In this regular PCRU feature we explore cases of rarer lung conditions and their presentation. In this short case discussion Fran Robinson interviews Dr Stephen Gaduzo as they discuss John, an amateur footballer who has recently been diagnosed with asthma. Originally published in the Winter 2018 edition of the Primary Care Respiratory Update.

Fran Robinson interviews Dr Noel Baxter, Dr Binita Kane, Dr Georges Ng Man Kwong and Dr Jørgen Vestbo, to discuss their experience of setting up and running multidisciplinary respiratory virtual clinics. Originally published in the Winter 2018 edition of the Primary Care Respiratory Update.

Bronwen Thompson discusses the respiratory long-term plan for England with Professor Mike Morgan, National Clinical Director for Respiratory Disease at NHS England. Originally published in the Winter 2018 edition of the Primary Care Respiratory Update.

Q: My patient smokes cigarettes and has a BMI of 43, they drink 45 units of alcohol a week and their physical activity is limited. What should I do first or is it better to tackle all together?

Very Brief Advice (VBA) is our most practical tool to trigger a quit attempt, with structured behavioural support and medical treatment being the best method of quitting and ideally these are provided by stop smoking practitioners. If smokers are unwilling or unable to attend specialist stop smoking services to quit smoking support can be effectively offered by GPs within a series of standard 10-minute appointments.

ASK : ADVISE : ACT Using VBA does not depend on the person's readiness to quit and you do not need to assess it before you start Very Brief Advice or VBA is a simple and powerful approach designed to be used opportunistically in less than 30 seconds in almost any consultation with a smoker. VBA is a public health intervention delivered in a one-to-one health setting and can be delivered by any professional.

Please read the guidance notes which provide potential steps and questions to ask when using the Asthma Slide Rule.

PCRS believe that it is the responsibility of every healthcare professional to treat tobacco dependency systematically and effectively. PCRS advocate that people wishing to quit using

Tobacco dependency is a long-term relapsing condition that usually starts in childhood This tobacco dependency pragmatic guide is a practical, immediately implementable, evidence-based framework to enable healthcare professionals to routinely identify smokers, encourage a quit attempt and support that quit attempt within the real-world context of their own professional sphere.