Please click the relevant flowchart box to be taken directly to textual information.
Over 35 years
Smokers or ex-smokers
Have any or a combination of the following symptoms
There is no single diagnostic test for COPD and on examination various signs may be present. The diagnosis is based on a combination of history (substantial smoking history or exposure to other noxious compound, persistent progressive symptoms, recurrent ‘winter bronchitis), the presence of symptoms (some of: exertional breathlessness, cough, regular sputum production, wheeze), the confirmation of airflow obstruction by spirometry testing, and the absence of any reasonable other diagnosis.
Obstruction demonstrated on spirometry testing with a history and symptoms consistent with COPD confirms the diagnosis. If there is diagnostic doubt negative reversibility testing rules out asthma as a differential diagnosis.
If you suspect COPD the following should be performed:
Diagnosing COPD Checklist:
The following should be completed on an annual basis, NICE guidance suggests that those most vulnerable and at risk of deterioration should be seen more frequently.
Smoking cessation is a vital part in the management of COPD and must be discussed at every opportunity. Quit attempts are four times more likely to be successful when supported by appropriate pharmacotherapy and behavioural support.
Refer or direct the patient to the Healthy Lifestyles Gloucestershire service support (self-referral is available via the website).
See the Smoking Cessation page for further information.
Please see the Clinician Education section for VBA Smoking cessation training for Health Care Professionals.
The aim of treatment for people with COPD is to improve current control and prevent future risk (by preventing exacerbations and slowing disease progression). The Gloucestershire formulary guidelines follow national prescribing recommendations.
Additional GCCG Optimising the use of Inhaled Corticosteroids in COPD Guidance
The use of inhaled corticosteroids in patients with COPD should be considered for people who are GOLD category D. Some people may have been prescribed inhaled corticosteroids as part of their treatment regimen following older guidelines which may no longer be considered appropriate so consideration may be given to prescribing such therapy. A treatment algorithm has been developed for safe reduction to removal of inhaled corticosteroid.
Other relevant respiratory prescribing links can be found in the respiratory section of our joint formulary.
Supporting COPD self-management
Self-management plans are a tool around which patients can be engaged and motivated in their own care and encouraged to take responsibility for their health, giving them the information and education to do so.
Shared decision-making and patient-centred care need to be embedded in everyday practice — become routine — so that rather than consult, clinicians take a more coaching, motivational interviewing approach towards people with long-term conditions, such as COPD and supported to manage in the longer term. Supporting self-management is not a substitute for care from doctors and nurses, but a ‘hallmark of good care’.
Please use this COPD self-management plan.
An acute exacerbation of chronic obstructive pulmonary disease (COPD) is described as a sustained worsening of symptoms that is beyond normal day-to-day variation, and is acute in onset. This is a significant event that may result in worsening prognosis. Acute exacerbations of COPD may be due to bacterial or viral infection, or poor air quality.
GRS is an integrated specialist respiratory service delivered by nurses, physiotherapists, occupational therapists, clinical support workers and administrators in the acute sites (GHFT) and the community (GCS).
The acute team operates primarily to support ward-staff with patients requiring specialist respiratory input and facilitates and supports early discharge of patient admitted with exacerbation of their respiratory disease.
The community respiratory team provides clinic appointments (or home-visits for house-bound patients) to optimise the management and quality of life of patients with chronic respiratory disease including COPD, asthma, bronchiectasis and interstitial lung disease.
Please follow this link to the referral form.
Respiratory consultants at GHNHSFT offer an enhanced and responsive acute service to support people with acute respiratory illnesses who are threatening hospital admission.
The respiratory “Hot Consultant” is available from 8.30am - 5.30pm, Monday to Friday and can be reached by telephoning 07384 834430
Where appropriate, the consultant may offer your patient a clinic review in ambulatory care at GRH within 48 (working) hours.
Alternatively you may be signposted to Rapid Response (Urgent Care) via SPCA on 0300 421 0300. To discuss your patient with the team prior to referral you can call 0300 421 6900
For routine advice and guidance from a respiratory medicine consultant, you can refer via e-RS with a response by the end of the next working day.
The majority of COPD can be managed in primary care or with the support of the Gloucestershire Respiratory Service in the community. If in doubt please use the respiratory advice and guidance service on e-RS.
Accurate systematic READ coding of all care is vital for the audit process and therefore improvements in patient care once full PDSA audit cycles have been completed. Quality improvement is more than data collection. Data needs to be studied, improvement planned and implemented and results monitored. The cycle then needs to be repeated making small adjustments to achieve the desired improvement.
Not all changes result in improvement first time around. This is not to be viewed as failure – just the need for adjustment.
Please click here for the Read Code Specification to support the COPD Winter Reviews 2016/17.
Please follow the resource link below for nationally recommended read codes.