Mark Levy - Academia.edu (original) (raw)
Papers by Mark Levy
Respiratory Medicine, 2011
Objective: To evaluate the retail sales of pressurised metered-dose inhalers (pMDIs), dry-powder ... more Objective: To evaluate the retail sales of pressurised metered-dose inhalers (pMDIs), dry-powder inhalers (DPIs) and liquids for nebulisation in 16 European countries. Methods: Retail sales data relating to pMDIs, DPIs and liquids for nebulisation delivering shortand long-acting bronchodilators, corticosteroids and combinations between 2002 and 2008 were obtained from the IMS sales database. The IMS database ensured that wholesalers' stock sales accurately matched that of retail pharmacies and included purchases by panel
American Journal of Respiratory and Critical Care Medicine, 2021
The Global Initiative for Asthma (GINA) Strategy Report provides clinicians with an annually upda... more The Global Initiative for Asthma (GINA) Strategy Report provides clinicians with an annually updated evidence-based strategy for asthma management and prevention, which can be adapted for local circumstances (e.g., medication availability). This article summarizes key recommendations from GINA 2021, and the evidence underpinning recent changes. GINA recommends that asthma in adults and adolescents should not be treated solely with short-acting b 2-agonist (SABA), because of the risks of SABA-only treatment and SABA overuse, and evidence for benefit of inhaled corticosteroids (ICS). Large trials show that as-needed combination ICS-formoterol reduces severe exacerbations by >60% in mild asthma compared with SABA alone, with similar exacerbation, symptom, lung function, and inflammatory outcomes as daily ICS plus as-needed SABA. Key changes in GINA 2021 include division of the treatment figure for adults and adolescents into two tracks. Track 1 (preferred) has low-dose ICS-formoterol as the reliever at all steps: as needed only in Steps 1-2 (mild asthma), and with daily maintenance ICS-formoterol (maintenance-and-reliever therapy, "MART") in Steps 3-5. Track 2 (alternative) has as-needed SABA across all steps, plus regular ICS (Step 2) or ICS-long-acting b 2-agonist (Steps 3-5). For adults with moderate-to-severe asthma, GINA makes additional recommendations in Step 5 for add-on long-acting muscarinic antagonists and azithromycin, with add-on biologic therapies for severe asthma. For children 6-11 years, new treatment options are added at Steps 3-4. Across all age groups and levels of severity, regular personalized assessment, treatment of modifiable risk factors, self-management education, skills training, appropriate medication adjustment, and review remain essential to optimize asthma outcomes.
Archives of Disease in Childhood, 2017
This review discusses issues related to managing problematic severe asthma in children and young ... more This review discusses issues related to managing problematic severe asthma in children and young people. A small minority of children have genuinely severe asthma symptoms which are difficult to control. Children with genuinely severe asthma need investigations and treatments beyond those described within conventional guidelines. However, the majority of children with poor symptom control despite high-intensity treatment achieve improvement in their asthma control once attention has been paid to the basics of asthma management. Basic asthma management requires optimisation of inhaler technique and treatment adherence, avoidance of environmental triggers and self-management education. It is also important that clinicians recognise risk factors that predispose patients to asthma exacerbations and potentially life-threatening attacks. These correctable issues need to be tackled in partnership with children and young people and their families. This requires a coordinated approach betwee...
Primary Care Respiratory Journal, Apr 1, 2006
The British journal of general practice : the journal of the Royal College of General Practitioners, 2016
This article 1 has unfortunately been widely publicised in a sensational and, in my opinion, dest... more This article 1 has unfortunately been widely publicised in a sensational and, in my opinion, destructive manner in the UK. 2 Although only five of the 110 patients diagnosed with spirometry, in this study, were found to be incorrectly diagnosed, the accuracy of the diagnosis in the remaining 500+ patients in this study has not been established. A retrospective analysis of the
European Respiratory Journal, Sep 1, 2012
Primary Care Respiratory Journal, 1999
Aims: To develop a mechanism to write three research protocols within 10 hours while simultaneous... more Aims: To develop a mechanism to write three research protocols within 10 hours while simultaneously enhancing the research protocol writing skills of participants. Method: Members of the General Practitioners In Asthma Group (GPIAG) were invited to attend a research protocol workshop with pre-and postworkshop questionnaires. The main outcome measures were the development of three detailed research protocols and improvement in participants' perceived research protocol writing skills. Results: Three detailed research protocols were completed within the time allocated. Thirty (88%) participants completed pre-and post-workshop questionnaires. Participants believed there were improvements in their ability to formulate an answerable research question (p < 0.01), choose an appropriate methodology to answer the question (p < 0.01), choose appropriate outcome measures (p = 0.03), choose appropriate statistical methods (p = 0.01), devise a research timetable (p < 0.01), and improve their overall ability to write a research protocol (p < 0.01). Conclusion: It is possible to identify a mechanism, based on a weekend workshop, to write accelerated research protocols whilst simultaneously significantly increasing the research protocol writing skills of participants. This approach has potential to promote the development of research skills within primary care.
