‘SIMPLES’: a structured primary care approach to adults with difficult asthma

Online first

Case-based Learning

^*Dermot Ryan¹, Anna Murphy², Björn Ställberg³, Noel Baxter⁴, Liam G Heaney<sup>5

1</sup> General Practitioner, Woodbrook Medical Centre, Loughborough, UK; Honorary Clinical Research Fellow, Allergy and Respiratory Research Group, The University of Edinburgh, Edinburgh, UK

² Consultant Respiratory Pharmacist, University Hospitals of Leicester NHS Trust, Department of Respiratory Medicine, Glenfield Hospital, Leicester, UK

³ General Practitioner, Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Sweden

⁴ General Practitioner, Surrey Docks Health Centre, Downtown Road, Surrey Quays, London, UK

⁵ Professor of Respiratory Medicine, Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, N Ireland

Received 30 June 2013 • Accepted 31 July 2013 • Online 23 August 2013


Abstract
The substantial majority of patients with asthma can expect minimal breakthrough symptoms on standard doses of inhaled corticosteroids with or without additional add-on therapies. SIMPLES is a structured primary care approach to the review of a person with uncontrolled asthma which encompasses patient education monitoring, lifestyle and pharmacological management and addressing support needs which will achieve control in most patients. The small group of patients presenting with persistent asthma symptoms despite being prescribed high levels of treatment are often referred to as having ‘difficult asthma’. Some will have difficult, ‘therapy resistant’ asthma, some will have psychosocial problems which make it difficult for them to achieve asthma control and some may prove to have an alternative diagnosis driving their symptoms. A few patients will benefit from referral to a ‘difficult asthma’ clinic. The SIMPLES approach, aligned with close co-operation between primary and specialist care, can identify this patient group, avoid inappropriate escalation of treatment, and streamline clinical assessment and management.

Cite as: Ryan D, Murphy A, Stallberg B, Baxter N, Heaney LG. ‘SIMPLES’: a structured primary care approach to adults with difficult asthma. Prim Care Respir J 2013; Available from: URL: http://dx.doi.org/10.4104/pcrj.2013.00075

Keywords
difficult asthma, primary care, asthma control

* Corresponding author. Dermot Ryan Tel: +44 (0)1224 553972 Fax: +44 (0)1224 550683 Email: dermotryan@doctors.org.uk

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