Respiratory disease in practice - 2010

Comment: The National Clinical Strategy – at last
Philip W Ind
pp 3-3
We are pleased to bring you RDIP again, with articles on small airways disease in asthma, commissioning of respiratory services, severe chronic obstructive pulmonary disease (COPD), and sleep apnoea. These are exciting times in the respiratory world, particularly in COPD: the long-awaited National Clinical Strategy (NCS) for COPD (including asthma) in England, the updated COPD guidelines from NICE in June, and the recent oxygen guidelines. Later in the year, two new drugs for COPD will be launched. The NCS is the final culmination of much effort by clinicians, the Department of Health, the British Thoracic Society , the British Lung Foundation (BLF) and other stakeholders. The NCS stems from pressure that led to the 2004 report from the Chief Medical Officer. It joins those for other conditions including cancer, diabetes, renal disease and stroke.

An overview of commissioning for respiratory services in primary care
Linda Pearce
pp 5-6
It is assumed that primary care professionals have knowledge and understanding of disease management and patient needs, and also the ability to satisfy these needs by providing improved services. As a result of these assumptions, the commissioning of services within primary care is being implemented across the country – either through primary care trusts (PCTs) commissioning for populations, or through practice-based commissioning (PBC).

Investigation and treatment of severe chronic obstructive pulmonary disease (COPD)
David MG Halpin
pp 7-11
Patients with severe chronic obstructive pulmonary disease (COPD) have distressing symptoms, significant exercise limitation, reduced quality of life and a poor prognosis. What is less clear is how to define severe COPD, largely as a result of its multisystem nature and the heterogeneity of its clinical presentation.

Using mandibular splints for sleep apnoea
Atul Gulati
pp 9-11
Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) affects 4% of middle-aged men and 2% of middle-aged women. The most effective treatment is continuous positive airway pressure (CPAP) therapy, which prevents collapse of the upper airway during sleep. Treatment with CPAP therapy, however, can be very obtrusive and noisy. Compliance with, and acceptability of, CPAP is another major issue, with initial acceptance varying, in reported series, from 72% to 84% with only 46–83% of initial acceptors using it for more than four hours each night.