The surgery's respiratory nurse phoned as many patients as possible who had not attended in the last year despite being sent three letters. She found that, by talking to patients on the telephone, she was able to assess control and arrange additional medication as needed.

The practice then invited their local consultant to visit to discuss the management of some of their difficult COPD cases.

They also held a staff meeting in the surgery where all the different types of inhalers were demonstrated, and included local pharmacists, which proved to be very beneficial.

The practice was given funding to allow their other two practice nurses to attend a respiratory course.

The practice found that the use of an inspiratory flow meter enabled a better assessment of people's inhaler technique, and the correct choice of delivery device. They also discovered the importance of early spirometry in ensuring correct diagnosis of the condition and treatment as appropriate

Home visits are also now performed by the respiratory nurse, to ensure that patients are receiving the correct inhalers and she also runs a nurse led respiratory clinic in the practice.

The health care assistant has attended a course in spirometry and the practice as a whole discusses its COPD cases and changes that are made to medication.

There has been a 50% improvement overall.