No abstract

The full British Thoracic Society Guideline for Bronchiectasis in Adults is published in Thorax. The following is a summary of the recommendations and good practice points. The sections referred to in the summary refer to the full guideline. The appendices are available in the full guideline.

Specific inhaler errors have been identified as critical errors, evidenced by frequency and association with asthma outcomes. Asthma management should target inhaler training to reduce key critical errors.

BackgroundDespite the availability of national and international guidelines, evidence suggests that chronic obstructive pulmonary disease (COPD) treatment is not always prescribed according to recommendations. This study evaluated the current management of patients with COPD using a large UK primary-care database.MethodsThis analysis used electronic patient records and patient-completed questionnaires from the Optimum Patient Care Research Database. Data on current management were analyzed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) group and presence or absence of a concomitant asthma diagnosis, in patients with a COPD diagnosis at ≥35 years of age and with spirometry results supportive of the COPD diagnosis.ResultsA total of 24,957 patients were analyzed, of whom 13,557 (54.3%) had moderate airflow limitation (GOLD Stage 2 COPD). The proportion of patients not receiving pharmacologic treatment for COPD was 17.0% in the total COPD population and 17.7% in the GOLD Stage 2 subset. Approximately 50% of patients in both cohorts were receiving inhaled corticosteroids (ICS), either in combination with a long-acting β2-agonist (LABA; 26.7% for both cohorts) or a LABA and a long-acting muscarinic antagonist (LAMA; 23.2% and 19.9%, respectively). ICS + LABA and ICS + LABA + LAMA were the most frequently used treatments in GOLD Groups A and B. Of patients without concomitant asthma, 53.7% of the total COPD population and 50.2% of the GOLD Stage 2 subset were receiving ICS. Of patients with GOLD Stage 2 COPD and no exacerbations in the previous year, 49% were prescribed ICS. A high proportion of GOLD Stage 2 COPD patients were symptomatic on their current management (36.6% with modified Medical Research Council score ≥2; 76.4% with COPD Assessment Test score ≥10).ConclusionCOPD is not treated according to GOLD and National Institute for Health and Care Excellence recommendations in the UK primary-care setting. Some patients receive no treatment despite experiencing symptoms. Among those on treatment, most receive ICS irrespective of severity of airflow limitation, asthma diagnosis, and exacerbation history. Many patients on treatment continue to have symptoms.

The Asthma Control Questionnaire (ACQ) has been validated in adults to measure the primary goal of management (minimisation of symptoms, activity limitations, short-acting b 2 -agonist use and airway narrowing). The present study evaluated the validity, measurement properties and interpretability of the ACQ in children aged 6-16 yrs.35 children attended clinic on three occasions (0, 1 and 4 weeks) and completed the ACQ, Mini Paediatric Asthma Quality of Life Questionnaire and the Royal College of Physicians' ''Three Questions''. Parents completed the Paediatric Asthma Caregiver's Quality of Life Questionnaire. Between visits, children completed the Asthma Control Diary and measured peak expiratory flow. At weeks 1 and 4, clinicians and parents completed Global Rating of Change Questionnaires.All patients completed the study. 19 children were stable between two assessments and provided evidence of good test-retest reliability (intraclass correlation coefficient 0.79). The ACQ was responsive to change in asthma control (p50.026) and the mean¡SD Minimal Important Difference was 0.52¡0.45. Both cross-sectional and longitudinal correlations between the ACQ and the other outcomes were close to predicted and provided evidence that the ACQ measures asthma control in children.The ACQ has strong measurement properties and is valid for use in children aged 6-16 yrs. In children aged 6-10 yrs, it must be administered by a trained interviewer.KEYWORDS: Asthma control, measurement, outcome questionnaire, paediatric asthma T he Asthma Control Questionnaire (ACQ) [1] was developed to measure asthma control as defined by international guidelines; namely, that the goal of management should be to minimise asthma symptoms, activity limitations, airway narrowing and rescue bronchodilator use, and thus reduce the risk of exacerbations. 91 clinicians, who were members of international asthma guideline committees [2][3][4][5] and who represented clinicians looking after both adults and children, identified the symptoms that are most important for assessing control. The five top-scoring symptoms, which were the same for both adults and children, were included in the ACQ. The sixth question asks about the number of puffs of rescue short-acting b 2 -agonist used each day. The clinicians indicated that the measurement of airway calibre should be the forced expiratory volume in 1 s % predicted (FEV1 % pred) pre-bronchodilator; this is the seventh question. Patients recall their experiences during the previous week and respond to the first six questions (night-time waking, symptoms on waking, activity limitation, shortness of breath, wheeze and rescue short-acting b 2 -agonist use) on a 7-point scale (05no impairment; 65max-imum impairment). Clinic staff score FEV1 % pred pre-bronchodilator on a similar 7-point scale. The items are equally weighted and the ACQ score is the mean of the seven items and therefore between 0 (well controlled) and 6 (extremely poorly controlled).The ACQ has been validated for use in adults and has strong...