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Looking after lungs in primary care

Lung disease doesn’t discriminate, writes Debbie Roots

Lung disease doesn’t discriminate. It affects men, women, children, smokers, and individuals who have never smoked. Under-diagnosis of respiratory disease is a serious issue in the UK. Around 10% of the adult population have chronic breathlessness but the problem is recorded for less than half of them. Additionally, 900,000 people were diagnosed with COPD in 2010 but estimates suggest 3 million people experience it. This leaves 2 million undiagnosed. Finally, 30,000 deaths a year in the UK are attributed to COPD.

This is why the British Lung Foundation is running the year-long ‘Listen to your lungs’ public health campaign. It is aimed at finding the millions of people who are living with undiagnosed lung disease.

It encourages people not to dismiss feeling breathless during everyday tasks and to take a simple online breath test.

The organisation also wants to raise awareness among primary care professionals, encouraging them to take appropriate diagnostic steps when a patient presents with breathlessness. Nurses can use tests such as spirometry and ausculation, as well as taking the patient’s clinical and smoking history, if breathlessness is suspected. It may also be prudent to refer the patient for a chest x-ray.

Breathlessness can have various causes so it is crucial that practice nurses reach the correct diagnosis as quickly as possible, and the patient is referred on to a specialist service where necessary.

Primary care nurses are able to educate patients and contribute to respiratory conditions being diagnosed earlier. Once a diagnosis has been made, they ensure patients have the information they need to self-manage their illness and can help them access pulmonary rehabilitation, where appropriate.

Making sure patients always have the medication they need and are able to use their inhaler correctly is also vital. National and local guidelines on inhaler technique can help nurses educate patients in the right way to use devices. This is crucial, as many patients still get it wrong. Nurses must know how each device works and the appropriate way to use them.

Primary care nurses can ensure that patients have a personal action plan for asthma or COPD. Knowledgeable explanations of what medications are and do, what to do if a patient feels worse and how to self-manage will go a long way to reducing the number of deaths attributed to lung disease.

Debbie Roots, cardiorespiratory nurse consultant, Homerton University Hospital