Anticholinergic drugs are bronchodilators that act by blocking acetylcholine, the
neurotransmitter for the parasympathetic nervous system. By blocking parasympathetic
stimulation, anticholinergics reduce cholinergic tone, therefore producing
bronchodilation. In this article we review when and how these drugs should be used.
What are their potential benefits and what should we tell patients who need them?
The role of Beta2 agonists in managing asthma
Beta agonists are the only class of drugs that is recommended for the management of
asthma at every level of current guidelines, including those from the British Thoracic
Society (BTS). This means that they are used across the spectrum of severity of
asthma, from mild intermittent disease (step one) to severe asthma symptoms (step
five). In this article, we take you through the key things that you – and your patients – need to
know about these drugs.
Rhinitis: Successful Diagnosis and Management
Runny, blocked noses are a common problem in the winter months, accounting for a
substantial number of general practice consultations. Successful treatment depends
on identifying the correct cause of the symptoms. In this article we give you key
information on rhinitis – what it is, how to diagnose it and how to treat it successfully.
Is Immunotherapy an Option for my Patients with Severe Seasonal Allergic Rhinitis?
Severe seasonal allergic rhinitis (hayfever) has a significant impact on sufferers’ quality of life
and productivity, and can be a challenging condition to manage in primary care. As a majority
of these patients have poor or only partial symptom control in primary care, they may be
suitable for referral to secondary care. Some of these patients may be appropriate for
treatment with specific allergen immunotherapy and this article reviews the impact of severe seasonal
allergic rhinitis and highlights recent data on the effectiveness of sublingual immunotherapy.
Editorial: London Marathon
Bless you for your support and best wishes for my fifth London Marathon that took place in
late April. My chosen charities this year (Arrhythmia Alliance, www.arrhythmiaalliance.org.uk
and Stars, http://stars.org.uk) are special for me as I have had a pacemaker for ten years. It
was a surprise to be informed that I would have a new box fitted just three weeks before the
Marathon. However those of you who know me would know that would not stop my attempt!
But there are times when even I have to admit defeat! After completing over half the course in
two hours, I decided to let my heart rule my head for once and bail out gracefully before I
collapsed from heat exhaustion! When I was overtaken by a large carrot I knew it was going
to be a real struggle!
A quick guide to interstitial lung disease
Interstitial lung disease (ILD) is a general term for a number of diseases characterised by
progressive pulmonary fibrosis or ‘scarring’ of the lungs. The term fibrosis implies formation
of abnormal connective tissue within the lung parenchyma. These diseases are less
commonly seen in primary care than airways diseases such as asthma and COPD. However,
like COPD, they produce progressive debilitating breathlessness for the patient. It is important
that practice nurses, particularly those with an interest in respiratory diseases, are aware of this
group of diseases and their management as early referral to specialist care is important.
The Null Hypothesis: There’s Nothing to it
Respiratory Infections: How to Minimise the Impact
Accurate diagnosis of respiratory tract infection can be difficult in primary care,
particularly in older patients. Time constraints meaning that most consultations allow
less than six minutes to deal with patients’ clinical problems – with much of the time
devoted to achieving political and financially driven targets – can make it even more
difficult. In this article, we provide practical tips on how to recognise and treat common
respiratory infections.
Hypothesis Testing – Just an ‘Educated Guess’?
Editorial: Giving up smoking for the New Year?
We are about to hit the festive season, but it is also a time when many
people reflect on the past year and make plans for the next – including
thinking about giving up smoking. In this issue we reflect on the impact of
the smoking ban in the UK. Hilary Wareing and Nina Gotz from the Tobacco
Control Collaborating Centre show how there have been significant benefits
in terms of air quality and increased numbers of quitters since the
smokefree legislation came into force between March 2006 and July 2007.
This has been a significant step forward in improving public health, and
provides a foundation to encourage more of your patients to quit.
What is Bronchiectasis?
Bronchiectasis is characterised by abnormal, permanent distortion and dilation of one or more of the medium-sized bronchi (>2 mm). It occurs most commonly as a consequence of infection or inflammation. Although relatively uncommon, bronchiectasis is an important and probably under-diagnosed condition and it often coexists with COPD. Accurate diagnosis and appropriate management are needed to reduce the symptoms that patients experience. Primary care professionals need to be alert to the signs and symptoms of bronchiectasis to ensure quick referral to specialist services.
The Evaluation and Management of Cough in Adults
Cough as a symptom results in significant impairment of quality of life for patients. Its
wide and varied causes and presentations make diagnosis and management complex.
Many sets of guidelines have been produced to help clinicians in the evaluation and
management of acute and chronic cough. This article uses the British Thoracic Society
(2006) guidelines to provide a summary of the evaluation and management of cough.
