follow-up of COPD in primary care
Last reviewed 02/2021
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 (stages 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:
-
The severity of airflow obstruction should be assessed according to the reduction in FEV1 as shown in table
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 2008
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: