COPD in primary care. H. John Fardy, David Bellamy and Rachel Booker.

Sydney: McGraw-Hill Australia; 2003.

Richard Ruffin, Head, Division of Medicine, Queen Elizabeth Hospital, Woodville, SA

The title 'COPD in primary care - all a GP needs to know about chronic obstructive pulmonary disease (Australian adaptation)' describes the breadth of the book content accurately. The style makes for easy reading with the key points presented at the beginning of each chapter. It also facilitates a very quick review of the book by readers letting them focus where they want to read in depth.

There is an appropriate background of pathology, physiology, diagnostic strategies and management strategies. The COPD-X Guidelines for Australia1are also summarised. There is a chapter on possible new therapies for chronic obstructive pulmonary disease (COPD) which are useful for practitioners to answer patients' common question - 'What is likely to be new in COPD?'.

The book's strengths include:

• highlighting and providing information on pulmonary rehabilitation and social issues
• touching on end-of-life issues
• a challenging chapter on the identification of COPD patients in general practice, which will challenge the current system of care and point to strategies to improve outcomes for patients
• useful contact numbers for a range of activities, including the Quitline for smoking cessation.

There are several weaknesses which affect the reading of the book:

• non-approved medications for COPD are included in the book (this highlights the difficulty of updating, when it is likely that some medications will be approved by the Therapeutic Goods Administration for use in Australia in the future)
• the levels of evidence are not highlighted within the book although there is a table outlining the classification of levels of evidence
• Table 11.1 ('Deciding whether to treat an acute exacerbation at home or in hospital') could be made more relevant to the Australian setting. It is most important for practitioners to take away the message that it is the rate of change of arterial oxygen tension that is the key issue in deciding whether someone is to be admitted, rather than the absolute value. Additionally, the absolute value given in this table is low by Australian standards. It would also be preferable to put in oxygen saturations because pulse oximetry will become more of a standard as the equipment becomes more widely available.
• the chapter on smoking provides a broad-brush approach, but does not engage all of the specifics that can be provided in this process. It would be useful to reference Australian guidelines such as those contained in the Therapeutic Guidelines: Respiratory.

Overall the book is going to be a useful reference for people to brush up on issues with regard to COPD management and to provide accurate information to the patient.