WEBVTT Kind: captions Language: en Style: ::cue(c.colorCCCCCC) { color: rgb(204,204,204); } ::cue(c.colorE5E5E5) { color: rgb(229,229,229); } ## 00:00:01.560 --> 00:00:07.570 align:start position:0% [Music] 00:00:07.570 --> 00:00:07.580 align:start position:0% [Music] 00:00:07.580 --> 00:00:10.190 align:start position:0% [Music] good<00:00:08.580> morning<00:00:08.969> and<00:00:09.210> welcome<00:00:09.480> to<00:00:09.809> the<00:00:09.930> ers 00:00:10.190 --> 00:00:10.200 align:start position:0% good morning and welcome to the ers 00:00:10.200 --> 00:00:12.440 align:start position:0% good morning and welcome to the ers daily<00:00:10.740> highlights<00:00:10.950> I'm<00:00:11.820> delighted<00:00:12.210> to<00:00:12.389> be 00:00:12.440 --> 00:00:12.450 align:start position:0% daily highlights I'm delighted to be 00:00:12.450 --> 00:00:14.510 align:start position:0% daily highlights I'm delighted to be joined<00:00:12.809> by<00:00:13.110> my<00:00:13.350> colleagues<00:00:13.830> here<00:00:14.129> Steve 00:00:14.510 --> 00:00:14.520 align:start position:0% joined by my colleagues here Steve 00:00:14.520 --> 00:00:16.850 align:start position:0% joined by my colleagues here Steve Holmes<00:00:14.820> the<00:00:15.030> GP<00:00:15.389> from<00:00:15.510> the<00:00:15.660> UK<00:00:16.020> and<00:00:16.290> T<00:00:16.590> Spain 00:00:16.850 --> 00:00:16.860 align:start position:0% Holmes the GP from the UK and T Spain 00:00:16.860 --> 00:00:18.980 align:start position:0% Holmes the GP from the UK and T Spain Nolan<00:00:17.369> and<00:00:17.610> from<00:00:18.090> the<00:00:18.180> Netherlands<00:00:18.689> who's<00:00:18.960> a 00:00:18.980 --> 00:00:18.990 align:start position:0% Nolan and from the Netherlands who's a 00:00:18.990 --> 00:00:22.130 align:start position:0% Nolan and from the Netherlands who's a global<00:00:19.770> medical<00:00:20.040> expert<00:00:20.520> like<00:00:20.730> myself<00:00:21.140> teeth 00:00:22.130 --> 00:00:22.140 align:start position:0% global medical expert like myself teeth 00:00:22.140 --> 00:00:24.440 align:start position:0% global medical expert like myself teeth being<00:00:22.380> a<00:00:22.470> GP<00:00:22.860> and<00:00:23.040> I've<00:00:23.130> been<00:00:23.369> a<00:00:23.399> primary<00:00:24.180> care 00:00:24.440 --> 00:00:24.450 align:start position:0% being a GP and I've been a primary care 00:00:24.450 --> 00:00:25.400 align:start position:0% being a GP and I've been a primary care nurse<00:00:24.630> for<00:00:24.869> many<00:00:24.989> years 00:00:25.400 --> 00:00:25.410 align:start position:0% nurse for many years 00:00:25.410 --> 00:00:28.100 align:start position:0% nurse for many years we're<00:00:26.099> here<00:00:26.250> to<00:00:26.430> start<00:00:26.700> to<00:00:27.360> talk<00:00:27.540> about<00:00:27.689> some 00:00:28.100 --> 00:00:28.110 align:start position:0% we're here to start to talk about some 00:00:28.110 --> 00:00:29.780 align:start position:0% we're here to start to talk about some of<00:00:28.140> the<00:00:28.439> things<00:00:28.800> we<00:00:28.980> learned<00:00:29.189> from<00:00:29.309> yesterday 00:00:29.780 --> 00:00:29.790 align:start position:0% of the things we learned from yesterday 00:00:29.790 --> 00:00:32.630 align:start position:0% of the things we learned from yesterday around<00:00:29.939> the<00:00:30.329> primary<00:00:30.689> care<00:00:31.279> symposium<00:00:32.279> and 00:00:32.630 --> 00:00:32.640 align:start position:0% around the primary care symposium and 00:00:32.640 --> 00:00:35.450 align:start position:0% around the primary care symposium and there<00:00:33.450> is<00:00:33.570> one<00:00:33.750> big<00:00:33.989> issue<00:00:34.110> I<00:00:34.290> think<00:00:34.440> we<00:00:34.829> really 00:00:35.450 --> 00:00:35.460 align:start position:0% there is one big issue I think we really 00:00:35.460 --> 00:00:36.860 align:start position:0% there is one big issue I think we really want<00:00:35.489> to<00:00:35.670> kick<00:00:35.880> off<00:00:36.030> with<00:00:36.270> and<00:00:36.540> that<00:00:36.660> is<00:00:36.690> the 00:00:36.860 --> 00:00:36.870 align:start position:0% want to kick off with and that is the 00:00:36.870 --> 00:00:39.470 align:start position:0% want to kick off with and that is the diagnosis<00:00:37.649> of<00:00:37.680> asthma<00:00:38.030> now<00:00:39.030> we<00:00:39.090> are<00:00:39.300> being 00:00:39.470 --> 00:00:39.480 align:start position:0% diagnosis of asthma now we are being 00:00:39.480 --> 00:00:42.170 align:start position:0% diagnosis of asthma now we are being challenged<00:00:40.170> as<00:00:40.350> primary<00:00:40.800> care<00:00:41.180> practitioners 00:00:42.170 --> 00:00:42.180 align:start position:0% challenged as primary care practitioners 00:00:42.180 --> 00:00:44.180 align:start position:0% challenged as primary care practitioners about<00:00:42.510> the<00:00:42.660> accuracy<00:00:43.110> of<00:00:43.140> the<00:00:43.350> diagnosis<00:00:44.040> and 00:00:44.180 --> 00:00:44.190 align:start position:0% about the accuracy of the diagnosis and 00:00:44.190 --> 00:00:46.160 align:start position:0% about the accuracy of the diagnosis and obviously<00:00:44.460> it's<00:00:44.610> truly<00:00:45.240> really<00:00:45.570> important 00:00:46.160 --> 00:00:46.170 align:start position:0% obviously it's truly really important 00:00:46.170 --> 00:00:48.800 align:start position:0% obviously it's truly really important