Chronic obstructive pulmonary disease (COPD) is a common disabling condition with a high mortality. The most effective treatment is smoking cessation. Oxygen therapy has been shown to prolong life in the later stages of the disease and has also been shown to have a beneficial impact on exercise capacity and mental state. Some patients respond to inhaled steroids. Many patients respond symptomatically to inhaled beta agonists and anti-cholinergics. Pulmonary rehabilitation has been shown to produce an improvement in quality of life.
The majority of patients with COPD are managed by general practitioners and members of the primary healthcare team with onward referral to secondary care when required. This measure is one of five Chronic Obstructive Pulmonary Disease (COPD) measures. The Chronic Obstructive Pulmonary Disease (COPD) set focuses on the diagnosis and management of patients with symptomatic COPD.
There is a gradual deterioration in lung function in patients with COPD. This deterioration accelerates with the passage of time. There are important interventions which can improve quality of life in patients with severe COPD. It is therefore important to monitor respiratory function in order to identify patients who might benefit from pulmonary rehabilitation or continuous oxygen therapy.
Current guidance states that there are no clear guidelines with regard to the optimum frequency of spirometry for patients with COPD and the time interval was pragmatically set at two years. However, NICE Clinical Guideline 12 (Feb 2004), endorsed by the British Thoracic Society, now suggests that FEV1 and inhaler technique should be assessed at least annually for people with mild/moderate COPD (and in fact at least twice a year for people with severe COPD). The purpose of regular monitoring is to identify patients with increasing severity of disease who may benefit from referral for more intensive treatments/diagnostic review.
The Quality and Outcomes Framework (QOF) does not set specific criteria for the management of severe COPD. However, practices should identify by symptoms and regular spirometry those patients who would benefit from long-term oxygen therapy and pulmonary rehabilitation.
These measures require specialist referral because of the need to measure arterial oxygen saturation to assess suitability for oxygen therapy, and the advisability of specialist review of patients prior to starting pulmonary rehabilitation.
The long-term administration of oxygen (greater than 15 hours per day) to patients with chronic respiratory failure has been shown to increase survival and improve exercise capacity.
