This section features a regularly updated list of recently published articles relevant to nurse prescribing.

Abstracts of the papers are included and users are encouraged to submit their views about published papers through the feedback section.

Please note: In this section of the website we aim to cover articles on areas where nurses do prescribe. However, not all the treatments or appliances mentioned are prescribable by nurses. For that reason, nurses should check the up-to-date versions of the Nurse Prescribers’ Formulary for District Nurses and Health Visitors (NPF) and the Nurse Prescribers’ Extended Formulary (NPEF) and Drug tariff if they are in any doubt. Alternatively contact your Regional Nurse Prescribing Lead for clarification.

Respiratory system

Click on the article titles below to read the summaries.

• Doubts about efficacy of OTC cough medicines for children
• Hayfever and nurse prescribing
• Poorly controlled asthma
• Allergic rhinitis guidelines published
• Diagnosis and management of allergic rhinitis

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• Diagnosis and management of allergic rhinitis

Birch D. and Williams A. Allergic rhinitis. Professional Nurse 2002; 17(7): 403-404

This article describes the diagnosis of allergic rhinitis, the use of skin prick tests, and management of the condition. Treatments fall into two categories: preventers and symptomatic relief.

Corticosteroids, administered either topically or orally, and sodium cromoglycate are used as preventers. Symptoms can be treated with antihistamines, decongestants and ipratropium bromide (DoH list of POMS prescribable by nurses).

• Allergic rhinitis guidelines published

Walker S. ARIA guidelines. Practice Nurse 2002; 10 May: 40-46

New guidelines for managing allergic rhinitis and its impact on asthma have been published as a result of an international collaboration, following recognition of the link between the two conditions.

A framework for therapy should be based on understanding the inflammatory reaction in general, rather than symptoms, according to the ARIA guidelines. Allergic rhinitis and asthma often coexist and improving the management of rhinitis may lead to a reduction in asthma symptoms. Patients with persistent rhinitis should be evaluated for asthma and vice versa.

This article then describes the symptoms of allergic rhinitis, its causes, diagnosis, classification and management. The new guidelines suggest that it should be classified on the basis of symptom duration and/or severity. Patients are classified as having either intermittent or persistent symptoms that are either mild or moderate/severe. Quality of life parameters are also used to assess severity. Previous guidelines used seasonal, perennial or occupational symptoms as the basis for classification.

For mild, intermittent symptoms, as well as advice about avoiding allergens, treatment should include a non-sedating antihistamine. Symptoms may be controlled by a topical antihistamine if they are confined to the nose or eyes.

For persistent symptoms that are moderate/severe, a combination of treatments is likely to give optimal symptom control. The primary symptoms should be the basis of choice of drug treatment, however. Daily application of a topical nasal steroid is the first-line treatment for nasal blockage although some newer antihistamines may be helpful. Prescription of these nasal sprays should be accompanied by an explanation of how to use the devices and patients should be followed up two weeks after the onset of symptoms.

For rhinorrhoea, itching and sneezing, a combination of daily topical nasal steroid and non-sedating antihistamine is usually best. A short course of oral prednisolone may be useful if symptoms are uncontrolled, particularly for important events such as exams or weddings.

• Poorly controlled asthma

Roberts J. The management of poorly controlled asthma. Primary Health Care 2002; 12(4); 43-49

Although 5.1 million people are affected by asthma in the UK, and its physiology and triggers are now better understood, there is evidence that a large proportion of asthma cases are still not well controlled.

This article discusses the management of asthma, avoidance of trigger factors, treatment, patient education and self-management. The author highlights the importance of compliance with treatment in controlling asthma and discusses ways of encouraging it.

Website: www.primaryhealthcare.net

• Hayfever and nurse prescribing

Weller T. Hayfever. Nurse prescribing. Practice Nurse 2002; 23(2): 48-54

Independent nurse prescribers will be able to prescribe hayfever medication from the extended formulary. The author highlights the significant effects that hayfever symptoms can have on quality of life.

Among the POMs that can be prescribed by independent nurse prescribers are oral antihistamines, eye drops, nasal steroids and other nasal drugs. The article includes a guide to appropriate prescribing, concluding that the extension of prescribing should be beneficial for this often neglected patient group.

• Doubts about efficacy of OTC cough medicines for children
  

Schroeder K and Fahey T. Should we advise parents to administer over the counter cough medicines for acute cough? Systematic review of randomised controlled trials. Arch Dis Child 2002; 86:170-175

OTC cough medicines cannot be recommended as a first-line treatment for children with acute cough, according to the authors of this systematic review of randomized controlled trials.

The authors examined the results of six trials involving 438 children that compared the efficacy of OTC cough medicines with placebo at relieving cough symptoms caused by upper respiratory tract infection (URTI).

Coughs caused by URTI can be very troublesome for children and is something parents frequently consult health professionals about. Not offering any treatment may be seen as unacceptable by parents, but these results show that there is very little evidence that these medicines are effective.