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Book Details
Abstract
The fully updated fourth edition of this practical and concise handbook shows professionals how to manage COPD in primary care successfully and with worthwhile outcomes for patients. In this book, you will find guidance, protocols, plans and tests – all appropriate to the primary care situation – that will streamline your diagnosis and management of COPD.
There have been major developments in our understanding and management of COPD over the last decade and this new edition has extensively reviewed the known literature and latest Guidelines to provide the most up to date and comprehensive picture of diagnosis, investigation and best patient care and management. The style remains readily accessible with key references and guides to further reading.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Chronic Obstructive Pulmonary Disease in Primary Care | Cover | ||
| Title Page | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Foreword to the fourth edition | x | ||
| Foreword to the first edition | xi | ||
| Acknowledgements | xiv | ||
| Abbreviations | xv | ||
| 1. Introduction | 1 | ||
| Main points | 1 | ||
| What is new in this fourth edition | 2 | ||
| Why COPD is important | 4 | ||
| How important is COPD? | 6 | ||
| The global situation | 7 | ||
| What is the economic burden of COPD? | 8 | ||
| Doctors’ and patients’ attitudes to COPD | 9 | ||
| What can be done? | 11 | ||
| 2. Pathology and pathophysiology | 14 | ||
| Main points | 14 | ||
| Risk factors | 15 | ||
| Chronic asthma | 22 | ||
| Chronic bronchitis | 24 | ||
| Emphysema | 25 | ||
| Small airways disease | 28 | ||
| COPD – a mixed spectrum of diseases | 28 | ||
| 3. COPD as a systemic disease, co3 morbidity and cause of death | 35 | ||
| Main points | 35 | ||
| Reduced FEV1 and increased mortality | 36 | ||
| COPD mortality – what is the cause of death? | 37 | ||
| Co-morbid conditions associated with COPD | 37 | ||
| 4. Presentation and history | 42 | ||
| Main points | 42 | ||
| Symptoms | 43 | ||
| History taking | 45 | ||
| Clinical history | 47 | ||
| Clinical signs | 47 | ||
| Summary | 49 | ||
| 5. Spirometry and pulmonary function tests | 50 | ||
| Main points | 50 | ||
| Spirometry | 52 | ||
| Why is FEV1 the preferred test? | 61 | ||
| Flow/volume measurement | 65 | ||
| Early screening for COPD | 68 | ||
| 6. Assessment | 72 | ||
| Main points | 72 | ||
| Making the diagnosis and establishing a baseline | 73 | ||
| Bronchodilator reversibility | 74 | ||
| Measurement of COPD severity | 76 | ||
| Corticosteroid reversibility | 78 | ||
| Other tests to consider in newly diagnosed COPD or in helping to make a diagnosis | 79 | ||
| Excluding alternative and coexisting pathologies | 79 | ||
| Disability and handicap | 82 | ||
| Assessing breathlessness | 84 | ||
| Assessing walking distance: field tests of disability | 86 | ||
| Assessing the impact of the disease on daily activities | 87 | ||
| Impact of the disease on psychosocial functioning | 87 | ||
| Assessing health status | 89 | ||
| Summary | 90 | ||
| 7. Smoking cessation | 95 | ||
| Main points | 95 | ||
| Why do people smoke? | 97 | ||
| How can smokers stop smoking? | 98 | ||
| What kind of support works? | 99 | ||
| Pharmacotherapy | 101 | ||
| Helping patients to stop smoking | 108 | ||
| 8. Pharmacotherapy | 113 | ||
| BRONCHODILATORS | 113 | ||
| Main points | 113 | ||
| How do bronchodilators work? | 115 | ||
| Short-acting bronchodilators | 116 | ||
| Long-acting inhaled bronchodilators | 117 | ||
| The UPLIFT study | 118 | ||
| Combined LABAs and LAMAs | 119 | ||
| Oral long-acting bronchodilators | 119 | ||
| Phosphodiesterase inhibitors (PDE4 inhibitors): Roflumilast | 120 | ||
| Nebulised bronchodilators | 120 | ||
| CORTICOSTEROID THERAPY | 126 | ||
