Although principally an inflammatory respiratory disease, chronic obstructive pulmonary
disease (COPD) is now recognised as a complex disorder that also manifests in
extrapulmonary and systemic effects. Nutritional manifestations of the disease, notably
weight loss and obesity, have been recognised. However, the complexity of nutritional
problems in COPD has been poorly understood, and the consequences largely underrated. Now,
linked to increasing knowledge regarding systemic inflammation, it is becoming clear that poor
nutritional status is not only a manifestation of COPD but also a predictor of mortality and
healthcare utilisation.
How are Patients with Respiratory Disease Treated for Anxiety
As mentioned in the last issue ( Sept 2008), anxiety is a significant and
distressing problem for patients with respiratory disease. Anxiety is more common in
respiratory disease than in cancer, heart failure or other chronic medical conditions
(Kvaal et al 2001). The previous article gave a background to anxiety and highlighted
that practice nurses are in an ideal position to screen for anxiety and to provide appropriate
support and basic treatment. This article focuses on the management of anxiety using cognitive
behavioural therapy skills and techniques.
Cystic Fibrosis: What do we need to know?
Cystic fibrosis (CF) is the most common inherited genetic disease in the UK.
Improvements in both diagnosis and treatment over the last 30 years have resulted in
increased survival with children born in the 1990s now likely to live into their forties.
Although much of the treatment is delivered in hospitals, healthcare professionals in
primary care should be aware of management principles and understand the impact of the
condition on patients and their families. This article provides an overview of CF and shows how
to support patients and families in primary care.
Useful techniques to manage breathlessness
Although breathlessness is a complex symptom, appropriate management in primary
care can be very rewarding, and does not have to rely on complex, hi-tech
interventions. This article discusses the rationale behind the practical interventions
that practitioners in primary care can consider.
Sexual relationships, breathlessness and the respiratory patient
The rising incidence of a range of respiratory disorders means an increasing emphasis
on treatment, management and care. Although some respiratory diseases are acute,
many are chronic, bringing with them a burden of morbidity affecting patients in many
areas of everyday life. One area of concern for patients may be sexual functioning so
somewhere in the process of management and care the practice nurse may need to address the
issues of sexuality (Petty 1986, Kaptein et al. 2008).
Occupational asthma: how to help the wheezy workers
Approximately one in every ten cases of adult-onset asthma is attributable to
occupational exposure. Unless occupation is considered, a diagnosis of occupational
asthma will be missed so it is likely to be underdiagnosed. An average practice with
around 6,000 patients will typically have approximately 600 adult patients with asthma,
of whom 60 may have occupational asthma if we assume 10% of cases are related to
occupational exposure. Can you think of 60 patients with occupational asthma in your practice?
Getting it Right: Asthma Devices in Children
Asthma medications should routinely be delivered by a pressurised metered dose inhaler
(pMDI) and spacer system, with a facemask where necessary, in children under five,
according to the National Institute for Health and Clinical Excellence (NICE).1
For older children, aged 5-15 years, NICE has advised that a child’s therapeutic needs,
the ability to develop and maintain an effective technique, the suitability of a device for the
child’s and carer’s lifestyles (ie portability and convenience) and the likelihood of good
compliance are the factors that should govern the choice of device.2 Only once these factors
have been taken into account, should choice be made on the basis of cost minimisation.
Cough as a Presenting Symptom in General Practice
Cough is a common presenting symptom in primary care. It has a prevalence of 30% in
the general European population, and in a US National Medical Case Survey in 1991
cough was the commonest presenting complaint. Between 10% and 38% of all new
patient referrals to UK hospital chest clinics are for chronic cough. This article covers
the physiological nature of cough and its role as an essential protective reflex, focuses on the
differential diagnosis of cough in general practice in both adults and children, and discusses the
use of treatment as a diagnostic tool.
Urticaria and angioedema
Allergic diseases such as hayfever and allergic asthma are becoming increasingly common
in westernised countries such as the United Kingdom, with an estimated 25% of the
population now suffering from some form of allergic condition. Urticaria and angioedema
are commonly thought of as allergic problems although in general only acute symptoms
are related to allergen exposure. Here we discuss the diagnosis and management of urticaria and
angioedema in primary care, with particular focus on identifying allergic triggers and managing
long-term symptoms successfully.
Seven Steps to a Successful Flu Vaccination Campaign
Planning a flu vaccination campaign during the autumn is always a difficult concept to
take on board. But, from experience, the earlier you plan a campaign, the more
successful it will be. Adequate planning and organisation will ease the pressure on all
members of the team during a very busy period. It will also ensure that all patients in
the ‘at risk’ groups are vaccinated and targets achieved. This article gives seven easy steps for a
stress-free flu vaccination campaign.
Non-respiratory causes of breathlessness
Abnormal breathlessness is a common symptom with a wide variety of causes and it can
be quite a challenge to diagnose the cause and plan appropriate treatment. Practice
nurses are often the first point of contact for patients with these conditions and play an
important role as part of the multidisciplinary healthcare team. This article completes a
series of three on causes of breathlessness (‘The breathless patient: is it asthma or COPD?’ Vol 2,
Issue 1, December 2007 and ‘Respiratory causes of breathlessness.’ Vol 2, Issue 2, March 2008).
Food Allergy in Childhood
Milk, eggs and peanuts are the most common foods causing allergy in early childhood.
The prevalence of these allergies is on the increase. A thorough clinical history
together with an allergy test allows for a clear diagnosis and implementation of a
comprehensive management plan. This article outlines some of the key features in
diagnosing and managing childhood allergies.
