Making Best Practice, Every Day Practice
Heart failure is characterised by fatigue, breathlessness and retention of fluid. The update of the National Institute for Health and Clinical Excellence chronic heart failure guidelines has simplified its management by using a stepped approach to investigation and treatment. In this article, we focus on the practical aspects of managing the two main symptoms associated with heart failure – oedema and 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.
Breathlessness is a very common problem in the patients we see in general practice, and
there is a range of possible causes. In this article – the first in a series of three looking
at how to diagnose what’s wrong with a breathless patient – we explore how to
distinguish between two of the commonest respiratory causes of breathlessness,
asthma and chronic obstructive pulmonary disease.
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).
The development of shortness of breath (SOB) is an expected outcome of overexertion,
as normally occurs after strenuous exercise. SOB occurring at rest or during marginal
exertion is considered abnormal. Multiple organ systems are involved in the differential
diagnosis of SOB but for the purpose of this article, we concentrate on the pulmonary
system and include chronic obstructive pulmonary disease (COPD), asthma, pneumonia,
pneumothorax, interstitial lung disease, lung cancer and dysfunctional breathlessness. This is
the second in a series of three articles focusing on diagnosis of the breathless patient.
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).
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