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Appendix A: COPD Severity Assessment Scales The following scales can be self-administered while the patient is waiting for their appointment and can be used indirectly to guide therapy. Administration is recommended upon diagnosis to establish baseline, and following a serious exacerbation (i.e., one requiring oral antibiotics or hospitalization).
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In clinical practice, an integrated, comprehensive approach to care should include: a diagnosis of COPD confirmed with spirometry; clinical evaluation of the patient; and comprehensive management, which includes non-pharmacological and pharmacological interventions. (Figure 1).
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About two million Canadians live with chronic obstructive pulmonary disease (COPD), but as many as one million more may have it without even knowing it. In this resource, we will be highlighting strategies that can help you manage your COPD, stay out of the hospital, and live a full and active life.
• Review with your patient measures to prevent future COPD exacerbations including smoking cessation, annual influenza vac- cination, pneumococcal vaccination and appropriate use of inhaled daily medications.
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- Definition
- COPD and Comorbidities
- Diagnosis
- ? Chest X-ray
- ? Other Pulmonary Function Tests
- Assessment Tools
- Management
- Advance Care Planning
- 2. Pharmacologic Management
- Inhaled Medications
- Stepwise Approach to Pharmacologic Therapy
- Indications for Referral
- Follow-up Care
- Palliative Care
- Appendices
- Associated Documents
- The principles of the Guidelines and Protocols Advisory Committee are to:
- Disclaimer
- Appendix C: BC Home Oxygen Program Medical Eligibility
COPD is characterized by persistent airflow limitation that is typically progressive, not fully reversible, and associated with an abnormal inflammatory response of the lungs to noxious particles or gases (e.g., exposure to cigarette smoke). The two most common conditions that contribute to COPD are emphysema (destruction of alveoli) and chronic br...
COPD patients commonly present with comorbidities which reduce quality of life. In patients with mild to moderate COPD, cardiovascular diseases are the leading cause of hospitalizations and the second leading cause of mortality after lung cancer. In severe and very severe COPD, respiratory failure and pneumonia are the leading causes of morbidity ...
While a diagnosis is based on a combination of medical history and physical examination, it is the documentation of airflow limitation using spirometry that confirms the diagnosis. Consider a COPD diagnosis for a patient ≥ 40 years of age who has: Respiratory symptoms, including: dyspnea (progressive, persistent and worse with exercise); chronic c...
A chest x-ray is not helpful in diagnosing COPD. A chest x-ray that shows hyperinflation may suggest COPD, but the diagnosis requires objective confirmation with spirometry. A chest x-ray may be useful, and should be documented, if there are concerns about other significant comorbidities (e.g., heart failure, tuberculosis, pneumonia).
Other pulmonary function tests (e.g., body plethysmography, difusing capacity, arterial blood gas measurement) are not required for a COPD diagnosis, but may be helpful in assessing the severity of COPD or when considering alternative diagnoses. For example, a body plethysmography may help in the assessment of severity of COPD, but is not essential...
To assist in determining the current level of a patient’s symptoms, use a tool such as the COPD Assessment Test (CAT) (website: www.catestonline.org). The MRC Breathlessness/Dyspnea Scale (website: www.mrc.ac.uk/research/facilities-and-resources-for-researchers/mrc-scales) may also be useful.
The therapeutic goals of COPD management include:8 to alleviate breathlessness and other respiratory symptoms that afect daily activities; to prevent and reduce the frequency and severity of acute exacerbations; to minimize disease progression and reduce the risk of morbidity/mortality; and to optimally manage comorbidities (if present) to reduce e...
Initiate advance care planning discussions for all patients with a diagnosis of COPD. Advance care planning should be tailored to the needs of the patient along the disease trajectory, and should incorporate the patient’s values and goals, indicate potential outcomes, and identify health care professionals involved in care. The advanced care plan i...
When developing the patient’s therapeutic goals and pharmacologic management plan, individualize the plan based on the patient’s symptoms, exacerbation history, response to treatment and their risk of adverse efects. For more information on specific medications, refer to Appendix A: Prescription Medication Table for COPD.
Many new inhaled medications, including fixed dose combinations, have been introduced in recent years. It is recommended to: Ensure that drug classes are not duplicated when initiating or modifying drug therapy. Evaluate the patient’s inhaler technique and adherence regularly, as up to 90% of patients use their device incorrectly. Evaluating inhal...
Implement pharmacologic therapy in a stepwise approach and use the lowest step that achieves optimal control based on the patient’s severity of COPD (see Figure 1). When assessing for the next step, consider exertional dyspnea, functional status, history of exacerbations, complexity of medicines or devices, patient preference (e.g., cost and abilit...
Refer patient to a specialist in cases where: the diagnosis is uncertain; a patient is < 40 years with COPD and limited smoking history, or has severe symptoms and disability which is disproportionate to their lung function; there is evidence of an alpha-1 antitrypsin (A1AT) deficiency (e.g. early onset of emphysema or COPD, unexplained liver dise...
Modify therapeutic goals and management plans as appropriate. Use routine follow-ups to ask about and monitor the patient’s key clinical indicators, including: lung function; changes in symptoms (e.g. any improvement since starting/changing treatment; changes in level of breathlessness, activity level, sleep quality, etc.); exacerbation history (fr...
Making decisions about the intensity of palliative care is a highly individualized process and requires continuous review as COPD progresses. Once the decision to initiate palliative care is made, the goal of therapy is to manage symptoms, reduce treatment burden, and maximize comfort and quality of life. This may include providing support for the ...
Appendix A: Prescription Medication Table for COPD Appendix B: Antibiotic Treatment Recommendations for Acute Exacerbation of COPD Appendix C: BC Home Oxygen Program Medical Eligibility
Patient Care Flow Sheet COPD Flare-up Action Plan Resource Guide for Patients COPD Management Services Referral Form (for Vancouver Coastal Health, Providence Health Care and Fraser) This guideline is based on scientific evidence current as of the efective date. The guideline was developed by the Guidelines and Protocols Advisory Committee, approve...
encourage appropriate responses to common medical situations recommend actions that are suficient and eficient, neither excessive nor deficient permit exceptions when justified by clinical circumstances
The Clinical Practice Guidelines (the “Guidelines”) have been developed by the Guidelines and Protocols Advisory Committee on behalf of the Medical Services Commission. The Guidelines are intended to give an understanding of a clinical problem, and outline one or more preferred approaches to the investigation and management of the problem. The Guid...
Medical eligibility criteria may vary slightly between health authorities. Refer to health authorities for more details on local criteria and application forms. All Home Oxygen Program applicants are expected to seek and be compliant with optimal medical or adjunctive treatment prior to use of oxygen therapy. Notes Island Health and Vancouver Coas...
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Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease (2018 Report) The content of this care map is based on current available evidence and has been reviewed by medical experts. It is provided for information purposes only.
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