New look BMJ Clinical Evidence for mobiles

The BMJ Clinical Evidence website at has recently been updated and is fully optimised to fit your mobile, tablet or laptop. To see for yourself you can view a sample systematic review by following this link – Chronic obstructive pulmonary disease (COPD)

Take a look for yourself and see what else might be useful.


AQuA weekly update

This week’s news:

Event: Academic Health Science Networks: Who, What and Why?
24 April 2013
Secondary Care Toolkit for COPD from NHS Improvement Lung available here….
25 April 2013
The Kings Fund explain the top ten priorities for commissioners….
26 April 2013
Developing a specification for lifestyle weight management services. Best practice guidance for tier 2 services” from the Department of Health dated March 2013, find it here…
26 April 2013
The Cardiovascular Disease Outcomes Strategy has been published recently..take a look
26 April 2013
End of Life Care profiles added to our benchmarking section…
26 April 2013
GP outcomes indicators added to our benchmarking section
26 April 2013
New End of Life Care resources available
26 April 2013
New Spirometry guide…
29 April 2013
New materials added to our CKD pack, see what they are in the discussion forum
29 April 2013

A.G. Mathioudakis comments: Chronic bronchitis: an objective diagnosis of exclusion

The authors of the above article published would like to thank A.G. Mathioudakis and co-workers for their interest and comments regarding our recently published article in the July issue of the European Respiratory Journal [1].

A.G. Mathioudakis and co-workers raise a concern regarding the term of “chronic bronchitis phenotype” and the actual diagnosis. They also comment that the phenotype could include patients with tuberculosis, lung cancer, asthma, bronchiectasis and heart failure, and that these diagnoses were not sufficiently investigated in our study. We agree with the position that the phenotype includes patients with other conditions and, in this way, the term was addressed in our study [1]. The self-reported comorbidity (asthma, tuberculosis and lung cancer) of the subjects with spirometric diagnosis of chronic obstructive pulmonary disease (COPD) is clearly shown in table 3 of our article (description of subjects with COPD, by chronic bronchitis) [1]. However, we think that the problem is that A.G. Mathioudakis and co-workers did not understand the type of study PLATINO (Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar) is. This study is a well-known population-based study on COPD and not a study of a selected COPD population, so it is not possible to conduct additional analyses to rule out, for example, congestive heart failure in this type of study. In addition, we think that it is important to highlight the existing proposal for defining COPD phenotypes as “a single or combination of disease attributes that describe differences between individuals with COPD as they relate to clinically meaningful outcomes (symptoms, exacerbations, response to therapy, rate of disease progression, or death).” This more focused definition allows classification of patients into distinct prognostic and therapeutic subgroups for both clinical and research purposes [2]. This definition is not restricted exclusively to selected COPD samples (there is no limit for its use in unselected populations), so it can also be used to study COPD phenotypes in a population-based sample and this is the case of our study. We presented the association of chronic bronchitis symptoms (a single attribute of the disease) in the PLATINO COPD population with the severity of airway obstruction, subjects’ perceptions of their general health status, physical activity limitation and exacerbations (relation to clinically meaningful outcomes).

A.G. Mathioudakis and co-workers also made a comment regarding the low prevalence of the chronic bronchitis phenotype and suggest that this could be associated with the use of post-bronchodilator forced expiratory volume in 1 s/forced vital capacity ratio <0.70 to define COPD and the possible over-diagnosis of stage I COPD patients with low symptom prevalence. Unfortunately, it seems that A.G. Mathioudakis and co-workers have not reviewed the supplementary material of our study, which shows all analyses performed using the lower limit of normal (LLN) to define COPD [1]. Interestingly, supplemental tables 1 and 2 showed the parallel analysis using the LLN to define COPD, and the proportion of persons in both groups was quite similar to that found with the use of the fixed ratio [1]. Supplemental table 3 (description of subjects with COPD), and supplemental figures 1 and 2 (Global Initiative for Chronic Obstructive Lung Disease severity distribution of COPD subjects by chronic bronchitis and general health status assessed in COPD and non-COPD subjects, respectively) also showed the analyses using the LLN definition with similar findings [1].

Finally, we think that the data presented in our article helps to better understand the prevalence of the chronic bronchitis phenotype in an unselected COPD population using different criteria for defining COPD, and the association of this phenotype with some important outcomes (reduced pulmonary function, more respiratory symptoms and exacerbations, worse health status, and more physical activity limitation).

see link


Map of Medicine – how can it help your practice?