| Main points | 126 | ||
| The NICE guidelines advice on inhaled corticosteroids in COPD | 128 | ||
| The main actions of inhaled corticosteroids in COPD | 129 | ||
| Summary of important messages from major inhaled corticosteroid studies | 130 | ||
| What are the implications for primary care? | 131 | ||
| Oral corticosteroids: what is their role? | 131 | ||
| Corticosteroids for acute exacerbations | 132 | ||
| Synopsis of important clinical trials of inhaled corticosteroids in COPD | 133 | ||
| COMBINED LONG-ACTING BRONCHODILATORSAND INHALED CORTICOSTEROIDS | 141 | ||
| Main points | 141 | ||
| Salmeterol/fluticasone studies | 141 | ||
| Formoterol/budesonide studies | 143 | ||
| Triple therapy | 143 | ||
| MUCOLYTICS | 144 | ||
| DRUG THERAPY OF THE FUTURE | 145 | ||
| Main points | 145 | ||
| New inhaled long-acting bronchodilators and corticosteroids | 146 | ||
| Anti-inflammatory therapies | 146 | ||
| Phosphodiesterase-4 (PDE4) inhibitors | 147 | ||
| Antiproteases | 147 | ||
| Alpha-1 antitrypsin | 147 | ||
| Antioxidants | 148 | ||
| Statins | 148 | ||
| Drugs for pulmonary hypertension | 149 | ||
| 9. Pulmonary rehabilitation | 150 | ||
| Main points | 150 | ||
| Evidence for the effectiveness of rehabilitation in COPD | 151 | ||
| Why rehabilitation programmes are needed | 152 | ||
| The setting and timing of pulmonary rehabilitation | 154 | ||
| The components of pulmonary rehabilitation | 155 | ||
| The role of the primary health care team | 159 | ||
| 10. Other forms of therapy | 166 | ||
| Main points | 166 | ||
| Oxygen therapy | 168 | ||
| Surgery | 178 | ||
| Vaccinations and antiviral drugs | 180 | ||
| Nutrition | 182 | ||
| Exercise | 183 | ||
| Psychological and social issues | 184 | ||
| Severe breathlessness and palliative care | 186 | ||
| 11. Acute exacerbations and referral to hospital | 193 | ||
| Main points | 193 | ||
| Defining an exacerbation | 194 | ||
| Management of the acute exacerbation | 196 | ||
| Natural history of an exacerbation | 197 | ||
| Treatment in the community | 199 | ||
| Recurrent exacerbations | 201 | ||
| Prevention of acute exacerbations | 202 | ||
| Met Office and anticipatory care plans | 205 | ||
| Hospital-at-home schemes for acute exacerbations | 207 | ||
| Respiratory failure | 208 | ||
| Treatment of associated conditions | 208 | ||
| Consideration of specialist referral | 209 | ||
| 12. The 2010 NICE update, GOLD 2009, The National Clinical Strategy and NICE Quality Standards | 212 | ||
| THE NICE GUIDELINE UPDATE 2010 | 212 | ||
| Diagnosis | 212 | ||
| Spirometry | 215 | ||
| Determining disease severity | 215 | ||
| Management of stable disease | 217 | ||
| Pulmonary rehabilitation | 218 | ||
| Self-management advice | 218 | ||
| Exacerbations | 218 | ||
| Referral to a specialist | 219 | ||
| Follow up in primary care | 219 | ||
| THE GOLD GUIDELINES | 222 | ||
| What is GOLD? | 222 | ||
| The GOLD definition of COPD | 222 | ||
| Main clinical indicators for considering a diagnosis of COPD | 222 | ||
| Classification of COPD by severity | 223 | ||
| Goals of management | 224 | ||
| Assessing and monitoring disease | 224 | ||
| Managing stable COPD | 225 | ||
| THE NATIONAL CLINICAL STRATEGY FOR COPD 2010 | 226 | ||
| Consultation on a strategy for services for COPD in England | 226 | ||
| Aims of the strategy | 226 | ||
| Strategy objectives | 227 | ||
| Implementation | 228 | ||
| Prevention and identification | 228 | ||
| High quality care and support | 231 | ||
| End-of-life care | 233 | ||
| THE NICE QUALITY STANDARDS FOR COPD | 234 | ||
| 13. Organisation and training needs | 236 | ||
| Main points | 236 | ||
| Finding the patients | 238 | ||
| The practice nurse’s role | 242 | ||
| Protocol and audit | 243 | ||
| Glossary | 251 | ||
| Useful addresses | 259 | ||
| Index | 263 |