Chronic Obstructive Pulmonary Disease Sufferers Research Articles

GAMBARAN KEBIASAAN MEROKOK DENGAN KEJADIAN PENYAKIT PARU OBSTRUKSI KRONIK (PPOK) DIBALAI BESAR KESEHATAN PARU MASYARAKAT MAKASSAR

Chronic obstructive pulmonary disease (COPD) is a disease characterized by airflow obstruction in the airways that is not completely reversible. The airflow obstruction that occurs is progressive, related to the lung's inflammatory response to toxic or dangerous particles or gases. Emphysema and chronic bronchitis are often caused by smoking and are included in the COPD group. Based on data from the Makassar Community Lung Health Center, The number of COPD sufferers has decreased over the last three years. In 2019 there were 521 COPD patients. The aim of this study was to determine the description of smoking habits and the incidence of COPD. This research used descriptive research with 38 samples from 129 populations diagnosed with COPD at the Makassar Community Lung Health Center. where the description of smoking habits and the incidence of COPD for each subject/research sample was observed only once. The results of this study showed that of the 38 COPD respondents, 20 people (52.6%) had heavy smoking habits, and 18 people (47.4%) had moderate smoking habits. The conclusion of the research is an overview of smoking habits and the incidence of COPD at the Community Lung Health Center. It is recommended that everyone immediately stop smoking to avoid COPD and health workers are expected to increase education about the dangers of smoking

A Cross-sectional Study Investigating the Impact of Asthma and Chronic Obstructive Pulmonary Disease on the Quality of Life of Rural Residents

The goal of this study was to assess how the quality of life of rural Charsadda and surrounding areas people are impacted by asthma and chronic obstructive pulmonary disease (COPD). Data were gathered for this cross-sectional research, and descriptive statistics were used to analyze it. The data analysis revealed that the (Quality-of-Life) of 200 study participants was lower than that of the general population. Most asthma and COPD sufferers struggled to regulate their symptoms because they had limited healthcare access and a limited budget.These patients' average (Quality-of-Life) scores were (74.03) (SD = 16.3) and 73.3 (SD = 16.7), respectively, both lower than those of the general population. To properly treat COPD and asthma, rural Charsadda and its neighbouring regions need greater access to healthcare.

Analysis of Influencing Factors for Exercise Ventilation Efficiency of COPD Patients.

Dynamic pulmonary hyperinflation and abnormal air exchange are the primary causes of the exercise limitation of chronic obstructive pulmonary disease (COPD) patients. During exercise, COPD sufferers' lungs are dynamically hyperinflated. Increased inefficient ventilation reduces ventilation efficiency and causes a mismatch between ventilation volume and blood flow. The ventilatory equivalent for CO2 (VeqCO2) is a physiological parameter that can be measured using cardiopulmonary exercise testing. Therefore, the aim of this exploratory study was to perform cardiopulmonary exercise testing on people with COPD, investigate the impact of static pulmonary function on ventilation efficiency under the exercise state, and screen the predictive indicators of ventilation efficiency. Subject. The aim of this study was to look at the factors that influence the exercise ventilation efficiency of people with COPD. Method. A total of 76 people with COPD were recruited during the stable period. Age, gender, body height, body mass, and other basic information were recorded. The body mass index (BMI) was determined, and forced vital capacity (FVC), forced expiratory volume in one second (FEV1), residual volume/total lung capacity (RV/TLC), diffusing capacity of the lung for carbon monoxide (DLCO), and DLCO divided by the alveolar volume (DLCO/VA) were measured. The ventilatory equivalent for carbon dioxide (VE/VCO2) under the rest state (EqCO2rest), anaerobic threshold (EqCO2at), and maximum exercise state (EqCO2 max) were calculated to investigate the influencing factors for ventilation efficiency of people with COPD. Results. FEV1% was negatively correlated with EqCO2rest (r = −0.277, P value <0.05); FEV1/FVC % was negatively correlated with EqCO2rest and EqCO2at (r = −0.311, −0.287, P value <0.05); DLCO% was negatively correlated with EqCO2rest, EqCO2at, and EqCO2max (r = −0.408, −0.462, and −0.285, P value <0.05); DLCO/VA% was negatively correlated with EqCO2rest, EqCO2at, and EqCO2max (r = −0.390, −0.392, and −0.245, P value <0.05); RV/TLC was positively correlated with EqCO2rest and EqCO2at (r = 0.289, 0.258, P-value <0.05). The prediction equation from the multivariable regression analysis equation was Y = 40.04–0.075X (Y = EqCO2, X = DLCO/VA%). Conclusions. As the degree of ventilatory obstruction increased, the ventilation efficiency of the stable people with COPD under the exercise state showed a progressive decrease; the ventilation efficiency of the people with COPD decreased significantly under the maximum exercise state, and the ventilation capacity and diffusion capacity were the significant factors that affected the exercise ventilation efficiency. The diffusion function may predict the maximum ventilation efficiency and enable primary hospitals without exercise test equipment in developing countries to predict and screen patients at risk for current exercise based on limited information.

