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Advice for nurses on diagnosis, treatment and care of people affected by the two most common lung conditions
A report Drawing Breath from the National Asthma and Chronic Obstructive Pulmonary Disease Audit Programme has pulled together data on chronic obstructive pulmonary disease and asthma to provide what it calls a ‘state-of-the-nation’ view.
Primary Health Care. 33, 3, 10-10. doi: 10.7748/phc.33.3.10.s4
Published: 30 May 2023
To diagnose COPD, tests may include spirometry, breathing and oxygen levels, chest X-ray, blood tests, and more general measurements such as weight, heart rate and blood pressure.
Patients should also be asked questions about their health, including: if they cough; have a lot of mucus; any breathlessness and what causes it; how their daily life is affected; their smoking history; general health, including any childhood chest problems; and whether they have been exposed to dust, fumes or chemicals during their working life.
For asthma, the path towards gaining a diagnosis depends on whether the patient is an adult or child, and whether it may be classed as severe – which will be about 4% of cases. Severe asthma is harder to control, even when following a treatment plan and taking medications.
For adults, asthma can be diagnosed by either a GP or an asthma nurse, says Asthma + Lung UK. They should look at symptoms, such as breathlessness; coughing and wheezing; triggers; and a family and clinical history. Specific tests may then be carried out to confirm or rule out asthma. These tests may include a spirometry and bronchodilator reversibility test, a fractional exhaled nitric oxide test, peak flow, a bronchial challenge test and allergy tests.
Getting a diagnosis for a child can be a longer process, particularly if the child is under five, says Asthma + Lung UK. There is no single test for asthma and tests on their own are not enough to confirm diagnosis, the charity explains. Symptoms and family history are also important elements.
It is important to take the time to understand how a patient might be feeling, says Asthma + Lung UK respiratory nurse specialist Caroline Fredericks. ‘Sometimes when people are diagnosed with lung conditions they may be upset and find it hard to accept their new diagnosis,’ she says.
But acceptance can influence someone’s response, including their adherence to any medications. ‘That’s why an explanation of their lung condition and how their medicines work is absolutely crucial,’ says Ms Fredericks.
Nurses also play a key role in ensuring patients have a good inhaler technique, says Ms Fredericks, including using a spacer if appropriate.
The report recommends improving the provision of early and accurate diagnosis, timely care and care received from the right people. Those with asthma or COPD should also be able to benefit from joined-up care pathways and high-quality information, says the report, while any variations in care should be minimal.
A key recommendation is that hospitals should have a respiratory nurse specialist trained in the care of children and young people with asthma.
Approaching patients and their care holistically is crucial, according to Ms Fredericks. ‘It’s important you listen to your patients and understand what their individual needs are,’ she says.
People with asthma should have a yearly review with their GP or nurse, help with their inhaler technique and a written asthma plan. Some patients with COPD should be referred for pulmonary rehabilitation if appropriate, and given help to quit smoking, says the charity.
‘However, this isn’t happening in most cases,’ says Ms Fredericks. ‘Our data suggests less than one third of people with asthma are receiving all the elements of basic care, while for COPD patients it’s only one fifth. Nurses can play an important role in delivering this basic care, which can hugely benefit patients’ health and well-being.’