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).
- 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.
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:
- 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
- Respiratory infections
- Socioeconomic status
Medical Research Council grading of functional limitation due to dyspnoea MRC Breathlessness Scale
- 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.
- Assess impact of symptoms on lifestyle e.g., limitation of activities, effect on work, effect on mood, alcohol intake.
- If the diagnosis is confirmed, record in the Disease Register.
- Raise awareness - smoking, housing.
- Healthy eating tips
- Record BMI and advise about nutrition as appropriate.
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
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:
- 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.