The Consultation on a Strategy for Services for COPD in England is the culmination of five years' work by respiratory specialists from all disciplines, as well as representatives from the voluntary sector, patients, carers and planners. It has been led by the Department of Health in England and the joint National Directors for the programme, Professor Sue Hill and Dr Robert Winter. The Strategy outlines service standards for providers of COPD care and is complementary to the UK National Institute for Health and Clinical Excellence (NICE) guidelines on the management of COPD. Its key elements are:• preventing the development and progression of COPD • diagnosing COPD accurately and at an early stage • developing structured care based on national guidance • promoting self-management education • reducing the number of people admitted to hospital • improving access to end-of-life care • promoting good asthma services.In essence this is an aspirational strategy which aims to change the way that the NHS in England delivers care for people with COPD by identifying them earlier and managing them optimally in order to reduce the likelihood of progression to the more severe stages of the disease. An economic impact assessment shows that implementing the Strategy will save approximately £1billion over 10 years as well as sparing many people from a debilitating illness.This supplement is based on the Strategy Consultation document as well as the NICE guidelines for COPD management. It aims to elucidate practical implementation of the COPD Strategy, and includes verbatim the Strategy recommendations as well as highly relevant clinical information from the NICE guidelines. Implementation of the Strategy recommendations should lead to optimum care for patients with COPD. S2

PHARMACOLOGICAL DEVELOPMENTS are unfolding so rapidly in the realm of anaesthesia that almost every week a new drug is made available for study and trial. With the increasing use of the cautery and the concerted effort to avoid explosions, a marked need has arisen for a safe, potent, non-inflammable inhalation anaesthetic drug. Robbms (1) in 1946 investigated a number of non-explosive fluorinated hydrocarbons an the laboratory and conc]uded that stx might be of clinieal value No further work was done until 19N3; when Krantz et al. (9.) reported on the safety of a fluorinated ethyl vinyl ethei. Unfortunately, this compound was explosive In anaesthelac concentrations (8). Meanwhile, Suckling in England, while screening non-explosive fluoride compounds, synthesized 2 bromo-2 ehloro-l,l,1, trittuoroethane (CF3CHC1Br). This compound, c,alled Fluothane, was investigated pharmacologically by Raventos (4), who found it to be a potent and safe anaesthelae drug m several speems of ammals. Within the last year several clinical reports attesting to the value of this drughave been published (5, 6, 7, 8). Fluothane is a clear, colourless llqmd with a sweet, pleasant odour resembling triehlorethylene or chloroform (Table I). The boiling point (50.2~ renders TABLE I PHYSICAL PROPERTIES OF FLUOTItANE Appearance Colourless, clear Odour Sweet, pleasant Molecular welght 197 39 Bmhng point 50 2 ~ C Specific gravity 1 862 at 22 ~ C Off/water solubdlty 330 Vapour pressure 243 mm at 20 ~ C

No abstract