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Furnace House Surgery Chronic Obstructive Pulmonary Disease. Protocol Date: 13 th April 2005 Review Date: April 2006 Acknowledgement: Sarah Hicks. Aims and objectives of this protocol . to improve COPD care in this Practice to reduce emergency admissions to hospital due to COPD
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Date: 13th April 2005
Review Date: April 2006
Acknowledgement: Sarah Hicks
The underlying causes of COPD yet to be fully elucidated but include:
severity of disease rather than presumed underlying causes. The objective measure used for this and monitoring progression of the disease is Forced Expiratory Volume in one second (FEV 1).
Severity of Airflow ObstructionFEV1% predicted
Think of a diagnosis of COPDfor patients who are:
Perform spirometry if COPD seems likely.
The following will take place at an initial clinic appointment:
The following will take place at a each follow-up clinic appointment:
Reversibility tests involve measuring spirometry before and after treatment and can help distinguish between COPD and asthma. Tests may include reversibility to bronchodilators (beta2 agonists or anticholinergics) or inhaled / oral steroids.
Significant reversibility is defined as a rise in FEV1 that is both greater than 200ml and 15% of the pre-test value.
Substantial reversibility (>400ml) indicates asthma.
Mucolytic drug therapy should be considered in patients
NB. Only if a patient is hypercapnic or acidotic should the nebuliser be
driven by compressed air, not oxygen (to avoid worsening
hypercapnia). The driving gas for nebulised therapy should
always be specified in the prescription.
MRC Dyspnoea Score
Grade Degree of breathlessness related to Activities
Adapted from Fletcher CM, Elmes PC, Fairbairn MB et al. (1959) The significance of
respiratory symptoms and the diagnosis of chronic bronchitis in a working
population. British Medical Journal 2:257–66.
Healthcare professionals should be alert to the presence of depression in patients with moderate to severe COPD. The presence of anxiety and depression should be considered in patients:
exacerbation of COPD.
The presence of anxiety and depression in patients with COPD can be identified using validated assessment tools.
Patients found to be depressed or anxious should be treated with conventional pharmacotherapy.
For antidepressant treatment to be successful, it needs to be supplemented by spending time with the patient explaining why depression needs to be treated alongside the physical disorder.
See depression score
Ref. Birchell et al (1989) The Depression Scoring Instrument (DSI): J Affect Disorder 16 269-281