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The ‘unified airway’: the RCPCH care pathway for children with asthma and/or rhinitis
  1. Gillian Vance1,
  2. Kate Lloyd2,
  3. Glenis Scadding3,
  4. Samantha Walker4,
  5. Fiona Jewkes5,
  6. Lynette Williams6,
  7. Lisa Dixon7,
  8. Claire O'Beirne8,
  9. Penny Fletcher9,
  10. Trevor Brown10,
  11. Jenny Hughes11,
  12. Dalbir Sohi12,
  13. Cher Piddock13,
  14. Michael Shields14,
  15. Michael McKean15,
  16. John Warner16 on behalf of the Science and Research Department, Royal College of Paediatrics and Child Health
  1. 1Paediatric Allergy, Great North Children's Hospital, Newcastle Upon Tyne
  2. 2Royal College of Paediatrics and Child Health, London, UK
  3. 3Allergy/ENT, Royal National Throat, Nose and Ear Hospital, London, UK
  4. 4Education for Health, Warwick, UK
  5. 5Joint Royal Colleges Ambulance Liaison Committee, Cockburnspath, Berwickshire, UK
  6. 6Royal Shrewsbury Hospital NHS Trust, Shrewsbury, UK
  7. 7Allergy and Immunology, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  8. 8Patient/Carer Representative, UK
  9. 9Pharmacy, Imperial College Healthcare Trust, London, UK
  10. 10Paediatric Allergy, The Ulster Hospital, Dundonald, Belfast, UK
  11. 11Paediatrics, Antrim Area Hospital, Antrim, UK
  12. 12Paediatrics, North Middlesex University Hospital NHS Trust, London, UK
  13. 13Asthma UK, London, UK
  14. 14Paediatrics, Queen's University Belfast and Royal Belfast Hospital for Sick Children, Belfast, UK
  15. 15Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  16. 16 Department of Paediatrics, Imperial College, St Mary's Hospital Campus, London, UK
  1. Correspondence to Dr Gillian Vance, Paediatric Allergy, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle Upon Tyne NE1 4LP, UK; gillian.vance{at}nuth.nhs.uk

Abstract

Aims The Royal College of Paediatrics and Child Health (RCPCH) Science and Research Department was commissioned by the Department of Health to develop national care pathways for children with allergies: the asthma/rhinitis care pathway is the third such pathway. Asthma and rhinitis have been considered together. These conditions co-exist commonly, have remarkably similar immuno-pathology and an integrated management approach benefits symptom control.

Method The asthma/rhinitis pathway was developed by a multidisciplinary working group and was based on a comprehensive review of evidence. The pathway was reviewed by a broad group of stakeholders including the public and was approved by the Allergy Care Pathways Project Board and the RCPCH Clinical Standards Committee.

Results The pathway entry points are defined by symptom type and severity at presentation. Acute severe rhinitis and life-threatening asthma are presented as distinct entry routes to the pathway, recognising that initial care of these conditions requires presentation-specific treatments. However, the pathway emphasises that ideal long term care should take account of both conditions in order to achieve maximal improvements in disease control and quality of life.

Conclusions The pathway recommends that acute presentations of asthma and/or rhinitis should be treated separately. Where both conditions exist, ongoing management should address the upper and lower airways. The authors recommend that this pathway is implemented locally by a multidisciplinary team (MDT) with a focus on creating networks. The MDT within these networks should work with patients to develop and agree on care plans that are age and culturally appropriate.

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Footnotes

  • Funding This project was funded by the Department of Health.

  • Competing interests TB: MSD-UK, GSK, ALK-Abello, Mead Johnson, Danone (Nutricia), Astra-Zeneca, Allergy NI, Schering Plough; CO'B: shareholder, Joint Director: Biopharm Services; GS: GSK, Schering Plough, ALK, Groupo Uriach, GSK, ALK, Schering Plough, Merck, Capnia, Oxford Therapeutics; MS: Merck Sharp & Dohme, AstraZeneca, GSK, ALK, Novartis; GV: Nutricia, Mead Johnson, ALK, Allergy Therapeutics; JW: Novartis, Danone, Airsonette, Merck, Allergy Therapeutics, Phadia, Research, GSK, AstraZeneca, Merck, Allergy Therapeutics, ALK; LW: GSK, MSD, Education for Health.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

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