Improving practice

Chronic obstructive pulmonary disease (COPD) exerts a major burden on healthcare resources in addition to the significant morbidity it imposes on the affected patient. Much of this burden falls upon primary care, and therefore it essential that GPs respond with appropriate strategies to improve patient management. Accurate identification of affected patients will invariably require spirometry, and the General Medical Services (GMS) contract recognises the importance of this diagnostic tool, and provides financial rewards to those practices which employ such services. Despite this, there are numerous problems in providing quality spirometry services in the community. The availability of practical guidelines may go some way to improve the management of the condition, and recently the National Institute for Health and Clinical Excellence (NICE) have published COPD management guidelines from a UK perspective. However, there is some deviation between the NICE guidance and the quality indicators used within the GMS contract, particularly with regard to reversibility testing. Here, we outline some practical approaches to managing patients with varying severities of COPD including appropriate lifestyle advice, pharmacotherapy, pulmonary rehabilitation and palliative care.