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PCRS advocate a pragmatic approach to the pharmacological management of patients with COPD guided by the predominance of breathlessness and/or exacerbations and the presence or absence of comorbid asthma. Clinicians must undertake a holistic evaluation for alternative causes of persistent daily symptoms or repeated exacerbations and consider seeking advice from a respiratory specialist before escalating to triple therapy (a respiratory specialist may be a GP/nurse/consultant).

In this article the authors review current evidence and guidance for the treatment of Chronic obstructive pulmonary disease (COPD) in order to bring up to date the Primary Care Respiratory Society (PCRS) consensus approach and algorithm first published in 2017 known as ‘Keeping it Simple’.

Spirometry is a component of the diagnosis and management of respiratory conditions in primary care and should ideally be performed via referral to a primary care network respiratory diagnostic service or community diagnostics centre (CDC) with expertise in the diagnosis of the most common respiratory conditions and of less common diagnoses. Where limited resources create a challenge for testing everyone with a new suspected diagnosis of asthma, those with an intermediate probability should be prioritised for spirometry and also FENO where available.

This update from PCRU guest editor and PCRS Executive Chair, Katherine Hickman, gives an overview of the latest edition of the update. Katherine says: "I hope this edition inspires confidence in managing COPD, addressing COVID-19 concerns, and ultimately reflecting on the loss of Dr Iain Small who really was one in a million. I hope you are able to take some time off over the Christmas break, recharge, and come back in the New Year invigorated and impassioned to continue our mission of supporting those with respiratory disease."

In this edition, we focus on COPD and revisit the 2017 PCRS consensus on COPD treatment titled 'Keeping it Simple.' The updated algorithm aligns with the latest GOLD and NICE guidance, and maintains a focus on patient-centred treatment grounded in evidence, medication optimisation, and continuous monitoring. The article highlights the ongoing evolution in COPD management while prioritising patient well-being within the ever-changing healthcare landscape.

In this episode we dive into the topic of breathing pattern disorder. Anna Spathis a Consultant working in Palliative Medicine is in conversation with Catherine Moffat - a specialist respiratory physiotherapist. They both work in the Cambridge Breathlessness Intervention Service (CBIS) - a specialist service for people with long term conditions living with chronic breathlessness. This episode covers three key areas relating to breathing pattern disorder:

This episode features Dr Fiona Mosgrove, GP with special interest in respiratory medicine, in conversation with Professor Robin Taylor, consultant physician with NHS Lanarkshire. Robin has in-depth experience of difficult prognostic conversations with patients with progressive lung disease. This insightful episode dives into why care in advanced lung disease is such an important topic and what we can do as clinicians to help our patients with advanced COPD and Interstitial Lung Disease, and their families.

Spirometry is a component of the diagnosis and management of respiratory conditions in primary care and should ideally be performed via referral to a primary care network respiratory diagnostic service or community diagnostics centre (CDC) with expertise in the diagnosis of the most common respiratory conditions and of less common diagnoses. Where limited resources create a challenge for testing everyone with a new suspected diagnosis of asthma, those with an intermediate probability should be prioritised for spirometry and also FENO where available.

Primary care should seek to identify and provide proactive support to older people living with frailty. An extended consultation should be considered that should ideally include the patient’s usual carer to enable a comprehensive review, confirmation of current diagnoses, and review of all medications. Appropriateness of self-administered medication should be considered if dexterity or cognitive issues are present. Patients should have a clear, concise management plan that is available to and understood by all those providing care.