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The PCRS Respiratory Leadership Programme celebrated its 10th anniversary in 2017. To mark this milestone we are highlighting how some of the programme’s alumni are using the skills they have learned to improve patient care. Originally published in the Winter 2017 edition of the Primary Care Respiratory Update. Find out more about the Respiratory Clinical Leadership Programme

How one long term condition might be used to fulfil the potential of PCN investment. PCRS Service Development Committee member, Stuart Shields, has written "10 top tips for PCN clinical directors - The respiratory long term condition perspective"  to support Primary Care Network clinical directors working to improve local respiratory services.  

The exhaled carbon monoxide (CO) test detects exposure to CO in the last 12-18 hours. This can be used to assess smoking status AFTER a quit attempt and used prior to a quit attempt as a motivational tool. Higher levels (parts per million) equate with greater inhalation of tobacco smoke assuming the cause is tobacco smoking. It must be noted that the exhaled CO test indicates recent exposure to CO and will not indicate smokeless tobacco use and is not a measure of dependency.

Alongside a detailed clinical history and other important tests to assess variability (peak flow, reversibility and challenge tests) it is used to support the diagnosis of asthma. PCRS has produced this consensus position on the use of FeNO in primary care to support the diagnosis of asthma. The article reviews the NICE and BTS/SIGN clinical guideline recommendations on the issue. It also explores the benefits, limitations and challenges of using this test in the primary care setting. The article concludes that:

The PCRS position on changes to QoF.

Since the Quality and Outcomes Framework (QOF) was introduced, PCRS has engaged with the process of developing and shaping the respiratory indicators. The process of development has varied over the years, and is currently run by NICE, which develops indicators which are put forward to the negotiating committees for inclusion in the GMS contract in each of the four nations each year. 

We have guidelines on asthma from two different sources in the UK – BTS/SIGN and NICE. The British Asthma guideline from BTS/SIGN was first published in 2003 and is well established, respected and comprehensive. NICE decided to develop first a guideline on diagnosis and monitoring in asthma, and then a guideline on asthma management, and they finally came together in a single published guideline in November 2017. 

Briefing document for National Respiratory Strategies – the NHS Long term plan and Lung Health Taskforce 5 year plan.

This is the most recent briefing paper on the latest update to the BTS/SIGN British Asthma Guideline.