and<00:00:46.560> for<00:00:47.070> many<00:00:47.250> years<00:00:47.580> or<00:00:48.060> the<00:00:48.180> recent<00:00:48.420> years 00:00:48.800 --> 00:00:48.810 align:start position:0% and for many years or the recent years 00:00:48.810 --> 00:00:50.390 align:start position:0% and for many years or the recent years we've<00:00:48.990> been<00:00:49.110> thinking<00:00:49.500> about<00:00:49.680> the<00:00:49.950> concept 00:00:50.390 --> 00:00:50.400 align:start position:0% we've been thinking about the concept 00:00:50.400 --> 00:00:53.270 align:start position:0% we've been thinking about the concept probability<00:00:51.240> but<00:00:51.480> I<00:00:51.540> think<00:00:51.780> yesterday<00:00:52.350> we<00:00:53.040> had 00:00:53.270 --> 00:00:53.280 align:start position:0% probability but I think yesterday we had 00:00:53.280 --> 00:00:55.850 align:start position:0% probability but I think yesterday we had that<00:00:53.490> bust<00:00:53.910> through<00:00:54.390> a<00:00:54.420> bit<00:00:54.690> by<00:00:54.990> Luke<00:00:55.470> Danes 00:00:55.850 --> 00:00:55.860 align:start position:0% that bust through a bit by Luke Danes 00:00:55.860 --> 00:00:58.490 align:start position:0% that bust through a bit by Luke Danes and<00:00:56.400> Steve<00:00:57.240> I<00:00:57.450> wondered<00:00:57.840> what<00:00:57.989> you<00:00:58.170> took<00:00:58.440> from 00:00:58.490 --> 00:00:58.500 align:start position:0% and Steve I wondered what you took from 00:00:58.500 --> 00:01:01.100 align:start position:0% and Steve I wondered what you took from that<00:00:58.890> session<00:00:59.190> I<00:00:59.760> I<00:01:00.390> guess<00:01:00.870> there<00:01:01.020> were<00:01:01.079> a 00:01:01.100 --> 00:01:01.110 align:start position:0% that session I I guess there were a 00:01:01.110 --> 00:01:02.960 align:start position:0% that session I I guess there were a number<00:01:01.230> of<00:01:01.410> things<00:01:01.560> that<00:01:01.739> I<00:01:01.950> that<00:01:02.220> I<00:01:02.610> took<00:01:02.820> from 00:01:02.960 --> 00:01:02.970 align:start position:0% number of things that I that I took from 00:01:02.970 --> 00:01:04.850 align:start position:0% number of things that I that I took from that<00:01:03.150> I<00:01:03.180> think<00:01:03.480> the<00:01:03.600> first<00:01:03.900> thing<00:01:04.259> was<00:01:04.500> that 00:01:04.850 --> 00:01:04.860 align:start position:0% that I think the first thing was that 00:01:04.860 --> 00:01:07.340 align:start position:0% that I think the first thing was that the<00:01:05.339> diagnosis<00:01:06.060> of<00:01:06.240> asthma<00:01:06.509> is<00:01:06.990> still 00:01:07.340 --> 00:01:07.350 align:start position:0% the diagnosis of asthma is still 00:01:07.350 --> 00:01:10.990 align:start position:0% the diagnosis of asthma is still challenging<00:01:07.680> and<00:01:08.750> it<00:01:09.750> challenges<00:01:10.320> both 00:01:10.990 --> 00:01:11.000 align:start position:0% challenging and it challenges both 00:01:11.000 --> 00:01:13.700 align:start position:0% challenging and it challenges both clinicians<00:01:12.000> in<00:01:12.330> primary<00:01:12.690> care<00:01:12.870> but<00:01:12.930> also<00:01:13.080> our 00:01:13.700 --> 00:01:13.710 align:start position:0% clinicians in primary care but also our 00:01:13.710 --> 00:01:16.250 align:start position:0% clinicians in primary care but also our friends<00:01:14.550> in<00:01:14.670> secondary<00:01:15.060> care<00:01:15.330> as<00:01:15.479> well<00:01:15.659> so 00:01:16.250 --> 00:01:16.260 align:start position:0% friends in secondary care as well so 00:01:16.260 --> 00:01:17.450 align:start position:0% friends in secondary care as well so it's<00:01:16.650> not<00:01:16.800> always<00:01:16.979> a<00:01:17.130> straightforward 00:01:17.450 --> 00:01:17.460 align:start position:0% it's not always a straightforward 00:01:17.460 --> 00:01:21.050 align:start position:0% it's not always a straightforward diagnosis<00:01:18.360> I<00:01:18.570> think<00:01:19.530> the<00:01:20.159> second<00:01:20.610> area<00:01:20.790> on 00:01:21.050 --> 00:01:21.060 align:start position:0% diagnosis I think the second area on 00:01:21.060 --> 00:01:24.469 align:start position:0% diagnosis I think the second area on that<00:01:21.360> is<00:01:21.900> we<00:01:22.680> can<00:01:22.950> use<00:01:22.979> a<00:01:23.430> probability<00:01:24.090> how 00:01:24.469 --> 00:01:24.479 align:start position:0% that is we can use a probability how 00:01:24.479 --> 00:01:27.260 align:start position:0% that is we can use a probability how likely<00:01:24.840> is<00:01:25.110> it<00:01:25.140> that<00:01:25.290> it<00:01:25.440> is<00:01:25.560> a<00:01:25.740> smo<00:01:26.130> all<00:01:26.790> we<00:01:27.150> can 00:01:27.260 --> 00:01:27.270 align:start position:0% likely is it that it is a smo all we can 00:01:27.270 --> 00:01:29.690 align:start position:0% likely is it that it is a smo all we can try<00:01:27.510> to<00:01:27.570> move<00:01:27.870> towards<00:01:28.290> a<00:01:28.380> more<00:01:28.590> scientific 00:01:29.690 --> 00:01:29.700 align:start position:0% try to move towards a more scientific 00:01:29.700 --> 00:01:31.850 align:start position:0% try to move towards a more scientific let's<00:01:30.090> do<00:01:30.390> tests<00:01:30.900> and<00:01:31.020> say<00:01:31.170> this<00:01:31.409> must<00:01:31.680> be 00:01:31.850 --> 00:01:31.860 align:start position:0% let's do tests and say this must be 00:01:31.860 --> 00:01:34.969 