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.

2002 Respiratory system
 

Respiratory system

Click on the article titles below to read the summaries.

• Asthma guideline analysed
• Acute adrenal crisis risk with high-dose inhaled corticosteroids
• Medicines for colds and 'flu

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• Medicines for colds and ‘flu

Blenkinsopp A et al. Nurse prescribers: Respiratory illness III – Colds and flu. Primary Health Care 2002/2003; 12(10): 33-34

With 232 over-the-counter medicines available for colds and coughs, patients welcome help from nurses in deciding which could help. This article looks at the common ingredients of treatments for the symptoms of colds and ‘flu, pointing out that analgesics, decongestants and antihistamines can reduce cold symptoms. The evidence for zinc, Echinacea and Vitamin C is less conclusive.

Zanamivir is recommended for at-risk adults when influenza is circulating, providing treatment is started within 48 hours. Immunization programmes for at-risk adults remain the key action for ‘flu.

One review of antibiotic use concluded that evidence for benefits of their use in upper respiratory tract infection is insufficient to justify their routine use and the BNF recommends that they are only used in certain sinusitis cases.

Website: www.primaryhealthcare.net
 

• Acute adrenal crisis risk with high-dose inhaled corticosteroids

Todd GRG et al. Survey of adrenal crisis associated with inhaled corticosteroids in the United Kingdom. Arch Dis Childhood 2002; 87(6): 457-461
Keywords: adrenal crisis; high-dose fluticasone; inhaled corticosteroids

Acute adrenal crisis is more commonly associated with high-dose inhaled corticosteroids than previously thought, according to this questionnaire survey of consultant paediatricians and adult endocrinologists in the UK, prompted by finding four additional cases.

Of an initial 2912 questionnaires, 28 children and five adults met the criteria for acute adrenal crisis: of the 23 children with acute hypoglycaemia, 13 had decreased levels of consciousness or coma, nine had coma and convulsions, and one died. Five children and four adults had insidious symptom onset.

Fluticasone was associated with 94% of the cases, even though it is the least prescribed and most recently introduced. It is licensed for doses up to 400 micrograms a day in children but is prescribed in higher doses under British Thoracic Society guidelines, as was found in this study. The authors therefore caution against exceeding the licensed dosage unless the patient is supervised by a physician with experience of problematic asthma. High-dose inhaled corticosteroids should not, however, be stopped abruptly until adrenal function has been assessed, as this too can trigger an acute adrenal crisis.

The author of the study, consultant chest physician Geoffrey Todd, is quoted in Nursing Standard (3 December 2002, p7) as saying that nurses should ensure that patients on higher doses of fluticasone are being supervised by an asthma specialist.
 

• Asthma guideline analysed

1. Mead M. Respiratory Disease. New asthma guideline. Practice Nurse 2003; 25(4): 50-54

2. Small I. Attacking asthma. Primary Health Care 2003; 13(2): 22-24

3. Roberts J. The new asthma guidelines: a patient-centred approach to asthma. Professional Nurse 2003; 18(7): 379-382. Keywords: Asthma; BTS/SIGN guidelines; personalised asthma action plans.

4. Weller T. Review of the new asthma guidelines. Nursing Times 2003; 99(11): 44-45. Keywords: Asthma management; pharmacological management; non-pharmacological management.

These articles all examine the new BTS/SIGN guideline for asthma management (see news item).

Mike Mead [1] looks at how the new guideline differs from the 1997 asthma guidance and describes the recommendations at each step. He says that the emphasis on pharmacological management has changed, particularly with respect to using inhaled long-acting beta-agonists at step 3, the introduction of leukotriene receptor agonists and the omission of cromoglycate. The recommendation that every asthma patient should have a personalised asthma action plan is also a major change.

The guideline is considered in the context of what is frequently sub-optimal control and low patient expectations by Iain Small [2], who also looks at the main implications of changes in the guidelines for nurses in primary care. Personalised asthma action plans are now strongly recommended, and this author feels they can bring benefits both to patients and to healthcare professionals. Some treatments lend themselves particularly well to such plans. Nurses are vital in encouraging patient-focused care in the management of asthma and he discusses the ways in which this can be achieved. Primary care nurses often have an important role in the emergency treatment of asthma and the author draws attention to the significant points in the guideline. He concludes that it is fundamentally important that the guideline is implemented, that clinicians are supported in this process, and that a co-ordinated team-based approach is taken.

June Roberts [3] also highlights the patient-centred and evidence-based nature of the guideline, looking at the use of a structured clinical review to optimise asthma control, self-management education including the use of written personalised asthma action plans, the role of nurses in implementing these plans and the changes to the step-wise pharmacological management of asthma. She examines the components of a personalised asthma action plan, at how to develop self-management programmes, and at the implications for nurses of these and other changes.

The implications for practice are also examined by Trisha Weller [4], who discusses the new or changed recommendations in the guideline and points out that there are resource implications for their implementation. They will need to be disseminated to all those who care for people with asthma, protocols will need revising in the light of the changes to recommendations, new equipment may be needed, and training needs may be identified.

Websites: Primary Healthcare and Nursing Times