Periostin and Thymic Stromal Lymphopoietin-Potential Crosstalk in Obstructive Airway Diseases.

Periostin and thymic stromal lymphopoietin (TSLP) are newly described markers of obstructive airway diseases and the mechanism by which both markers participate in immune response remains poorly understood. The aim of our study was to determine periostin and TSLP concentration in serum and induced sputum (IS) in patients with atopic asthma, chronic obstructive pulmonary disease (COPD), and controls, as well as to evaluate the potential link between periostin, TSLP, and Th2 immune response. Serum and IS levels of periostin, TSLP, IL-4, and IL-13 were determined in 12 atopic asthmatics, 16 COPD sufferers, and 10 controls. We noticed a significantly higher IS periostin and TSLP concentration at protein and mRNA level in asthmatics compared to the two other groups; additionally, periostin and TSLP were correlated positively with IS eosinophil count. A strong positive correlation between IS periostin and TSLP protein levels (r = 0.96) as well as mRNA expression level (r = 0.95) was found in patients with asthma. The results of our study show that periostin and TSLP are associated with eosinophilic airway inflammation and seem to be important drivers of atopic asthma but not COPD pathobiology. Very strong correlations between local periostin, TSLP, eosinophils, and IL-4 in asthma point to the link between periostin–TSLP and Th2 response.

Effectiveness Active Cycle of Breathing Technique (ACBT) with Pursed Lips Breathing Technique (PLBT) to tripod position in increase oxygen saturation in patients with COPD, West Sumatera

Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung disease characterized by obstruction or obstruction of airflow in a reversible or partial nonreversible airway. Dyspnea is a common symptom in COPD sufferers; this can cause problems with oxygen saturation, or the oxygen saturation value is below normal. Non-pharmacological actions given in the form of breathing exercises can be done by a nurse to help reduce shortness of breath in COPD patients. The exercise is given by adjusting the resting position that is comfortable and comfortable so that the extra breath muscles can work well. The position that can do the position of the tripod with Active Cycle of Breathing and Pursed lips are breathing so that shortness of breath is reduced and SaO2 can have increased so that more oxygen has obtained in Lung Hospital, West Sumatra. This research is quantitative research, with quasi-experimental research methods. They used two pre-test-posttest design groups. The sample in this study amounted to 30 people with quota sampling technique. In this study showed that there was a difference in the increase in oxygen saturation of COPD patients which was effective in the tripod position group with Active Cycle Breathing Technique (ACBT) with a p-value of 0.00 while in the tripod position group with the Active Respiratory and Lip Cycle there was a difference of p-value 0.023. It has concluded that the tripod position with ACT and PBLT could increase oxygen saturation and nasal breathlessness reduced, but the tripod position with ACT is more effective in COP patients because with chronic respiratory patients who are short of breath due to sputum buildup, then with ACT will clean the airway and the flow of the road effective breathing so that shortness of breath have reduced and oxygen saturation increases. Furthermore, it has recommended that in hospitals, especially nurses, in dealing with COPD patients in addition to the correct position of breathing exercises with ACT to help patients.