align:start position:0% let's do tests and say this must be asthma<00:01:32.220> now<00:01:32.430> on<00:01:32.820> a<00:01:32.880> certain<00:01:33.420> basis<00:01:33.870> and<00:01:34.140> that 00:01:34.969 --> 00:01:34.979 align:start position:0% asthma now on a certain basis and that 00:01:34.979 --> 00:01:37.130 align:start position:0% asthma now on a certain basis and that leaves<00:01:35.250> clinicians<00:01:35.940> still<00:01:36.479> in<00:01:36.600> the<00:01:36.810> the 00:01:37.130 --> 00:01:37.140 align:start position:0% leaves clinicians still in the the 00:01:37.140 --> 00:01:38.870 align:start position:0% leaves clinicians still in the the difficulty<00:01:37.530> of<00:01:37.770> working<00:01:38.250> with<00:01:38.460> people<00:01:38.790> in 00:01:38.870 --> 00:01:38.880 align:start position:0% difficulty of working with people in 00:01:38.880 --> 00:01:41.750 align:start position:0% difficulty of working with people in front<00:01:39.119> of<00:01:39.270> them<00:01:39.630> I<00:01:40.440> guess<00:01:41.070> my<00:01:41.310> third 00:01:41.750 --> 00:01:41.760 align:start position:0% front of them I guess my third 00:01:41.760 --> 00:01:44.930 align:start position:0% front of them I guess my third reflection<00:01:42.450> on<00:01:42.570> that<00:01:42.600> session<00:01:43.530> was<00:01:44.190> around 00:01:44.930 --> 00:01:44.940 align:start position:0% reflection on that session was around 00:01:44.940 --> 00:01:46.609 align:start position:0% reflection on that session was around the<00:01:45.119> fact<00:01:45.330> that<00:01:45.479> a<00:01:45.810> lot<00:01:45.960> of<00:01:45.990> the<00:01:46.200> people<00:01:46.350> that<00:01:46.590> I 00:01:46.609 --> 00:01:46.619 align:start position:0% the fact that a lot of the people that I 00:01:46.619 --> 00:01:50.120 align:start position:0% the fact that a lot of the people that I see<00:01:46.979> have<00:01:47.430> asthma<00:01:48.320> but<00:01:49.320> they<00:01:49.560> will<00:01:49.740> also<00:01:49.920> have 00:01:50.120 --> 00:01:50.130 align:start position:0% see have asthma but they will also have 00:01:50.130 --> 00:01:53.450 align:start position:0% see have asthma but they will also have other<00:01:50.960> issues<00:01:51.960> that<00:01:52.200> produce<00:01:52.590> breathlessness 00:01:53.450 --> 00:01:53.460 align:start position:0% other issues that produce breathlessness 00:01:53.460 --> 00:01:58.010 align:start position:0% other issues that produce breathlessness like<00:01:54.450> anxiety<00:01:54.979> or<00:01:55.979> obesity<00:01:56.490> or<00:01:57.390> the<00:01:57.689> fact<00:01:57.930> that 00:01:58.010 --> 00:01:58.020 align:start position:0% like anxiety or obesity or the fact that 00:01:58.020 --> 00:02:00.890 align:start position:0% like anxiety or obesity or the fact that they<00:01:58.260> are<00:01:58.380> deconditioned<00:01:59.130> they<00:01:59.280> are<00:01:59.430> unfit<00:01:59.900> so 00:02:00.890 --> 00:02:00.900 align:start position:0% they are deconditioned they are unfit so 00:02:00.900 --> 00:02:02.330 align:start position:0% they are deconditioned they are unfit so do<00:02:01.020> you<00:02:01.110> think<00:02:01.170> it's<00:02:01.439> more<00:02:01.590> difficult<00:02:01.650> for<00:02:02.189> a 00:02:02.330 --> 00:02:02.340 align:start position:0% do you think it's more difficult for a 00:02:02.340 --> 00:02:04.039 align:start position:0% do you think it's more difficult for a primary<00:02:02.670> care<00:02:02.820> physician<00:02:02.850> because<00:02:03.689> because 00:02:04.039 --> 00:02:04.049 align:start position:0% primary care physician because because 00:02:04.049 --> 00:02:05.870 align:start position:0% primary care physician because because you're<00:02:04.259> seeing<00:02:04.500> patients<00:02:04.799> that<00:02:05.220> are<00:02:05.400> not 00:02:05.870 --> 00:02:05.880 align:start position:0% you're seeing patients that are not 00:02:05.880 --> 00:02:07.940 align:start position:0% you're seeing patients that are not respiratory<00:02:06.540> patients<00:02:07.049> necessarily<00:02:07.740> do<00:02:07.860> you 00:02:07.940 --> 00:02:07.950 align:start position:0% respiratory patients necessarily do you 00:02:07.950 --> 00:02:09.740 align:start position:0% respiratory patients necessarily do you think<00:02:08.129> it's<00:02:08.310> because<00:02:08.939> the<00:02:09.060> air<00:02:09.179> and<00:02:09.509> paper 00:02:09.740 --> 00:02:09.750 align:start position:0% think it's because the air and paper 00:02:09.750 --> 00:02:11.839 align:start position:0% think it's because the air and paper challenged<00:02:10.530> us<00:02:10.679> all<00:02:10.860> as<00:02:11.069> clinicians<00:02:11.400> last 00:02:11.839 --> 00:02:11.849 align:start position:0% challenged us all as clinicians last 00:02:11.849 --> 00:02:14.449 align:start position:0% challenged us all as clinicians last year<00:02:12.150> to<00:02:12.390> say<00:02:12.569> that<00:02:13.080> perhaps<00:02:13.260> 30<00:02:13.769> percent<00:02:14.310> of 00:02:14.449 --> 00:02:14.459 align:start position:0% year to say that perhaps 30 percent of 00:02:14.459 --> 00:02:16.339 align:start position:0% year to say that perhaps 30 percent of patients<00:02:14.700> who<00:02:15.120> are<00:02:15.269> diagnosed<00:02:15.810> in<00:02:15.959> primary 00:02:16.339 --> 00:02:16.349 align:start position:0% patients who are diagnosed in primary 00:02:16.349 --> 00:02:19.290 align:start position:0% patients who are diagnosed