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The United Kingdom (UK) National Review of Asthma Deaths (NRAD) (2011–2014) identified a number of contributory risk factors which had not previously been recognized by those caring for people with asthma. Only one of the 19 NRAD recommendations has so far been implemented nationally, and that only partially, and as yet systems are not in place to identify patients at risk of attacks and dying from asthma. In 2015/2016 Bedfordshire Clinical Commissioning Group (CCG) in England, UK, initiated a quality asthma audit of people with asthma to identify some of the risk factors identified in the NRAD report with the aim of optimizing patient care. Fifty (89%) of the General Practices caring for 415,152 patients (27,587 diagnosed with asthma (prevalence 7%; range 4–12%)), participated and the results identified a wide variation in process of care and presence of risk factors including: excess short acting reliever and insufficient preventer prescriptions, failure to issue personal asthma action plans, and to perform annual reviews or check inhaler technique. Identification of these patients involved high-intensity input by trained asthma nurses using sophisticated data extraction software. GP computer systems used in primary care currently do not have the functionally, without the need for manual audit, to implement the NRAD recommendations, starting with the identification of patients at risk. Modifications to existing systems within both primary and secondary care are required in order to prevent unnecessary deaths related to asthma. There is a pressing need to move towards a more pro-active model of care., Asthma: Encouraging proactive care Pro-active disease management for patients with asthma is crucial and could be vastly improved with an overhaul of computer systems in primary care. Following the UK National Review of Asthma Deaths (NRAD) in 2011–2014, multiple mortality risk factors were identified that have yet to be factored into asthma care. The NHS Bedfordshire Clinical Commissioning Group, with support from NSHI and Dr Mark L Levy (Harrow CCG), conducted a manual audit of 50 Bedfordshire doctors’ surgeries to identify relevant NRAD recommendations to optimize patient care. Levy’s team found marked variations in asthma care between the surgeries. Risk factors present included excessive short-acting reliever inhaler prescriptions and inadequate prescribing of preventer inhalers, together with limited implementation of personal asthma plans and annual reviews. The researchers highlight the limitations of existing computer systems for these purposes and recommend an overhaul of asthma tracking and automated alerts.

An asthma attack or exacerbation signals treatment failure. Most attacks are preventable and failure to recognize risk of asthma attacks are well recognized as risk factors for future attacks and even death. Of the 19 recommendations made by the United Kingdom National Review of Asthma Deaths (NRAD) (1) only one has been partially implemented—a National Asthma Audit; however, this hasn’t reported yet. The Harrow Clinical Commissioning Group (CCG) in London implemented a clinical asthma audit on 291 children and young people aged under 19 years (CYP) who had been treated for asthma attacks in 2016. This was funded as a Local Incentive Scheme (LIS) aimed at improving quality health care delivery. Two years after the publication of the NRAD report it is surprising that risks for future attacks were not recognized, that few patients were assessed objectively during attacks and only 10% of attacks were followed up within 2 days. However, it is encouraging that CYP hospital admissions following the audit were reduced by 16%, with clear benefit for patients, their families and the local health economy. This audit has provided an example of how clinicians can focus learning on patients who have had asthma attacks and utilize these events as a catalyst for active reflection in particular on modifiable risk factors. Through identification of these risks and active optimization of management, preventable asthma attacks could become ‘never events’., Asthma attacks: learning from experience Encouraging self-reflection and best practice can help doctors improve patient care following asthma attacks. A recent UK national review uncovered multiple shortfalls in asthma management. Mark Levy at Harrow Clinical Commissioning Group in London and co-workers conducted a clinical asthma audit to assess the after-care of 291 patients under the age of 19 who had been treated for an asthma attack in Harrow during 2016. Analysis of patient records showed that risks of future attacks were not routinely highlighted during follow-up consultations. Only a third of patients had a personal asthma action plan and only 10 per cent of attacks were followed up within two days. During the audit, doctors from each surgery attended focus groups aimed at encouraging best practice. Following the audit, patient hospital admissions from these surgeries dropped by 16 per cent.

