Primary Care Knowledge Boost

• Asthma Guidelines: What's new?

  Doctors Lisa and Sara take a deep dive into the recent combined asthma guidelines with Dr Murugesan Raja who is a GP and clinical lead for respiratory medicine for NHS Greater Manchester Strategic Clinical Network.  We go through the new asthma recommendations for the different age groups, starting with a reminder of what symptoms make up a typical asthma history, moving on to the new pathway of investigations, and ending with a chat about management covering AIR and MART.  We also touch on green prescribing, steroid cards and other important areas of management such as adherence and inhaler technique.   You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Resources: Joint asthma guideline: https://www.nice.org.uk/guidance/ng244 GMMMG asthma guidelines: https://gmmmg.nhs.uk/guidance/clinical-guidance-and-pathways/gm-asthma-guideline-2024-for-web/ Asthma and Lung UK: https://www.asthmaandlung.org.uk/ Right Breathe: https://www.rightbreathe.com/ Asthma and Lung UK explainer videos: https://www.asthmaandlung.org.uk/living-with/inhaler-videos ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

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• Nasal Obstruction in Children

  Episode four of four on Paediatric ENT. Doctors Lisa and Sara are back with Paediatric Ear Nose and Throat Consultant Dr Simone Schaefer for this episode on nasal obstruction in children. We use examples of typical cases to discuss an approach to assessing these patients, discussing who ENT might want to see urgently, and differentials for these presentations. We discuss options for management in Primary Care and what ENT can do.    You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Resources: Efficacy and Safety of Nasal Steroids reference: Li Y, Xiong J, Zhang Z, Liao K, Zho X, Li J, Xiang J, Xu L. Efficacy and safety of various corticosteroids in the treatment of children with allergic rhinitis: A systematic review and network meta-analysis. J Evid Based Med. 2024 Sep;17(3):626-642: https://pubmed.ncbi.nlm.nih.gov/39313999/ Safety of Intranasal Steroids link: McDonnell J, Weller K, Pien LC. Safety of Intranasal Steroids: an Updated Perspective. Curr Allergy Asthma Rep. 2020 Sep 7;20(11):69. https://pubmed.ncbi.nlm.nih.gov/32893309/ ENT UK Paediatric Snoring and Obstructive Sleep Apnoea in Children and Adolescents (accessed May 2025): https://www.entuk.org/_userfiles/pages/files/guidelines/global%20ent%20guidelines/global_health_guidelines_pediatric_snoring_obstructive_sleep_apnoea.pdf ENT UK Chronic Rhinosinusitis in Children: https://www.entuk.org/patients/conditions/64/chronic_rhinosinusitis_in_children/ NICE Clinical Knowledge Summaries Allergic Rhinitis (Jan 2024): https://cks.nice.org.uk/topics/allergic-rhinitis/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

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• Recurrent Epistaxis in Children

  Episode three of four on Paediatric ENT. Doctors Lisa and Sara are back with Paediatric Ear Nose and Throat Consultant Dr Simone Schaefer for this episode on Recurrent Epistaxis in Children. We discuss important differentials, including a rare condition that can present in predominantly teenage boys not to be missed, before moving on to discuss options for management and why the vast majority of these patients can often be safely managed in the community. We discuss cases that would be useful to be seen by the ENT team. Short and sweet, full of useful resources.   You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Resources: Success Rates of Naseptin (Chlorhexidine dihydrochloride and neomycin sulfate) in reducing Epistaxis: Garry S, Wauchope J, Hintze J, Ryan E, O'Cathain E, Heffernan C. Factors affecting Naseptin treatment success – A prospective cohort study. International Journal of Pediatric Otorhinolaryngology. Volume 171. 2023: https://www.sciencedirect.com/science/article/abs/pii/S0165587623001878#:~:text=80.8%25%20(n%20%3D%20101),effects%20(skin%20irritation%20etc.) ENT UK: How to use a Nasal Spray: https://www.entuk.org/patients/conditions/79/how_to_use_nasal_sprays/ Asthma and Lung UK, How to use a Nasal Spray useful Video for patients: https://www.youtube.com/watch?v=S31maomo1xQ Alder Hey Children’s Hospital Patient leaflet: Nosebleeds: https://www.alderhey.nhs.uk/conditions/symptoms-checker/nosebleeds/ ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

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• Recurrent Tonsillitis in Children

  Episode two of four on Paediatric ENT conditions. Doctors Lisa and Sara are back with Paediatric Ear Nose and Throat Consultant Dr Simone Schaefer for this episode on Recurrent Tonsillitis in Children. We go through the definition of tonsillitis and what ENT class as recurrent Tonsillitis that would hit the criteria for Tonsillectomy in our region. We use a case and discuss why referral criteria are so strict, as well as some exceptions to the criteria.    Resources: ENT UK Recurrent Tonsillitis Decision Making Tool for Tonsillectomies (for parents): https://www.entuk.org/patients/conditions/63/helping_you_decide_about_tonsil_surgery_for_your_child NHS England ENT UK Recurrent Tonsillitis Decision Making Tool for Tonsillectomies (for adults and Children): https://www.england.nhs.uk/publication/decision-support-tool-making-a-decision-about-recurrent-tonsillitis-in-children-and-adults/   You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

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• Recurrent Acute Otitis Media in Children

  Episode one of four on Paediatric ENT conditions. Doctors Lisa and Sara are joined by Paediatric Ear Nose and Throat Consultant Dr Simone Schaefer for this episode on Recurrent Acute Otitis Media (AOM) in Children. A common problem, we take a classic presentation and work through getting the diagnosis right, red flags and differentials before discussing management and which children may need referrals. We then discuss the limited options of what might be done in an ENT clinic and helpful resources for families.   You can use these podcasts as part of your CPD - we don’t do certificates but they still count :) Useful Resources: NICE Clinical Knowledge Summaries on Acute Otitis Media (including initial presentation, persistent infections and recurrent infections (updated August 2024): https://cks.nice.org.uk/topics/otitis-media-acute/ Hoberman et al. 2021 NEJM Tympanostomy tube placement or medical management for recurrent acute otitis media: https://www.nejm.org/doi/full/10.1056/NEJMoa2027278 Resource for Patients: https://www.nhs.uk/conditions/ear-infections/ https://www.hopkinsmedicine.org/health/conditions-and-diseases/ear-infections-in-babies-and-toddlers ENT UK: Decision making aid for parents re Grommets: https://www.entuk.org/patients/conditions/5/grommets_a_decisionmaking_aid_for_parents ENT UK: Explainer leaflets, How to use ear drops or sprays: https://www.entuk.org/patients/conditions/74/how_to_use_ear_drops_or_sprays The Royal Children’s Hospital Melbourne. Clinical Paediatric Guideline (good algorithm, pictures of erythematous Tympanic Membranes versus Acute Otitis Media with bulging/effusion): https://www.rch.org.au/clinicalguide/guideline_index/acute_otitis_media/ ENT Guidelines for Derbyshire (includes details of Topical Drops in specific cases: https://www.derbyshiremedicinesmanagement.nhs.uk/assets/Clinical_Guidelines/Formulary_by_BNF_chapter_prescribing_guidelines/BNF_chapter_12/Chapter_12_Ear_nose_and_oropharynx.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: [email protected] ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

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