in primary care<00:02:16.529> actually<00:02:17.010> don't<00:02:17.760> have<00:02:18.029> us 00:02:19.290 --> 00:02:19.300 align:start position:0% care actually don't have us 00:02:19.300 --> 00:02:21.780 align:start position:0% care actually don't have us I<00:02:19.330> just<00:02:20.050> wonder<00:02:20.319> is<00:02:20.380> it<00:02:20.500> more<00:02:20.650> difficult<00:02:21.190> as<00:02:21.400> a 00:02:21.780 --> 00:02:21.790 align:start position:0% I just wonder is it more difficult as a 00:02:21.790 --> 00:02:23.010 align:start position:0% I just wonder is it more difficult as a primary<00:02:22.210> care<00:02:22.360> physician 00:02:23.010 --> 00:02:23.020 align:start position:0% primary care physician 00:02:23.020 --> 00:02:24.449 align:start position:0% primary care physician I<00:02:23.050> mean<00:02:23.230> maybe<00:02:23.380> tease<00:02:23.709> with<00:02:23.890> lights<00:02:24.069> winter 00:02:24.449 --> 00:02:24.459 align:start position:0% I mean maybe tease with lights winter 00:02:24.459 --> 00:02:27.840 align:start position:0% I mean maybe tease with lights winter being<00:02:24.640> here<00:02:24.940> well<00:02:26.010> the<00:02:27.010> problem<00:02:27.370> is<00:02:27.459> of<00:02:27.640> course 00:02:27.840 --> 00:02:27.850 align:start position:0% being here well the problem is of course 00:02:27.850 --> 00:02:30.870 align:start position:0% being here well the problem is of course what<00:02:28.150> is<00:02:28.270> asthma<00:02:28.950> that's<00:02:29.950> very<00:02:30.160> difficult<00:02:30.400> and 00:02:30.870 --> 00:02:30.880 align:start position:0% what is asthma that's very difficult and 00:02:30.880 --> 00:02:33.000 align:start position:0% what is asthma that's very difficult and it's<00:02:31.030> in<00:02:31.150> over<00:02:31.990> the<00:02:32.110> past<00:02:32.319> twenty<00:02:32.680> years<00:02:32.709> we've 00:02:33.000 --> 00:02:33.010 align:start position:0% it's in over the past twenty years we've 00:02:33.010 --> 00:02:34.620 align:start position:0% it's in over the past twenty years we've seen<00:02:33.190> many<00:02:33.550> many<00:02:33.790> papers<00:02:34.030> saying<00:02:34.420> that 00:02:34.620 --> 00:02:34.630 align:start position:0% seen many many papers saying that 00:02:34.630 --> 00:02:37.320 align:start position:0% seen many many papers saying that primary<00:02:34.990> care<00:02:35.110> physicians<00:02:35.590> do<00:02:36.070> don't<00:02:36.940> do<00:02:37.090> very 00:02:37.320 --> 00:02:37.330 align:start position:0% primary care physicians do don't do very 00:02:37.330 --> 00:02:40.170 align:start position:0% primary care physicians do don't do very well<00:02:37.480> in<00:02:37.990> in<00:02:38.320> diagnosis<00:02:39.010> on<00:02:39.490> the<00:02:39.520> other<00:02:39.760> hand<00:02:39.940> I 00:02:40.170 --> 00:02:40.180 align:start position:0% well in in diagnosis on the other hand I 00:02:40.180 --> 00:02:42.000 align:start position:0% well in in diagnosis on the other hand I think<00:02:40.260> primary<00:02:41.260> care<00:02:41.410> physician<00:02:41.740> is<00:02:41.830> doing 00:02:42.000 --> 00:02:42.010 align:start position:0% think primary care physician is doing 00:02:42.010 --> 00:02:44.430 align:start position:0% think primary care physician is doing very<00:02:42.310> well<00:02:42.400> on<00:02:42.580> us<00:02:42.790> in<00:02:43.120> diagnosing<00:02:43.840> asthma<00:02:44.170> you 00:02:44.430 --> 00:02:44.440 align:start position:0% very well on us in diagnosing asthma you 00:02:44.440 --> 00:02:46.020 align:start position:0% very well on us in diagnosing asthma you have<00:02:44.680> a<00:02:44.709> patient<00:02:45.010> in<00:02:45.280> front<00:02:45.459> of<00:02:45.700> them<00:02:45.880> they 00:02:46.020 --> 00:02:46.030 align:start position:0% have a patient in front of them they 00:02:46.030 --> 00:02:47.910 align:start position:0% have a patient in front of them they have<00:02:46.150> symptoms<00:02:46.570> of<00:02:46.720> asthma<00:02:46.870> and<00:02:47.290> they<00:02:47.650> treat 00:02:47.910 --> 00:02:47.920 align:start position:0% have symptoms of asthma and they treat 00:02:47.920 --> 00:02:49.559 align:start position:0% have symptoms of asthma and they treat it<00:02:47.950> like<00:02:48.190> a<00:02:48.220> smile<00:02:48.610> that's<00:02:48.790> basically<00:02:49.300> what 00:02:49.559 --> 00:02:49.569 align:start position:0% it like a smile that's basically what 00:02:49.569 --> 00:02:52.949 align:start position:0% it like a smile that's basically what they<00:02:49.690> do<00:02:50.430> what<00:02:51.430> I<00:02:51.459> learned<00:02:51.820> from<00:02:51.970> yesterday<00:02:52.690> is 00:02:52.949 --> 00:02:52.959 align:start position:0% they do what I learned from yesterday is 00:02:52.959 --> 00:02:56.580 align:start position:0% they do what I learned from yesterday is that<00:02:53.200> then<00:02:53.739> if<00:02:53.950> you<00:02:54.130> add<00:02:54.489> Destin's<00:02:55.209> tests<00:02:56.110> like 00:02:56.580 --> 00:02:56.590 align:start position:0% that then if you add Destin's tests like 00:02:56.590 --> 00:02:59.850 align:start position:0% that then if you add Destin's tests like spirometry<00:02:57.250> and<00:02:57.900> reversibility<00:02:58.900> you<00:02:59.650> see 00:02:59.850 --> 00:02:59.860 align:start position:0% spirometry and reversibility you see 00:02:59.860 --> 00:03:01.890 align:start position:0% spirometry and reversibility you see