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Bradford VTS Clinical Resources




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COPD at a Glance

Rx of Acute Infective Exac of COPD if patient NOT on prophylactic antibiotics

  1. Give abx – amox, or doxy or clarithromycin usually 5 days
  2. Give steroids – Prednisolone 30mg od for 5 days   (PS remember it is 40mg for asthma)

Rx of Acute Infective Exac of COPD if patient IS on prophylactic antibiotics

  1. Continue the azithromycin – do not stop.
  2. Give additional acute abx – amox, or doxy usually for 5 days.   
    DO NOT give clarithromycin or erythromycin (similar drug class to azithro, prolong QT interval >>> can cause arryhmias)
  3. Give steroids – Prednisolone 30mg od for 5 days

Over-reliance on SABA inhalers is a global problem and one that we are yet to crack. How about reframing the issue?

  • A GTN spray has up to 200 puffs in it; the same as many SABA inhalers. Are we happy with our patients having 200 puffs of a GTN spray for ‘just a bit of a chest pain’? Probably not
    How have we become so comfortable with our patients with asthma having 200 puffs a month for ‘just a bit of breathlessness’?
  • Start a conversation with your patient/colleagues today about over-reliance on SABA – see the Asthma Right Care Slide Rule


  • Inhalers are a key part of treating your asthma. The most important thing is that your asthma is kept as well controlled as possible, using inhalers that suit you well.
  • Some types of inhaler have a bigger carbon footprint than others. That is, they have a bigger effect on climate change (global warming).
  • Everyone has a carbon footprint. If you would like to think about reducing the carbon footprint of your asthma treatment, this decision aid explains the options. It is intended to help discussions between people aged 12 and over and their healthcare professionals.


  • Do not stop using the inhalers you already have without talking to your healthcare professional. It is important to make a choice that is right for you. Talk to your healthcare professional before making any changes to your treatment. A good time to do this might be at your next routine asthma appointment.
  • If you stop your treatment, your asthma might get out of control, which can be dangerous for your health. It will also have a higher carbon footprint because you will need to use your reliever (rescue) inhaler more and may need more visits to your GP or hospital.
  • People with COPD and a persistent resting stable oxygen saturation of 92% or less should be assessed for their suitability for long-term oxygen therapy (LTOT) by referring to the local oxygen team / BOC.
  • For GPs to order oxygen for palliative or cluster headache patients they need to complete a HOOF A form (see link below on ‘how to guide’) and send to Baywater.
  • HOOF confirmations/prescriptions need to be sent to the central mailbox: .
  • For more information see the Good HOOF Guide (2020)

Ramadan & Fasting Advice for Respiratory Disease

Fasting is an obligation for competent, healthy adult Muslims although there are exemptions. Many of those who could seek exemption might still want to fast. It is important to respect this but it is advisable to start planning 6-8 weeks before Ramadan to avoid adverse outcomes e.g. patient self-adjustment of medication.

Who is exempt from fasting?

  • Acute or chronic illness
  • Travellers
  • Pregnant/breastfeeding*
  • Menstruating/postpartum bleeding
  • Children
  • Mentally unwell/lacks capacity

*Consensus by Islamic scholars that it is permissible not to fast if there is threat of harm to mother/child

The fast of Ramadan lasts from dawn to sunset for a period of 29 or 30 days. It follows the lunar calendar so is brought forward by about 10 days each year.   Fasting people generally eat two meals a day: often a smaller meal before dawn (Suhoor) and a larger one after sunset (Iftar).  No fluids or food are taken during daylight hours. This includes water and most medication.

Permissible interventions/medications

  • Blood tests
  • Vaccinations
  • Asthma inhalers*
  • Ear drops*
  • Eye drops
  • Transdermal patches

*Difference of opinions exist. Encourage patients to contact their local imam, or BIMA for advice.


Should I advise my patient not to fast?

BIMA have an interactive traffic light tool that help to classify patients into low/moderate risk, high risk, and very high risk at 

Patients in the two higher tiers should be advised that they ‘must not fast’ and ‘should not fast’ respectively. Consider advising these patients to fast in the shorter winter months. If they insist to fast, monitor regularly and ask that they should be prepared to break the fast in case of adverse events. Below is a shortened summary of the advice:


  • Acute exacerbations of lung disease


  • Poorly controlled lung disease with frequent exacerbations


  • Well-controlled asthma
  • Well-controlled COPD

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Bradford VTS was created by Dr. Ramesh Mehay, a Programme Director for Bradford GP Training Scheme back in 2001. Over the years, it has seen many permutations.  At the time, there were very few resources for GP trainees and their trainers so Bradford decided to create one FOR EVERYONE. 

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