npj Primary Care Respiratory Medicine, 2014
BACKGROUND: Healthy Outlook is a service delivered by the UK Met Office directly to patients with... more BACKGROUND: Healthy Outlook is a service delivered by the UK Met Office directly to patients with chronic obstructive pulmonary disease (COPD) that has been in place since 2006. Its objective is to reduce the severity and length of COPD exacerbations, hence improving the quality of life and life expectancy. AIMS: To assess the effect of the Healthy Outlook service on hospital admission rates of all general practitioners that have used the service. METHODS: Control practices were selected for each of the 661 participating practices. The number of hospital admissions for each practice was extracted from the Hospital Episode Statistics database. The differences in admission rates per practice between the first year of use of the Healthy Outlook service and the previous year were compared by paired t-test analyses. RESULTS: For admissions with a primary diagnosis of COPD, the difference between participating and control practices was − 0.8% (95% confidence interval (CI) = − 1.8 to 0.2%; P = 0.13). For admissions with a primary or co-morbid diagnosis of COPD, the difference was − 2.3% (95% CI = − 4.2 to − 0.4%; P = 0.02). CONCLUSIONS: Participation in the Healthy Outlook service reduces hospital admission rates for patients coded on discharge with COPD (including co-morbid).
Primary Care Respiratory Journal, 2010
Inhaled medications are the preferred therapies for patients with asthma and COPD, but their effe... more Inhaled medications are the preferred therapies for patients with asthma and COPD, but their effectiveness is limited by the patient's ability to use the device properly, an issue often neglected when these medications are prescribed. Correct inhaler technique must be taught and learnt, and requires educational and motivational programs aimed at patients and healthcare providers alike. Written instructions alone are manifestly insufficient: education must include practical demonstration and periodic re-assessment and reeducation, since correct technique and motivation usually deteriorate with time. Several devices are available on the market, the purpose of which is to train patients to use inhalers correctly. They are often directed at particular devices or groups of devices and/or particular critical aspects of technique. This paper reviews the devices currently available for training patients in the correct use of both pressurised metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs).
Primary Care Respiratory Journal, 2012
Background: Most patients with chronic obstructive pulmonary disease (COPD) in Europe are treated... more Background: Most patients with chronic obstructive pulmonary disease (COPD) in Europe are treated in primary care, but perceptions on what guides primary care physicians (PCPs) in managing patients are lacking. Aims: To describe factors associated with the assessment by PCPs of COPD severity and those associated with impaired health status, as assessed by patient-reported outcomes. Methods: This cross-sectional study evaluated health-related quality of life (HRQL) in 2,294 COPD patients from five European countries. The severity of COPD was clinically judged by the PCPs and GOLD stage severity was calculated using spirometry data. Results: PCPs' categories of severity reflected a wider range of HRQL scores (St George's Respiratory Questionnaire (SGRQ) total score: mild 30.3; moderate 41.7; severe 55.0; very severe 66.1) than GOLD severity grading (Stage I 38.2; Stage II 41.1; Stage III 49.9; Stage IV 58.5). Multiple ordinal logistic regression models showed that factors most closely related to PCP-rated COPD severity were Medical Research Council (MRC) dyspnoea grade, forced expiratory volume in 1 second (FEV1) percent predicted, HRQL score (either SGRQ or COPD Assessment Test (CAT)), and previous hospitalisations (model generalised R 2 =0.45 or 0.44 (SQRQ or CAT in model, respectively); all factors p<0.0001). Factors with the highest association with HRQL scores (SGRQ or CAT) were MRC dyspnoea grade, COPD severity (PCP-rated), sputum production, and number of co-morbidities (model R 2 =0.46 or 0.37 (SQRQ or CAT in multiple linear regression model, respectively); all factors p<0.0001). Conclusions: PCPs successfully graded COPD severity clinically and appeared to have greater discriminative power for assessing severity in COPD than FEV1-based staging. Their more holistic approach appeared to reflect the patients' HRQL rating and was consistent across five European countries.
