A dummy guide to conducting successful COPD reviews

Following our dummy guide on conducting asthma reviews, we have received a request for a similar dummy guide to conducting successful COPD reviews. This is useful in helping meet the thresholds for QOF indicators COPD010 and COPD014. We have summarised the key points as follows.

1. Appointment Scheduling:
   • Contact the patient to schedule a COPD review appointment. Regular reviews are essential for all COPD patients to monitor disease progression, assess symptoms, and adjust treatment plans accordingly. Reviews should ideally occur at least once a year, but more frequent reviews may be necessary for patients with severe or poorly controlled COPD.
2. Preparation:
   • Gather the patient’s medical history, including previous COPD assessments, test results (e.g., spirometry), medication list, exacerbation history, and any recent hospital admissions related to COPD.
3. Patient Assessment:
   • Begin the review by assessing the patient’s current COPD symptoms and their impact on daily activities and quality of life. Inquire about symptoms such as breathlessness, coughing, sputum production, and exercise tolerance.
   • Evaluate any changes in symptoms since the last review, including exacerbations or acute respiratory events.
   • Assess the patient’s smoking status and provide smoking cessation support if applicable.
4. Medication Review:
   • Review the patient’s current COPD medications, including inhalers (bronchodilators and corticosteroids), oral medications, and supplemental oxygen therapy if prescribed.
   • Ensure the patient is using inhalers correctly and address any concerns or difficulties with medication adherence.
   • Consider adjustments to the medication regimen based on symptom control, exacerbation history, and GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines.
5. Assessment of COPD Severity and Control:
   • Use spirometry and other relevant tests to assess the severity of airflow limitation and COPD staging according to GOLD guidelines.
   • Evaluate the patient’s level of symptom control using validated assessment tools such as the COPD Assessment Test (CAT) or the modified Medical Research Council (mMRC) dyspnea scale.
   • Discuss the results of COPD severity and symptom assessments with the patient and explain their implications for disease management.
6. Exacerbation Risk Assessment:
   • Assess the patient’s risk of COPD exacerbations based on their exacerbation history, symptom severity, and lung function. Consider factors such as previous hospitalizations, frequent exacerbations, and comorbidities.
   • Develop a personalized exacerbation prevention plan, including strategies to reduce exacerbation triggers and optimize medication management.
7. Pulmonary Rehabilitation and Self-Management Education:
   • Discuss the benefits of pulmonary rehabilitation programs and encourage eligible patients to participate.
   • Provide COPD self-management education, including techniques for managing breathlessness, sputum clearance, and recognizing early signs of exacerbations.
   • Empower the patient to take an active role in managing their COPD and adhering to treatment plans.
8. Vaccination and Preventive Measures:
   • Ensure the patient is up-to-date with recommended vaccinations, including the annual influenza vaccine and pneumococcal vaccine.
   • Advise the patient on preventive measures to reduce the risk of respiratory infections, such as hand hygiene, avoiding exposure to respiratory irritants, and maintaining good indoor air quality.
9. Referral and Follow-Up:
   • Consider referral to specialist respiratory services for patients with severe or complex COPD, including those requiring assessment for surgical interventions or advanced therapies.
   • Schedule a follow-up appointment based on the patient’s COPD severity, exacerbation risk, and treatment plan adjustments.
10. Documentation and Communication:
    • Document the findings of the COPD review, including symptom assessment, medication review, exacerbation risk history/ assessment, education provided, and any referrals or follow-up plans, in the patient’s medical record.
    • Share any significant findings and treatment recommendations with the GP, COPD nurse or community COPD team to ensure coordinated care and continuity of management.

We hope you find this useful in helping you conduct successful COPD reviews. Let us know your thoughts in the comments below.