A pilot study of a mobile spirometry service in primary care.

This evaluation of an inexpensive mobile spirometry service demonstrates how patients with respiratory problems can be diagnosed and referred to appropriate services, with major potential benefits to the patient and the health service.

A qualitative study of compliance with medication and lifestyle modification in Chronic Obstructive Pulmonary Disease (COPD).

AIM: The aim of this study is to examine patients' perceptions of factors that influence their compliance with inhaled therapy for COPD, and their compliance with health related behaviours related to smoking cessation, exercise and diet. METHODS: Five focus groups of 29 diagnosed COPD patients who had not attended pulmonary rehabilitation were recruited from secondary and primary care. The severity of their illness ranged from mild to severe. For each group, the moderator asked patients what they had been told and what they actually did with regard to medication, smoking, exercise and diet. RESULTS: All patients except one reported good compliance with medication but some patients expressed concerns about technique. All patients reported being told to stop smoking, but patients varied as to whether they believed that smoking was harmful or not. Some had stopped smoking, some had tried to cut down, and others continued as normal. Patients had not been offered constructive help to quit smoking. Patients had been told to exercise but were given inadequate information as to why this was helpful. Patients were unsure how much they should exercise, and were unsure whether breathlessness during exercise was harmful. Patients had been given minimal advice about diet. CONCLUSIONS: Patients with COPD have low levels of intentional non-compliance with medication in COPD, probably because, unlike asthmatics, these patients are chronically symptomatic. Fear of dyspnoea and feelings of vulnerability also appear to contribute to good compliance. Information given by health professionals about lifestyle modification was poor. COPD patients require better education to manage their disease effectively.

The role of the practice nurse in the management of chronic obstructive pulmonary disease (COPD).

AIMS: To assess the range of activities performed by practice nurses in COPD management and their training for these tasks. METHODS: A postal questionnaire was sent to the nurse with prime responsibility for respiratory care in 179 practices in Cornwall and Southwest Devon. RESULTS: The response rate was 64%. Spirometers were available in 64% of practices (range 0-6 per practice). Of these, spirometry was performed by nurses alone in 72%; in 44% spirometry was performed less than once a week. Spirometry was used for diagnosis in 91%; monitoring in 87% and screening asymptomatic smokers in 45%. Reversibility testing was performed by 61% of the practices. Formal training in spirometry had been undertaken by 52%, informal training in 41% and none in 7%. They would like to see the development of one-stop COPD clinics, support from specialist nurses and pulmonary rehabilitation, preferably based in the community. CONCLUSION: Nurses face many problems managing COPD in general practice including equipment, training and professional support.

The role of the practice nurse in the management of asthma.

BACKGROUND: The role of the practice nurse may include diagnosis and management of asthma, this study examines the range of activities performed by nurses and their training. AIMS: To ascertain the role and confidence levels of the practice nurse in diagnosis and management of asthmatic patients. METHODS: A postal questionnaire sent to the named respiratory nurse in 179 practices in Cornwall and Southwest Devon, to assess the number of practice nurses offering asthma management, extent of services and confidence level of nurses in this role. RESULTS: The response rate was 64%: Dedicated asthma clinics operated in 47% of practices, 87% undertaken by the nurse alone. Responsibilities undertaken by nurses alone included: instruction of inhaler technique 93%, supervising self-management plans 87%, changing medication dosage 71%, withdrawing treatment 53%, diagnosing asthma 45% and managing acute exacerbations 29%. Nurses initiated treatment alone, without consulting a doctor, as follows; inhaled bronchodilators 55%, long acting bronchodilators 54%, inhaled steroids 56%, oral steroids 15%, anti-leukotrienes 5% and theophyllines 3%. The confidence level of the nurses performing these tasks was high. Formal training had been undertaken by 74% of respondents. There were statistically significant associations between performance of organisational tasks and training, but surprisingly no apparent statistical associations with training and independent initiation of treatments. CONCLUSIONS: Practice nurses are performing activities previously undertaken by doctors. A minority have not had formal training and performing these activities, without well-defined shared care protocols, may be outside current legal frameworks.