The effect of short-term pulmonary rehabilitation on the exercise ability and life quality of male patients with acute exacerbations of chronic obstructive pulmonary disease

Objective To investigate the effects of short-term pulmonary rehabilitation on the exercise ability and life quality of men with acute exacerbations of chronic obstructive pulmonary disease (COPD). Methods Thirty-eight male COPD patients with acute exacerbation were selected and randomly divided into a rehabilitation group (n=20) and a control group (n=18). Both groups were given routine health education and medication, while the rehabilitation group was additionally provided with a 7-day, three-stage rehabilitation intervention, including the respiratory training, resistance training using a resistance band and gradual low-intensity walking training, all under remote electrocardiographic monitoring. Before and after the intervention, both groups′ exercise ability was evaluated using the 30-second chair sitting test (30-STS) and a 30-second forearm load flexion test (30-ACT). Each subject′s quality of life and ability in the activities of daily living were evaluated by two qualified rehabilitation therapists. The subjects′ level of daily physical activity was assessed 2 months after discharge. Results After the intervention the average 30-STS and 30-ACT results of the rehabilitation group had improved significantly. The 30-ACT results of the control group were also significantly improved. After the intervention the average 30-STS and 30-ACT results of the rehabilitation group were significantly better than the control group′s averages. The average CAT and MBI scores of both groups were significantly better after the intervention, with the rehabilitation group′s averages significantly better than those of the control group. Two months after discharge, the number of patients with at least moderate daily physical activity increased from 6 to 19 in the rehabilitation group and from 4 to in the control group, a significant difference between the two groups. Conclusion The three-stage pulmonary rehabilitation program is helpful for improving the exercise ability and quality of life of COPD sufferers, and their ability in the activities of daily living. Their level of daily physical activity is higher 2 months after discharge. Key words: Obstructive pulmonary disease; Exercise ability; Quality of life; Activities of daily living

T2 Biologics for Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality worldwide. In contrast to other chronic diseases, COPD is increasing in prevalence and is projected to be the third leading cause of death and disability worldwide by 2030. Recent advances in understanding the underlying pathophysiology of COPD has led to the development of novel targeted therapies (biologics and small molecules) that address the underlying pathophysiology of the disease. In severe asthma, biologics targeting type 2 (T2)- mediated immunity have been successful and have changed the treatment paradigm. In contrast, no biologics are currently licensed for the treatment of COPD. Those targeting non-T2 pathways have not demonstrated efficacy and in some cases raised concerns related to safety. With the increasing recognition of the eosinophil and perhaps T2-immunity possibly playing a role in a subgroup of patients with COPD, T2 biologics, specifically anti-IL-5(R), have been tested and demonstrated modest reductions in exacerbation frequency. Potential benefit was related to the baseline blood eosinophil count. These benefits were small compared with asthma. Thus, whether a subgroup of COPD sufferers might respond to anti-IL-5 or other T2-directed biologics remains to be fully addressed and requires further investigation.

Chronic obstructive pulmonary disease is not associated with worse in-hospital outcomes after surgical aortic valve replacement in Spain (2001-2015).