Primary Care Respiratory Journal, 2010
EDITORS' CHOICE • It is with considerable pride, but also sadness, that we welcome you to Mark Le... more EDITORS' CHOICE • It is with considerable pride, but also sadness, that we welcome you to Mark Levy's last issue after 15 years as Editor-in-Chief of the PCRJ. Over this time the PCRJ has evolved from a simple twice-yearly newsletter into a reputable and influential Medline-listed scientific journal with an increased 2009 SCImago Journal Rank (SJR) of 0.182 (from 0.117 in 2008),* reflecting the increased prestige of the journal in the academic community. This is a tremendous achievement. On pg 299, he says farewell as Editor-in-Chief, gives his perspective on the last 15 years, and highlights the challenges which face his successors. (*http://info.scopus.com/journalmetrics/processors.php)
Primary Care Respiratory Journal, 2010
Primary care respiratory journal : journal of the General Practice Airways Group, 2007
This article describes the formation and development of the UK General Practice Airways Group (GP... more This article describes the formation and development of the UK General Practice Airways Group (GPIAG), from its inception as a small respiratory special-interest group founded by six general practitioners in 1987 through to its transformation into the largest primary care specialist society in the UK. It highlights the historical context in which the GPIAG was founded - at a time when there was increasing concern about under-treatment and under-diagnosis of asthma in primary care - and describes the way in which its foundation was one of the major influences that led to profound innovation in the primary care management of respiratory disease as well as changes across the primary/secondary care interface. The GPIAG is now a registered charity, has an expanding membership, and has acquired a high profile both nationally and internationally as an advisory body on policy and strategy for the management of respiratory disease in primary care. This review is a 20th anniversary tribute no...
Journal of Public Health, 2011
Background We sought to understand the barriers and facilitators to participation in research fro... more Background We sought to understand the barriers and facilitators to participation in research from the perspectives of South Asian people with asthma. Methods Eight focus groups were conducted in the preferred language of participants. Sampling was purposeful to ensure inclusion of males and females from differing ethnic, linguistic and religious backgrounds. Results The forming of trusting relationships was described as pivotal to the successful recruitment of minority ethnic groups into research; personalized approaches were likely to be better received than more impersonal written approaches. Notable barriers to participation included: the stigma of being labelled with asthma; concerns surrounding participation in pharmaceutical trials; major time or travel commitments and a failure to show respect by not making information available in minority ethnic languages. Flexibility, in terms of timing, location and respecting of cultural and religious sensitivities around gender segregation, together with the offer of incentives, were highlighted as key factors to promote participation. Conclusions The barriers to recruitment are largely surmountable, but these will necessitate the use of resource intensive and more personalized approaches than are commonly employed for the White European origin population. Our proposed model to enhance recruitment is likely to have transferability beyond the field of asthma.
European Respiratory Journal, 2011
npj Primary Care Respiratory Medicine
The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization ... more The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization and the US National Heart Lung and Blood Institute to improve asthma awareness, prevention and management worldwide. GINA develops and publishes evidence-based, annually updated resources for clinicians. GINA guidance is adopted by national asthma guidelines in many countries, adapted to fit local healthcare systems, practices, and resource availability. GINA is independent of industry, funded by the sale and licensing of its materials. This review summarizes key practical guidance for primary care from the 2022 GINA strategy report. It provides guidance on confirming the diagnosis of asthma using spirometry or peak expiratory flow. GINA recommends that all adults, adolescents and most children with asthma should receive inhaled corticosteroid (ICS)-containing therapy to reduce the risk of severe exacerbations, either taken regularly, or (for adults and adolescents with “mild” asthma) as...
Primary care respiratory journal : journal of the General Practice Airways Group, 2006
The association between the upper and lower airways has been recognised for almost 2000 years. Ep... more The association between the upper and lower airways has been recognised for almost 2000 years. Epidemiological data suggest that most asthma patients also suffer from allergic rhinitis, and that both diseases share similar trigger factors and pathophysiology. This IPCRG Guideline on the management of rhinitis in primary care is fully consistent with the ARIA guidelines. It highlights the treatment goals and the classification of the condition according to symptom frequency (intermittent or persistent) and severity (mild or moderate-severe). It covers the need for allergen avoidance, pharmacologic therapy including immunotherapy, alternative therapies, management of ocular symptoms, the management of co-existing allergic rhinitis and asthma, and the need for follow-up and ongoing care for patients with rhinitis.
