Ongoing monitoring and review of stable COPD

Review patients with chronic obstructive pulmonary disease (COPD) regularly; the frequency of review depends on the disease severity (symptoms and exacerbation history).

Suggested review intervals and assessments according to severity are outlined in Review intervals and suggested assessment of patients with COPD according to severity.

At each review, consider whether any change (step up or step down) of therapy is required.

The COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) dyspnoea scale are useful to assess changes in quality of life, breathlessness and functional limitation, and can help to quantify the patient’s perception of treatment adequacy.

Table 1. Review intervals and suggested assessment of patients with COPD according to severity
Mild to moderate COPD [NB1]
Review at least annually [NB2] Assess: need for referral to specialist physician or other services (see Multidisciplinary care for COPD) smoking status and motivation to quit adequacy of symptom control, including breathlessness and exercise tolerance exacerbation frequency need for pulmonary rehabilitation presence of sequelae of COPD (eg hypoxaemia) benefits and adverse effects of each drug treatment inhaler technique adherence written COPD action plan presence of psychiatric comorbidities (eg depression, anxiety) Measure: FEV₁ and FVC [NB3] CAT score [NB4] mMRC breathlessness score [NB5] BMI
Severe COPD [NB1]
Review at least twice per year [NB2] Assess as for mild to moderate COPD, plus: presence of cor pulmonale presence of coexisting cardiovascular disease (including heart failure, atrial fibrillation, ischaemic heart disease), particularly if there is evidence of recent COPD deterioration need for long-term oxygen therapy nutritional state need for social services and occupational therapy input need for referral for specialist surgical procedures need for end-of-life discussion and advance care planning Measure as for mild to moderate COPD, plus: arterial blood gases if SpO₂ is less than 90%
Note: BMI = body mass index; CAT = COPD Assessment Test; COPD = chronic obstructive pulmonary disease; FEV₁ = forced expiratory volume in 1 second; FVC = forced vital capacity; mMRC = modified Medical Research Council; SpO₂ = oxygen saturation measured by pulse oximetry NB1: See Classification of stable COPD severity for classification of COPD severity. NB2: More frequent opportunistic assessment of factors such as inhaler technique, smoking status, symptom control and adverse effects of treatment is encouraged. NB3: Perform spirometry annually in all patients with COPD. NB4: The CAT is available here. NB5: The mMRC dyspnoea scale is available here.