Background: In practice it is logical that inhalers are prescribed only after patients have received training and demonstrated their ability to use the device. However, many patients are unable to use their pressurised metered-dose inhaler devices (pMDIs) correctly. We assessed the relationship between asthma control and patients' ability to use their prescribed pMDIs. Methods: Evaluation of 3,981 (46% male) primary care asthma patient reviews, which included inhaler technique and asthma control, by specialist nurses in primary care in 2009. The paper focuses on people currently prescribed pMDI devices. Results: Accurate data on reliever and preventer inhaler prescriptions were available for 3,686 and 2,887 patients, respectively. In patients prescribed reliever inhalers, 2,375 (64%) and 525 (14%) were on pMDI alone or pMDI plus spacer, respectively. For those prescribed preventers, 1,976 (68%) and 171 (6%) were using a pMDI without and with a spacer, respectively. Asthma was controlled in 50% of patients reviewed. The majority of patients (60% of 3,686) were using reliever pMDIs, 13% with spacers. Incorrect pMDI use was associated with poor asthma control (p

We have developed a winter forecasting service to predict when patients with COPD are at higher risk of an exacerbation and alert them via an automated telephone call. To assess the effect of the service and its ability to predict periods of increased risk. A 4-month prospective randomised controlled trial using clinical criteria and the EXACT PRO questionnaire to identify exacerbations. Patients were randomly allocated to receive alert calls. All patients completed a diary including the EXACT PRO questionnaire on a BlackBerry Smartphone each day. They were contacted and assessed if they appeared to be exacerbating. 79 patients participated, 40 received alert calls. The exacerbation frequency per patient per week was significantly greater during periods of predicted high risk (0.086±0.010 v 0.055±0.010). The exacerbation frequency (± standard error of the mean, SEM) in patients receiving alert calls was lower (0.95±0.27 v 1.17±0.29) but this was not statistically significant. Fewer patients receiving alert calls had one or more EXACT event compared to the controls (34% v 53%, p=0.11), their duration was shorter (8.2±2.0 v10.1±1.9 days, p=0.481) and they were less severe (AUC 65±21 v 115±22, p=0.118). There were no significant differences in the mean change (±SEM) in SGRQ scores between the groups. The ability of the forecast to predict high risk periods was confirmed unequivocally. Alert calls appeared to reduce the frequency and severity of exacerbations but these effects did not reach statistical significance, perhaps because of the number of participants, lower than expected exacerbation rates, and the fact that there was contact with patients in both groups whenever they appeared to be exacerbating.

Introduction: The UK National Health Service (NHS) is essentially publicly funded through general taxation. Challenges facing the NHS include the rise in prevalence of long-term conditions and financial pressures.National policy trends: Political devolution within the UK has led to variations in the way services are organised and delivered between the four nations.Primary care respiratory services in the UK: Primary care is the first point of contact with services. Most respiratory conditions are managed here, including prevention, diagnosis, treatment and palliative care.Epidemiology: Respiratory disease accounts for more primary care consultations than any other type of illness, with 24 million consultations annually.Access to care: Equitable access to care is an ongoing challenge: telehealthcare is being tried as a possible solution for monitoring of asthma and COPD.Referral and access to specialist care: Referrals for specialist advice are usually to a secondary care respiratory physician, though respiratory General Practitioners with a Special Interest (GPwSIs) are an option in some localities.Conclusions: Prevalence of asthma and COPD is high. Asthma services are predominantly nurse-led. Self-management strategies are widely promoted but poorly implemented. COPD is high on the policy agenda with a shift in focus to preventive lung health and long-term condition management. (C) 2011 Primary Care Respiratory Society UK. All rights reserved. Q Zhang et al. Prim Care Respir J 2011; 20(1): 97-101 doi:10.4104/pcrj.2010.00061

Inhaled medications are the preferred therapies for patients with asthma and COPD, but their effectiveness is limited by the patient's ability to use the device properly, an issue often neglected when these medications are prescribed. Correct inhaler technique must be taught and learnt, and requires educational and motivational programs aimed at patients and healthcare providers alike. Written instructions alone are manifestly insufficient: education must include practical demonstration and periodic re-assessment and reeducation, since correct technique and motivation usually deteriorate with time. Several devices are available on the market, the purpose of which is to train patients to use inhalers correctly. They are often directed at particular devices or groups of devices and/or particular critical aspects of technique. This paper reviews the devices currently available for training patients in the correct use of both pressurised metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs).