British Journal of General Practice, 2004
Respiratory Medicine, 2011
Objective: To evaluate the retail sales of pressurised metered-dose inhalers (pMDIs), dry-powder ... more Objective: To evaluate the retail sales of pressurised metered-dose inhalers (pMDIs), dry-powder inhalers (DPIs) and liquids for nebulisation in 16 European countries. Methods: Retail sales data relating to pMDIs, DPIs and liquids for nebulisation delivering shortand long-acting bronchodilators, corticosteroids and combinations between 2002 and 2008 were obtained from the IMS sales database. The IMS database ensured that wholesalers' stock sales accurately matched that of retail pharmacies and included purchases by panel
American Journal of Respiratory and Critical Care Medicine, 2021
The Global Initiative for Asthma (GINA) Strategy Report provides clinicians with an annually upda... more The Global Initiative for Asthma (GINA) Strategy Report provides clinicians with an annually updated evidence-based strategy for asthma management and prevention, which can be adapted for local circumstances (e.g., medication availability). This article summarizes key recommendations from GINA 2021, and the evidence underpinning recent changes. GINA recommends that asthma in adults and adolescents should not be treated solely with short-acting b 2-agonist (SABA), because of the risks of SABA-only treatment and SABA overuse, and evidence for benefit of inhaled corticosteroids (ICS). Large trials show that as-needed combination ICS-formoterol reduces severe exacerbations by >60% in mild asthma compared with SABA alone, with similar exacerbation, symptom, lung function, and inflammatory outcomes as daily ICS plus as-needed SABA. Key changes in GINA 2021 include division of the treatment figure for adults and adolescents into two tracks. Track 1 (preferred) has low-dose ICS-formoterol as the reliever at all steps: as needed only in Steps 1-2 (mild asthma), and with daily maintenance ICS-formoterol (maintenance-and-reliever therapy, "MART") in Steps 3-5. Track 2 (alternative) has as-needed SABA across all steps, plus regular ICS (Step 2) or ICS-long-acting b 2-agonist (Steps 3-5). For adults with moderate-to-severe asthma, GINA makes additional recommendations in Step 5 for add-on long-acting muscarinic antagonists and azithromycin, with add-on biologic therapies for severe asthma. For children 6-11 years, new treatment options are added at Steps 3-4. Across all age groups and levels of severity, regular personalized assessment, treatment of modifiable risk factors, self-management education, skills training, appropriate medication adjustment, and review remain essential to optimize asthma outcomes.
Archives of Disease in Childhood, 2017
This review discusses issues related to managing problematic severe asthma in children and young ... more This review discusses issues related to managing problematic severe asthma in children and young people. A small minority of children have genuinely severe asthma symptoms which are difficult to control. Children with genuinely severe asthma need investigations and treatments beyond those described within conventional guidelines. However, the majority of children with poor symptom control despite high-intensity treatment achieve improvement in their asthma control once attention has been paid to the basics of asthma management. Basic asthma management requires optimisation of inhaler technique and treatment adherence, avoidance of environmental triggers and self-management education. It is also important that clinicians recognise risk factors that predispose patients to asthma exacerbations and potentially life-threatening attacks. These correctable issues need to be tackled in partnership with children and young people and their families. This requires a coordinated approach betwee...
Primary Care Respiratory Journal, Apr 1, 2006
The British journal of general practice : the journal of the Royal College of General Practitioners, 2016
This article 1 has unfortunately been widely publicised in a sensational and, in my opinion, dest... more This article 1 has unfortunately been widely publicised in a sensational and, in my opinion, destructive manner in the UK. 2 Although only five of the 110 patients diagnosed with spirometry, in this study, were found to be incorrectly diagnosed, the accuracy of the diagnosis in the remaining 500+ patients in this study has not been established. A retrospective analysis of the
European Respiratory Journal, Sep 1, 2012
Primary Care Respiratory Journal, 1999
Aims: To develop a mechanism to write three research protocols within 10 hours while simultaneous... more Aims: To develop a mechanism to write three research protocols within 10 hours while simultaneously enhancing the research protocol writing skills of participants. Method: Members of the General Practitioners In Asthma Group (GPIAG) were invited to attend a research protocol workshop with pre-and postworkshop questionnaires. The main outcome measures were the development of three detailed research protocols and improvement in participants' perceived research protocol writing skills. Results: Three detailed research protocols were completed within the time allocated. Thirty (88%) participants completed pre-and post-workshop questionnaires. Participants believed there were improvements in their ability to formulate an answerable research question (p < 0.01), choose an appropriate methodology to answer the question (p < 0.01), choose appropriate outcome measures (p = 0.03), choose appropriate statistical methods (p = 0.01), devise a research timetable (p < 0.01), and improve their overall ability to write a research protocol (p < 0.01). Conclusion: It is possible to identify a mechanism, based on a weekend workshop, to write accelerated research protocols whilst simultaneously significantly increasing the research protocol writing skills of participants. This approach has potential to promote the development of research skills within primary care.