Respiratory viruses during winter can strain the NHS with an influx of patients, as well as more staff illness. In most cases, rest, increased fluid intake, and paracetamol are sufficient. However, winter can be much more serious for people with pre-existing conditions, such as COPD.  Total excess winter mortality is between 20,000 and 50,000 annually in England and Wales, principally from respiratory, cardiovascular or cerebrovascular diseases.  Older age, female gender and a history of respiratory disease confer greater vulnerability.
Optimising management of chronic conditions is a process, not an event, and clinicians can be supported in this by using the Map of Medicine.   The following care maps are accredited by the Royal College of Physicians (RCP) and offer evidence-based, practice-informed guidance for the on-going management of chronic conditions:

  • ‘Chronic obstructive pulmonary disease (COPD)’ – covers management in both primary and secondary care, and includes treatment of acute exacerbations of breathlessness, which can occur in response to viral infection
  • ‘Cardiovascular disease (CVD) risk management’ – gives information on primary and secondary prevention of cardiac disease
  • ‘Stroke and transient ischaemic attack (TIA)’ – includes information on the secondary prevention of cerebrovascular events

The Map and the RCP bring together evidence and practice to support clinical decisions at the point of care. The Map can be customised to reflect local needs by clinicians looking to support clinical decision-making. Over 150 organisations have ‘localised’ more than 1,300 care pathways. Local additions to the care maps for these chronic conditions range from signposting services, for example local telehealth initiatives and social care packages, to providing information on topics such as factors to consider when deciding where exacerbations of COPD should be managed, and which teams are responsible for delivering care.

Click here to see how the Map could help your organisation.

Action plan for respiratory disease treatment published | Department of Health

Action plan for respiratory disease treatment published | Department of Health.

A new action plan for treatment of respiratory problems is set out in guidance published today for the NHS.

Some 45 best practice actions are outlined for the treatment of Chronic Obstructive Pulmonary Disease (COPD) and asthma. The two can be confused due to similar symptoms and understanding the similarities and differences will help doctors provide better treatment. A key part of the new strategy is reducing the variation in COPD diagnosis and care around the country.  Extract from


Latest updates from NHS Evidence

The following new style Evidence Updates were published recently:

 Pregnancy and complex social factors: Evidence Update January 2012: focuses on a summary of selected new evidence relevant to NICE clinical guideline 110, ‘A model for service provision for pregnant women with complex social factors’ (2010).

Bacterial meningitis and meningococcal septicaemia: Evidence Update January 2012: focuses on a summary of selected new evidence relevant to NICE clinical guideline 102, ‘Management of bacterial meningitis and meningococcal septicaemia in children and young people younger than 16 years in primary and secondary care’ (2010).

Chronic obstructive pulmonary disease: Evidence Update February 2012: focuses on a summary of selected new evidence relevant to NICE clinical guideline 101, ‘Management of chronic obstructive pulmonary disease in adults in primary and secondary care’ (2010).

Venous thromboembolism: reducing the risk, Evidence Update February 2012: focuses on a summary of selected new evidence relevant to NICE clinical guideline 92, ‘Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital’ (2010).

Inflammatory Bowel Disease Forum: 16 November

East Cheshire News

  • Macclesfield District General Hospital, Education and Training Centre. The second forum will focus on IBD and your diet, IBD and immuno supression and IBD and your joints.
  • Presentations will be delivered on these topics by
    Dr Knight – Consultant Rheumatologist,
    A Hamilton – GI Dietician and
    Dr Koss and Dr Saravanan.
    If you would like to attend, please contact Liz Nelson or Janet Stubbs on 01625 661653.

Don’t forget World COPD Day  16 November

News from NHS Networks: 30 Sept

Two new respiratory quick reference guides have been published to help support patients with asthma and COPD.
This research scan describes how junior doctors have been engaged in quality improvement and factors that help and hinder their involvement.
The NHS must address the significant variations in care experienced by the 170,000 patients who have major emergency abdominal surgery each year, says a new report published by the Royal College of Surgeons.
The NHS could have saved a total of £625 million if it had prescribed NICE-recommended drugs for the treatment of type 2 diabetes as opposed to other treatment options, according to a new study.

2 articles: Psychological care after stroke + Managing COPD

NHS Improvement
Psychological care after stroke: improving stroke services for people with cognitive and mood disordersThis publication is intended to be a guide for services who would like to improve psychological support for people with stroke. The target audience is clinical staff working in stroke services who would like to make local improvements but also stroke networks, SHA leads and commissioners of stroke services interested in large scale improvement in psychological support after stroke.

Managing COPD as a long term condition: emerging learning from the national improvement projects
This report contains practical examples to support clinical teams in delivering quality and productivity to patients and a wide range of stakeholders.