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COPD. Alex Gibbins. Contents. Numbers Assessment Management – NICE guideline CG101 June 2010 When to refer. Numbers. 835000 in UK have COPD Up to 2 million un-diagnosed 2 nd commonest cause of emergency hospital admission 30,000 deaths per year 60% of NHS costs due to unscheduled care.

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Alex Gibbins

  • Numbers
  • Assessment
  • Management – NICE guideline CG101 June 2010
  • When to refer
  • 835000 in UK have COPD
  • Up to 2 million un-diagnosed
  • 2nd commonest cause of emergency hospital admission
  • 30,000 deaths per year
  • 60% of NHS costs due to unscheduled care
consider it in people who
Consider it in people who…
  • Over 35, smoker / ex-smoker with:
    • Exertional SoB
    • Chronic cough
    • Regular sputum production
    • Frequent winter ‘bronchitis’
    • Wheeze
    • AND do not have features of asthma (variability, nocturnal dry cough etc)
  • Spirometry
  • CXR
  • FBC
assessment of severity
Assessment of severity

Degree of airflow obstruction (FEV1/ FVC ratio <0.7):

Stage 1 — mild: FEV1 80% of predicted value or higher (symptoms must be present).

Stage 2 — moderate: FEV1 50–79% of predicted value.

Stage 3 — severe: FEV1 30–49% of predicted value.

Stage 4 — very severe: FEV1 less than 30% of predicted value.


MRC dyspnoea scale

  • Not troubled by breathlessness except during strenuous exercise
  • Short of breath when hurrying or walking up a slight hill
  • Walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace
  • Stops for breath after walking about 100 m or after a few minutes on the level
  • Too breathless to leave the house, or breathless when dressing or undressing

Calculate BMI

  • Assess for Cor Pulmonale:
  • Peripheral oedema.
  • Raised jugular venous pressure.
  • Systolic parasternal heave.
  • A loud pulmonary second heart sound (over the second left intercostal space).
  • Widening of the descending pulmonary artery on chest X-ray.
  • Right ventricular hypertrophy on electrocardiography.
  • Smoking history
  • Screen for depression
pulmonary rehab
Pulmonary Rehab
  • If MRC dyspnoea or above 3 or above
  • If admitted with an exacerbation
  • BUT NOT if:
  • Recent MI / Unstable angina / Poor mobility

Oxygen saturation less than or equal to 92% breathing air.

  • Very severe airflow obstruction (forced expiratory volume in 1 second [FEV1] less than 30% predicted).
  • Cyanosis.
  • Secondary polycythaemia (erythrocytosis).
  • Peripheral oedema.
  • Raised jugular venous pressure.
  • Consider referring people with severe airflow obstruction (FEV1 30–49% predicted) for assessment for the need for LTOT.
  • Optimize medical treatment before referral.
  • Warn people using oxygen not to smoke because of the risk of fire or explosion.
  • Diagnostic uncertainty.
  • Referral may be needed for this reason for black and Asian people, for whom normal ranges for forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) are not known.
  • COPD that is very severe (for example FEV1 less than 30% predicted) or worsening (rapid decline in FEV1).
  • Continued smoking, if the primary healthcare professional considers that referral would increase the likelihood of smoking cessation.
  • The person with COPD requests a second opinion.
  • Cor pulmonale.
Dysfunctional breathing (abnormal breathing patterns associated with anxiety).
  • Onset of symptoms at an age younger than 40 years, or a family history of alpha1-antitrypsin deficiency.
  • Frequent infections.
  • Symptoms disproportionate to lung function.
  • For pulmonary rehabilitation (for a person who considers themselves functionally disabled by COPD), if direct referral is not possible.
  • For assessment of the need for:
  • Long-term oxygen therapy , ambulatory oxygen therapy, or short-burst oxygen therapy.
  • Nebulizer therapy or long-term oral corticosteroids.
  • Lung surgery (for example, for a person with bullous lung disease who is still symptomatic on maximal therapy).