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The British Thoracic Society (BTS) Guidelines for Bronchiectasis in adults were published in January 2019, and comprise recommendations for treatment from primary to tertiary care. Here, we outline the practical implications of these guidelines for primary care practitioners. A diagnosis of bronchiectasis should be considered when a patient presents with a recurrent or persistent (>8 weeks) productive cough. A definitive diagnosis is made by using thin-section chest computed tomography (CT). Once diagnosed, patients should be initially assessed by a specialist respiratory team and a shared management plan formulated with the patient, the specialist and primary care teams. The cornerstone of primary care management is physiotherapy to improve airway sputum clearance and maximise exercise capacity, with prompt treatment of acute exacerbations with antibiotics.

The ability to provide oxygen in a patient’s home can offer enormous benefits, including improvements in life expectancy when given in the appropriate setting. Confusingly, however, home oxygen is available in many forms, including long-term oxygen therapy (LTOT), ambulatory oxygen therapy (AOT), palliative oxygen therapy (POT) and short-burst oxygen therapy (SBOT)—each with varying degrees of supporting evidence. The British Thoracic Society (BTS) has recently published new guidance on home oxygen therapy, after collating the available evidence. This article aims to summarise those guidelines, focusing on who should and should not be considered for oxygen therapy. Although the BTS guidelines target a UK audience, many of the principles covered below are applicable internationally, even if the availability of certain oxygen modalities and supporting service arrangements may vary between different healthcare systems.

IntroductionThe purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for home oxygen provision in the UK, together with measurable markers of good practice. Quality statements are based on the British Thoracic Society (BTS) Guideline for Home Oxygen Use in Adults.MethodsDevelopment of BTS Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards.Results10 quality statements have been developed, each describing a key marker of high-quality, cost-effective care for home oxygen use, and each statement is supported by quality measures that aim to improve the structure, process and outcomes of healthcare.DiscussionBTS Quality Standards for home oxygen use in adults form a key part of the range of supporting materials that the society produces to assist in the dissemination and implementation of a guideline’s recommendations.

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This chapter addresses the fundamental nursing in managing breathlessness. Every nurse should possess the knowledge and skills to assess patients holistically, to select and implement evidence-based strategies, to manage breathlessness, and to review the effectiveness of these to inform any necessary changes in care. The nurse has a key role in managing this often frightening symptom, which may be caused by many disorders, including certain heart and respiratory conditions, strenuous exercise, or anxiety. Breathlessness is described as a distressing subjective sensation of uncomfortable breathing (Mosby, 2009) and can be expressed as an unpleasant or uncomfortable awareness of breathing, or of the need to breathe (Gift, 1990). The term dyspnoea, also meaning breathlessness, is derived from the Greek word for difficulty in breathing. Whilst it is difficult to estimate the prevalence of dyspnoea, it is apparent when we exercise beyond our normal tolerance levels; pathologically, dyspnoea occurs with little or no exertion and is a symptom response to different aetiologies (causes of illness). Breathlessness is a common symptom in patients with both cardiac (McCarthy et al., 1996) and respiratory disease (Dean, 2008), and also in people with neuromuscular diseases approaching the end of life; this can prove difficult and distressing to manage (see Chapter 18 Managing End-of-Life Care). There is a peak incidence of chronic dyspnoea in the 55–69 age group (Karnani, 2005), and the prevalence and severity of dyspnoea increases with age. This is associated with an increase in mortality and reduction in quality of life (Huijnen et al., 2006). It is estimated that 70% of all terminal cancer patients experience breathlessness in their last 6 weeks of life (Davis, 1997). Both physiological and psychological responses (including pain, emotion, and anxiety) can lead to an increase in respiratory rate. Breathing is controlled by the respiratory centre in the medulla of the brain. Higher centres in the cerebral hemispheres can voluntarily control respiratory rate so that breathing can be temporarily stopped, slowed, or increased. The respiratory centre generates the basic rhythm of breathing, with the depth and rate being altered in response to the body’s requirements, mainly by nervous and chemical control (Ward and Linden, 2008).

Vikki Knowles reviews the case of Mrs Beech who has both asthma and COPD with severe breathlessness