that<00:03:00.040> a<00:03:00.070> number<00:03:00.280> of<00:03:00.430> these<00:03:00.550> patients<00:03:00.870> do<00:03:01.870> not 00:03:01.890 --> 00:03:01.900 align:start position:0% that a number of these patients do not 00:03:01.900 --> 00:03:05.070 align:start position:0% that a number of these patients do not have<00:03:02.080> a<00:03:02.290> reversibility<00:03:03.010> and<00:03:03.660> then<00:03:04.660> you<00:03:04.900> add 00:03:05.070 --> 00:03:05.080 align:start position:0% have a reversibility and then you add 00:03:05.080 --> 00:03:07.800 align:start position:0% have a reversibility and then you add another<00:03:05.110> test<00:03:05.680> like<00:03:05.920> Fino<00:03:06.400> and<00:03:06.760> even<00:03:07.540> more 00:03:07.800 --> 00:03:07.810 align:start position:0% another test like Fino and even more 00:03:07.810 --> 00:03:10.530 align:start position:0% another test like Fino and even more patients<00:03:08.410> do<00:03:08.709> not<00:03:08.739> have<00:03:09.090> fulfilled<00:03:10.090> the 00:03:10.530 --> 00:03:10.540 align:start position:0% patients do not have fulfilled the 00:03:10.540 --> 00:03:11.640 align:start position:0% patients do not have fulfilled the diagnosis<00:03:11.140> of<00:03:11.230> asthma 00:03:11.640 --> 00:03:11.650 align:start position:0% diagnosis of asthma 00:03:11.650 --> 00:03:13.410 align:start position:0% diagnosis of asthma if<00:03:11.920> you<00:03:12.280> don't<00:03:12.519> do<00:03:12.760> broker<00:03:13.239> high 00:03:13.410 --> 00:03:13.420 align:start position:0% if you don't do broker high 00:03:13.420 --> 00:03:15.000 align:start position:0% if you don't do broker high responsiveness<00:03:14.050> at<00:03:14.290> the<00:03:14.380> end<00:03:14.530> of<00:03:14.680> the<00:03:14.800> day 00:03:15.000 --> 00:03:15.010 align:start position:0% responsiveness at the end of the day 00:03:15.010 --> 00:03:16.740 align:start position:0% responsiveness at the end of the day from<00:03:15.070> the<00:03:15.400> hundred<00:03:15.820> asthma<00:03:16.150> patients<00:03:16.660> have 00:03:16.740 --> 00:03:16.750 align:start position:0% from the hundred asthma patients have 00:03:16.750 --> 00:03:19.740 align:start position:0% from the hundred asthma patients have been<00:03:16.930> diagnosed<00:03:17.440> maybe<00:03:18.040> 20%<00:03:18.459> has<00:03:19.030> as<00:03:19.420> four 00:03:19.740 --> 00:03:19.750 align:start position:0% been diagnosed maybe 20% has as four 00:03:19.750 --> 00:03:22.410 align:start position:0% been diagnosed maybe 20% has as four fault<00:03:19.959> all<00:03:20.380> the<00:03:20.620> tests<00:03:20.980> and<00:03:21.190> that<00:03:22.030> doesn't 00:03:22.410 --> 00:03:22.420 align:start position:0% fault all the tests and that doesn't 00:03:22.420 --> 00:03:24.660 align:start position:0% fault all the tests and that doesn't mean<00:03:22.630> that<00:03:22.690> they<00:03:22.989> don't<00:03:23.170> have<00:03:23.440> a<00:03:23.590> smile<00:03:23.890> yes 00:03:24.660 --> 00:03:24.670 align:start position:0% mean that they don't have a smile yes 00:03:24.670 --> 00:03:28.190 align:start position:0% mean that they don't have a smile yes but<00:03:24.940> we've<00:03:25.120> got<00:03:25.329> an<00:03:25.450> issue<00:03:25.600> here<00:03:25.840> you<00:03:26.380> know 00:03:28.190 --> 00:03:28.200 align:start position:0% but we've got an issue here you know 00:03:28.200 --> 00:03:30.449 align:start position:0% but we've got an issue here you know diagnosis<00:03:29.200> and<00:03:29.410> what's<00:03:29.560> the<00:03:29.739> difference<00:03:30.100> for 00:03:30.449 --> 00:03:30.459 align:start position:0% diagnosis and what's the difference for 00:03:30.459 --> 00:03:32.280 align:start position:0% diagnosis and what's the difference for me<00:03:30.519> because<00:03:31.060> we're<00:03:31.239> condemning<00:03:31.600> people<00:03:31.959> to<00:03:32.260> a 00:03:32.280 --> 00:03:32.290 align:start position:0% me because we're condemning people to a 00:03:32.290 --> 00:03:34.170 align:start position:0% me because we're condemning people to a life<00:03:32.560> with<00:03:32.769> a<00:03:32.799> diagnosis<00:03:33.519> that<00:03:33.549> may<00:03:33.910> not<00:03:34.120> be 00:03:34.170 --> 00:03:34.180 align:start position:0% life with a diagnosis that may not be 00:03:34.180 --> 00:03:37.110 align:start position:0% life with a diagnosis that may not be secure<00:03:34.780> so<00:03:35.380> it<00:03:35.530> is<00:03:36.040> difficult<00:03:36.610> to<00:03:36.760> make<00:03:37.000> the 00:03:37.110 --> 00:03:37.120 align:start position:0% secure so it is difficult to make the 00:03:37.120 --> 00:03:39.360 align:start position:0% secure so it is difficult to make the diagnosis<00:03:37.780> I<00:03:37.870> mean<00:03:38.019> I<00:03:38.140> recognize<00:03:38.799> this<00:03:39.100> and 00:03:39.360 --> 00:03:39.370 align:start position:0% diagnosis I mean I recognize this and 00:03:39.370 --> 00:03:41.220 align:start position:0% diagnosis I mean I recognize this and Luke<00:03:39.940> began<00:03:40.239> to<00:03:40.390> talk<00:03:40.540> about<00:03:40.660> clinical 00:03:41.220 --> 00:03:41.230 align:start position:0% Luke began to talk about clinical 00:03:41.230 --> 00:03:43.620 align:start position:0% Luke began to talk about clinical prediction<00:03:41.500> models<00:03:42.040> so<00:03:42.340> what<00:03:43.209> did<00:03:43.329> you<00:03:43.420> take 00:03:43.620 --> 00:03:43.630 align:start