Asthma Tutorial. Trainer MRW. Consider the two scenarios, make an attempt at the questions, what guidance have you used?

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1 Registrar: LG PR RS Topic Asthma and COPD Asthma Tutorial Trainer MRW Date of Tutorial 18 th Jan 2007 Objectives of the tutorial How to diagnose What investigations and when Treatment guidelines QoF Criteria How to follow up o Who o When o How Pre-Tutorial Reading and tasks Review relevant QoF and BNF sections Consider the two scenarios, make an attempt at the questions, what guidance have you used? Mrs B attends with her son age 8. He has been getting nighttime cough, which she thinks is due to infection, she wants an antibiotic like the other Dr. gave him. Mr G age 50 attends. He has a persistent cough and complains of breathlessness. You examine his chest and detect mild generalised wheeze. What other elements do you need in the histories? What features of the examinations should be recorded? What investigations do you plan? What do you tell the patient? With what and when do you code the diagnosis/problem? What is your treatment plan? When would you refer?

2 Appendix for Teachers: QoF (revised 2004) criteria COPD - Rationale for Inclusion of Indicator Set COPD is a common disabling condition with a high mortality. The most effective treatment is smoking cessation. Oxygen therapy has been shown to prolong life in the later stages of the disease and has also been shown to have a beneficial impact on exercise capacity and mental state. Some patients respond to inhaled steroids. Many patients respond symptomatically to inhaled beta agonists and anti-cholinergics. Pulmonary rehabilitation has been shown to produce an improvement in quality of life. The majority of patients with COPD are managed by general practitioners and members of the primary healthcare team with onward referral to secondary care when required. Consultation rates in patients with COPD are 2 to 4 times higher than the equivalent rates for patients with angina. This indicator set focuses on the diagnosis and management of patients with symptomatic COPD. A diagnosis of COPD should be considered in any patient who has symptoms of persistent cough, sputum production, or dyspnoea, and/or a history of exposure to risk factors for the disease. The diagnosis is confirmed by spirometry. It is not anticipated that patients will be registered as asthmatic and as having COPD. Patients diagnosed as COPD who were previously on the asthma register should be coded as inactive on the asthma register. COPD is diagnosed if: the patient has an FEV1 of less than 70% of predicted normal and has an FEV1/FVC ratio of less than 70% and there is a less than 15% response to a reversibility test. The FEV1 is set at 70% although the GOLD and BTS guidelines state 80%. The rationale is that a significant number of patients with an FEV1 less than 80% predicted may have minimal symptoms. The use of 70% enables clinicians to concentrate on symptomatic COPD.

3 Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2006)

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11 CLINICAL FORUM Investigation and management of chronic cough using a probability-based algorithm J.A. Kastelik, I. Aziz, J.C. Ojoo, R.H. Thompson, A.E. Redington and A.H. Morice Eur Respir J 2005; 25: DOI: / Copyright_ERS Journals Ltd 2005

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