COPD

 

 

DIAGNOSIS:¹

• CXR
• FBC – (to identify anaemia or polycythaemia)
• Spirometry
• MRC breathlessness scale

 

PRIMARY CARE MANAGEMENT PRIOR TO REFERRAL:

Assessing severity of COPD:

• COPD Assessment Test (https://www.catestonline.org/patient-site-test-page-english.html)
• MRC dyspnoea scale (if≥3 refer pulmonary rehab)
  • COPD Prescribing Guidelines
• Use DPIs before MDIs due to significant climate impact of MDIs and better control with DPIs. See webinar: https://youtu.be/vCqW9DmXTxc
  • Advice on treatment or investigations can be requested via the respiratory email advice and guidance service.

 

 WHEN TO REFER TO SECONDARY CARE:

(for all - Include COPD impact score/MRC dyspnea scale if possible)

• High frequency of exacerbations, uncontrolled symptoms despite treatment optimization or rapidly declining
• Before referral:
• Follow Cornwall COPD guideline - review fundamentals of COPD management
• Has inhaled treatment been optimised & inhaler technique/adherence checked?
• Chest Xray, Spirometry (within last 12 months), FBC, BNP if indicated
• Onset of less than 40 years of age:
  • Before referral: Perform Spirometry with reversibility, send blood for alpha 1 antitrypsin, Chest Xray
• Diagnostic uncertainty
  • Before referral: Chest Xray, Spirometry with reversibility , FBC, ECG & BNP if indicated
• For assessment for lung surgery in bullous disease:
• A lung volume reduction procedure may be appropriate in patients with severe COPD who have no significant co-morbidities, no signs of cor pulmonale, hyperinflation in CXR and have undergone pulmonary rehab and have stopped smoking. They can be referred to RCHT but the procedures are only available out of county.
  • Before referral: Chest Xray, Spirometry, FBC
• Patients with Cor pulmonale
  • Before referral: Chest Xray, Spirometry, FBC plus consider echo
• Family history of alpha-1 antitrypsin deficiency– check levels and refer if abnormal.

 

WHEN TO REFER TO COMMUNITY SPECIALIST NURSES:

• Assessments for Long term home oxygen
• Assessments for Ambulatory oxygen
• Assessments for need for a Nebuliser
• Palliative symptoms support.
• Patients with frequent exacerbations and admissions

Inclusion Criteria:

• Sats </= 92% on air
• FEV <30% predicted
• Cyanosis
• Secondary polycythaemia

Exclusion Criteria:

• Continued smoking is an absolute contraindication to oxygen therapy at home.

Please refer to the specialist nurses via the following email: cpn-tr.MidRespiratoryTeam@nhs.net

 

USEFUL RESOURCES:

- Local support groups for COPD: http://breathers.org.uk/

- Healthy Outlook for COPD click here (service designed to focus on supporting service users to manage their mental health in order to better manage their physical health condition)

- Pulmonary Rehabilitation click here

- Smoker Free Cornwall https://www.healthycornwall.org.uk/make-a-change/smokefree-cornwall/

- COPD Inhaler Prescribing Guidelines click here

- Inhaler technique videos- https://www.asthma.org.uk/advice/inhaler-videos/

- British Lung foundation- www.blf.org.uk/.../chronic-obstructive-pulmonary-disease-COPD

 

 

REFERENCES:

1. CKS (NICE) COPD guidelines - https://cks.nice.org.uk/topics/chronic-obstructive-pulmonary-disease/
2. https://respiratoryacademy.co.uk/clinical/cpd-modules/spirometry/

 

Review date                  15^th March 2022

Next review due            15^th March 2023

GP reviewer                   Dr Madeleine Attridge

Contributors                   Dr Matthew Berry Respiratory Consultant RCHT

                                       Dr Susheela Banerji

                                       Jill Leyshon (respiratory nurse specialist)