CQC rating Requires Improvement

Respiratory

Annual respiratory reviews

Anyone with Asthma or COPD should have an annual review. This is to check if anything has changed with their illness; to make sure they are on the right medications; to help them manage their own illness and to give any information they may need relating to their illness.

Being invited for a review

We now have care co-ordinators who invite patients in for their review. They run regular checks to see who is due a review and will invite you in both by letter and text. Sometimes you may not agree that you are due a review, this might be because;

  • You think you have recently had a review. This is sometimes our fault because we forget to tick one of the boxes that says you have been reviewed.
  • You are under a specialist and don’t think you need to see us, though often we like to keep in touch with what is going on with your condition even when you are under a specialist.
  • You no longer think you have the illness or never thought you did in the first place
  • You think someone else, GP/ACP/Specialist Nurse saw you who could do your review.

If this is the case, please contact us by one of the following methods and we will check to see if this can be changed.

The review

We have been trying to make these reviews as effective as possible in recent years but also realise that they are sometimes difficult to attend for people with busy family and working lives. With this in mind, we offer a number of different ways of being reviewed, including traditional face to face reviews and telephone reviews. We also audit patients notes to see who might need a more urgent review, this may be because they are having lots of flare ups or because they are over-using medication.

Some patients with asthma might not need to speak to anyone at all if the audit suggests they are well. They would be asked to complete a questionnaire about their asthma to reassure us that their conditions remains stable from the previous year. Face to face reviews usually last 20 minutes and are with one of our practice nurses trained in respiratory conditions. Telephone reviews usually also last about 20 minutes and may be with a practice nurse or pharmacist trained in respiratory conditions. We will often send out a questionnaire before the review to help us see how things are before we ring you.

Who does the review

Traditionally this has been a practice nurse who you may have known well and enjoyed having a annual check up with. Unfortunately some of our team have moved on or retired and because of the rapidly increasing number of people with Long Term Conditions, such as Asthma and COPD, we have had to look at who else can do these reviews, so this may now be your GP during a consultation about something else, a Pharmacist or a Physicians Associate.

Sometimes these teams are from outside Affinity Care and are either part of some research or an external company who are helping us to make sure everyone gets a review. If they are doing research they will explain this to you and ask your permission to do it which you are welcome to decline and we can arrange your review by a different person. They are all knowledgeable about your condition and able to offer you the most effective and up to date treatments.

Specialist respiratory clinic

We hold Specialist Respiratory Clinics at all the practices with our two specialist respiratory nurses Rob and Vicky.

What we do

Patients are seen in these clinics if they have particularly complex respiratory conditions or are still having problems with their breathing despite the best efforts of their GP or Practice Nurse. Patients are usually referred by their practice nurse or GP but may also be picked up following a hospital admission.

This is a unique service to Affinity Care. The service maintains close links with the hospital respiratory team including the severe asthma clinic and Bradfords Respiratory Research Team. Patients are often referred onwards to the hospital respiratory team where needed but can be seen earlier than a hospital referral, usually within 4-6 weeks compared to 4-6 months by the hospital team.

We have recently recruited another Respiratory Specialist Nurse who will be seeing those patients with severe breathing difficulties who are housebound.

COPD Breathing Tests

We will no longer be doing breathing tests in annual reviews for COPD. In 2019 annual breathing tests were stopped based on national guidance, this was before the pandemic.

The test did not accurately tell us how bad your lung function is, and it is not a useful screen for lung cancer (which is what we used it for before).
What is more accurate is to check on your symptoms and how often you have flare ups.
We can ask you about these on a telephone review or when we meet you and arrange tests (eg: an x-ray)

Inhalers

It doesn’t matter how good the drugs in inhalers are, if the drug isn’t getting into the lung properly. Research tells us that less than 40% of patients taken their inhalers correctly reducing their effectiveness. Our practice nurses and pharmacists can help with this and it also worth speaking to you local chemist if you are unsure.

Remember that there is no best inhaler and different inhalers suit different people. There are over 150 different inhalers we can try so if you arn’t getting on with yours, please ask us to consider a change. When you change your inhaler it is helpful if your practice nurse or pharmacist reviews you after 4-6 weeks, please ask if this doesn’t happen. The following videos and app can help with learning how to take your inhaler.

Remember many inhalers should be used with a spacer.