The aims of this study were: 1) to examine incidence, characteristics and in-hospital outcomes of surgical aortic valve replacement (SAVR) among patients with or without COPD; 2) to compare both groups matched by sex, age, year hospitalized for SAVR and implanted valve type; and 3) to identify factors associated with in-hospital mortality (IHM) among chronic obstructive pulmonary disease (COPD) patients. We used the Spanish National Hospital Discharge Database for patients aged ≥40 years from 2001 to 2015. We selected patients whose medical procedures included SAVR. We grouped hospitalizations by COPD status. Main outcomes were incidences and IHM. Covariates included comorbidities and concomitant procedures. We identified 78,223 hospitalizations with SAVR and COPD accounted for 9.14% (6028 men and 1125 women). Incidence of hospitalizations for SAVR increased overtime in patients without COPD, but not in COPD sufferers. COPD patients were more likely to receive bioprosthetic valves than those without COPD. The proportion of mechanical valves implanted decreased as the bioprosthetic valves increased overtime in both groups. Crude IHM was 6.77% for COPD patients and 6.48% for non-COPD (P=0.17). IHM decreased significantly over time in both groups of patients. After matching no differences were found in IHM between COPD and matched not-COPD patients who received a mechanical or bioprosthetic SAVR. Among COPD patients, IHM was associated with older age, more comorbidities and concomitant coronary artery bypass graft. Our analysis suggest that COPD per se should not represent a contraindication to SAVR. No differences were found for IHM between patients with and without COPD beside the type of valve used.

Befriending to Relieve Anxiety and Depression Associated with Chronic Obstructive Pulmonary Disease (COPD): A Case Report

ABSTRACTChronic obstructive pulmonary disease (COPD) is a chronic lung disease characterized by airflow obstruction and shortness of breath, which as a result can severely limit activities of daily living. COPD sufferers are 85% more likely to develop anxiety disorders than healthy matched controls. Some of the factors that have been suggested to be associated with high anxiety in people with COPD include dyspnoea, the inability to perform daily activities or fulfil social roles, rehospitalisation and some COPD treatments. There is substantial evidence that cognitive behaviour therapy (CBT) is effective in managing mood disorders, but there is also some evidence that befriending can assist people. Befriending is an intervention that focuses on everyday conversation topics and can be delivered by volunteers with training and supervision. The case presented here illustrates the use of befriending provided over the phone for a participant with severe anxiety and depression. It was part of a larger RCT comparing CBT and befriending for the management of anxiety and depression in people with COPD. Symptoms were alleviated after a course of 8 weeks of befriending telephone calls from a volunteer. While befriending is not a substitute for CBT it may be useful in circumstances where CBT is not easily accessible.

Health within Illness among Persons living with Chronic Obstructive Pulmonary Disease

The purpose of this descriptive qualitative study is to explore perceptions of health within illness, a health strategy used by persons with chronic obstructive pulmonary disease (COPD) to maintain their quality of life. A convenience sample of 11 community-dwelling, English-speaking adults with COPD was recruited from the Southwestern United States. The study was conducted in the homes of the participants. Naturalistic inquiry using content analysis and constant comparative techniques was used to analyze the transcribed data. Five conceptual categories emerged in the final stage of analysis that provided answers to the research questions from the perspectives of the participants. The categories were: (a) Cut Off from Life, (b) Health is Everything, (c) Making the Best of It, (d) Living with It, and (e) Breaking the Cycle. Each of the categories was inducted from emergent themes and clusters of data that represented the participants’ descriptions of living with COPD. The findings of this study highlight strategies and practices portrayed by the participants to promote their health despite suffering from a serious illness. Data from the study participants suggest the management of COPD is a complex process that requires considerable flexibility, creativity, and resilience to achieve a sense of health within illness. The study highlights important ways to improve self-care among COPD sufferers on how to manage this chronic illness beyond a trial and error process.

