In December 2018, the National Institute for Health and Care Excellence (NICE) published new guidelines on the diagnosis and management of chronic obstructive pulmonary disease (COPD) in over 16s, which have subsequently been updated in July 2019 (NICE, 2019). Here, Jaqui Walker, advanced nurse practitioner/general practice nurse, Stirling, looks at what the 2019 changes are, how they are influencing practice, and gives handy tips on how to implement the key changes.
Spirometry is very easy to do, and very easy to get wrong (Martin, 2010; personal communication). Not only is quality
assured spirometry dependent on the effort exerted by the patient, and the technical ability of the spirometer operator,
but also on the understanding of the results by the person interpreting them.
Interpretation of the results is essential if any meaningful decision is to be made about the patient’s care.
Wheezing is a common problem among preschool children (Bhatt, 2013), and its prevalence is rising in the UK (Kuehni et al, 2001). This has an inevitable impact on healthcare costs. Indeed, it is estimated that caring for this patient group costs around £53 million (Brand et al, 2008). This article informs general practice nurses (GPNs) about the condition which can vary greatly in frequency and acuity, so that appropriate supportive management and follow-up can be offered when a child presents with this condition to the surgery. The patient story sets the scene of a typical wheezing preschool child, and raises the questions about whether to treat or not to treat; the concerns parents have about treatment, acute episodes and the overall management of preschool children with wheeze.
Respiratory disorders, in particular asthma and chronic obstructive pulmonary disease (COPD), have been recognised for many years and remain among the most common chronic long-term conditions that are seen in primary care. Despite the development of guidelines, standards and effective treatments, both diseases continue to carry a high morbidity and mortality, a significant societal cost in terms of lost school and work days, and high consultation and admission rates.This article follows the development of our knowledge of these common disorders and looks at how far we have progressed in our diagnosis, knowledge and treatments, as well as what the future may look like in terms of care management and treatment options.
Asthma is a common long-term condition affecting adults and children. Despite a number of evidence-based guidelines for treatment and new medications and inhaler devices, mortality rates remain static. Key findings from the National Review of Asthma Deaths (Royal College of Physicians [RCP], 2014) highlighted the importance of personalised asthma action plans (PAAPs) in good asthma care. This article looks at how healthcare professionals need to work with adults and children with asthma, involving them throughout the process, to produce a meaningful, useful plan that has been developed with the person, and parents or carers. The plan should be used as an educational tool to help understand how, when and why asthma medication should be used, what is meant by asthma control, and recognition of when control is slipping.
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