INTRODUCTION: The identification and management of adults presenting with pneumonia is a major challenge for primary care health professionals. This paper summarises the key recommendations of the British Thoracic Society (BTS) Guidelines for the management of Community Acquired Pneumonia (CAP) in adults. METHOD: Systematic electronic database searches were conducted in order to identify potentially relevant studies that might inform guideline recommendations. Generic study appraisal checklists and an evidence grading from A+ to D were used to indicate the strength of the evidence upon which recommendations were made. CONCLUSIONS: This paper provides definitions, key messages, and recommendations for handling the uncertainty surrounding the clinical diagnosis, assessing severity, management, and follow-up of patients with CAP in the community setting. Diagnosis and decision on hospital referral in primary care is based on clinical judgement and the CRB-65 score. Unlike some other respiratory infections (e.g. acute bronchitis) an antibiotic is always indicated when a clinical diagnosis of pneumonia is made. Timing of initial review will be determined by disease severity. When there is a delay in symptom or radiographic resolution beyond six weeks, the main concern is whether the CAP was a complication of an underlying condition such as lung cancer.

Primary care spirometry services can be provided by trained primary care staff, peripatetic specialist services, or through referral to hospital-based or laboratory spirometry. The first of these options is the focus of this Standards Document. It aims to provide detailed information for clinicians, managers and healthcare commissioners on the key areas of quality required for diagnostic spirometry in primary care — including training requirements and quality assurance. These proposals and recommendations are designed to raise the standard of spirometry and respiratory diagnosis in primary care and to provide the impetus for debate, improvement and maintenance of quality for diagnostic (rather than screening) spirometry performed in primary care. This document should therefore challenge current performance and should constitute an aspirational guide for delivery of this service.

Introduction Allergic diseases are common, increasing, and associated with significant morbidity and occasional, but potentially avoidable, mortality. There is widespread public, professional and government agreement about the poor quality of care received by many patients with allergic diseases in the UK. Many remain undiagnosed, few have access to specialist services, and the majority of primary care health professionals have no allergy training. We report an evaluation of a novel, UK NHS-funded primary care-based allergy service in North West London. Methods The clinic was run by a specialist allergy nurse and a general practitioner (GP) with a special interest in respiratory disease and allergy. Referrals from local GPs were made on dedicated proformas and handled according to developed and agreed community care pathways. Results 141/151 (93%) of those referred attended the clinic. On average, patients waited 15.7 (SD 15.67) days from referral to an offer of an appointment and were seen 18.11 (SD18.07) days from the date of referral. The majority of patients were referred for hives or wheals (61;40%), suspected food allergy (28;40%), multiple reasons, (19;12%) or rhinitis (19;12%). Skin prick and specific-IgE tests were performed on 69 (49%) and 19 (14%) patients respectively, with 4 (0.3%) patients having both. We estimated an overall saving of at least pound13,580 to the local health economy - through reduced secondary care referrals - during the nine months' duration of the clinic. Assessed using a validated patient satisfaction questionnaire, most patients rated their satisfaction with the service with an overall median score of 75% (IQR 65.64-82.32). Conclusions A primary care allergy service provided by appropriately trained personnel can cater adequately for the majority of primary care referrals. This model provides a pathway of care that supports self-directed care, reduces inappropriate referrals, and encourages care in the local community. The model is one that could easily be developed further into a clinical assessment service for allergy including respiratory based (asthma) problems. This would expand the scope and ensure value for money as well as responding to a clinical need with significant incidence locally. The UK Department of Health should consider rolling out this primary care-based model nationally.

Aerosol inhalation is considered the optimal route for administering the majority of drugs for the treatment of obstructive airways diseases. A number of Pressurised Metered-Dose and Dry Powder Inhalers are available for this purpose. However, inhalation of therapeutic aerosols is not without difficulty; it requires precise instructions on the inhalation manoeuvre, which is different from spontaneous normal breathing. Also, the characteristics of the inhaler device have to be suitable for the user. Available data indicate a frequent lack of knowledge demonstrated by health professionals and patients on the inhalation manoeuvre and handling of inhalers, resulting in a reduction of therapeutic benefit. This paper reviews the literature concerning the fundamental aspects of inhaler devices, inhalation manoeuvre and device selection, in an attempt to increase the knowledge of, and to optimise the clinical use of, therapeutic inhalers.