Fifty Years On: GWAS Confirms the Role of a Rare Variant in Lung Disease

Fifty Years On: GWAS Confirms the Role of a Rare Variant in Lung Disease

Oral Chinese Herbal Medicine for Improvement of Quality of Life in Patients with Stable Chronic Obstructive Pulmonary Disease: A Systematic Review

This study evaluates published clinical trials of Chinese herbal medicine (CHM) for chronic obstructive pulmonary disease (COPD) that employ a health-related quality of life (HRQoL) outcome measure. Searches were conducted in April 2011 on MEDLINE, Embase, the Cochrane Controlled Trials Register, CINAHL, Scopus, and Chinese databases (CNKI, CQVIP, WANFANG). Randomized controlled trials involving oral administration of CHM formulae or single herb, with or without blinding, compared to placebo, no treatment, routine pharmacotherapy control, or CHM plus routine pharmacotherapy versus routine pharmacotherapy, with a HRQoL questionnaire as an outcome measure were identified. The methodological quality was assessed using the Cochrane risk of bias assessment. A total of 27 studies involving 1966 patients were identified. St. George Respiratory Questionnaire (SGRQ) or Cai's QoLQ were used in 13 and 14 studies, respectively. Assessment of the Cochrane risk of bias revealed adequate sequence of generation in 10 studies and adequate allocation concealment in 1 study; double blinding was not described adequately in any studies. Seventeen (17) studies addressed incomplete outcome data, and 17 studies were free of selective reporting. The main results of meta-analysis showed improvement of total HRQoL scores (SGRQ and Cai's QoLQ) when CHM was compared to no treatment (-6.07 [-9.21, -2.93] and -0.20 [-32, -0.07], respectively) and for CHM plus routine pharmacotherapy versus routine pharmacotherapy (-5.15 [-7.26, -3.05]) and (-0.25 [-0.37, -0.13]). While the results of CHM on HRQoL for stable COPD sufferers were promising, they need to be interpreted with caution due to methodological problems, which should be addressed in future trials.

Influenza vaccination coverage and uptake predictors among Spanish adults suffering COPD

The aim of this study is to compare influenza vaccination coverage among Spaniards aged 40 y or over who suffer from chronic obstructive pulmonary disease (COPD) with those without this illness to identify the factors that influence vaccination uptake among patients with COPD. Data was extracted from the European Health Survey performed in Spain in 2009/10, and analyzed data on 15,355 Spaniards (≥ 40 y of age), of whom 1,309 (8.2% 95%CI 7.7–8.7) had COPD was used. We considered the answer (yes/no) to the question about whether or not the interviewed person had been vaccinated against influenza in the previous flu season. We used the answer to this question as the dependent variable. For independent variables, we analyzed social demographic characteristics, health related variables, and the utilization of health care services. Vaccination coverage among patients with COPD is 49.4% (95% CI: 46.3–52.5%) and 21.3% (95% CI: 20.7–21.9) among people without (p < 0.001). The probability of being vaccinated is three times greater for COPD patients (crude OR = 3.0, 95% CI: 2.6–3.5). Among COPD patients the uptake of vaccination increased with age. Other factors associated with an increase in vaccination coverage were: being male, perceiving one’s health as fair or poor, not smoking, and having seen a doctor during the previous month. The rate of flu vaccination among adult Spaniards with COPD is lower than desired. Urgent strategies for increasing vaccination coverage are necessary for COPD sufferers aged under 65 of age and those with unhealthy lifestyles.

Panax ginseng C.A Meyer root extract for moderate chronic obstructive pulmonary disease (COPD): study protocol for a randomised controlled trial.

