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. When you install the update, you will see that each toolkit has a small QR code icon 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 install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency 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.
There are safety concerns regarding the inappropriate use of high dose corticosteroid inhalers and the importance of ensuring that the patient’s steroid load is kept to the minimum level whilst effectively treating symptoms. It is recognised that some patients will require treatment with high-dose ICS. This indicator acts as a guide for highlighting use of inhaled high dose corticosteroids but is unable to distinguish between patients with asthma and COPD. The STU software will allow GP practices to identify patients within each cohort for review.
Patients on inhaled high dose corticosteroids (or multiple steroid preparations) should be issued with a steroid treatment card (blue) as shown below. There is an additional steroid emergency card (also shown below) which alerts patients who are dependent on long term steroids and at risk of adrenal insufficiency to the potentially serious, systemic side effects from them. A full list of steroid doses to assist with determining who should be issued with a steroid emergency card (red) is contained within the Healthcare Improvement Scotland advice18 and STU software will assist identification of these patients. The most concerning side effect is adrenal suppression, others include growth failure; reduced bone density; cataracts and glaucoma; anxiety and depression; and diabetes mellitus.31
The chart below shows that high dose corticosteroid inhaler prescribing has increased in most NHS boards since 2021.
The numerical data for NTI graphs can also be viewed here.
The most up to date national therapeutic indicator data is available here.
This guidance is not for children; therefore prescribers should refer to guidance on asthma management in children, however, there are two medication safety points to highlight. Prescribing of high dose inhaled corticosteroids in children, aged under 12 years, is of particular concern due to long term safety concerns. Children on high dose corticosteroids should be reviewed and under the care of paediatricians with a special interest in respiratory medicine. Transition from child to adult services should be considered for children with unstable asthma or co-existing risks, such as food allergies and a review carried out in children’s services to facilitate this. There is a report available using the STU utility to identify high dose corticosteroid use in children under 12 years.
When treating children with ICS:
SIGN 158 recommends the following for adults and children.6
Patients should be maintained at the lowest possible dose of inhaled corticosteroid. Reduction in inhaled corticosteroid dose should be slow as patients deteriorate at different rates. Reductions should be considered every three months, decreasing the dose by approximately 25 to 50% each time. It is difficult to set a specific threshold level of ICS inhalers for review due to their varying potencies, dosing and quantities (for example 200 actuations in most ICS MDIs and 100 doses in some ICS DPIs).
It is important to arrange for a regular review of patients as treatment is reduced. When deciding the rate of reduction, it is important to take into account the following aspects: the severity of asthma, the side effects of the treatment, time on current dose, the beneficial effect achieved, and patient preference.
The dose – response curve for inhaled corticosteroids (below)32 shows the difference in clinical effect and side effects when a corticosteroid dose is increased. At doses of 800 micrograms per day and above, the clinical benefit of increasing inhaled corticosteroid dose is outweighed by increase in side effects.
Reproduced with permission from National Library of Medicine (Hannu Kankaanranta, Aarne Lahdensuo, Eeva Moilanen, and Peter J Barnes)32
Respiratory : Quality prescribing strategy - a guide for improvement