1. CHP Respiratory meeting Welcome Dr Ninian Hewitt

2. What we do well Asthma - Control improved with ICS in the 90’s

3. What we do well COPD - More patients diagnosed - Referrals to PR

4. What we do well Prescribing - Lothian is one of the most efficient low cost Regions in Scotland

5. Objectives If we are doing reasonably well why the fuss?

6. Objectives Correct DIAGNOSIS Correct DRUG CorrectDOSE  All quality based  We can do better for our patients

7. Quality Improvement Asthma Isle of Wight Involved all Practices and Pharmacies Result Reduced Acute episodes Reduced admissions Reduced prescribing All by concentrating on drug concordance and inhaler technique

8. Quality Improvement Asthma Northern Ireland  Co-ordinated drug control by GP pharmacy and Patients  Led to lower prescribing and better control This has been sustained!

9. Quality Improvement Asthma  Step down  Inhaler usage  Acute Prescribing COPD  Diagnosis (spirometry)  Inhaler for appropriate Severity  Maximising exercise tolerance

10. CORRECT DDD  Prescribing to be introduced by - Katie Johnston & Maureen Reid  LJF first line may cover 90% of all patients  Asthma  COPD

11. CORRECT DDD Practical sessions – Anne Ritchie/Liz Young Central to all review  Inhaler technique Central to diagnosis esp. COPD  Spirometry

12. Future  We are at an unprecedented time with new inhalers especially for COPD  Watch out for news from LJF this autumn  New Combined  New dose schedules  LAMA/ LABA

13. Respiratory Toolkit The paper bag Contents Web addresses Paper inserts Trainhaler COPD 6

14. Thank You and Enjoy the day