Managing severe breathlessness in patients with end-stage COPD.

The disease trajectory in chronic obstructive pulmonary disease (COPD) can be long and uncertain, making it difficult to identify when patients are at the end-stage of the disease. Patients with COPD have been found to experience similar levels of symptom burden to those with lung cancer, yet they are less likely to receive palliative care and treatment with opiates, anxiolytics or antidepressants. This article focuses on pharmacological and non-pharmacological approaches to the management of severe breathlessness in patients with end-stage COPD.

Improving inhaler technique in patients with asthma.

This article provides an overview of the key issues relating to the selection and use of inhaler devices in the treatment of asthma. The article reviews the features of the main types of inhaler devices and the factors affecting choice. The importance of patient involvement and the need for teaching and ongoing review of correct inhaler technique is also discussed.

Setting the standard for routine asthma consultations: a discussion of the aims, process and outcomes of reviewing people with asthma in primary care.

Globally, asthma morbidity remains unacceptably high. If outcomes are to be improved, it is crucial that routine review consultations in primary care are performed to a high standard. Key components of a review include: * Assessment of control using specific morbidity questions to elucidate the presence of symptoms, in conjunction with the frequency of use of short-acting bronchodilators and any recent history of acute attacks * After consideration of the diagnosis, and an assessment of compliance, inhaler technique, smoking status, triggers, and rhinitis, identification of poor control should result in a step-up of treatment in accordance with evidence-based guideline recommendations * Discussion should address understanding of the condition, patient-centred management goals and attitudes to regular treatment, and should include personalised self-management education Regular review of people with asthma coupled with provision of self-management education improves outcomes.

Correct technique for using aerosol inhaler devices.

Using an inhaler device correctly is essential to ensure that patients receive maximum benefit from their prescribed medication. The most effective inhaler device is one that the individual patient can and continues to use to deliver the right amount of medication consistently. This article discusses the key points to consider when using aerosol inhalers.