npj Primary Care Respiratory Medicine, 2014
BACKGROUND: Healthy Outlook is a service delivered by the UK Met Office directly to patients with... more BACKGROUND: Healthy Outlook is a service delivered by the UK Met Office directly to patients with chronic obstructive pulmonary disease (COPD) that has been in place since 2006. Its objective is to reduce the severity and length of COPD exacerbations, hence improving the quality of life and life expectancy. AIMS: To assess the effect of the Healthy Outlook service on hospital admission rates of all general practitioners that have used the service. METHODS: Control practices were selected for each of the 661 participating practices. The number of hospital admissions for each practice was extracted from the Hospital Episode Statistics database. The differences in admission rates per practice between the first year of use of the Healthy Outlook service and the previous year were compared by paired t-test analyses. RESULTS: For admissions with a primary diagnosis of COPD, the difference between participating and control practices was − 0.8% (95% confidence interval (CI) = − 1.8 to 0.2%; P = 0.13). For admissions with a primary or co-morbid diagnosis of COPD, the difference was − 2.3% (95% CI = − 4.2 to − 0.4%; P = 0.02). CONCLUSIONS: Participation in the Healthy Outlook service reduces hospital admission rates for patients coded on discharge with COPD (including co-morbid).
Primary Care Respiratory Journal, 2010
Inhaled medications are the preferred therapies for patients with asthma and COPD, but their effe... more Inhaled medications are the preferred therapies for patients with asthma and COPD, but their effectiveness is limited by the patient's ability to use the device properly, an issue often neglected when these medications are prescribed. Correct inhaler technique must be taught and learnt, and requires educational and motivational programs aimed at patients and healthcare providers alike. Written instructions alone are manifestly insufficient: education must include practical demonstration and periodic re-assessment and reeducation, since correct technique and motivation usually deteriorate with time. Several devices are available on the market, the purpose of which is to train patients to use inhalers correctly. They are often directed at particular devices or groups of devices and/or particular critical aspects of technique. This paper reviews the devices currently available for training patients in the correct use of both pressurised metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs).
Primary Care Respiratory Journal, 2012
Background: Most patients with chronic obstructive pulmonary disease (COPD) in Europe are treated... more Background: Most patients with chronic obstructive pulmonary disease (COPD) in Europe are treated in primary care, but perceptions on what guides primary care physicians (PCPs) in managing patients are lacking. Aims: To describe factors associated with the assessment by PCPs of COPD severity and those associated with impaired health status, as assessed by patient-reported outcomes. Methods: This cross-sectional study evaluated health-related quality of life (HRQL) in 2,294 COPD patients from five European countries. The severity of COPD was clinically judged by the PCPs and GOLD stage severity was calculated using spirometry data. Results: PCPs' categories of severity reflected a wider range of HRQL scores (St George's Respiratory Questionnaire (SGRQ) total score: mild 30.3; moderate 41.7; severe 55.0; very severe 66.1) than GOLD severity grading (Stage I 38.2; Stage II 41.1; Stage III 49.9; Stage IV 58.5). Multiple ordinal logistic regression models showed that factors most closely related to PCP-rated COPD severity were Medical Research Council (MRC) dyspnoea grade, forced expiratory volume in 1 second (FEV1) percent predicted, HRQL score (either SGRQ or COPD Assessment Test (CAT)), and previous hospitalisations (model generalised R 2 =0.45 or 0.44 (SQRQ or CAT in model, respectively); all factors p<0.0001). Factors with the highest association with HRQL scores (SGRQ or CAT) were MRC dyspnoea grade, COPD severity (PCP-rated), sputum production, and number of co-morbidities (model R 2 =0.46 or 0.37 (SQRQ or CAT in multiple linear regression model, respectively); all factors p<0.0001). Conclusions: PCPs successfully graded COPD severity clinically and appeared to have greater discriminative power for assessing severity in COPD than FEV1-based staging. Their more holistic approach appeared to reflect the patients' HRQL rating and was consistent across five European countries.
