Volume 21, Number 1

Linda Pearce DNursing MSc RN OHNC NPDip Respiratory Nurse Consultant and Clinical Lead for Suffolk COPD Services, West Suffolk Hospital, Bury St Edmunds

It is assumed that primary care professionals have knowledge and understanding of disease management and patient needs, and also the ability to satisfy these needs by providing improved services. As a result of these assumptions, the commissioning of services within primary care is being implemented across the country – either through primary care trusts (PCTs) commissioning for populations, or through practice-based commissioning (PBC).

David MG Halpin MA DPhil FRCP Consultant Physician and Honorary Senior Clinical Lecturer in Respiratory Medicine, Royal Devon and Exeter Hospital, Exeter

Patients with severe chronic obstructive pulmonary disease (COPD) have distressing symptoms, significant exercise limitation, reduced quality of life and a poor prognosis. What is less clear is how to define severe COPD, largely as a result of its multisystem nature and the heterogeneity of its clinical presentation.

Philip W Ind, Editor

We are pleased to bring you RDIP again, with articles on small airways disease in asthma, commissioning of respiratory services, severe chronic obstructive pulmonary disease (COPD), and sleep apnoea.

Omar S Usmani MD PhD Clinical Senior Lecturer and Consultant Physician; Peter J Barnes FRS FMedSci Head of Respiratory Medicine, Airway Disease Section, National Heart and Lung Institute, Imperial College, London

Asthma and chronic obstructive pulmonary disease (COPD) are both chronic inflammatory disorders of the respiratory tract characterised by airflow limitation. They are distinct conditions with different causes, different airway inflammatory cells and distinct immune mediators. However, the pathophysiology in both asthma and COPD involves not only proximal large airways, but also the distal small airways. Indeed, severe asthma is associated with greater peripheral inflammation and, in COPD, the inflammation primarily affects the small airways and lung parenchyma, with important clinical consequences. The small airways are thus an important therapeutic target in both diseases.

Atul Gulati MD MRCP Specialist Registar in Respiratory Medicine, Addenbrooke’s Hospital, Cambridge

Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) affects 4% of middle-aged men and 2% of middle-aged women (see Box 1). The most effective treatment is continuous positive airway pressure (CPAP) therapy, which prevents collapse of the upper airway during sleep. Treatment with CPAP therapy, however, can be very obtrusive and noisy. Compliance with, and acceptability of, CPAP is another major issue, with initial acceptance varying, in reported series, from 72% to 84% with only 46–83% of initial acceptors using it for more than four hours each night.