Assessment of a Patient
Variable Airflow Obstruction
Confirming a Diagnosis
Starting treatment
Demonstration patient consultation: Asthma review
Achieving complete control
When to use FeNO; understanding the clinical application of the test
Interpreting the FeNO test results
Understanding the issues with interpreting a FeNO measurement
The Clinical Assessment
Confirming a diagnosis of COPD
Subjective clinical impression of COPD
Screening or case finding?
Pre and post bronchodilator spirometry
Spirometry and COPD diagnosis
Asthma COPD Overlap Syndrome (ACOS)
The breathlessness pathway
Consider a differential diagnosis
The impact of misdiagnosis
The Development of COPD
A Structured Approach to Breathlessness
Confirming a diagnosis of COPD
Referral for high value interventions
Categorise the patient into three COPD phenotypes
The COPD Annual Review
Assessment of Severity
With or without Sputum Purulence?
Point of Care CRP Testing
When to admit to hospital
Beyond normal day-to-day variation
Self-Management Plans and Rescue Packs
Introduction to ELCBG Measurement
Movement of O2 and CO2
The journey in the blood
Gas solubility and binding to Haemoglobin
Why the earlobe?
Gas exchange terminology
Oxyhaemoglobin Dissociation Curve
Factors affecting Haemoglobin affinity
Acid-Base Balance
The Henderson Hasselbalch equation
Indications and Contraindications of ELCBGs
Safe Sampling
Patient consent
PaO2, PaCO2 and pH electrodes
Maintenance of a blood gas analyser
Three phases of patient sampling
Guidelines and Protocols of ELCBGs
Test preparation
Equipment required to perform an ELCBG
Puncturing the earlobe
Collecting the blood sample
The Analytic Phase
The Post-Analytic Phase
Quality Assurance Procedures
Test sensitivity
Earlobe Capillary Blood Gases (ELCBGs)
Arterial blood gas measurement
Pulse oximetry
Transcutaneous measurements
Normal Values
pH Normal Range
PaO2 Normal Range
PaCO2 Normal Range
HCO3 Normal Range
Base Excess Normal Range
SaO2 Normal Range
SpO2 Normal Range
Fractional Inspired Oxygen Concentration
The patient’s clinical context
Is the pH normal?
Compensatory mechanisms for acid-base imbalance
Respiratory and Metabolic Acidosis and Alkalosis
Respiratory abnormalities
Type I Respiratory Failure
Type II Respiratory Failure
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Abnormalities
Metabolic Acidosis
Metabolic Alkalosis
Advanced Interpretation Algorithm (branch 1)
Advanced Interpretation Algorithm (branch 2)
Advanced Interpretation Algorithm (branch 3)
Oxygen partial pressure, saturation of haemoglobin and inspired oxygen
Case study 1
Case study 2
Case study 3
Case study 4
Case study 5
Case study 6
Case study 7
Case study 8
Case study 9
Case study 10
Confirm hypercapnic respiratory failure
Tutorial 1: Right Patient for Acute NIV
Initial Management Steps
Tutorial 2: Right Equipment for Acute NIV
Initiating Non-Invasive Ventilation
Tutorial 3: Right Settings for Acute NIV
Referral to ICU
Tutorial 4: Right Management
Assessment of suspected Community Acquired Pneumonia
New consolidation on a chest x-ray
Assessing severity using the CURB65 score
1st line, 2nd line and 3rd line antibiotic options
A sufficient course of antibiotics
When to suspect ILD
Chest auscultation in ILD
Initial investigations and referral to secondary care
Tutorial: The Role of Specialist TB Teams
Airway access using a tracheostomy
The All Wales TRACHES Checklist
Reducing Adverse Outcomes
Anatomy of the upper airway
Reasons for a tracheostomy
Components of a tracheostomy tube
Routine weaning from a tracheostomy
Difference between a Tracheostomy and Laryngectomy
Tapes and Dressings
Red flags
Assessment of the Inner Tube
Cuff pressure
Humidification and Oxygen therapy
Emergency Management
Maximising a patient’s communication
Cuff deflation and speaking valves
Above cuff vocalisation (ACV)
Swallowing problems
Step 1: Checking the patency and integrity of the chest drain
Step 2: Use of the 3-way tap
Step 3: Checking for blockages and flushing the circuit
Step 4: Replacing the bottle and tubing
Step 5: Assessing the chest drain dressing
What happens during sleep?
