Effective COPD reviews are shown to improve outcomes for patients. Patients with COPD should be reviewed both after an exacerbation and yearly or 6 monthly, according to the severity of their condition .
The guide below gives you some ideas about the questions you can ask during a COPD review. You can use our COPD Self-Management Plan to record the outcomes of the review. You can also give your patient our Living with COPD and our Breathlessness booklets.
| Question to ask | Why this question matters |
|---|---|
| How are you getting on with your COPD? |
This gives your patient the opportunity to share:
Listening with compassion and respect helps to build the therapeutic relationship with your patient This is essential for motivating them to become involved with and take ownership of their care, which will improve their outcome. |
| Have you had any flare ups since your last review? Have you used your rescue pack? |
Repeated exacerbations are associated with worse patient outcomes and many exacerbations go unreported .
|
| Does your breathlessness ever make you feel frightened? | Anxiety related to COPD can be debilitating and responds well to cognitive behavioural techniques. |
| What medications are you currently taking? Are they working well for you? Are you having any side effects? |
Understanding what your patient is actually taking and how it is helpful or unhelpful will guide you to optimising their mediations |
| Can you show mw how you use your inhaler? Do you find it easy to remember to take it? How often are you using your reliever inhaler? |
Ensure that your patient is able to use their inhaler device, understands when to use it and is taking it as prescribed. SABA use can indicate increased breathlessness which could be helped by self-management strategies or by changing inhaler/other medications. |
| Do you smoke at all? | Non-judgemental questioning makes sure that your patient can be honest and not feel ashamed or guilty about smoking especially if they have relapsed. Offering smoking cessation advice should be offered at every contact in case this is the right moment for your patient to quit. |
| Can I tell you about something I think you’ll really benefit from – it’s called pulmonary rehabilitation. | As with smoking cessation, offer PR to your patient even if they have previously declined. You can also make them aware of our Keeping Active programme. |
| Are you bringing up any phlegm from your chest? How much? What colour is it? Is it ever bloody? |
Understanding your patient’s mucous production and the effect is is having on their life enables you to:
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| Have you had all the vaccinations that you need? | Use this opportunity to talk through any worries or concerns your patient might have about vaccinations and give missed vaccines opportunistically. |
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How are you feeling emotionally? Do you feel worried, or low in mood? |
People with COPD are more likely to experience anxiety and/or depression than people without COPD, and tend to have worse outcomes if they do. |
| How’s everything at home? Are you managing cooking/cleaning/shopping/washing etc? | To identify if they have any care needs due to change in their physical condition. Refer to social prescriber if necessary. |
| Do you have any concerns around money? | Your patient may not be aware of the benefits that are available to them, including winter fuel payments and attendance allowance. If your patient is on home oxygen, they can receive help with electricity bills. |
Physical assessment
| Record | Why this is important |
|---|---|
| Record their CAT and mMRC score Check heart rate and rhythm, blood pressure and assess nutritional status Check for peripheral oedema. |
To measure changes in breathlessness and health status since their last review. To identify any comorbidities such as hypertension, atrial fibrilation, cor pulomnale, malnutrition or obesity. |
| Check their vitamin D levels | Low vitamin D is associated with moderate/severe exacerbations |
| Check oxygen saturations | To identify if your patient needs to be referred for an oxygen assessment. |