IMR Agency
Title Detail
View:   Synopsis     Table of Contents     Territory     Found In

10-minute consultation: persistent pain | case studies
by Advisory board: M Johnson A Taylor
10-minute consultation
Book (64 Pages)
March 2016
Many persistent pain patients can be seemingly complex, in terms of symptoms and management. Case studies are the most succinct way to demonstrate many of the principles that have been discussed in The 10-minute consultation: persistent pain, plus illustrate some disease-specific information.

The aim of this supplementary guide is therefore to introduce several case studies written by clinical experts, with the following objectives:
Illustrate how to assess, screen and diagnose the issues presented in the cases.
To develop a management plan in order to address the key factors presented.
To reflect on the issues presented and provide further information that readers can access if interested in pursuing inquiry into the topic area.
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
This title is available for license in the following territories:

  • Worldwide
This title is can be found in the following categories: