AEC Respiratory Pathways

To access the AEC Respiratory Pathways please follow the links below to the Urgent Care section;

COPD - Breathlessness/Intractable Dyspnoea - Treatment

COPD - Breathlessness/Intractable Dyspnoea Decision Tree

Diagnosis, Characteristics & RED Flags for COPD - Glos Protocol

Diagnosis of a COPD Exacerbation

  •  Diagnosis of an exacerbation is made clinically
  •  Diagnosis does not depend on the results of investigations
  •  Investigations may assist in ensuring appropriate treatment is given.
  •  Different investigation strategies are required for patients in hospital (who will tend to have more severe exacerbations) and those in the community.

Characteristics of a COPD Exacerbation (in the absence of concurrent pneumonia)

  • Increased cough
  • Increased breathlessness
  • Increased sputum production
  • Sputum purulence

All characteristics are measured against the patient’s norm.



Arrange urgent acute admission and/or discussion with the GP if there is any suspicion of respiratory failure or sudden decline in health status:

  • Severe pain and sudden hypoxia suggestive of pulmonary embolism. Multiple small emboli may present as pleuritic pain
  • Respiratory Failure: bounding pulse, confusion, worsening mental ability, depressed respiratory rate (<12/min), peripheral shut down, CO2 flap, headache (especially in waking), cyanosis, clammy skin
  • Chest pains associated with angina can be misinterpreted as chest tightness
  • Significant co-morbidities which may mask signs and symptoms e.g. ketoacidosis

For more information follow the link to the Gloucestershire Protocol on COPD Exacerbation.

Pulmonary Rehabilitation

Referral and Management of COPD - Gloucestershire Respiratory Team

The community respiratory team is made up of physiotherapists and nurses specialising in respiratory diseases.They provide services for Admission avoidance, optimisation of therapy and symptom management

They aim to provide a personalised service to patients which is focused on individual needs and a package of support.

For more information on this service please follow the Resource Link below to the GCS website page for GRT.

For a referral form for this service please look in the Referral Forms tab under Respiratory.