When to suspect OSA in your patients?
Making a referral to a sleep service
Epidemiology of OSA
The health burden of Obstructive Sleep Apnoea
Anatomy of the Upper Airway
Pathogenesis of OSA
Predisposing risk factors of OSA
Symptoms of OSA
Red flag symptoms of OSA
OSA in children
Co-morbidities of Obstructive Sleep Apnoea
OSA and Hypertension
OSA and heart disease
Other common causes of excessive daytime sleepiness
A spectrum of sleep disordered breathing
Central Sleep Apnoea
Obesity Hypoventilation Syndrome
COPD/OSA overlap
Nocturnal Asthma
Questionnaires to predict the presence of OSA
The Epworth Sleepiness Scale
Routine and urgent referrals
Lifestyle advice for patients with suspected OSA
Diagnosis of OSA
Continuous Positive Airway Pressure (CPAP)
Other treatment options for OSA
The sleepy driver
Assessing fitness to drive
Oxygen need versus breathlessness
Baseline pulse oximetry
Referral to Home Oxygen Service
Step 1: Confirm presence of Pseudomonas aeruginosa
Step 2: Assessment for clinical deterioration
Step 3: First line and second line treatment
Step 4: Prevent future exacerbations
How to do the test properly
How to identify and rectify the most common errors in spirometry
How to check and report your results
How to look after your spirometry equipment
Understanding the important variables
How to review and confirm the spirometry results are good quality
Defining normal
Patterns of abnormality
Introducing the NHS Wales HealthHub apps


COPE Data Collection Proforma
Asthma, chronic obstructive pulmonary disease, or both?
Quality Assured Diagnostic Spirometry for Chronic Obstructive Pulmonary Disease
NICE Quality Standard: Chronic obstructive pulmonary disease in adults
Asthma COPD and Asthma – COPD Overlap Syndrome (ACOS)
Southwark and Lambeth Breathlessness Assessment Algorithm
An evaluation of screening for COPD against the National Screening Committee criteria
Opportunities to diagnose COPD in routine care in the UK: a retrospective study of a clinical cohort
Diagnosis and management of COPD in primary care
All-Wales COPD Management and Prescribing Guideline (updated November 2023)
RightBreathe Inhaler prescribing information
COPDhub: website
Empowering Patients with COPD to access High Quality Care
The FLAME Study
Global Strategy for the Diagnosis, Management and Prevention of COPD
Patient leaflet: National Exercise Referral Scheme
BTS Guideline on Pulmonary Rehabilitation in Adults
The QALY Pyramid
The COPD Assessment Test: What Do We Know So Far?
Respiratory (chest) physiotherapy for people with COPD
Self management for patients with COPD (Cochrane Review)
The Lung Health Study
The PACE Study
Gas transport in the blood
The ANTT Clinical Practice Framework
CAVUHB Protocol for Earlobe Capillary Blood Gas Sampling in Adults
HDUHB Earlobe Capillary Blood Gas Sampling Procedure
ABL800 FLEX System Manual
i-STAT®1 System Manual
Capillary blood gas—a more ‘patient friendly’ alternative to arterial blood gas?
BTS Guidelines for Home Oxygen Use in Adults
TB info sheet – English (word)
Active TB leaflet – English (pdf)
Tuberculosis in Wales Annual Report 2019
Tracheostomy Emergency Airway Algorithm
Example of a Home Oxygen Risk Assessment Form
Pseudomonas aeruginosa infection and exacerbations in bronchiectasis: more questions than answers
Restarting diagnostic spirometry in Wales
Quality control in lung function testing
Protocol and Procedure for undertaking and interpreting spirometry
Contraindications to spirometry
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