The 2008 BTS/SIGN British Guideline on the management of asthma provides comprehensive updated evidence-based guidance on asthma management for healthcare professionals. This primary care-focussed summary has been produced to aid dissemination and implementation of the key guideline messages into primary care. The section on diagnosis emphasises the new integrated symptom-based approach with clinicians using their deductive skills to determine the probability that the patient has asthma. The various tools used for monitoring asthma are discussed. There are sections on both non-pharmacological and pharmacological management of chronic asthma in adults and children. Treatment options for children are subdivided into the under-5s and children aged 5-12 years. Poor asthma control is manifested by exacerbations and acute asthma. Personalised asthma action plans for guided self management should be provided and used when levels of asthma control change. There are sections on difficult asthma and the treatment of exacerbations and acute severe asthma. Various outcome measures for auditing the quality of asthma care are discussed.

The UK Department of Health (DoH), with input from with the Royal College of General Practitioners and UK General Practice Airways Group (GPIAG), has drawn up guidelines for the appointment of General Practitioners or other Practitioners with a Special Interest (GPwSIs or PwSIs, respectively) in respiratory medicine. This Discussion paper is based on the deliberations of a GPIAG-organised multi-professional Working Party held in November 2005. It highlights the three key roles of respiratory GPwSIs/PwSIs, and it aims to provide existing and potential specialist practitioners with a checklist of specific points to consider when drawing up a contract with their employing authority. Whilst this system is particular to the provision of primary care in the UK, other countries may choose to follow this model.

This article describes the formation and development of the UK General Practice Airways Group (GPIAG), from its inception as a small respiratory special-interest group founded by six general practitioners in 1987 through to its transformation into the largest primary care specialist society in the UK. It highlights the historical context in which the GPIAG was founded — at a time when there was increasing concern about under-treatment and under-diagnosis of asthma in primary care — and describes the way in which its foundation was one of the major influences that led to profound innovation in the primary care management of respiratory disease as well as changes across the primary/secondary care interface. The GPIAG is now a registered charity, has an expanding membership, and has acquired a high profile both nationally and internationally as an advisory body on policy and strategy for the management of respiratory disease in primary care. This review is a 20th anniversary tribute not only to those who have contributed to the success of the GPIAG over the last twenty years, but also to its current membership who enable the GPIAG to continue working towards its charitable aim of “optimal respiratory care for all.”

The association between the upper and lower airways has been recognised for almost 2000 years. Epidemiological data suggest that most asthma patients also suffer from allergic rhinitis, and that both diseases share similar trigger factors and pathophysiology. This IPCRG Guideline on the management of rhinitis in primary care is fully consistent with the ARIA guidelines. It highlights the treatment goals and the classification of the condition according to symptom frequency (intermittent or persistent) and severity (mild or moderate-severe). It covers the need for allergen avoidance, pharmacologic therapy including immunotherapy, alternative therapies, management of ocular symptoms, the management of co-existing allergic rhinitis and asthma, and the need for follow-up and ongoing care for patients with rhinitis.

This Diagnosis paper constitutes the second of the IPCRG Guideline papers on the management of chronic respiratory diseases in primary care. Primary care health professionals are usually the first point of contact for patients who can present a wide range of initial symptoms which may or may not constitute their first presentation of a chronic disease such as asthma, COPD, or rhinitis. This paper is focussed upon the early identification and diagnosis of chronic respiratory diseases in primary care. It uses a symptom-based approach, and includes original questionnaires and diagnostic guides to help the primary care clinician proceed systematically through the diagnostic process.

Allergic diseases affect 20-30% of the UK population and when severe are associated with considerable morbidity and occasional mortality. Initiatives to improve allergy services in the UK have been led by consultant allergists and have focussed on increasing the number of hospital training posts to improve access to specialist services. A high profile campaign to raise awareness of the lack of allergy services has so far failed to generate further training numbers for allergy as a single specialty. Although the campaign to improve tertiary allergy services continues, most mild or moderate allergy symptoms (e.g. hayfever, allergic asthma, urticaria and some food allergy problems), can be managed successfully in primary care with appropriate interest and training. Despite the high and increasing numbers of patients with allergy and the ease with which the majority of symptoms can be controlled, many doctors in primary care are reluctant to take a more proactive approach to managing allergic conditions. This appears to be due to concerns about overburdening an already busy service, but may also be due to recommendations from allergy specialists which have implied that high quality allergy care is not possible without identification of specific allergic triggers using skin prick tests or blood tests. In reality, symptoms can usually be controlled using pharmacotherapy, although a working knowledge of the appropriate guidelines is helpful. In this paper, we propose minimum levels of knowledge for all practitioners in order to raise the standards of primary care allergy management, and provide recommendations for training for those wishing to manage successfully more difficult allergy cases and allergy diagnosis.

Summary Aims: To present an age-stratified approach to the diagnosis of obstructive lung disease based on asthma and COPD guidelines and epidemiology. Methods: Asthma guidelines emphasize the role of the history and physical examination, with pulmonary function used primarily to confirm the diagnosis. COPD guidelines begin with symptoms and risk exposure, presenting spirometry as the primary diagnostic maneuver. Data from the National Health Interview Survey and the Third National Health and Nutrition Examination Survey illustrate relationships in prevalence of asthma and COPD in nationally representative samples. Results: Asthma prevalence in adults declines with age from 5–10% at age 20–40 to 4–8% above age 60. COPD is uncommon in adults under age 40 but increases with age, surpassing asthma in older adults. Conclusions: These trends suggest that asthma screening is most useful in adults up to age 40, after which COPD screening and differential diagnosis are of comparable or greater utility.

Healthy Outlook is a service delivered by the UK Met Office directly to patients with chronic obstructive pulmonary disease (COPD) that has been in place since 2006. Its objective is to reduce the severity and length of COPD exacerbations, hence improving the quality of life and life expectancy. To assess the effect of the Healthy Outlook service on hospital admission rates of all general practitioners that have used the service. Control practices were selected for each of the 661 participating practices. The number of hospital admissions for each practice was extracted from the Hospital Episode Statistics database. The differences in admission rates per practice between the first year of use of the Healthy Outlook service and the previous year were compared by paired t-test analyses. For admissions with a primary diagnosis of COPD, the difference between participating and control practices was −0.8% (95% confidence interval (CI)=−1.8 to 0.2%; P=0.13). For admissions with a primary or co-morbid diagnosis of COPD, the difference was −2.3% (95% CI=−4.2 to −0.4%; P=0.02). Participation in the Healthy Outlook service reduces hospital admission rates for patients coded on discharge with COPD (including co-morbid). A telephone service giving advanced warning of weather conditions that exacerbate lung disease may help reduce hospital admissions. Atmospheric conditions such as cold temperatures and excess humidity can adversely affect the respiratory health of patients with chronic obstructive pulmonary disease (COPD). The ‘Healthy Outlook’ phone service, run by the Met Office in England from 2006 to 2013, gave advanced warning of difficult weather conditions accompanied by medical advice, aiming to improve COPD patients' quality of life. Christophe Sarran at the Met Office, Exeter, together with scientists across the UK, analyzed data on hospital admissions for over 31,000 COPD patients from 661 GP practices who received Healthy Outlook calls. Sarran's team found an average reduction of 16% in hospital admissions in the first year of operation of the call service.

BACKGROUND: A UK survey of general practitioners (GPs) in 2002 found that they perceived allergy care throughout the UK National Health Service (NHS) to be poor. We conducted a follow-up survey in 2009 to see if GPs' perceptions had changed. OBJECTIVES: To determine GP perceptions of allergy care in the NHS in the wake of recent Government reports into allergy care, and to compare the findings of this survey to a similar survey conducted in 2002. METHODS: A cross-sectional postal survey of 500 UK GPs was conducted, using an adapted version of the 2002 questionnaire, modified to reflect recent developments in primary care. RESULTS: We obtained valid responses from 149 GPs, 87% of whom were based in England. 74% were GP principals and 63% worked in training practices. Most GPs (71%; 95%CI 63–79) rated overall NHS allergy care as poor, expressing concern about both primary care and access to allergy specialists. There were no significant differences in GPs' perceptions of the quality of allergy care provided in primary (p=0.33) and secondary care (p=0.97) or access to specialists (p=0.37), between 2002 and 2009. CONCLUSION: This survey suggests that recent professional and parliamentary reviews have not led to any notable improvements in GP perceptions of UK NHS allergy services between 2002 and 2009.

To develop a mechanism to write three research protocols within 10 hours while simultaneously enhancing the research protocol writing skills of participants. Members of the General Practitioners In Asthma Group (GPIAG) were invited to attend a research protocol workshop with pre- and post-workshop questionnaires. The main outcome measures were the development of three detailed research protocols and improvement in participants' perceived research protocol writing skills. Results: Three detailed research protocols were completed within the time allocated. Thirty (88%) participants completed pre- and post-workshop questionnaires. Participants believed there were improvements in their ability to formulate an answerable research question (p

