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BPJ 42 February 2012

Best Practice Journal

Diagnosing and managing asthma in children

New Zealand has one of the highest rates of childhood asthma in the developed world. It is the leading cause of sleep disturbance, missed school days and hospital admissions in children. Asthma affects Māori and Pacific children disproportionately to other children in New Zealand. The challenge is for primary healthcare to assist in addressing these disparities, to detect asthma early and to manage it effectively, while minimising unnecessary treatment caused by inaccurate diagnosis.

Child asthma guidelines have now been updated, see here: https://bpac.org.nz/2020/asthma-children.aspx

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The new role of HbA1c in diagnosing type 2 diabetes

A position statement released by the New Zealand Society for the Study of Diabetes (NZSSD) now recommends the use of glycated haemoglobin (HbA1c) for the diagnosis of type 2 diabetes. In addition, HbA1c should also be the test of choice for opportunistic screening in the majority of people. View Article

Initiating insulin for people with type 2 diabetes

Due to its progressive nature, many people with type 2 diabetes will eventually require insulin treatment. Insulin initiation is frequently managed in secondary care. However, New Zealand guidelines now recommend that insulin initiation for people with type 2 diabetes be managed in primary care where possible, with additional support as required. View Article

Substance misuse in adolescents: alcohol, cannabis & other drugs

The risk of injury or death during adolescence is two to three times higher than it is during childhood. The main reason for this increase is the emergence of risk-taking behaviour occurring at a time when many adolescents first experiment with sex, smoking, alcohol and other drugs. It is important to identify substance misuse in people in any age group, however, identifying problems and providing intervention for adolescents can help to avoid serious substance misuse and addiction in adulthood. View Article

Schedule changes for asthma inhalers

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Prescribing citalopram safely: an update

Evidence of adverse cardiac effects associated with citalopram has prompted a reduction in the recommended maximum daily dose to 40 mg per day in adults.* It is also recommended that doses above 20 mg are avoided in people aged over 65 years or in people with hepatic impairment. These changes are due to two recent clinical studies which found that citalopram is associated with a dose dependent change in the electrical activity of the heart, potentially leading to QT interval prolongation. *"Citalopram is not approved for use in people aged under 18 years" View Article

Correspondence: Migraine in breast feeding; Gluten-free diets

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