RESPIRATORY DISEASES

Health Evidence Bulletins - Wales
Team Leader: Dr M. Burr

Original Protocol Statements

(Original Welsh protocol intervention in brackets)

The original Protocols for Investment in Health Gain were written in the early 1990s to suggest areas where the introduction, or more widespread use, of certain practices could lead to worthwhile improvements in health for the people of Wales. The documents also highlighted current practices which were of questionable value.

In certain areas, elements of the original statements have not been included into the revised statements.  Where this occurs, reasons for omission are given.  The original Welsh Protocol intervention is given in brackets after each statement, these refer to the following;

Original Welsh Protocol intervention

  1. Interventions that increase health gain
  2. Interventions that appear promising but require further evaluation
  3. Interventions with uncertain effects which require further evaluation
  4. Interventions that should be abandoned in light of available evidence

1. Cystic Fibrosis

Prevention and promotion:
Genetic counselling (1); Antenatal screening and counselling (1); Population screeening (3)
Diagnosis and assessment:
Neonatal screening (1/2); Sweat testing (1); DNA analysis (2)
Treatment and care:
Centralised care (1,2); Shared care (2); Pancreatic enzyme supplements (1); Heart and lung transplant (2); Vigorous antibiotic treatment (1); Physiotherapy to clear sputum (1); Exercise programme (3); Nutritional advice (1)
Rehabilitation and continuing care:
Multidisciplinary approach (1); Access to CF clinical specialist nurse (1); Physiotherapy (1); Nutritional advice (1); Access to social services (1)
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Record of elements of the original statements not incorporated into the revised statements

Subject Reasons for omission
Sweat testing Standard good practice included in Guidelines (see statement h).
Heart/lung transplant  
Exercise programme  
Nutritional advice  

2. Respiratory diseases in the newborn

b mimetics (1)

Corticosteroids to prevent RDS (1)

3. Acute bronchiolitis and bronchitis

Prevention and promotion:
Avoidance of passive smoking (1)
Diagnosis and assessment:
Improved training and awareness at primary health care level (1)
Treatment and care:
Use of antibiotics (3, 4); Anti-viral therapy (3)
Rehabilitation and continuing care:
Follow-up to detect asthma (2)

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Record of elements of the original statements not incorporated into the revised statements

Subject Reasons for omission
Improved training and awareness at primary care level Accepted good practice - No appropriate evidence available

4. Upper Respiratory Tract Infections

Prevention and promotion:
MMR immunisation (1); Anti-smoking action (1); Pertussis immunisation (1)
Diagnosis and assessment:
Consistent guidelines (1); Routine throat swabs (4)
Treatment and care:
Education (1); Advice from pharmacists (2); Use of antibiotics (3, 4)

Record of elements of the original statements not incorporated into the revised statements

Subject Reasons for omission
MMR immunization Accepted good practice relating to specific infections not covered in this Bulletin.
Pertussis immunization  
Routine throat swabs (4) Not in common use.
Education Accepted good practice - No appropriate supporting evidence available.
Advice from pharmacists  

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5. Asthma - Non-drug management

Diagnosis and assessment:

Childhood asthma:
Greater awareness of asthma in children (1); More education of primary health care professionals (1)
Adult asthma:
Occupational screening (2); Detailed history (1)
Treatment and care:
Childhood asthma:
Early therapy (1); Self-help groups (1); Consistent approach (2); Inappropriate hospital referral (4) and hospital follow-up (4)
Adult asthma:
Oxygen (1); Guidelines (1); Education of patients and carers to prevent episodes (1); Education for professionals (1); Advice from pharmacists (2); Inappropriate hospital referral (4) and hospital follow-up (4)
Rehabilitation and continuing care:
Childhood asthma:
Good follow-up (1); Physical exercise (1); Education of patients, carers and other contacts especially teachers.
Adult asthma:
Occupational advice (2); Education of patients, carers and other contacts (1)
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Record of elements of the original statements not incorporated into the revised statements

Subject Reasons for omission
More education of primary health care professionals Accepted good practice - No appropriate supporting evidence found.
Occupational screening and history  
Consistent approach  
Occupational advice  
Physical exercise  

6. Asthma - Drug management

Treatment and care:
Early therapy (1); Attention to method of administration (1); Consistent approach (2); Nebulisers (2); Use of antibiotics (4); Advice from pharmacists (2)

Record of elements of the original statements not incorporated into the revised statements

Subject Reasons for omission
Advice from pharmacists Accepted good practice - no appropriate evidence found.

7. Influenza

Prevention and promotion:
Immunisation of at-risk groups (1); Public education (1)
Diagnosis and assessment:
Identification of complications (1)
Treatment and care:
Anti-viral agents (3); Use of antibiotics (4)
Rehabilitation and continuing care:
Increased public awareness (2)
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Record of elements of the original statements not incorporated into the revised statements

Subject Reasons for omissions
Public education and awareness Accepted good practice - No appropriate supporting evidence found
Identification of complications  

8. Pneumonia

Prevention and promotion:
BTS guidelines (1)
Treatment and care:
Early administration of antibiotics (1); Analgesia (2)

Record of elements of the original statements not incorporated into the revised statements

Subject Reasons for omission
Analgesia The use of analgesia for pain is accepted good practice.

9. Chronic Bronchitis and Emphysema - non-drug treatment

Prevention and promotion:
Anti-smoking action (1); Attention to humidity (2); Avoidance of polluted areas (2)
Treatment and care:
Routine prescription of nebulisers, broncho-inhalers (4); Routine prescription of oral steroids (4); Anti-influenza vaccine (2); Anti-trypsin protein (3); Long-term oxygen (1); Education for sufferers (1); Smoking cessation (1); Routine long-term follow-up in hospitals (4)
Rehabilitation and continuing care:
Education for sufferers and families (1); Nutritional advice (2)
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Record of elements of the original statements not incorporated into the revised statements

Subject Reasons for omission
Humidity No appropriate evidence found
Pollution Covered in Introduction as general risk factor
Nutritional advice No appropriate evidence found

10. Chronic Bronchitis and Emphysema - drug management

Treatment and care:
Routine prescription of nebulisers, broncho-inhalers (4); Routine prescription of oral steroids (4); Anti-influenza vaccine (2); Anti-trypsin protein (3); Long-term oxygen (1); Education for sufferers (1); Smoking cessation (1); Routine long-term follow-up in hospitals (4)

Record of elements of the original statements not incorporated into the revised statements

Subject Reasons for omission
Influenza vaccine No appropriate evidence found.
Anti-trypsin protein  

11. Tuberculosis

Prevention and promotion:
General immunisation (2); Immunisation for at-risk babies (1); Contact tracing (1)
Treatment and care:
Chemotherapy (1); Check-up after treatment post-6 months (4); Annual check-up (4)
Rehabilitation and continuing care:
Education for sufferers and families (1); Nutritional advice (2)

Record of elements of the original statements not incorporated into the revised statements

Subject Reasons for omission
Contact tracing Included in Guidelines
Education and nutritional advice  
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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk