COPD Management (Read Code H3) - Pennine GP Training



COPD Management (Read code H3)

Definition

Usually over the age of 35 with a history of greater than 10 pack years of smoking (daily smokes x years of smoking divided by 20).

Common (2x angina) but often undiagnosed.

Diagnosis (Post bronchodilator FEV1 < 80% of predicted requirement removed) = post bronchodilator FEV1/FVC ratio < 0.7 indicating an obstructive picture with a history consistent with COPD.

Do not Read code as COPD (H3 or by severity as below) unless the diagnosis is confirmed by history and post bronchodilator spirometry. All FEV1 and FVC values should be Read coded!

Grading of severity no longer influences management

MRC dyspnoea scale – needed at diagnosis and annual review

Readcode via the template

|Grade |Degree of breathlessness related to activities |

|1 |Not troubled by breathlessness except on strenuous exercise |

|2 |Short of breath when hurrying or walking up a slight hill |

|3 |Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking|

| |at own pace |

|4 |Stops for breath after walking about 100m or after a few minutes on level ground |

|5 |Too breathless to leave the house, or breathless when dressing or undressing |

| | |

Assessment at diagnosis

▪ Hx > 10 pack years smoking hx and > 35 years – if not re-consider the diagnosis.

▪ Objective assessment with post bronchodilator FEV1/FEV ratio < 0.7 with no significant reversibility. Record grade: mild, moderate or severe on the basis of percentage post bronchodilator FEV1 vs predicted.

▪ Record BMI

▪ CXR to exclude bullae, tumour, pulmonary oedema, bronchiectasis (CT may be required )

▪ FBC is required, as presence of eosinophilia changes management.

▪ Consider alpha-antrypsin deficiency if < 40 years old

When to refer

1. Uncertain diagnosis e.g. History or Examination: age 110, unable to speak in sentences or confused.

• SaO2 4 x seven day courses in a lifetime).

• Inhaled steroid > 1000mcg day beclomethasone.

If unable to have a DEXA then use FRAX to see if they are at high risk then 1st line Rx = a bisphosphonate.

If able to have a DEXA, then use T score and FRAX risk to decide if a bisphosphonate in needed.

QOF summary 2019/20 points

COPD001 COPD register 3

COPD002 post-bronchodilator spirometry 5

if diagnosed after 1/4/11

(3/12 before to 12/12 after diagnosis)

COPD003 Annual review, including 9

MRC dyspnoea scale

COPD008 MRC score (recorded in last 12 months) with a

Score of 3 or more who have been offered

pulmonary re-hab 2

COPD007 fluvax in preceding 1st August 6

to 31st March

total 25

BRIG ROYD SURGERY

COPD Action Plan

WHAT ACTION TO TAKE IF YOUR SYMPTOMS (cough, sputum or shortness of breath) GET WORSE

1. RELIEVER TREATMENT

Via inhaler or nebuliser

Maximum dose ______ / ______ times per day

2. Check the colour of your sputum:

Cough sputum onto a white tissue

If your sputum colour has changed from clear or pale to a darker shade

e.g. yellow or green: start ANTIBIOTICS:

Please take your home supply

or obtain a prescription without delay from the surgery

3. PREDNISOLONE

If breathlessness is not improved by relievers, take 30mg once daily

(6 x 5mg tablets) for planned course (duration may vary).

4. Follow up

Let us know (same or next working day) if you have needed to use your standby treatment. We will usually want to review your chest and treatment after an episode like this

5. If you are not getting better with treatment or getting worse despite treatment, let us know (or out of hours NHS 111) as you may need an urgent assessment.

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