Pragmatic Guides

Can Only Plan Daily - COPD is a serious disease needing the right diagnosis and treatment with the person’s need sitting front and centre. ‘All that glitters is not GOLD, nor is it even NICE’ is a consensus-based article that sets out a simple treatment pathway based on the predominant characteristics of COPD for an individual – whether symptoms or exacerbations – distilled from current guidelines.

Asthma Guidelines in Practice – A PCRS Consensus is a practical and pragmatic guide for healthcare professionals working in primary and intermediate care.  This guide was commissioned to provide clarity on aspects of diagnosis, management and monitoring of asthma that are uncertain due to differences between current national UK guidelines.

Spirometry, a test used to measure and monitor lung function, is an important component of the diagnosis, management and monitoring of respiratory conditions in primary care. Spirometry should be delivered and interpreted by healthcare professionals who have met the criteria and are included in the Association for Respiratory Technology & Physiology (ARTP) National Register of Certified Spirometry Professionals and Operators hosted by the Academy for Healthcare Science (AHCS).

As a point of principle, we support initiatives to improve air quality, and minimise short- and long-term damage to the environment, particularly those with an impact on climate change resulting from greenhouse gases.

Concerns about the environmental impact of the propellant gases used in pressurised metered dose inhalers (pMDIs) and the plastics used in all single-use inhaler devices have made them an important focus for efforts to reduce the environmental impact of the NHS. Patients themselves may also be concerned about the environmental impact of their inhalers and express a preference for alternatives. PCRS do not support ‘blanket switching’ of patients from one inhaler type to another.

PCRS cautiously welcome the implementation of the pilot phase of the Targeted Lung Health Check Programme in England. Having reviewed the protocol in the context of our work with the diagnostic workstream of the Lung Health Taskforce we suggest that the pathway for people who are found to have non-cancer respiratory symptoms which need investigating, and the implications for workload in general practice will need careful evaluation before a national roll-out.

PCRS have issued a position statement on strategies to care for patients with respiratory disease and frailty in the community setting. Frailty is thought to affect around 10% of those aged over 65 years and up to half of those aged over 85 years. The health and social care needs of these vulnerable patients can be complex and require a holistic approach that should involve confirmation of current diagnoses and review of all medications giving consideration to the goals of treatment, likely benefits and likely side effects.

Healthcare professionals should be prepared to help their patients to quit tobacco smoking and should be knowledgeable about e-cigarettes so they can answer questions if asked or be able to direct people to the most up to date source of information.