COPD in Primary Care

Foreward by Professor Duncan M GeddesPrefaceAbbreviationsNational Heart, Lung and Blood Institute categories1 Introduction Main points Why COPD is important How important is COPD? What is the economic burden of COPD? Doctors' and patients' attitudes to COPD What can be done?2 Pathology and pathophysiology Main points Risk factors Chromic asthma Chronic bronchitis Emphysema Small airways disease COPD - a mixed spectrum of diseases 3 Presentation and history Main points Symptoms History taking Clinical signs Summary4 Spirometry and lung function tests Main points Spirometry Why is FEV1 the preferred test? Flow/volume measurement Early screening for COPD5 Assessment Main points Making the diagnosis and establishing a baseline Bronchodilator reversibility Corticosteroid reversibility Excluding alternative and coexisting pathologies Disability and handicap Assessing breathlessness Assessing walking distance Impact of the disease on psychosocial functioning Assessing health status Summary6 Smoking cessation Main points Why do people smoke? How can smokers stop smoking? Nicotine replacement therapy Bupropion Helping patients to stop smoking7 Bronchodilators Main points How do bronchodilators work? Short-acting bronchodilators Long-acting inhaled bronchodilators Oral long-acting bronchodilators Nebulised bronchodilators8 Corticosteroid therapy Main points The rationale for using corticosteroids Advice on inhaled steroids in COPD Combined inhaled long-acting beta-2 agonist and corticosteroid: salmeterol and fluticasone; eformoterol and budesomide New clinical information on inhaled steroids What are the implications for primary care? Is there a role for long-term oral steroids? Steroids for acute exacerbations Synopsis of important clinical trials of inhaled steroids in COPD9 Pulmonary rehabilitation Main points Evidence for the effectiveness of rehabilitation in COPD Why rehabilitation programs are needed The components of a hospital-based pulmonary rehabilitation program The role of the primary health care team10 Other forms of therapy Main points Oxygen therapy Surgery Vaccinations Nutrition Exercise Social and psychological issues Severe breathlessness and palliative care11 Acute exacerbations and referral to hospital Main points Defining an exacerbation Management of the acute exacerbation Natural history of an exacerbation Treatment in the community Recurrent exacerbations Prevention of acute exacerbations Hospital-at-home schemes for acute exacerbations Respiratory failure Treatment of associated conditions Consideration of specialist referral12 The GOLD guidelines Main points What is GOLD? The GOLD definition of COPD Goals of management Assessing and monitoring disease Reducing risk factors Managing stable COPD Managing exacerbations Future research13 COPDX - the Australian guidelines Main points History and purpose The COPDX definition of COPD Grading severity Goals of management What is different to the GOLD guidelines? Non-medical issues to be addressed The future 14 Drug therapy of the future Main points Anti-inflammatory therapies Antiproteases Alpha-1 antitrypsin Antioxidants Drugs affecting mucus production Pulmonary vasodilators15 Organisation and training needs Main points Finding the patients The practice nurse's role Protocol and audit GlossaryUseful addressesIndexFardy, John is the author of 'COPD in Primary Care' with ISBN 9780074713211 and ISBN 0074713213.