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Symptom control poor

·Asthma symptoms are fully controlled in less than 20 per cent of patients, according to a major new study of asthma reviews.

The University of Dundee study, which analysed 65,567 patients across 1,127 practices, also found significant gender inequalities.

Men were more likely than women to be non-compliant with their asthma medication and less likely to report symptoms.

Women were significantly more likely to be using a self-management plan than men and were likely to have more days off work as a result of their asthma.

Targeted protocols

·A targeted protocol to reduce airway inflammation can prevent exacerbations in patients with difficult asthma, according to a new study.

Testing sputum for levels of eosinophilic inflammation and treating accordingly cut the number of doses of rescue steroids used each year from 4.21 per person to 2.66.

It also cut the number of emergency admissions in half, from 1.34 to 0.6 per cent.

COPD non-smokers

·As many as 15 per cent of patients with COPD are non-smokers, whose symptoms are caused by exposure to occupational hazards or pollution, researchers claim.

A City Hospital Sunderland study found that of 602 patients with COPD identified in primary care, 89 were non-smokers.

Of these 60 had suffered occupational exposure to dust, asbestos, fumes or welding, reporting an average of two to three pollutants.

The researchers also found a large number of non-smokers with airflow limitation have a cough and produce sputum daily.

Steroid injections

·Patients with life-threatening asthma who are

non-compliant with medication could benefit from intramuscular steroid injections.

Researchers from the Institute of Lung Health treated 18 patients at stage five of BTS asthma guidelines ­ and who were poorly compliant with inhaled or oral therapy ­ with a three-month course of monthly 40-80mg triamcinolone injections.

FEV1 rose from 62 per cent before therapy to 76 per cent after three months and sputum eosinophil count fell from 13.8 to 1.1 per cent over the same period.

None of the patients suffered adverse events.

Anticholinergics backed

·A long-acting inhaled anticholinergic licensed for maintenance of COPD can improve lung function and reduce exacerbations, GP researchers claim.

Patients randomised to receive tiotropium suffered 52 per cent fewer exacerbations than those on placebo during the 12-week trial.

FEV1 and FVC were also improved in those taking tiotropium and use of rescue medication was significantly lower, the University of Abderdeen study concluded.

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