COPD in Primary Care

Anita Sharma, Penney Vasey

• Publisher: CRC Press
• Year: 2018
• Print ISBN: 9781138446045
• eBook ISBN: 9781315357720
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

The burden of chronic obstructive pulmonary disease (COPD) is enormous and is increasing, but early, accurate diagnosis in a primary care setting can have a crucial impact on managing the condition. New NICE guidelines and the GMS Contract with incentives give GPs and practice nurses the opportunity to diagnose COPD patients and manage them in a structured fashion. This book brings together clear and concise information for GPs and primary healthcare teams on how this can be achieved accurately and effectively. This book sets out a very practical approach to caring for one group who can demonstrably benefit from access to the very best that primary care can offer: patients living with COPD. This book is for busy primary care physicians and nurses committed to improving diagnosis, enabling self-management, ensuring rapid treatment, and providing truly patient-centred care. Written by an experienced, practising general practitioner, it provides a timely contribution to the high-quality primary care services needed now and in the future.A " - from the Foreword by Gail Richards Anita Sharma is to be congratulated on producing a clear, concise and practical book on COPD which will educate, give confidence to, and encourage primary care physicians to manage this important disease effectively and at an early stage.A" - from the Foreword by Joyce Barclay

1

What is chronic obstructive pulmonary disease?

Definition

Chronic obstructive pulmonary disease (COPD) has been defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as follows:¹

COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterised by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.

The four major international thoracic societies have similar definitions of COPD. However, they differ in how they classify the severity of the disease.^{1, 2, 3, 4} COPD is the internationally preferred term, which includes chronic bronchitis, emphysema, chronic airflow obstruction and chronic airflow limitation, either alone or in combination.

TABLE 1.1 Predicted forced expiratory volume in 1 second (FEV₁) (%), according to the different classifications of the severity of the disease

SEVERITY	GOLD	ATS	BTS	ERS
Mild	> 80	> 50	50–80	> 70
Moderate	50–80	35–49	30–49	50–69
Severe	30–50	< 35	< 30	< 50
Very severe	< 30

GOLD, Global Initiative for Chronic Obstructive Lung Disease; ATS, American Thoracic Society; BTS, British Thoracic Society; ERS, European Respiratory Society.

Some conditions that can cause airflow obstruction, such as cystic fibrosis and bronchiectasis, are not included in the term COPD.

COPD has an insidious onset, usually occurs above the age of 50 years and is predominantly caused by smoking, although it does occur rarely in non-smokers.

The Quality and Outcomes Framework (QOF) gives GPs an ‘incentive’ to identify patients with COPD.

TABLE 1.2 Comparison of the NICE and QOF definitions of COPD^5,6

	NICE	QOF
FEV1/FVC ratio	< 0.7	< 0.7
FEV1 (%)	< 80	< 70

FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity.

KEY POINTS

•  COPD is the term used internationally to refer collectively to several lung diseases that are progressive, irreversible and potentially life-threatening.

•  COPD is characterised by airflow obstruction (reduced FEV₁ and FEV₁/FVC ratio) that does not change markedly over a period of several months.

•  Most patients are not diagnosed until they are in their fifties.

References

1  Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease; www.goldcopd.com; 2006.

2  American Thoracic Society. Standards for the Diagnosis and Management of Patients with COPD; www.thoracic.org/sections/copd

3  British Thoracic Society. Guidelines on the Management of COPD; www.brit-thoracic.org.uk/ClinicalInformation/COPD/COPDGuidelines/tabid/121/Default.aspx

4  European Respiratory Society. COPD Guidelines; www.ers-education.org/pages/default.aspx

5  National Institute for Health and Clinical Excellence. National clinical guideline on the management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax. 2004: 59 (Suppl. 1).

6  British Medical Association. Revisions to the GMS Contract 2006–07. Delivering Investment in General Practice. London: BMA; 2006.

2

Epidemiology

Prevalence

The incidence of chronic obstructive pulmonary disease (COPD) is increasing. Globally, it is estimated that COPD will be the disease responsible for the third highest number of deaths by 2020.¹

The latest data on prevalence show a progressive increase among adult women because of increased cigarette smoking in the western world.² The British Lung Foundation conducted a survey of 1200 women, and found that only 1% of them regarded COPD as a major health concern. This highlights the need for public health and professional-led education.³

National p...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Forewords
• Preface
• About the author
• Acknowledgements
• 1 What is chronic obstructive pulmonary disease?
• 2 Epidemiology
• 3 Aetiology and risk factors
• 4 Pathophysiology
• 5 National profile
• 6 Diagnosis
• 7 Disease severity
• 8 Spirometry
• 9 Pulse oximetry in primary care
• 10 Management
• 11 Helping patients to quit smoking
• 12 Exacerbation
• 13 Avoiding hospital admission
• 14 Self-management
• 15 Impact on carers
• 16 Secondary care referral indicators
• 17 Pulmonary rehabilitation David Pitchforth
• 18 Palliative care
• 19 Commissioning services: a step-by-step guide
• 20 General practitioner with a special interest (GPwSI)
• 21 Audit ideas
• 22 Case studies
• 23 Multiple choice questions
• 24 Test your knowledge
• Glossary of terms in respiratory medicine
• Index