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Follow-up of COPD in primary care

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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 (stage 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:

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 2024

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:

  1. National Institute for Health and Clinical Excellence (NICE) 2018. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care.

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