Respiratory Support and Treatment for Patients in Primary Care
We provide a range of services and treatments for patients with asthma and COPD in primary care GP surgery settings. The information below explains how we care for and support patients with asthma and COPD.
Diagnosis
Asthma
Asthma can only be diagnosed following the completion of at least 2 objective tests. These include spirometry, FeNO and peak flow testing. A full diagnosis cannot be made until at least 2 tests have been carried out. It’s important for patients to make and attend any diagnostic testing appointments they are invited for to ensure their treatment is right for them and to ensure they are invited for annual review.
COPD
Your GP may refer you for a chest X-ray or other scan to rule out other possible causes of your symptoms. If COPD is suspected following this, you may be required to have a spirometry test to help confirm your diagnosis.
Monitoring
Patients with a confirmed diagnosis of asthma or COPD will be invited to have an annual review of their condition. This helps us to understand how well controlled your condition is and work with you to adjust your treatment plan accordingly. This may be through a range of measures including medicines such as inhalers, lifestyle changes and understanding your triggers. We will also work with you to perfect your inhaler technique. We may also refer you for additional therapies such as pulmonary rehabilitation, weight management or smoking cessation.
Attending your review is extremely important in preventing unnecessary deterioration or acute exacerbation and in supporting you to live as well as possible with your condition.
Exacerbation Follow Up
At the start of or following an acute exacerbation of asthma or COPD (including if you attend hospital), you should ensure you book an exacerbation follow up with one of our trained healthcare professionals.
Patients with COPD should also book an exacerbation follow up as soon as they start taking any medication from their rescue packs (stand by oral antibiotics and steroids). This is to ensure a further pack can be issued to you if needed and the Healthcare Professional can advise you on the best treatment plan to prevent a recurrence or worsening of your exacerbation.
Medication Reviews
Patients may be invited to have a structured medication review with our Practice Pharmacists. A structured medication review is all about making sure you are getting the most benefit from your medicines whilst minimising any risks. It’s an important part of your healthcare that helps keep you healthy and safe.
Patients with asthma or COPD may also be invited for a structured medication review where they:
- take 10 or more medicines or take medicines which may carry risk
- have 2 or more issues of antibiotics and steroids for chest infections in a single year (excluding COPD patients)
- order more than 3 Salamol inhalers in a single year (indicating poor control of their condition)
It’s important for patients to make and attend any medication review appointments they are invited for.
Rescue Medicines for COPD Patients
COPD rescue medicines are a supply of standby medications that you should start if your COPD gets worse. You may have been prescribed two different COPD rescue medications; steroid tablets and antibiotics. Rescue packs are not prescribed for patients with asthma but a combination of steroids and antibiotics may be prescribed to treat a chest infection on a one-off acute basis.
When should I take my COPD rescue medicines?
Your COPD may be getting worse (a flare-up) if you have a sustained worsening of your usual normal state beyond your normal day-to-day variation of the following symptoms:
- Increased breathlessness
- New or increased wheeze and/or chest tightness
- Change in sputum (phlegm) colour or quantity
- New or increased cough
If you have one of these symptoms, increase your reliever (salbutamol or ipratropium) inhaler medication, rest and stay indoors.
If one of the symptoms is a change in the colour of your sputum (phlegm) you should also start the antibiotics, especially if it is becoming green or brown or contact the surgery for an appointment.
Review and Re-Supply
If you start your rescue pack, you must inform the surgery that you are less well and that you have started the rescue pack – you will be given an appointment for a review.
What else should I do?
If after 3 days of starting your rescue pack your symptoms have not improved you should re-contact your GP or COPD nurse who may request a sputum sample.
Contact your GP Practice or 111 out of hours immediately if you develop any emergency symptoms, such as:
- Severe breathlessness
- Chest pain
- Inability to complete sentences · High fever or temperature
- Symptoms coming on very quickly
In an extreme emergency dial 999 and ask for an ambulance.
Things to remember:
Make sure you request a replacement rescue pack once you have recovered. You should also make a note of the expiry date of your medicines and ensure you request another supply from your GP or nurse if you have medicines that are out of date.
What should I do if I have forgotten to take a dose?
It is important that you take the medication as it has been prescribed. However, if you forget to take a dose, take it as soon as you remember and then carry on taking your next dose at its regular time. If you realise you have missed a dose but it is almost time for your next dose, do not take a double dose, skip the dose you have missed, take the next dose at its regular time and then carry on as normal with any remaining doses.
Are there any side effects?
All medications can cause side effects. Most people don’t have problems when taking medications for a short time, such as with your COPD medication. The patient information leaflet that is supplied with each medication lists the more common side effects and other precautions for each medication. Please read these leaflets. If you are concerned about any side effects please contact your COPD nurse, GP or community pharmacist for further information. Long term use of rescue pack medication can cause longer term issues such as affecting your bone / eye health, causing acne breakouts and making you feel poorly when you have not taken them. It’s important to remember that rescue medications are for short term use, and you should ensure you report to the surgery when you have used them.
The Intensive Home Support Service (IHSS)
If you are having frequent flare-ups that require your rescue drugs your GP may refer you to The Intensive Home Support Service (IHSS) who can provide support for you in your own home. A team of clinical staff will assess, investigate, support and help you manage flare-ups and avoid any unnecessary hospital admissions.