Primary care and palliative care

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Daryl Freeman, clinical research fellow,
David Price, professor

department of general practice and primary care, University of Aberdeen, Foresterhill Health Centre, Aberdeen.

Primary care

Over the past decade, interest in diagnosing and managing COPD in primary care has grown in recognition of its increasing burden on patients, families, health services, and society. Guidelines from bodies such as the British Thoracic Society, National Institute for Health and Clinical Excellence, Global Initiative for Chronic Obstructive Lung Disease, and International Primary Care Airways Group have also increased awareness of COPD among primary care doctors.

All patients should receive education about COPD

COPD is a cause of great misery to many patients and their carers. Decreasing lung function—with symptoms such as breathlessness, cough, wheeze, fluid retention, and fatigue—results in a downward spiral of reduced activity, social isolation, loss of independence, depression, and increased contact with health and social care providers. However, considerable help can and should be provided in primary care. Recently, the inclusion of COPD management in the UK general practice “new contract” has provided incentives for better care.

Assessing and correcting inhaler technique and, when necessary, switching to an alternative device are vital in all patients with COPD

Detection

Patients with COPD typically present late, often with respiratory tract infections that have not previously been linked with COPD or with breathlessness misdiagnosed as asthma. Studies suggest that, among cigarette smokers older than 40 years, about 20% of those without a respiratory diagnosis and at least a quarter of those with a diagnosis of asthma actually have COPD. By the time most have COPD diagnosed, at least 50% of their lung function will have been lost.

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Simple questionnaire for evaluating risk of COPD

Thus, a priority in primary care should be earlier detection and correct diagnosis. The use of simple questionnaires may allow easier detection of patients who need spirometry, avoiding the need for mass spirometry screening programmes.