BackgroundChronic obstructive pulmonary disease (COPD) impairs quality of life and leads to premature mortality. COPD sufferers experience progressive deterioration of lung function and decreased ability to undertake day-to-day activities. Ginseng has been used for thousands of years in Chinese medicine for respiratory symptoms. Several controlled clinical trials using ginseng for COPD have shown promising clinical effect, however these studies were generally small and with some potential bias, prompting the need for rigorously designed studies.AimThe objective of this study is to evaluate the therapeutic value and safety profile of a standardised root extract of Panax ginseng C.A Meyer (ginseng) for symptomatic relief, with a focus on quality of life (QoL) improvements in individuals with moderate (Stage II) COPD FEV1/FVC < 0.7 and FEV1 50% - 80% predicted.MethodsThis paper describes the design of a randomised, multi-centre, double-blind, placebo controlled, two-armed parallel clinical trial. Two trial sites in Melbourne Australia will proportionately randomise a total of 168 participants to receive either ginseng capsule (100 mg) or matching placebo twice daily for 24 weeks. The primary outcomes will be based on three validated QoL questionnaires, St Georges Respiratory Questionnaire (SGRQ), Short Form Health Survey (SF-36) and the COPD Assessment Test (CAT). Secondary outcomes are based on lung function testing, relief medication usage and exacerbation frequency and severity. Safety endpoints include blood tests and adverse event reporting. Intention-to-treat will be applied to all data analyses.DiscussionFindings from this study may lead to new therapeutic development for chronic respiratory diseases, particularly COPD. This protocol may also guide other investigators to develop quality herbal medicine clinical trials in the future.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000768099

Immunological basis of reversible and fixed airways disease

Asthma is characterized by airflow obstruction that is usually completely reversible either spontaneously or in response to treatment. However, a small subset of patients with asthma display FAO (fixed airflow obstruction) despite optimal treatment, a feature more commonly associated with smoking-induced COPD (chronic obstructive pulmonary disease). Why some asthma patients develop FAO is not understood, and it is not clear whether (i) they represent a subset of patients with more severe disease, (ii) they share some characteristics of patients who develop COPD, or (iii) they represent a different disease entity altogether. The present review compares the pulmonary inflammatory profile of asthma patients with FAO with those without FAO, as well as COPD sufferers. The inflammation in asthma patients with FAO can vary from neutrophilic with CD8 T-cell involvement, similar to that of COPD, to eosinophilic with CD4 Th2 cell involvement, akin to that of asthma patients without FAO. Although studies of FAO in asthma sufferers would benefit hugely from consistent inclusion criteria, further research work is also required to shed more light on the immunological processes involved.

Progression to chronic obstructive pulmonary disease (COPD): Could it be prevented by manual therapy and exercise during the ‘at risk’ stage (stage 0)?

A number of predisposing factors are recognised as increasing the risk of developing chronic pulmonary obstructive disease (COPD). There is increasing recognition that COPD may be an inflammatory disease with systemic consequences. However, the trigger for the transition from 'at risk' (stage 0) to COPD state remains unclear. The current approach to intervention for the 'at risk' group is risk factor avoidance. We propose that if interventions shown to improve chronic respiratory symptoms in COPD sufferers could be applied to the 'at risk' group, then moderation or even reversal of the changes typical of this transition becomes a possibility. Exercise training has been shown to be beneficial at all stages of COPD. Mobility of the chest wall influences lung function. We hypothesise that the application to 'at risk' individuals (stage 0) of therapeutic interventions known to improve chronic respiratory symptoms and cardiovascular function in mild/moderate COPD (stages 1 and 2) could delay progression of the disease (i.e. manifestation of mild/moderate COPD). If the hypothesis were confirmed, the potential to delay or even prevent the onset of COPD would be feasible.

The Treatment of Depression and Anxiety Within the Context of Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is estimated to be the fourth leading cause of death in the United States. This progressive condition is characterized by airflow obstruction causing symptoms such as fatigue and breathlessness. The National Institute for Clinical Excellence guidelines for management of this disease include pulmonary rehabilitation through exercise. However, this approach can be difficult because it increases symptoms in the short term. In addition, many COPD sufferers have comorbid psychological problems, such as depression and fear of activity, that may further complicate treatment. This case illustrates the treatment of a 75-year-old COPD sufferer with comorbid depression and anxiety. It highlights psychological methods that may help to reduce the impact of COPD on quality of life.