We sought to assess the accuracy of different search terms to identify individuals with active seasonal allergic rhinitis (SAR) in general practice.A reference search strategy was developed to identify patients with active SAR. This was applied through inspection of electronic health records of patients aged 15-45 years in a 10% random sample of a general practice database. Searches used Read codes and medication relating to SAR. Sensitivity, specificity, and positive and negative predictive values were calculated.Using the reference search strategy, 54/1092 (4.9%) of 15-45 year-old patients had current SAR. Searching for drugs used in nasal allergy had the highest sensitivity (85%) and good specificity (86%). Searching for a recorded history of SAR (H170) in the last two years was more specific (100%) but this approach only had limited sensitivity (17%).Electronic searches can be used to identify patients with current SAR, but the accuracy varies widely. Larger numbers of sufferers can be identified using broader search parameters, but with increasing numbers of false positives. In contrast, more focused search strategies give a smaller yield needing less cleaning of data to identify true positives, but there is an associated increase in the number of false negatives.

Australia has a complex health system with policy and funding responsibilities divided across federal and state/territory boundaries and service provision split between public and private providers. General practice is largely funded through the federal government. Other primary health care services are provided by state/territory public entities and private allied health practitioners. Indigenous health services are specifically funded by the federal government through a series of Aboriginal Community Controlled Organisations. NATIONAL POLICY AND MODELS: The dominant primary health care model is federally-funded private "small business" general practices. Medicare reimbursement items have incrementally changed over the last decade to include increasing support for chronic disease care with both generic and disease specific items as incentives. Asthma has received a large amount of national policy attention. Other respiratory diseases have not had similar policy emphasis.Australia has a high prevalence of asthma. Respiratory-related encounters in general practice, including acute and chronic respiratory illness and influenza immunisations, account for 20.6% of general practice activity. Lung cancer is a rare disease in general practice. Tuberculosis is uncommon and most often found in people born outside of Australia. Aboriginal and Torres Strait Islanders have higher rates of asthma, smoking and tuberculosis.Access to care is positively influenced by substantial public funding underpinning both the private and public sectors through Medicare. Access to general practice care is negatively influenced by workforce shortages, the ongoing demands of acute care, and the incremental way in which system redesign is occurring in general practice.Most general practice operates from privately-owned rooms. The Australian Government requires general practice facilities to be accredited against certain standards in order for the practice to receive income from a number of government programs. These standards require GPs to have ready access to spirometry, but do not require every practice to have a spirometer.The initial assessment and management of acute respiratory illnesses currently seen in primary health care settings will continue, but for this to occur the sector may have to adapt traditional workforce roles because of workforce shortages. In the longer term, climate change and migration patterns may result in changes in the epidemiology of regions and populations. The health system will continue to reform incrementally in order to deliver improved chronic disease care, including care of people with asthma and COPD. The incoming Labor Government's National Primary Health Care Strategy provides the high level policy opportunity to drive reform.Australia's complex primary health care system is incrementally changing from one of exclusive acute- and episodic-care orientation in both the public and private sectors to a system that delivers effective anticipatory chronic disease care as well. From a national policy perspective, asthma has received most attention. COPD and possibly other respiratory diseases may now receive focus.

The IPCRG Guidelines: Developing guidelines for managing chronic respiratory diseases in primary care

There is a need for agreed respiratory data entry codes for use in primary care; there are marked differences between codes used within and between different general practice computer systems. UK systems are based on READ Codes while the Dutch use ICPC codes in which only a small amount of information is systematically coded. The major advantage of the Dutch approach is its speed, as the time spent coding is limited to the essentials, while the UK READ codes are fairly comprehensive however these are not used systematically by many GPs and as a result, researchers and clinicians have difficulty comparing data drawn from primary care. With the establishment of the IPCRG, the primary care respiratory group of the ERS and the EUROPAD initiative, important steps towards international research collaboration have been taken. In the light of such initiatives internationally standardised data collection in General Practices may provide an extremely valuable source for disease management information. One possible solution involves the use of data entry templates utilizing agreed codes for different clinical situations. The GPIAG has initiated development of a comprehensive set of respiratory READ Codes to be categorized under the following headings: i) Minimum data set for codes which we would expect all doctors to enter when seeing patients with respiratory diseases and which would vary according to given situations; ii) an Extended data set for coding a wider range of respiratory consultation data, which would not necessarily be entered in every situation; iii) Maximum data set which would include all the available suggested codes for use and iv) those codes which should not be used for data entry.The Amsterdam conference will provide an opportunity for discussion of this important subject.