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Non-tuberculous mycobacteria (NTM) are a group of bacteria that are capable of causing opportunistic lung infections and the development of NTM pulmonary disease (NTM-PD). They are distinct from Mycobacterium tuberculosis (TB) and Mycobacterium leprae and are found in the natural environment and water supplies such as taps and shower heads.

In this article we review the major changes in the 2023 GOLD report as they impact on the initial and ongoing pharmacological management of COPD and consider the implications for primary care in the UK. Dr Fiona Mosgrove is a GP in Aberdeen and Clinical Lead for the Grampian Respiratory Improvement Programme. Dr Tracey Lonergan is the Policy Coordinator for the Primary Care Respiratory Society and Medical Writer with a special interest in respiratory disease.

This pragmatic guide on the identification, referral and ongoing management of adults and children with severe asthma has been developed by an expert group led by Dr Steve Holmes, a GP based in Shepton Mallet, Somerset and including Will Carroll, University Hospital of the North Midlands, Stoke-on-Trent, Fiona Mosgrove, Clinical Lead Grampian Respiratory Improvement Programme, Angela Pugh of the University Hospital of Llandough Cardiff & Vale University Health Board and Robert Stone, Taunton and Somerset NHS Foundation Trust.

This issue of PCRU introduces our latest pragmatic guide on severe asthma which guides you through this process ensuring the right patients end up in the right place with the right care. Also in this edition, there has been a major shift in how COPD is assessed and classified announced by GOLD. Fiona Mosgrove takes you through the implications of these changes and for anybody writing or updating their local guidelines this will be invaluable reading.

To mark World COPD Day we have recorded a special podcast exploring the topic of Exacerbations in COPD. Featuring Dr. Fiona Mosgrove in discussion with Professor of Respiratory Medicine and Senior Clinical Lead for the Royal College of Physicians National Asthma and COPD Audit Programme, Professor John Hurst.    

Digital health has come to the fore with the COVID pandemic. Some apps and digital strategies are welcome and we wish we had adopted them years ago – other initiatives are not so effective and we have concerns about how they will affect the healthcare we provide. There are many apps, some approved or recommended by the NHS but how can clinicians be confident that they are recommending something that is safe and evidence based? Moreover, what support is there to help clinicians understand and patients use the apps they are recommending.

Vikki Knowles - Surrey: Minimising MDIs Independent Respiratory Nurse Specialist Vikki Knowles shares the early stages of work being done to minimise the use of Metered Dose Inhalers (MDIs) in their practice in Surrey and how that can positively impact the greener healthcare environment.

Dr Kat Parker - Bristol: Switching to DPIs In this case study from Dr Kat Parker, she shares her experience of how her practice in Bristol has been switching patients from Metered Dose Inhalers (MDIs) to Dry Powder Inhalers (DPIs) where appropriate to do so, when and how they communicated with their patients, and how positive the experience has been for all involved.