Peak Inspiratory Flow Measured at Different Inhaler Resistances in Patients with Asthma.

Background: Patients' peak inspiratory flow rate (PIFR) may help clinicians select an inhaler device.

Objective: To determine the proportion of patients with asthma who could generate correct PIFRs at different inhaler resistance settings.

Methods: During a UK asthma review service, patients' PIFR was checked at resistance settings matching their current preventer inhaler device, at R5 (high-resistance dry powder inhaler [DPI]) and at R0 (low resistance, pressurized metered dose inhaler [pMDI]).

Implementation of a computer-guided consultation in the assessment of suspected obstructive sleep apnoea syndrome.

Background: We describe implementation of a clinical decision support system, a computer-guided consultation (CGC), in the assessment of subjects referred with suspected obstructive sleep apnoea syndrome (OSAS).

Methods: Two cohorts of patients were assessed. The first 100 cases had data collected with the CGC by a specialist sleep physician (stage1).

A review of asthma care in 50 general practices in Bedfordshire, United Kingdom.

The United Kingdom (UK) National Review of Asthma Deaths (NRAD) (2011-2014) identified a number of contributory risk factors which had not previously been recognized by those caring for people with asthma. Only one of the 19 NRAD recommendations has so far been implemented nationally, and that only partially, and as yet systems are not in place to identify patients at risk of attacks and dying from asthma. In 2015/2016 Bedfordshire Clinical Commissioning Group (CCG) in England, UK, initiated a quality asthma audit of people with asthma to identify some of the risk factors identified in the NRAD report with the aim of optimizing patient care.

A retrospective cohort study in severe asthma describing commonly measured biomarkers: Eosinophil count and IgE levels.

Background: Identifying asthma patients suitable for biologic therapy includes the assessment of blood biomarkers (IgE and eosinophils (EOS)). How they relate to each other is unclear.

Methods: This retrospective, database study used routinely collected clinical data to identify and evaluate an asthma cohort (classification code for asthma; ≥ 18 years; ≥1 prescription for asthma; ≥1 estimation of serum IgE, in 2 years prior to index date).

Characterisation of the frequent exacerbator phenotype in COPD patients in a large UK primary care population.

Background: The 'frequent exacerbator' is recognised as an important phenotype in COPD. Current understanding about this phenotype comes from prospective longitudinal clinical trials in secondary/tertiary care with little information reported in primary care populations.

Aims: To characterize the frequent-exacerbator phenotype and identify associated risk factors in a large UK primary care COPD population.

Asthma patients' inability to use a pressurised metered-dose inhaler (pMDI) correctly correlates with poor asthma control as defined by the global initiative for asthma (GINA) strategy: a retrospective analysis.

Background: In practice it is logical that inhalers are prescribed only after patients have received training and demonstrated their ability to use the device. However, many patients are unable to use their pressurised metered-dose inhaler devices (pMDIs) correctly. We assessed the relationship between asthma control and patients' ability to use their prescribed pMDIs.

Feasibility and impact of a computer-guided consultation on guideline-based management of COPD in general practice.

Background: Applying guidelines is a universal challenge that is often not met. Intelligent software systems that facilitate real-time management during a clinical interaction may offer a solution.

Aims: To determine if the use of a computer-guided consultation that facilitates the National Institute for Health and Clinical Excellence-based chronic obstructive pulmonary disease (COPD) guidance and prompts clinical decision-making is feasible in primary care and to assess its impact on diagnosis and management in reviews of COPD patients.

Technique training does not improve the ability of most patients to use pressurised metered-dose inhalers (pMDIs).

Aims: According to guidelines, inhaler technique should be tested in all patients, particularly those with poorly controlled asthma. We aimed to assess uncontrolled asthma patients' ability to use a pressurised metered-dose inhaler (pMDI) using the Aerosol Inhalation Monitor (AIM, © Vitalograph).

Methods: Practices invited patients for a detailed clinical review by trained asthma nurses according to practice-agreed protocols.