Respiratory  |  COPD Pathway - Initial Assessment




Respiratory

COPD Pathway - Initial Assessment

Note: Consider COPD in all smokers and ex-smokers over the age of 35 years.

Consider COPD in patients presenting with any of:

  • Recurrent chest infections.
  • Breathlessness (progressive dyspnoea, usually worse on exertion and during respiratory infections).
  • Sputum.
  • Chronic cough (present either intermittently or most days; usually during the day as well as at night).
  • History: including smoking, and/or exposure to noxious particles or chemicals. Read codes.


Patient question:

So, how do you know if you should have a pulmonary function screen? Ask yourself the following questions:

  • Are you 35 years old or older, currently smoke cigarettes or have smoked in the past?
  • Are you 35 years old or older and have a history of breathing irritants in your home environment or work place?
  • Do you sometimes have coughing fits or trouble breathing when exerting?
  • Do you have frequent bouts of bronchitis?
  • Do you cough up mucus or phlegm in the morning?
  • Does asthma, bronchitis or emphysema run in your family?
  • Do you sometimes have trouble keeping up with people your own age?

                

Risk factors for COPD:

  • Genes
  • Exposure to particles
  • Tobacco smoke
  • Occupational exposures
  • Occupational dusts, organic and inorganic
  • Indoor air pollution from heating and cooking with bio mass in poorly vented dwellings
  • Outdoor air pollution
  • Lung Growth and Development
  • Oxidative stress
  • Gender
  • Age
  • Respiratory infections
  • Socioeconomic status
  • Nutrition
  • Comorbidities
  • Asthma


Medical Research Council grading of functional limitation due to dyspnoea  MRC Breathlessness Scale


Examination:

  • Tar staining of fingers may be present.
  • Examination may be normal in mild disease.
  • There may be a wheeze (rhonchus), quiet breath sounds or features of over-inflation.
  • The degree of airways obstruction cannot be predicted from symptoms or signs.
  • In patients with severe disease the following physical signs may be present none is sufficiently diagnostic to remove the need for objective confirmation of the diagnosis.
  • Breathlessness on mild exertion or at rest.
  • Pursed-lip breathing and use of accessory respiratory muscles.
  • Signs of chronic over-inflation (loss of cardiac dullness, decreased cricosternal distance, increase in the AP diameter of the chest).
  • Rhonchi, especially on forced expiration.
  • Loss of weight is common but may also indicate occult carcinoma.
  • Central cyanosis, but its absence does not exclude minor degrees of hypoxaemia.
  • Flapping tremor, bounding pulse, drowsiness (signs of hypercapnia) may occur during acute exacerbations, but a high partial pressure of oxygen in arterial blood (PaCO2) can occur in patients with stable severe chronic obstructive pulmonary disease (COPD) without these signs.
  • Peripheral oedema may indicate the presence of cor pulmonale which is of prognostic significance.
  • Raised jugular venous pressure, right ventricular heave, loud pulmonary second sound, tricuspid regurgitation these signs of cor pulmonale can be modified or masked by over-inflation.

  1. Assess impact of symptoms on lifestyle e.g., limitation of activities, effect on work, effect on mood, alcohol intake.
  2. If the diagnosis is confirmed, record in the Disease Register.
  3. Raise awareness - smoking, housing.



Education:

  • Healthy eating tips

  • Record BMI and advise about nutrition as appropriate.

  • BMI

    Body mass index = kg/m2 (weight divided by height squared):

    • Less than 18.5 = Underweight
    • Between 18.5 and 24.9 = Healthy / Normal weight
    • Between 25 and 29.9 = Overweight
    • Over 30 = Obese


Nutrition:

If underweight, provide simple advice on more frequent but smaller high calorie meals, simple measures for food fortification (e.g., additional use of milk powder).


Initial Advice process:

  • Identify
  • Enrol
  • Referral Systems
  • Educate - supply resources
  • Whats the problem
  • What are we going to do about it
  • How are we going to do something about it



Last updated : Friday, October 23, 2015
Next review date : Saturday, October 22,2016


Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.