On the 24th October 2016 the Academy of Medical Royal Colleges brought out a report called Choosing Wisely . It was inspired by a world-wide initiative to encourage greater communication between clinicians and patients in order to avoid unnecessary tests, treatments and procedures.
As part of this initiative the Royal College of Paediatrics and Child Health recommended that:
Bronchodilators should not be used in the treatment of mild or moderate presentations of acute bronchiolitis in children without any underlying conditions.
The Royal College of Radiologists recommended that:
Where there is suspicion of a pulmonary embolus, imaging should be guided by clinical scoring systems.
There were no specific recommendations from the Royal College of Physicians so I wonder if anyone has any other ideas from the respiratory community?
Emily Farrow (new CSH Clinical Programme Deputy Director)
Thanks for asking.
The London Respiratory Network has developed quite a lot of material that is relevant.
1. Responsible respiratory prescribing and an ICS alert card to reduce unnecessary and potentially harmful prescribing of high dose ICS. Please see https://www.networks.nhs.uk/nhs-networks/london-lungs/responsible-respiratory-prescribing-rrp
2. Responsible oxygen prescribing: the LRN has produced ten messages on this: https://www.networks.nhs.uk/nhs-networks/london-lungs/documents/lcon-re…
3. LRN has produced its COPD Value Pyramid, that makes the case for prioritisation of flu vaccination (for staff and patients with COPD and asthma), stop smoking as a TREATMENT (see Helping Smokers Quit: https://www.networks.nhs.uk/nhs-networks/london-lungs/documents/helping…), pulmonary rehabilitation. See image of COPD value pyramid here: https://www.networks.nhs.uk/nhs-networks/london-lungs/latest-edition-of…
Hope that helps.
Siân
Hi Sian,
Thank you for that. One of the many interesting points from the London Respiratory Network on responsible respiratory prescribing has relevance to all specialties:
‘When prescribing any inhaled medication, ensure that the patient has undergone patient-centred education about the disease and inhaler technique training by a competent trainer’.
Ensuring patients are well educated about their medication and devices, no matter what specialty they come under, should lead to improved outcomes and reduced waste.
Thanks for that Emily. That's definitely true and the work by Rob Horne and others on this is always worth referencing - http://journals.plos.org/plosone/article?id=10.1371/journal.pone.008063…; What makes respiratory important is that, as our messages say, respiratory inhalers are expensive:
•The NHS spends more that £1 billion/year on inhaled respiratory medications
•Up till Nov 2015, 4/5 most expensive medicines to NHS were respiratory inhalers
•2/4 were for the highest dose of inhaled corticosteroids available for which there is very little evidence for increased efficacy over standard doses in both asthma and COPD
Evidence to suggest that these highest doses were being prescribed inappropriately and potentially doing harm
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