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Partial bronchodilator reversibility can be demonstrated in many patients with stable chronic obstructive pulmonary disease (COPD), but its relevance to exercise capacity and symptoms is uncertain. Previous data suggest that anticholinergic bronchodilators do not improve exercise tolerance in such patients. We studied 32 patients with stable COPD, mean age 65 yrs, in a double-blind, placebo-controlled, cross-over trial of the inhaled anticholinergic drug, oxitropium bromide. From the within and between day placebo spirometry, we derived the spontaneous variation in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) of this population (FEV1 140 ml; FVC 390 ml) and considered responses beyond this to be significant. Oxitropium bromide increased baseline FEV1 from 0.70 (0.28) l (mean (SD)) to 0.88 (0.36) l. The 6 min walking distance increased by 7% compared with placebo, whilst resting breathlessness scores fell from 2.0 to 1.23 at rest and 4.09 to 3.28 at the end of exercise after the active drug. Improvements in walking distances and symptoms were unrelated to changes in either FEV1 or FVC, indicating that routine reversibility testing is not a good predictor of symptomatic benefit in these patients.

lung cancer; 2 via the general chest clinics and 1 following re-referral with persistent haemoptysis. Conclusion We have shown that almost a quarter of RALC referrals did not adhere to strict referral protocols and would have been better served by a more appropriate referral elsewhere. We are working to educate our primary and secondary care colleagues to ensure that the only appropriate cases are referred to the RALC in order to reap the maximum benefit from this resource intensive service. P231AUDIT Table 1). The proportion given oxygen fell from 31% in the initial 4 weeks to 24% in the final 5 weeks of the audit when feedback was given to ambulance teams. The "ideal" figure for these cases was about 21% based on JRCALC guidance. 86% of cases were treated in accordance with JRCALC guidance in terms of receiving or not receiving oxygen and 73% were treated in full compliance (correct device and flow rate). The overall compliance rate was 4.4% higher (95% CI e2.3% to 11.0%) during the feedback period and full compliance rose by 9.9% (95% CI 1.6 to 18.2%) following feedback. Eight percent of cases received oxygen inappropriately and 3% were denied oxygen inappropriately. Our audit revealed that NWAS ambulance crews were unable to give controlled oxygen to COPD cases because Venturi masks were not carried. Several COPD cases received high dose oxygen from nebuliser masks throughout the journey because air driven nebulisers and nasal cannulae were not available. Only four of 14 cases with AECOPD had SpO 2 <88% but 12 were given oxygen and 10 developed SpO 2 >92%. Introduction Approximately 835 000 people in England have been diagnosed with COPD however it is estimated that over 3 million have the disease 1 and those cases that are diagnosed are mainly moderate or severe in nature.2 The direct cost of COPD to the UK healthcare system is estimated to be between £810m and £930 m per annum 3 and without change is set to grow Methodology It is essential that we offer good quality early diagnosis but the numbers involved are huge so a screening programme and pathway were developed. Patients at risk of COPD were initially defined as being aged over 40 with a smoking history. Vitalograph COPD6 devices, which measure FEV 1 were used across 22 practices to screen the target population at an average test time of 5 min compared to full spirometry of 20 min. All abnormal results were followed up with full spirometry, performed by an accredited health care provider. Results To date 2055 patients have been screened. 841 (41%) demonstrated an abnormal result on COPD6 screening. Of these so far 376 have had COPD confirmed by spirometry. That is 18.3% of the target population and 45% of the group who had abnormal COPD6 results. It is estimated that, nationally over 2 million people have undiagnosed COPD and of those over 50% are diagnosed with moderate to severe disease 2 however the results available to date suggest that early detection leads to the majority of patients being identified while their condition is still mild. Results...