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  1. 1. o Consider long-term home oxygen.Diagnosis and • Risk factor reduction:management of COPD o Check current smoking status o Advise of the risk of smoking and(COPDX) benefits of stopping o Refer to Quitline (131 848) o Pharmacological treatments forC: confirm diagnosis nicotine dependence.• History of symptoms: o Assess occupation: e.g. dusty o SOB condition. o Cough o Schedule follow-up visit o Sputum production D – Develop self-management plan:• Smoking: • Assist in the development of a self- o History: smoker, pack years management plan. o Willingness to quit: high, medium, • Check for psychosocial problems and low suggest supportive strategies, such as the o Previous smoker Australian Lung Foundation’s LungNet o Non-smoker National Support Network – 1800 654 301 o Other smoking-related disease • Refer for the pulmonary rehabilitation• Spirometry: • Refer to respiratory physician to: Pre- % pred Post Reversibility o Clarify diagnosis bronchodilat - o Consider other therapies orFEV1 o Consider long-term home oxygenFVC o Facilitate pulmonary rehabilitation.FEV1/ • Refer to hospital if:FVC o Inadequate response to ambulatory managementCOPD definition: post-bronchodilator o Inability to walk between roomsFEV1/FVC <0.7 and FEV1 < 80% predicated. when previously mobileIf fully resersible (to normal values) treat as o Inability to eat or sleep because ofasthma. dyspnoea o Altered mental status suggestive ofReversibility = (FEV1 post BD) – (FEV1 pre hypercapniaBD)/FEV1 pre BD x 100 o Worsening hypoxaemia or cor pulmonaleGrade COPD severity: o Newly occurring arrhythmia• FEV1% of predicted post-bronchodilator o Cannot manage at home• Mild: 60-80% o High risk comorbidity condition.• Moderate: 40-60% • X – manage eXacerbations:• Severe: <40% o Ensure understanding of exacerbations and importance ofO – Optimise function early action and management at• Check smoking status home if possible.• Query optimal drug therapy o Consider need for controlled• Check compliance oxygen• Review exercise status o Inhaled bronchodilators, oral• Check current device use glucocorticoids, and antibiotics are• Nutrition effective.• Consider sleep apnoea o Review regularly.P – Prevent deterioration• Essential steps: o Annual influenza vaccination o Pneumococcal vaccination