Abstract
Background:
COPD is a growing burden on the NHS which is preventable if diagnosed early and combined with smoking cessation. Diagnosis requires spirometry. A recent survey demonstrated major problems with existing spirometry in primary care. Many practices have no spirometer or have problems with interpreting the results. This study assessed the value of a trained Respiratory Specialist Nurse (RSN) offering structured COPD diagnostic and management services to practices in Plymouth PCT.
Methods:
A package of services was offered to a random sample of practices in Plymouth by the RSN. All these practices owned a spirometer. The package included:
- Education for practice staff on spirometry technique, interpretation of data and COPD management.
- Spirometry clinics performed by the RSN on patients referred with dyspnoea, either at the surgery or a nearby community clinic. Assessments included bronchodilator and steroid reversibility testing. Clinics were performed with or without the practice nurse being present.
- Spirometry results were analysed by the RSN and a GP with special interest in respiratory disease. Diagnosis and suggestions for ongoing management were then fed back to the practices.
- Guidance on appropriate referrals to other COPD services available locally, e.g. smoking cessation, pulmonary rehabilitation, physiotherapy and respiratory specialist nurses.
Results:
The service was offered to 14 practices of which 7 declined. In the 7 participating practices, 98 patients with breathing problems were assessed by the RSN over 3 months: 19 had asthma; 68 COPD (mild 25, moderate 16, severe 27); 5 had a pure restrictive picture; and 6 were normal. Only 10 patients had a previous diagnosis of COPD. High levels of satisfaction were reported by practices and patients. 22 patients were current cigarette smokers; 65 requested information about their disease; 52 had poor inhaler technique; 25 needed consultant referral; 20 needed referral to pulmonary rehabilitation.
Conclusions:
In practices in Plymouth that owned a spirometer there was often a lack of structured approach, skills and confidence to deal with breathless patients. This mobile COPD service diagnosed many new cases of COPD but often at a late stage. Once diagnosed, appropriate management can be started to control symptoms and reduce disease progression. Strategies included drug and oxygen therapy, consultant and specialist nurse support, pulmonary rehabilitation and smoking cessation. The advice about COPD management was well received. Currently, early diagnosis which can prevent COPD progression is not happening — this service could save lives.
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Jones, R. An assessment of a mobile COPD specialist nurse service in primary care. Prim Care Respir J 12, 65–66 (2003). https://doi.org/10.1038/pcrj.2003.31
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DOI: https://doi.org/10.1038/pcrj.2003.31