position:0% prediction models so what did you take 00:03:43.630 --> 00:03:45.270 align:start position:0% prediction models so what did you take from<00:03:43.690> that<00:03:43.959> you<00:03:44.560> know<00:03:44.620> we've<00:03:44.860> got<00:03:45.010> this<00:03:45.100> issue 00:03:45.270 --> 00:03:45.280 align:start position:0% from that you know we've got this issue 00:03:45.280 --> 00:03:46.949 align:start position:0% from that you know we've got this issue we've<00:03:45.880> got<00:03:46.000> some<00:03:46.180> tests<00:03:46.630> we've<00:03:46.780> got 00:03:46.949 --> 00:03:46.959 align:start position:0% we've got some tests we've got 00:03:46.959 --> 00:03:49.710 align:start position:0% we've got some tests we've got probability<00:03:47.950> we<00:03:48.250> need<00:03:48.459> to<00:03:48.640> be<00:03:48.820> seeking 00:03:49.710 --> 00:03:49.720 align:start position:0% probability we need to be seeking 00:03:49.720 --> 00:03:51.750 align:start position:0% probability we need to be seeking clarity<00:03:50.079> here<00:03:50.500> I<00:03:50.739> think<00:03:51.070> clarity<00:03:51.459> would<00:03:51.610> be 00:03:51.750 --> 00:03:51.760 align:start position:0% clarity here I think clarity would be 00:03:51.760 --> 00:03:53.130 align:start position:0% clarity here I think clarity would be nice<00:03:51.970> if<00:03:52.269> it's<00:03:52.450> appropriate 00:03:53.130 --> 00:03:53.140 align:start position:0% nice if it's appropriate 00:03:53.140 --> 00:03:56.340 align:start position:0% nice if it's appropriate are<00:03:53.980> you<00:03:54.280> mentioned<00:03:54.790> it<00:03:54.910> the<00:03:55.660> Aaron<00:03:56.110> paper 00:03:56.340 --> 00:03:56.350 align:start position:0% are you mentioned it the Aaron paper 00:03:56.350 --> 00:03:58.470 align:start position:0% are you mentioned it the Aaron paper suggested<00:03:57.070> that<00:03:57.250> primary<00:03:57.610> care<00:03:57.790> got<00:03:58.360> the 00:03:58.470 --> 00:03:58.480 align:start position:0% suggested that primary care got the 00:03:58.480 --> 00:04:00.990 align:start position:0% suggested that primary care got the diagnosis<00:03:59.049> wrong<00:03:59.230> in<00:03:59.470> about<00:03:59.709> 30%<00:04:00.130> of<00:04:00.519> cases 00:04:00.990 --> 00:04:01.000 align:start position:0% diagnosis wrong in about 30% of cases 00:04:01.000 --> 00:04:03.960 align:start position:0% diagnosis wrong in about 30% of cases but<00:04:01.510> if<00:04:01.660> you<00:04:01.750> look<00:04:01.930> at<00:04:02.110> Sean<00:04:02.350> Erin's<00:04:02.680> paper<00:04:03.579> in 00:04:03.960 --> 00:04:03.970 align:start position:0% but if you look at Sean Erin's paper in 00:04:03.970 --> 00:04:06.240 align:start position:0% but if you look at Sean Erin's paper in detail<00:04:04.570> it<00:04:04.930> showed<00:04:05.290> that<00:04:05.440> our<00:04:05.530> secondary<00:04:05.980> care 00:04:06.240 --> 00:04:06.250 align:start position:0% detail it showed that our secondary care 00:04:06.250 --> 00:04:08.940 align:start position:0% detail it showed that our secondary care colleagues<00:04:06.670> got<00:04:07.150> it<00:04:07.329> incorrect<00:04:07.989> in<00:04:08.230> exactly 00:04:08.940 --> 00:04:08.950 align:start position:0% colleagues got it incorrect in exactly 00:04:08.950 --> 00:04:10.800 align:start position:0% colleagues got it incorrect in exactly the<00:04:09.130> same<00:04:09.160> percentage<00:04:09.670> now<00:04:10.269> if<00:04:10.360> it<00:04:10.480> was<00:04:10.570> dead 00:04:10.800 --> 00:04:10.810 align:start position:0% the same percentage now if it was dead 00:04:10.810 --> 00:04:12.990 align:start position:0% the same percentage now if it was dead easy<00:04:11.019> we'd<00:04:11.799> all<00:04:11.920> get<00:04:12.070> the<00:04:12.220> same<00:04:12.250> we'd<00:04:12.760> all<00:04:12.880> get 00:04:12.990 --> 00:04:13.000 align:start position:0% easy we'd all get the same we'd all get 00:04:13.000 --> 00:04:14.729 align:start position:0% easy we'd all get the same we'd all get it<00:04:13.120> right<00:04:13.269> or<00:04:13.630> if<00:04:13.959> you're<00:04:14.140> a<00:04:14.170> specialist<00:04:14.680> you 00:04:14.729 --> 00:04:14.739 align:start position:0% it right or if you're a specialist you 00:04:14.739 --> 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we're looking for<00:04:21.880> is<00:04:22.270> parameters<00:04:22.900> that<00:04:23.260> we<00:04:23.410> can<00:04:23.440> use<00:04:23.919> that 00:04:24.540 --> 00:04:24.550 align:start position:0% for is parameters that we can use that 00:04:24.550 --> 00:04:26.400 align:start position:0% for is parameters that we can use that will<00:04:24.700> say<00:04:24.940> this<00:04:25.330> makes<00:04:25.630> it<00:04:25.840> much<00:04:26.080> more<00:04:26.350> likely 00:04:26.400 --> 00:04:26.410 align:start position:0% will say this makes it much more likely 00:04:26.410 --> 00:04:29.310 align:start position:0% will say this makes it much more likely to<00:04:26.919> be<00:04:27.010> asking<00:04:27.340> yeah 00:04:29.310 --> 00:04:29.320 align:start position:0% to be asking yeah 00:04:29.320 --> 00:04:31.480 align:start position:0% to be asking yeah that's<00:04:30.320> gonna<00:04:30.530> be<00:04:30.650> the<00:04:30.800> weight<00:04:30.950> and<00:04:31.190> minutes 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align:start position:0% that's important if you don't hesitate