The Prevalence and Risk Factors of Reflux Esophagitis Among Adult Chinese Population in Taiwan

Risk factors of reflux esophagitis among Chinese in Taiwan are at present not clear and the role of Helicobacter pylori infection in the development of reflux esophagitis is still controversial. The aim of this study was to examine the prevalence of reflux esophagitis, and to identify risk factors associated with reflux esophagitis in a multivariate context and to evaluate if H. pylori is a predictive factor for reflux esophagitis. A total of 482 physical check-up subjects who underwent upper gastrointestinal endoscopy were investigated. The severity of esophagitis was evaluated by Los Angeles classification. H. pylori status was assessed by serology. Twelve percent (58/482) demonstrated reflux esophagitis with 87% of grade A or B. Of those with reflux esophagitis, 48.3% had reflux symptoms whereas 17.4% of those with reflux symptoms had reflux esophagitis. Univariate analysis identified hiatal hernia, male sex, smoking, alcohol drinking, and overweight as risk factors associated with reflux esophagitis. Multivariable logistic regression showed that hiatal hernia [odds ratio (OR)=12.2, 95% confidence interval (CI)=5.0-29.9, P<0.0001], male sex (OR=4.2, 95% CI=1.9-9.0, P<0.001), and chronic obstructive pulmonary disease sufferers (OR=3.4, 95% CI=1.1-10.9, P<0.05) were 3 independent risk factors for development of reflux esophagitis. The prevalence of reflux esophagitis in Taiwanese is 12% and most are mild grade and free from reflux symptoms. Hiatus hernia, male sex, and chronic obstructive pulmonary disease are 3 independent risk factors for development of reflux esophagitis. H. pylori infection did not protect subjects from reflux esophagitis.

Influenza and pneumococcal vaccination in chronic obstructive pulmonary disease (COPD)

Patients who suffer from chronic obstructive pulmonary disease (COPD) often experience acute exacerbations, which frequently require hospitalization and lead to increased mortality. The most common causes of exacerbation are viruses, bacteria, and air pollutants. The risk of influenza and pneumococcal-related hospitalization and death has been shown to be high among COPD sufferers of all ages. Influenza vaccination has shown itself to be effective in reducing morbidity and mortality in patients with underlying chronic respiratory diseases. Pneumococcal vaccine is effective in reducing the incidence of invasive disease. Therefore, COPD sufferers are a target group to be vaccinated against influenza and pneumococcus. Several coverage studies have identified non-compliant subjects and factors associated with influenza and pneumococcal vaccination recommendations. Age-based strategies have proved better than vaccinating high-risk-specific groups. Joint administration of influenza and pneumococcal vaccination has shown beneficial additive effects. Notwithstanding, implementation of some other strategies are needed to improve coverage.

Chronic obstructive pulmonary disease: the case for widening access to primary mental health care and opportunities for new ways of working

The current focus on psychological well‐being and the treatment of people experiencing common mental disorder in primary care is of interest to health professionals and economists alike (Centre for Economic Performance Mental Health Policy Group, 2006). This brings with it an important opportunity to consider how services for people living with long term medical conditions may benefit from developments in widening access to psychological therapies. The National Service Framework for Longterm Conditions (DoH, 2005a) aims to improve the quality of life for people living with chronic medical conditions. Further to this, NICE Guidelines for the Management of Chronic Obstructive Pulmonary Disease (COPD) (NICE, 2004a) specifically focuses attention on quality of life issues for COPD sufferers and the influence of co‐morbid mental disorder on the ability of individuals to optimise selfmanagement of their condition. By examining issues relating to co‐morbidity of common mental disorders within the long‐term condition of COPD this paper concerns itself with how the agenda for widening access to psychological therapies delivered through a stepped model of care and the introduction of new mental health workforce roles such as community matrons, case managers and primary care graduate mental health workers (PCGMHWs) provides an opportunity for primary care services to integrate mental health care into chronic disease management for COPD, which in turn may provide a model for the development of services for other long‐term medical conditions.