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Follow-up of COPD in primary care

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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 Clinical Excellence (NICE) 2019. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care.

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