about<00:04:39.110> the<00:04:39.650> diagnosis<00:04:40.340> if<00:04:40.490> you<00:04:40.790> you<00:04:41.090> for 00:04:41.320 --> 00:04:41.330 align:start position:0% about the diagnosis if you you for 00:04:41.330 --> 00:04:43.210 align:start position:0% about the diagnosis if you you for example<00:04:41.630> I<00:04:41.810> have<00:04:41.900> one<00:04:42.080> or<00:04:42.200> two<00:04:42.350> tests<00:04:42.620> showing 00:04:43.210 --> 00:04:43.220 align:start position:0% example I have one or two tests showing 00:04:43.220 --> 00:04:45.520 align:start position:0% example I have one or two tests showing that<00:04:43.580> the<00:04:43.670> diagnosis<00:04:44.300> is<00:04:44.420> right<00:04:44.600> at<00:04:44.960> the<00:04:45.320> suit 00:04:45.520 --> 00:04:45.530 align:start position:0% that the diagnosis is right at the suit 00:04:45.530 --> 00:04:47.020 align:start position:0% that the diagnosis is right at the suit that's<00:04:45.770> a<00:04:45.890> certain<00:04:46.190> moment<00:04:46.370> you<00:04:46.580> have<00:04:46.760> to<00:04:46.880> say 00:04:47.020 --> 00:04:47.030 align:start position:0% that's a certain moment you have to say 00:04:47.030 --> 00:04:48.640 align:start position:0% that's a certain moment you have to say okay<00:04:47.330> this<00:04:47.480> is<00:04:47.540> a<00:04:47.690> smile<00:04:48.050> now<00:04:48.200> treat<00:04:48.500> this 00:04:48.640 --> 00:04:48.650 align:start position:0% okay this is a smile now treat this 00:04:48.650 --> 00:04:51.580 align:start position:0% okay this is a smile now treat this patient<00:04:48.920> so<00:04:49.910> so<00:04:50.240> we're<00:04:50.450> here<00:04:50.690> we're<00:04:51.140> having<00:04:51.470> a 00:04:51.580 --> 00:04:51.590 align:start position:0% patient so so we're here we're having a 00:04:51.590 --> 00:04:53.200 align:start position:0% patient so so we're here we're having a great<00:04:51.950> time<00:04:52.220> listening<00:04:52.580> to<00:04:52.760> this<00:04:52.880> science 00:04:53.200 --> 00:04:53.210 align:start position:0% great time listening to this science 00:04:53.210 --> 00:04:55.270 align:start position:0% great time listening to this science we're<00:04:53.720> trying<00:04:54.110> to<00:04:54.320> apply<00:04:54.530> this<00:04:54.590> to<00:04:54.890> practice 00:04:55.270 --> 00:04:55.280 align:start position:0% we're trying to apply this to practice 00:04:55.280 --> 00:04:56.890 align:start position:0% we're trying to apply this to practice one<00:04:55.670> of<00:04:55.700> the<00:04:55.820> messages<00:04:56.270> we<00:04:56.420> want<00:04:56.570> to<00:04:56.720> give<00:04:56.870> to 00:04:56.890 --> 00:04:56.900 align:start position:0% one of the messages we want to give to 00:04:56.900 --> 00:04:58.780 align:start position:0% one of the messages we want to give to our<00:04:57.170> colleagues<00:04:57.560> out<00:04:57.800> there<00:04:58.040> about<00:04:58.400> the 00:04:58.780 --> 00:04:58.790 align:start position:0% our colleagues out there about the 00:04:58.790 --> 00:05:01.270 align:start position:0% our colleagues out there about the diagnosis<00:04:59.360> glass<00:04:59.600> but<00:04:59.900> just<00:05:00.080> just<00:05:00.320> you<00:05:01.190> know 00:05:01.270 --> 00:05:01.280 align:start position:0% diagnosis glass but just just you know 00:05:01.280 --> 00:05:02.830 align:start position:0% diagnosis glass but just just you know next<00:05:01.550> week<00:05:01.790> when<00:05:01.970> you<00:05:02.090> go<00:05:02.210> into<00:05:02.360> your<00:05:02.420> practice 00:05:02.830 --> 00:05:02.840 align:start position:0% next week when you go into your practice 00:05:02.840 --> 00:05:04.180 align:start position:0% next week when you go into your practice will<00:05:02.990> you<00:05:03.050> do<00:05:03.200> anything<00:05:03.440> differently<00:05:03.980> or 00:05:04.180 --> 00:05:04.190 align:start position:0% will you do anything differently or 00:05:04.190 --> 00:05:05.500 align:start position:0% will you do anything differently or should<00:05:04.520> they<00:05:04.670> be<00:05:04.700> thinking<00:05:04.940> about<00:05:05.180> something 00:05:05.500 --> 00:05:05.510 align:start position:0% should they be thinking about something 00:05:05.510 --> 00:05:07.120 align:start position:0% should they be thinking about something differently<00:05:05.990> I'd<00:05:06.350> say<00:05:06.620> three<00:05:06.890> quick<00:05:07.100> things 00:05:07.120 --> 00:05:07.130 align:start position:0% differently I'd say three quick things 00:05:07.130 --> 00:05:10.450 align:start position:0% differently I'd say three quick things the<00:05:07.820> first<00:05:08.000> is<00:05:08.210> that<00:05:08.420> a<00:05:08.600> spa<00:05:08.840> is<00:05:09.020> variable<00:05:09.710> so 00:05:10.450 --> 00:05:10.460 align:start position:0% the first is that a spa is variable so 00:05:10.460 --> 00:05:12.820 align:start position:0% the first is that a spa is variable so if<00:05:10.730> you<00:05:10.850> do<00:05:11.120> tests<00:05:11.600> like<00:05:11.930> spirometry<00:05:12.560> it 00:05:12.820 --> 00:05:12.830 align:start position:0% if you do tests like spirometry it 00:05:12.830 --> 00:05:14.740 align:start position:0% if you do tests like spirometry it doesn't<00:05:13.100> always<00:05:13.310> mean<00:05:13.670> you<00:05:14.240> will<00:05:14.360> get<00:05:14.570> a 00:05:14.740 --> 00:05:14.750 align:start position:0% doesn't always mean you will get a 00:05:14.750 --> 00:05:17.410 align:start position:0% doesn't