Primary Care Respiratory Journal, 2010
EDITORS' CHOICE • It is with considerable pride, but also sadness, that we welcome you to Mark Le... more EDITORS' CHOICE • It is with considerable pride, but also sadness, that we welcome you to Mark Levy's last issue after 15 years as Editor-in-Chief of the PCRJ. Over this time the PCRJ has evolved from a simple twice-yearly newsletter into a reputable and influential Medline-listed scientific journal with an increased 2009 SCImago Journal Rank (SJR) of 0.182 (from 0.117 in 2008),* reflecting the increased prestige of the journal in the academic community. This is a tremendous achievement. On pg 299, he says farewell as Editor-in-Chief, gives his perspective on the last 15 years, and highlights the challenges which face his successors. (*http://info.scopus.com/journalmetrics/processors.php)
Primary Care Respiratory Journal, 2010
Primary care respiratory journal : journal of the General Practice Airways Group, 2007
This article describes the formation and development of the UK General Practice Airways Group (GP... more This article describes the formation and development of the UK General Practice Airways Group (GPIAG), from its inception as a small respiratory special-interest group founded by six general practitioners in 1987 through to its transformation into the largest primary care specialist society in the UK. It highlights the historical context in which the GPIAG was founded - at a time when there was increasing concern about under-treatment and under-diagnosis of asthma in primary care - and describes the way in which its foundation was one of the major influences that led to profound innovation in the primary care management of respiratory disease as well as changes across the primary/secondary care interface. The GPIAG is now a registered charity, has an expanding membership, and has acquired a high profile both nationally and internationally as an advisory body on policy and strategy for the management of respiratory disease in primary care. This review is a 20th anniversary tribute no...
Journal of Public Health, 2011
Background We sought to understand the barriers and facilitators to participation in research fro... more Background We sought to understand the barriers and facilitators to participation in research from the perspectives of South Asian people with asthma. Methods Eight focus groups were conducted in the preferred language of participants. Sampling was purposeful to ensure inclusion of males and females from differing ethnic, linguistic and religious backgrounds. Results The forming of trusting relationships was described as pivotal to the successful recruitment of minority ethnic groups into research; personalized approaches were likely to be better received than more impersonal written approaches. Notable barriers to participation included: the stigma of being labelled with asthma; concerns surrounding participation in pharmaceutical trials; major time or travel commitments and a failure to show respect by not making information available in minority ethnic languages. Flexibility, in terms of timing, location and respecting of cultural and religious sensitivities around gender segregation, together with the offer of incentives, were highlighted as key factors to promote participation. Conclusions The barriers to recruitment are largely surmountable, but these will necessitate the use of resource intensive and more personalized approaches than are commonly employed for the White European origin population. Our proposed model to enhance recruitment is likely to have transferability beyond the field of asthma.
European Respiratory Journal, 2011
npj Primary Care Respiratory Medicine
The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization ... more The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization and the US National Heart Lung and Blood Institute to improve asthma awareness, prevention and management worldwide. GINA develops and publishes evidence-based, annually updated resources for clinicians. GINA guidance is adopted by national asthma guidelines in many countries, adapted to fit local healthcare systems, practices, and resource availability. GINA is independent of industry, funded by the sale and licensing of its materials. This review summarizes key practical guidance for primary care from the 2022 GINA strategy report. It provides guidance on confirming the diagnosis of asthma using spirometry or peak expiratory flow. GINA recommends that all adults, adolescents and most children with asthma should receive inhaled corticosteroid (ICS)-containing therapy to reduce the risk of severe exacerbations, either taken regularly, or (for adults and adolescents with “mild” asthma) as...
Primary care respiratory journal : journal of the General Practice Airways Group, 2006
The association between the upper and lower airways has been recognised for almost 2000 years. Ep... more The association between the upper and lower airways has been recognised for almost 2000 years. Epidemiological data suggest that most asthma patients also suffer from allergic rhinitis, and that both diseases share similar trigger factors and pathophysiology. This IPCRG Guideline on the management of rhinitis in primary care is fully consistent with the ARIA guidelines. It highlights the treatment goals and the classification of the condition according to symptom frequency (intermittent or persistent) and severity (mild or moderate-severe). It covers the need for allergen avoidance, pharmacologic therapy including immunotherapy, alternative therapies, management of ocular symptoms, the management of co-existing allergic rhinitis and asthma, and the need for follow-up and ongoing care for patients with rhinitis.
British Journal of General Practice, 2004