Care pathway for asthma and/or rhinitis
The College's care pathway for asthma and/or rhinitis is presented in two parts:
an algorithm with the stages of ideal care, and
a set of competences required to diagnose, treat and optimally manage asthma and/or rhinitis.
The algorithm has numbers which correspond to the competences outlined within the body of the document.
(PDF, 1.7 MB, 17 pages).
We recommend that this pathway is implemented locally by a multidisciplinary team, with a focus on creating networks between staff in primary and community healthcare, social care, education and hospital-based practice to improve services for children with allergic conditions. All specialists should have paediatric training.
In the absence of an agreed gold standard definition, the Asthma/Rhinitis Working Group define asthma to be a condition that is characterised by the presence of one or more of the following symptoms - chest tightness, wheezing (and coughing), breathlessness - and in the absence of an alternative diagnosis.
Asthma is associated typically with chronic inflammation and hyper-responsiveness of the lower airway, leading to airway narrowing that is variable and reversible (by treatment or spontaneously).
A condition that is characterised by the presence of two or more of the following symptoms, for more than one hour per day on a recurrent or persistent basis:
- rhinorrhoea (watery, runny nose)
- bilateral nasal obstruction (congestion)
- itching (+ conjunctivitis).
Rhinitis may be accompanied by symptoms affecting the eyes, ears, sinuses, throat and chest.
The scope of this pathway does not extend to acute severe rhinosinusitis and the management of this condition is not considered. Acute severe rhinosinusitis is a condition that can be life-threatening. It is characterised by the sudden onset of two or more symptoms, one of which should be either nasal blockage/obstruction/congestion or thick nasal discharge. Additional symptoms may include facial pain/pressure, reduction or loss of smell and/or headache. If high fever and displaced globe are present, urgent secondary care referral is warranted.
Core knowledge documents
The core knowledge documents comprise the clinical guidance which informed the development of the care pathway. Healthcare professionals diagnosing and managing children with asthma/rhinitis should be aware of the following clinical guidance:
- British Thoracic Society/Scottish Intercollegiate Guidelines Network guideline on the management of asthma
- British Society for Allergy and Clinical Immunology (BSACI) guidelines for the management of allergic and non-allergic rhinitis
- BSACI guidelines for the management of rhinosinusitis and nasal polyposis
- European position (EPOS) paper on rhinosinusitis and nasal polyps
- Asthma UK: www.asthma.org.uk
- NHS Choices: asthma: www.nhs.uk/conditions/Asthma-in-children/Pages/Introduction.aspx
- NHS Choices: rhinitis: www.nhs.uk/conditions/Rhinitis---allergic/Pages/Introduction.aspx