always mean you will get a significant<00:05:15.440> amount<00:05:15.680> of<00:05:15.800> reversibility<00:05:16.420> so 00:05:17.410 --> 00:05:17.420 align:start position:0% significant amount of reversibility so 00:05:17.420 --> 00:05:19.390 align:start position:0% significant amount of reversibility so remember<00:05:17.990> the<00:05:18.110> variability<00:05:18.590> of<00:05:18.860> asthma<00:05:19.190> I 00:05:19.390 --> 00:05:19.400 align:start position:0% remember the variability of asthma I 00:05:19.400 --> 00:05:21.730 align:start position:0% remember the variability of asthma I think<00:05:19.880> the<00:05:20.060> second<00:05:20.510> thing<00:05:20.540> I<00:05:20.750> would<00:05:20.810> take<00:05:21.230> is 00:05:21.730 --> 00:05:21.740 align:start position:0% think the second thing I would take is 00:05:21.740 --> 00:05:24.310 align:start position:0% think the second thing I would take is the<00:05:22.310> diagnosis<00:05:23.030> can<00:05:23.300> be<00:05:23.330> difficult<00:05:23.840> don't<00:05:24.080> be 00:05:24.310 --> 00:05:24.320 align:start position:0% the diagnosis can be difficult don't be 00:05:24.320 --> 00:05:27.160 align:start position:0% the diagnosis can be difficult don't be afraid<00:05:24.740> to<00:05:24.920> reevaluate<00:05:25.310> the<00:05:25.880> diagnosis<00:05:26.570> even 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position:0% we are I think the third thing is really 00:05:34.820 --> 00:05:36.370 align:start position:0% we are I think the third thing is really think<00:05:35.090> when<00:05:35.390> you're<00:05:35.540> seeing<00:05:35.810> a<00:05:35.960> patient<00:05:35.990> with 00:05:36.370 --> 00:05:36.380 align:start position:0% think when you're seeing a patient with 00:05:36.380 --> 00:05:38.080 align:start position:0% think when you're seeing a patient with asthma<00:05:36.530> about<00:05:37.190> their<00:05:37.430> history<00:05:37.880> what 00:05:38.080 --> 00:05:38.090 align:start position:0% asthma about their history what 00:05:38.090 --> 00:05:40.150 align:start position:0% asthma about their history what examination<00:05:38.840> everybody<00:05:39.170> got<00:05:39.470> and<00:05:39.830> have<00:05:40.040> you 00:05:40.150 --> 00:05:40.160 align:start position:0% examination everybody got and have you 00:05:40.160 --> 00:05:41.830 align:start position:0% examination everybody got and have you got<00:05:40.310> any<00:05:40.340> evidence<00:05:40.970> of<00:05:41.120> airway<00:05:41.630> inflammation 00:05:41.830 --> 00:05:41.840 align:start position:0% got any evidence of airway inflammation 00:05:41.840 --> 00:05:45.610 align:start position:0% got any evidence of airway inflammation or<00:05:42.830> signs<00:05:43.340> of<00:05:43.630> reversibility<00:05:44.630> be<00:05:45.440> that 00:05:45.610 --> 00:05:45.620 align:start position:0% or signs of reversibility be that 00:05:45.620 --> 00:05:47.230 align:start position:0% or signs of reversibility be that eosinophils<00:05:46.010> fractional<00:05:46.730> exhaled<00:05:47.150> nitric 00:05:47.230 --> 00:05:47.240 align:start position:0% eosinophils fractional exhaled nitric 00:05:47.240 --> 00:05:49.600 align:start position:0% eosinophils fractional exhaled nitric oxide<00:05:47.900> if<00:05:48.140> they<00:05:48.290> are<00:05:48.380> available<00:05:48.560> in<00:05:48.980> your<00:05:49.130> area 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I think we could run and 00:06:04.970 --> 00:06:07.060 align:start position:0% thank you Steve I think we could run and run<00:06:05.120> with<00:06:05.300> this<00:06:05.480> one<00:06:05.690> I<00:06:05.720> think<00:06:06.500> that's<00:06:06.860> a 00:06:07.060 --> 00:06:07.070 align:start position:0% run with this one I think that's a 00:06:07.070 --> 00:06:09.190 align:start position:0% run with this one I think that's a fantastic<00:06:07.460> way<00:06:07.910> to<00:06:07.970> round<00:06:08.300> up<00:06:08.540> so<00:06:08.750> thank<00:06:09.050> you 00:06:09.190 --> 00:06:09.200 align:start position:0% fantastic way to round up so thank you 00:06:09.200 --> 00:06:10.570 align:start position:0% fantastic way to round up so thank you very<00:06:09.230> much<00:06:09.530> and<00:06:09.710> thank<00:06:09.950> you<00:06:10.040> also<00:06:10.370> for 00:06:10.570 --> 00:06:10.580 align:start position:0% very much and thank you also for 00:06:10.580 --> 00:06:12.310 align:start position:0% very much and thank you also for listening<00:06:11.150> we<00:06:11.570> have<00:06:11.750> some<00:06:11.930> more<00:06:12.110> of<00:06:12.200> these 00:06:12.310 --> 00:06:12.320 align:start position:0% listening we have some more of these 00:06:12.320 --> 00:06:14.110 align:start position:0% listening we have some more of these highlights<00:06:12.800> coming<00:06:13.040> so<00:06:13.430> I<00:06:13.460> hope<00:06:13.760> that<00:06:13.790> you 00:06:14.110 --> 00:06:14.120 align:start position:0% highlights coming so I hope that you 00:06:14.120 --> 00:06:16.030 align:start position:0% highlights coming so I hope that you were<00:06:14.270> following<00:06:14.720> them<00:06:14.960> each<00:06:15.080> day<00:06:15.110> thank<00:06:15.950> you 00:06:16.030 --> 00:06:16.040 align:start position:0% were following them each day thank you 00:06:16.040 --> 00:06:19.150 align:start position:0% were following them each day thank you very<00:06:16.190> much<00:06:16.430> and<00:06:16.640> thank<00:06:16.850> you<00:06:16.910> guys