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The 10-minute consultation: Chronic Obstructive Pulmonary Disease
Second Edition
by K Gruffydd-Jones, ML Levy, D Price and A Sheikh
The 10-minute consultation
Paperback Book (64 Pages)

Chronic obstructive pulmonary disease covers the spectrum of conditions formerly known as 'chronic bronchitis' and 'emphysema', in addition to poorly controlled asthma. Breathlessness is a characteristic symptom, but the disease is also associated with co-morbidities that can present major clinical problems and disability. About 80% of cases are thought to result from smoking.

The 10-minute consultation: chronic obstructive pulmonary disease is an authoritative and practical guide that helps primary care clinicians recognise and differentially diagnose chronic obstructive pulmonary disease within the '10-minute' consultation framework. The handbook describes the necessary diagnostic lung function tests in detail and outlines the latest management options to reduce symptoms, improve lung function plus prevent and treat acute exacerbations. It includes an evidence-based discussion on the use of inhalers, oxygen therapy and end-of-life issues.

The clinician's manual is designed to be used in the clinic and for studying, containing targeted guidance on all aspects of the primary care clinician's role. Written by experienced key opinion leaders, the book supports everyday patient care and improved outcomes.

Kevin Gruffydd-Jones is a general practitioner at the Box Surgery in Bath, UK, and the Royal College of General Practitioner's Clinical Champion for Respiratory Diseases.

Mark L. Levy is a general practitioner at the Kenton Bridge Medical Centre, UK, and Executive Member of the Global Alliance on Asthma (GINA).

David Price is Professor of Primary Care Medicine at the University of Aberdeen, UK, and lead of the International Primary Care Respiratory Group research programme.

Aziz Sheikh is Professor of Primary Care Research and Development and Director of Research at the University of Edinburgh and the Royal College of General Practitioner's Clinical Champion for Allergy.

What a useful little book - I hadn't realized how small and neat it would be! Using a clear bulleted style, The 10-minute consultation: COPD not only answers the practical questions about how to diagnose and treat COPD, but also provides an insight into the key evidence that informs management guidelines. I predict this book will become an indispensable guide to GPs and nurses caring for people with COPD in primary care.
Hilary Pinnock, co-lead of the education sub-committee of the International Primary Care Respiratory Group
This is a marvelously accessible small pocketbook, enabling clinicians to gain immediate access to pivotal information in the diagnosis and management of COPD, and I commend it highly.
Stephen T Holgate, Medical Research Council Clinical Professor of Immunopharmacology, Southampton Medical School, UK
1. Introduction 1
What is the spectrum of disease? 1
What is the main cause of disease? 2
What is the burden of disease? 4
2. Who and what to test 5
Screening and case fi nding 5
What issues should the GP cover during the 7
10-minute consultation?
Differential diagnosis: asthma, lung cancer and other 24
chronic lung diseases
3. How to manage the patient with COPD 29
Who to treat? 29
How to treat? 29
What is the value of treating COPD? 29
What are the treatment targets? 29
General lifestyle advice 30
Airfl ow obstruction and COPD 31
What are the benefi ts of immunization? 39
How are acute exacerbations of COPD prevented 39
and managed?
4. Person-centred care 43
How to identify the patient’s beliefs about COPD 43
(their concerns and expectations)?
What are the patient’s cultural beliefs and practices? 43
For review. Only reproduce with permission
from Cedilla Publishing Ltd.
Chapter 1
What is the spectrum of disease?
The term ‘chronic obstructive pulmonary disease’ (COPD; Figure
1.1) covers the spectrum of disease formerly known as ‘chronic
bronchitis’ and ‘emphysema’, in addition to poorly controlled
asthma (in which fi xed airways obstruction develops). The Global
Initiative for Chronic Obstructive Lung Disease (GOLD) uses the
following working defi nition:
‘Chronic Obstructive Pulmonary Disease (COPD) is a preventable
and treatable disease with some signifi cant extrapulmonary
effects that may contribute to the severity in individual
patients. Its pulmonary component is characterized by airfl ow
limitation that is not fully reversible. The airfl ow limitation is
usually progressive and associated with an abnormal infl ammatory
response of the lung to noxious particles or gases.’
COPD is a slowly progressive disorder, with episodes of acute
exacerbations. The progressive nature of the disease is noted not
only in its physiology, but also in worsening health status, dyspnoea
and exercise capacity.
What is COPD?
Airfl ow obstruction is defi ned, using spirometry, as reduced
postbronchodilator (eg, 400 μg salbutamol) FEV1 (forced expiratory
volume in 1 sec) and a reduced postbronchodilator FEV1-to-forced
vital capacity (FVC) ratio, such that cut-off values of FEV1 <80%
predicted and FEV1:FVC <70% are used (Figure 1.2). However,
there is a risk of underdiagnosing young people and overdiagnosing
older people using these absolute cut-off values, so it is better to
use a percentage of the FEV1:FVC ratio predicted values for age,
gender, ethnicity and height (eg, European Community for Steel and
Coal/European Respiratory Society).
How to recognise nonconcordance with 44
treatment strategies?
Are any treatments particularly appropriate? 46
5. Applying the evidence 49
What are the implications of the international 49
best-practice guidelines for GPs?
Selected landmark studies 50
GP prescribing options for tackling COPD in 55
primary care: a summary
When to refer? 55
6. Review and recall of the patient with COPD 61
What ongoing patient care, monitoring and follow-up 61
are necessary?
What role do other key healthcare workers have 63
in managing the patient?
What is the role of information technology (IT)? 64
What is the role of the expert patient? 65
Further reading 66
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