  • This should be changed yearly
  • Washed once a month
  • Primed when new or after a wash
  • Changed if becomes cloudy

Blue Inhalers

Blue inhalers are sometimes called relievers and individually called, Salamol, Ventolin, Salbutamol, Bricanyl or Terbutaline. Over the last 10 years we have increasingly realised that patients with ASTHMA who overuse these inhalers are poorly controlled, are at increased risk of flare ups, hospital admission and even dying of asthma. Due to this we have actively tried to restrict the number of inhalers these patients get and make sure their review is prioritised. We appreciate this may be a change from what you were told 10+ years ago but the change comes from new learning that shows that overuse of blue inhalers is not safe practice.

How much is too much? National and International guidelines suggest you should not need the blue inhaler more than 3 times per week and should not need to use it regularly before exercise. This will mean you need no more than 2 blue inhalers per year. Please see the following link to see how much you are using.

Online Asthma Slide Rule | Primary Care Respiratory Society (pcrs-uk.org)

This does not apply to patients with COPD, though everyone using blue inhalers should be aware that the body gets sued to them and so the more you use, the less it will help with your breathlessness.

Environmental impact of inhalers

In recent years we have become aware of the significant carbon footprint left by some inhalers. We have also learnt that the degree to which inhalers effect the environment varies considerably between the different inhalers and so it is sometimes possible to reduce our carbon footprint by using different inhalers.

We also know that COPD and asthma can be a scary and dangerous illness and the most important thing is to keep your illness as controlled as possible. For this reason a change in inhalers due to environmental factors is very much up to each patient. Please let us know if you would like to discuss this and we can arrange for a pharmacist or nurse to call you.

The inhalers that have the biggest carbon footprint are usually those that have a cylinder and omit an aerosol, we call them Metered Dose Inhalers or MDI’s. Particularly troublesome are the reliever (blue) MDI’s which cause the majority of the problems.

Please read the following article for how changing your inhaler might not only improve your impact on the environment but may also improve your asthma/COPD symptoms.

Why switching asthma inhaler could be better for you and the planet – BBC News

Asthma links

What does well controlled asthma look like:

  • No flare ups
  • Low use of Reliever (BLUE) Inhaler. No more than 3 times per week
  • Good sleep with asthma
  • Being able to exercise with asthma

Let us know if this doesn’t sound like you.

Asthma information Health advice | Asthma UK

WhatsApp ask about your asthma – WhatsApp service | Asthma UK

Asthma UK Helpline – 0300 222 5800 Helpline | Asthma UK

Self management plans – Asthma action plans | Asthma UK

Is my asthma well controlled? Asthma Attack Risk Checker | Asthma UK

Preventer Inhalers – Preventer inhalers | Asthma UK

Reliever Inhalers – Reliever inhalers | Asthma UK

COPD links

What is COPD? – COPD (chronic obstructive pulmonary disease) | BLF

COPD Flare Ups – COPD flare-ups | British Lung Foundation (blf.org.uk)

After giving up smoking, continuing to be active is the next most important thing you can do to improve your COPD. There are a number of ways we can help you with this:

Breathing exercises for COPD – How can I manage my breathlessness? | British Lung Foundation (blf.org.uk)

Support Groups – BLF support groups | British Lung Foundation

Support for those housebound with COPD – We can refer you to a support system called MyCare if you are very restricted by COPD. Please ask your GP or Practice Nurse for a referral to MyCare

Pulmonary fibrosis / interstitial lung disease

What is ILD/Pulmonary Fibrosis What is Pulmonary Fibrosis? – Action for Pulmonary Fibrosis (actionpf.org)

Support Groups Bradford Pulmonary Fibrosis Support Group – Action for Pulmonary Fibrosis (actionpf.org)

This condition is often managed by hospital consultants but our specialist respiratory nurses can provide support in between your appointments with the hospital. Please ask your GP/Pactice Nurse for a referral

Many patients will be referred to the Leeds ILD service. Talk to your consultant about this. Interstitial Lung Disease (leedsth.nhs.uk)

Smoking cessation

Bradford support 01274 437700 Smoking | Living Well (mylivingwell.co.uk)

Long COVID/Post Acute COVID Syndrome

Information – Post-COVID HUB – By Asthma UK and British Lung Foundation

Support Group – Home – Long Covid Support

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