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.
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.
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.
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