asthma specialist.
  • For children under five with suspected asthma, treat symptoms based on observation and clinical judgement, and review on a regular basis.
  • Offer a FeNO test to adults if a diagnosis of asthma is being considered. A FeNO level of 40 parts per billion (ppb) or more is a positive test.
  • Offer a short-acting beta agonist as a reliever treatment to adults with newly diagnosed asthma.
  • Offer a low dose of inhaled corticosteroid as the first-line maintenance treatment to adults.

Full Guideline: Asthma: diagnosis, monitoring and chronic asthma management

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People at high risk of diabetes should undergo intensive lifestyle change, says NICE

All people in England at high risk of developing type 2 diabetes should be offered a place on an intensive lifestyle change programme, says updated guidance from NICE | BMJ

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The guidance now states that anyone with a fasting glucose concentration between 5.5 and 6.9 mmol/L should be offered a place on such a programme but that priority should be given to anyone with a reading between 6.5 and 6.9 mmol/L, because of their increased risk of developing diabetes.

The guidance also states that anyone aged over 40 (except pregnant women), people aged 25-39 of south Asian, Chinese, African Caribbean, or black African origin, and people from other high risk ethnic minority groups should be offered a diabetes risk assessment, carried out at a general practice or a community pharmacy.

NICE guidance: managing medicines

NICE has published Managing medicines for adults receiving social care in the community

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This guideline covers medicines support for adults (aged 18 and over) who are receiving social care in the community. It aims to ensure that people who receive social care are supported to take and look after their medicines effectively and safely at home. It gives advice on assessing if people need help with managing their medicines who should provide medicines support and how health and social care staff should work together.

Full guideline: Managing medicines for adults receiving social care in the community

People who are dying should be asked about their spiritual beliefs

NICE has published new guidance calling on healthcare professionals to ask adults in the final days of life about their religious or spiritual beliefs.

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Cultural preferences and spiritual beliefs should be included in discussions about the care a person, and those close to them, want to receive, says NICE.

Knowing if someone holds a religious belief can be important for providing the care they desire. For example, someone who is Catholic may wish to receive the last prayers and ministrations.

The 2016 End of Life Care Audit reported nearly half of all deaths in England occurred in hospital. Spiritual wishes were only documented for one in 7 people who were able to communicate their desires.

Read the full overview here

Read the full guidance here

NICE guideline update – Surgical site infections: prevention and treatment

Surveillance report 2017 – Surgical site infections: prevention and treatment (2008) | NICE guideline CG74

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Surveillance decision: We will plan an update of the guideline on prevention and treatment of surgical site infections. The update will focus on:

  • nasal decontamination of Staphylococcus aureus
  • choice of preoperative skin antiseptics
  • application of intraoperative topical antiseptics/antimicrobials before wound closure
  • type of suture.

We will consider intraoperative perfusion and hydration, and intraoperative blood glucose control in a new guideline on perioperative care. Recommendations in the surgical site infection guideline will be withdrawn on publication of new recommendations in the perioperative care guideline.

Read the full update here

End of life care for infants, children and young people

NICE has published new NICE guidance: End of life care for infants, children and young people with life-limiting conditions: planning and management (NG61).

This guideline covers the planning and management of end of life and palliative care in for infants, children and young people (aged 0–17 years) with life-limiting conditions. It aims to involve children, young people and their families in decisions about their care, and improve the support that is available to them throughout their lives.

Additional link: NICE news report