InnovAiT: Education and inspiration for general practice

Asthma is a condition of paroxysmal, reversible airways obstruction. It is due to a chronic underlying inflammatory process and has characteristic features of reversible airway narrowing and airway hyper-responsiveness to a wide range of stimuli.

Asthma is a chronic inflammatory disease of the airways. It is characterized by recurrent episodes of dyspnoea, wheeze and cough caused by reversible airways obstruction. Three factors are responsible for the airways narrowing: bronchial muscle contraction, mucosal swelling/inflammation and increased mucous production (Fig. 1). About 10–15% of the UK population have asthma and the number appears to be growing although there is some difficulty understanding why. It affects 1 in 20 adults and 1 in 10 children. Approximately 5.1 million people are currently being treated for asthma in the UK.

Exposure to gases, vapours and dusts at work can lead to lung disease. If a patient develops an occupational lung disease, a doctor is obliged to notify the patient's employer in writing with the patient's consent. A list of notifiable respiratory diseases is included in Box 1. The doctor does not need to make a judgement about whether the disease is, in that particular case, caused by the occupation.

Keeping good notes is essential for effective medical care and for the day-today smooth and safe running of general practice. The GMC states as part of Good Medical Practice that:

A patient presenting with sudden visual loss can be a terrifying experience for both patient and doctor. Patients want to know if they could be permanently blinded and doctors are faced with a rarely encountered highly distressing symptom which they can often do little to improve in the surgery.

A dry eye (sometimes called keratoconjunctivitis sicca) is an eye where there are insuffi cient or inadequate tears to keep the front surface of the eye moist. Patients usually complain of grittiness or irritation which often worsens towards the end of the day.

Age-related macular degeneration (AMD) is the most common cause of blindness in the UK accounting for 16 000 registrations of blindness every year. One in fifty people over the age of 65 in the UK are blind in one or both eyes due to AMD. Macular degeneration is always a bilateral disease but one eye is usually more severely affected than the other. Smoking is the most important risk factor for development of AMD. The risk of developing AMD is 3.6 times greater for smokers and former smokers than those who have never smoked.