TY - JOUR T1 - COPD in primary care: from episodic to continual management JF - British Journal of General Practice JO - Br J Gen Pract SP - 60 LP - 61 DO - 10.3399/bjgp12X625003 VL - 62 IS - 595 AU - Berna DL Broekhuizen AU - Alfred PE Sachs AU - Theo JM Verheij Y1 - 2012/02/01 UR - http://bjgp.org/content/62/595/60.abstract N2 - Increased attention for chronic obstructive pulmonary disease (COPD) in primary care has paid off. In recent years guidelines were developed for spirometry and numerous GPs were trained to interpret results.1 Active case finding in patients with respiratory complaints, like cough, has revealed more early cases, while COPD used to be undetected until invalidating obstruction had occurred. Moreover, despite earlier fatalism, the benefit of treatment is now widely acknowledged and its evidence base was recently substantially consolidated.Stop-smoking interventions, self-management programmes, and vaccination against influenza have proven cost effective and improved quality of life.2–4 Clinical trials have shown that inhaled bronchodilators and to a lesser extent corticosteroids improve symptoms and reduce exacerbations.2,5,6 Notably, recent studies suggest that lung function decline is fastest in early instead of advanced COPD, and that maintenance treatment with inhaled medication is also beneficial in moderate, and not only in severe, obstruction.7Notwithstanding these achievements, much can still be gained regarding implementation of available evidence and guidelines in daily care. The number of established COPD cases in primary care largely increased during the last decade because of early detection and a shift of reimbursement from secondary to primary care. Considering the ageing population and limited improvement of smoking habits in deprived groups, this … ER -