Non-cystic fibrosis (CF) (bronchiectasis) is a common chronic lung condition, which occurs due to damage to the airways leading to persistent cough, sputum production and recurrent chest infections (Hill et al, 2018). This article focuses on the adult patient and describes the pathophysiology, aetiology, investigation, and management of bronchiectasis in the primary care setting. The aim is to raise awareness of this disease, which is increasing in prevalence and to empower community nurses with information to support patients through the bronchiectasis disease trajectory.
The importance of an asthma review at least annually is clearly evidenced by guidelines and, importantly, was highlighted in the ‘National Review of Asthma Deaths’ report as an opportunity for assessment and education that could help prevent asthma deaths (Royal College of Physicians [RCP], 2014). Community nurses are in an ideal position to ensure that all patients with asthma have reviews. This article aims to clearly set out what these should include, give practical advice as to how to carry out an asthma UHYLHZDQGZK\WKHGLͿHUHQWHOHPHQWVRIDQDVWKPDUHYLHZ are important.
Pneumonia has a huge impact upon the healthcare system in the UK and is not only associated with higher rates of hospital admissions than any other respiratory disease, but also carries a high risk of mortality. This article offers an overview of community-acquired pneumonia in adult patients, including the pathophysiology, common aetiologies, at-risk groups and pharmacological management. There is also a brief discussion on differential diagnoses and potential strategies to support clinical decision-making in the community.
Smoking has a significant negative effect on patients’ health status. The Department of Health (DH) recently announced a Tobacco Control Plan, which sets out the government’s strategy for reducing smoking rates and increasing patients’ access to smoking cessation services. This article examines the main points of the Tobacco Control Plan, as well as detailing how community nurses can use the plan to improve their own interactions with patients who smoke, as well as designing effective smoking cessation services.
Asthma is a common lung condition affecting many patients in the community. Nurses are pivotal in the diagnosis and management of people with both stable disease and during acute flare-ups. Asthma reviews offer opportunities to build therapeutic relationships and optimise treatment, helping patients to recognise and plan management of an asthma attack. On average, three people die of asthma every day in the UK - a stark statistic which should encourage nurses to be forever watchful of opportunities to regularly review the evidence base and produce patient-centred care. This article focuses on the management of chronic adult asthma, at diagnosis, management, and briefly touches on assessment of the acute exacerbation. They key differences between the asthma guidelines of the British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN, 2016) and the National Institute for Health and Care Excellence (NICE, 2017) guidelines, which are currently in use in the UK, are presented for reader consideration.
The provision of end of life care is important core work for community nursing teams. Once end of life has been recognised, a focus on palliation of symptoms and an emphasis upon assisting people to ‘live well until they die‘ becomes paramount. Breathlessness is a common distressing symptom for patients, significantly affecting their quality of life and is sometimes the cause of unnecessary admissions to hospital. This article explores the pathphysiology of breathing and breathlessness and offers some thoughts on history-taking and physical assessment, skills that nurses in advancing practice roles are now undertaking in the community setting to enhance the care they deliver to patients. This article aims to support community nurses to gain knowledge to inform the provision of effective evidence-based care and assist patients and their families to manage breathlessness at end of life.
Every 10 seconds someone in the UK has a potentially lifethreatening asthma attack and three people die every day from the condition. Tragically, evidence shows two-thirds of these deaths could be prevented by using some key elements of basic care. Also, many of these deaths occur in people with mild or moderate asthma, the kind that can be managed in primary care and with daily self-management.
In the course of their work, community nurses may often come across patients being treated with oxygen therapy for long-term conditions. This article examines the knowledge that community nurses need to provide effective evidence-based care, particularly referencing the British Thoracic Society (BTS) guidelines as well as how referral to specialist respiratory/oxygen teams can sometimes be the best option. The author also considers the potential benefits of providing community teams with pulse oximeters and how this would support them in assessing patients who might require oxygen therapy, identify at-risk patients and support clinical decision-making, particularly with referrals into specialist services.
Respiration is vital for life and understanding how to assess patients' respiration and the different types of respiratory rate is a vital skill for all community nurses. Respiration rate is one of the four vital signs and should not be ignored when assessing a patient. This article explains the different types of respiration; provides clear guidance on how to assess respiration, and explores some of the causes of abnormal respiratory patterns and how they can be managed.
