Comment: Vitamin D and asthma
Philip W Ind
pp 59-59
Vitamin D is a fat soluble vitamin; the main component, colecalciferol, being synthesised in the skin by the action of sunlight (UVB radiation). Dietary sources, oily fish, or added supplements, include colecalciferol (vitamin D3) and the other precursor ergocalciferol (vitamin D2). The active forms of vitamin D require liver 25- hydroxylation, while a secondary active metabolite is 1alpha, 25-dihydroxy-vitamin D. produced in the kidney (and also in the lungs and leukocytes). These are steroid hormones binding to a vitamin D receptor, regulating gene expression potentially affecting antibacterial, anti-viral, anti-inflammatory (anti- chemokine, anti-oxidant and anti-tumour) activities. Vitamin D has been investigated for beneficial effects in a wide variety of conditions including tuberculosis, cancers, rheumatoid arthritis, dementia and chronic obstructive pulmonary disease (COPD).
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Increasing value in respiratory care with the NHS RightCare approach
Matthew Cripps
pp 60-64
NHS RightCare was first developed as a concept in 2009 as part of a Quality, Innovation, Productivity and Prevention programme of work, using robust data to highlight and deal with unwarranted variation. Over recent years, the programme operated at a small scale working with a range of local health economies as the concept was proved. Since 2014, NHS RightCare has been hosted and operated wholly by NHS England as a national programme. It is committed to reducing unwarranted variation to improve people’s health and outcomes, and ensures that the right person has the right care, in the right place, at the right time, making the best use of available resources.
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Aspiration pneumonia
Nikesh Devani, Alexia Young, Olumide Adeotoye & Robin H Johns
pp 65-68
Aspiration pneumonia (AP) refers to a lower respiratory tract infection resulting from the inhalation of gastric or oropharyngeal secretions colonised by pathogenic bacteria. Seven to 24% of cases of community-acquired pneumonia (CAP) may result from aspiration with a 30-day mortality ranging between 17.2%–21%. AP patients have increased one year mortality and higher readmission rates than patients with other forms of CAP. Established risk factors are listed in Box 1 and described in more detail below.
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Management of difficult asthma in adults
Hannah K Bayes & Neil C Thomson
pp 69-74
Difficult asthma or difficult-to-control asthma is an umbrella term used to describe people with poorly controlled asthma due to a range of contributing factors, such as non-adherence, poor inhaler technique, co-morbidities, under-treatment and patient characteristics. A sub-group have severe disease after the identification and treatment of aggravating factors.
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Inhaler switching – potential benefit but a word of caution...
Sandra Olive
pp 70-70
There has been a proliferation of new inhalers for chronic obstructive pulmonary disease and asthma recently, resulting in some confusion, for both patients and clinicians. Choice of device is certainly a good thing and the newer molecules may offer some clinical benefit, but we need to be sure that prescribing decisions remain evidence-based.
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How can Asthma UK support you to improve patient adherence?
Dr Andy Whittamore
pp 75-75
• ‘Why should I take medicines even when I’m feeling well?’ • ‘The brown inhaler doesn’t do anything anyway!’ • ‘If I take an inhaler every day, it’ll stop working when I need it.’
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