Respiratory | COPD Pathway - Stable COPD
PATHWAYS
COPD Pathway - Stable COPD
Monitoring of COPD depends on the severity. However, it is recommended that patients with mild COPD be seen at least yearly, and more often in those with moderate or severe disease or with other co-morbidities.
Review:
- Smoking status and stage of change - see Smoking Cessation.
- Smoking Status Read Codes
Document exercise tolerance (walking distance in metres and activities of daily living (ADL)). Consider referral to Pulmonary Rehabilitation if FEV1 <50% and patients are symptomatic in spite of therapy, i.e., limited by breathlessness, MRC >=3 (this is a guide, not a fixed threshold)
Advise about nutrition and record BMI as appropriate.
Nutrition:
- Review the patient's nutritional intake and dietary pattern.
- 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).
- Advise on weight reduction measures if overweight /obese.
- Healthy eating tips
- Non Pharmacological interventions - Nutrition
- Less than 18.5 = Underweight
- Between 18.5 and 24.9 = Healthy / Normal weight
- Between 25 and 29.9 = Overweight
- Over 30 = Obese
- The Heart Foundation tick programme has an online calculator and result classification depending on ethnicity.
- Review medications and inhaler technique.
- Recommend annual flu vaccination.
- Consider chest X-rayand/or repeat spirometry if there is a significant change in symptoms.
- Review and reinforce action plan for an acute exacerbation. This is also recommended after each acute hospital admission / Emergency Department or after hours service visit. Consider providing supply of emergency medications to the patient and involving family and carers.
- Consider psychological factors.
Psychological Factors:
- Anxiety/depression - untreated anxiety/depression has a significant additional impact and early treatment is important
- Memory loss, cognitive impairment
- Alcohol dependence
- Had Scale
Review the contribution of co-morbid conditions e.g., cardiovascular disease (40% of patients with COPD die of cardiac disease), diabetes, osteoporosis. If symptoms are disproportionate to COPD severity assessment, consider referral to Respiratory Outpatients Department.
Note: if the disease has progressed, update the Disease Register. Consider using the patient recall system to ensure annual assessments.
Next review date : Thursday, March 30,2017
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.