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 for
C: 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
or
FEV1 o Consider long-term home oxygen
FVC o Facilitate pulmonary rehabilitation.
FEV1/ • Refer to hospital if:
FVC o Inadequate response to ambulatory
management
COPD definition: post-bronchodilator o Inability to walk between rooms
FEV1/FVC <0.7 and FEV1 < 80% predicated. when previously mobile
If fully resersible (to normal values) treat as o Inability to eat or sleep because of
asthma. dyspnoea
o Altered mental status suggestive of
Reversibility = (FEV1 post BD) – (FEV1 pre hypercapnia
BD)/FEV1 pre BD x 100 o Worsening hypoxaemia or cor
pulmonale
Grade 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 of
O – 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