We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. You will see that each toolkit has a small QR code icon in the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.
You may need to actively update to the latest release - RDS app version 4.7.1 - to see this improvement.
Updating to this latest version of the RDS app is also strongly recommended to get the full benefits of the new resilience arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:
On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.
On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.
Please get in touch with ann.wales3@nhs.scot with any questions.
This content is from the BTS/SIGN British guideline on the management of asthma (SIGN 158), 2019.
Theophyllines may improve lung function and symptoms, but are associated with an increase in adverse events.463
Addition of short-acting anticholinergics is generally of no value.464, 486 Addition of nedocromil to ICS is of marginal benefit. 457, 465
The aim of treatment is to control asthma using the lowest possible doses of medication.
Some patients with very severe asthma not controlled with high-dose ICS, and who have also been tried on or are still taking LABA, LTRA, tiotropium (adults only) or theophyllines, may require regular long-term steroid tablets. These patients should already be under the care of a specialist asthma service.
Patients on long-term steroid tablets (for example, longer than three months) or requiring frequent courses of steroid tablets (for example three to four per year) will be at risk of systemic side effects.463 To prevent and treat steroid tablet induced side effects:
Prednisolone is the most widely used steroid for maintenance therapy in patients with chronic asthma. There is no evidence that other steroids offer an advantage.
Although popular in paediatric practice, there are no studies to show whether alternate day steroids produce fewer side effects than daily steroids. No evidence was identified to guide timing of dose or dose splitting.
Studies using both subcutaneous and sublingual allergen immunotherapy (SCIT and SLIT) have shown some benefit in reducing asthma symptoms and bronchial hyper-reactivity (BHR) in children and adults currently on a range of other preventative strategies including ICS. There are, however, few studies comparing immunotherapy with ICS or of adding immunotherapy to ICS so there is difficulty precisely defining where in asthma management this approach should sit.
Trials of allergen-specific immunotherapy by subcutaneous injection of increasing doses of allergen extracts have consistently demonstrated beneficial effects compared with placebo in the management of allergic asthma. Allergens included house dust mite, grass pollen, tree pollen, cat and dog allergen and moulds.
There has been increasing interest in the use of sublingual immunotherapy (SLIT), which is associated with fewer adverse reactions than subcutaneous immunotherapy.
Despite the large volume of evidence evaluating the safety and clinical effectiveness of SLIT in adults and children, heterogeneity in studies (including in doses, allergens, treatment duration, other asthma medication and presence of asthma symptoms), together with the lack of data on its long-term effectiveness and concerns about study quality, mean there is currently insufficient evidence to recommend use of SLIT in adults or children with asthma.
Sublingual immunotherapy is not licensed for use in the treatment of asthma.
The aim of bronchial thermoplasty is to reduce bronchial smooth muscle mass, thus reducing the capacity for bronchoconstriction. Currently only a few UK centres offer this treatment which has considerable cost and resource implications.
[BTS/SIGN 2019]
Asthma pathway (BTS, NICE, SIGN) [SIGN 244]