Follow-up of COPD in primary care
Patients with mild/moderate/severe (stages 1 to 3) COPD:
- should be reviewed at least once per year, or more frequently if indicated
- review should cover the following issues
- smoking status and desire to quit
- adequacy of symptom control - breathlessness, exercise tolerance, estimated exacerbation frequency
- presence of complications
- effects of each drug treatment
- inhaler technique
- need for referral to specialist and therapy services
- need for pulmonary rehabilitation
- measurement of - FEV1 and FVC, BMI, MRC dyspnoea score
Patients with very severe (stage 4) COPD:
- should be seen at least twice a year
- specific attention should be paid to the following issues
- smoking status and desire to quit
- adequacy of symptom control - breathlessness, exercise tolerance, estimated exacerbation frequency o presence of cor pulmonale
- need for long-term oxygen therapy
- patient's nutritional state
- presence of depression
- effects of each drug treatment
- inhaler technique
- need for referral to specialist and therapy services
- need for pulmonary rehabilitation
- measurement of - FEV1 and FVC, BMI, MRC dyspnoea score, SaO2
Notes:
Post-bronchodilator FEV1/FVC | FEV1 % predicted | Severity of airflow obstruction Using NICE clinical guideline 12 (2004) | Severity of airflow obstruction Using ATS/ERS 2004 | Severity of airflow obstruction Using GOLD 2024 | Severity of airflow obstruction Using NICE clinical guideline 101 (2010) |
Post-bronchodilator | Post-bronchodilator | Post-bronchodilator | |||
< 0.7 | >80% | Mild | Stage 1 - Mild Stage | Stage 1 - Mild* | |
< 0.7 | 50-79% | Mild | Moderate | Stage 2 - Moderate | Stage 2 - Moderate |
< 0.7 | 30-49% | Moderate | Severe | Stage 3 - Severe | Stage 3 - Severe |
< 0.7 | < 30% | Severe | Very severe | Stage 4 - Very severe | Stage 4 - Very severe ** |
Reference:
- National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. Jul 2019 [internet publication].
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