Respiratory

The number of respiratory consultations in primary care increases in the winter months.
We see more patients with acute exacerbations of their underlying respiratory condition,
such as asthma or chronic obstructive pulmonary disease (COPD) caused by the cold
weather and the increased number of viruses and airborne infections that occur at this
time of year. So what advice should we give to patients with cold and flu-type symptoms during
the winter? And is the approach we take with respiratory patients in any way different from the
approach taken with otherwise healthy individuals?

The year is racing by – autumn is already upon us! It’s a time which fills me
with great expectations, with memories of starting a new academic year at
school or university. Many of you may still be experiencing this through your
children! I love the feeling of opening a clean ‘exercise book’! Some of you
may even be contemplating starting up studies again. The Education for Health
graduation ceremony is being held in October; it is one of the most thrilling
events in our academic calendar – seeing the smiles on the faces of the
mature graduates and their families as they attain awards that they never felt
would be possible! Let them be an inspiration to you all; it is never too late to
start! Our team here at Education for Health would be delighted to discuss any
programmes you might be interested in.

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.

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.

The NICE Technology Appraisal of continuous positive airway pressure (CPAP) published in
March 2008 has led to dramatically increased referrals for sleep apnoea in most areas.
Together with the National ‘Referral to Treatment’ (RTT) 18-week target, there is mounting
pressure on Primary Care Trusts to identify patients with obstructive sleep apnoea (OSA).
This article describes how OSA can be identified and diagnosed, and how CPAP can be managed in
primary care.

Cases of tuberculosis (TB) have been increasing over the past few years, with recent data
from the Health Protection Agency showing a rise of 2% from 2005 to 2006 in England,
Wales and Northern Ireland, following a rise every year since the late 1980s. Although
London continues to account for the highest proportion of cases – 42% – there have
been outbreaks throughout the country. In this article, we review the cause, pathology, clinical
investigations, diagnosis and management of TB.

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.