COPD Assessment and Action Plan

The assessment of COPD requires a multifactorial approach. Spirometry is required for diagnosis and is useful for assessment of severity of airway obstruction,
however after having established a spirometric diagnosis, management decisions should be individualized and guided by the severity of symptoms and disability,
as measured by the MRC scale.

Canadian Thoracic Society COPD Guidelines - 2008 update

Canadian Thoracic Society Abbreviated COPD Guidelines

What is COPD?
Who should be screened?
Who should get home O2?
Non-pharmacotherapy End of life care

Patient name		Date:
Patients age:		Sex:

Symptoms (Medical Research Council dyspnea scale):
1. Not troubled by breathlessness except with strenuous exercise
2. Troubled by shortness of breath when hurrying on the level or walking up a slight hill
3. Walks slower than people of the same age on the level because of breathlessness or has to stop for breath when walking at own pace on the level
4. Stops for breath after walking about 100 yards (90m) or after a few minutes on the level
5. Too breathless to leave the house or breathless when dressing or undressing

Smoking history:	Pack year	Current per day
What is your smoking history?

Exacerbation history:	Yes	No
One or more exacerbations per year for two consecutive years

Comorbidity symptoms:
Ankle swelling, findings of right heart failure/cor pulmonale
Weight loss/lean body mass

Spirometry results (post bronchodilator):
FEV1/FVC (post bronchodilator)
FEV1 as a percentage of the predicted (post bronchodilator)

COPD Action Plan

Family Doctor: Ph: Fax:

You have been diagnosed with COPD (chronic obstructive pulmonary disease)
COPD has 2 states:
1. You are stable. You are not short of breath, can do daily activities, can cough up mucus easily, sleep well, and are able to exercise. Or.....
2. You are having a flare up.

How to tell if you are having a flare up
A flare up may occur after you get a cold, get run down, are exposed to air pollution, or very hot/cold
weather. There are 3 things that define a flare up:
1. Increased shortness of breath from your usual level.
2. Increased amount of sputum from your usual level.
3. If your sputum changes from its usual colour to yellow, green, or rust colour.
You may also feel a change in mood, fatigue or low energy prior to a flare-up.

If 2 or more of these symptoms persist for 24 hours or more, do the following:
Take your rescue inhaler 2-4 puffs as needed (up to 4-6 times per day) for shortness of breath.
Call to make an appointment with your family doctor for a check up and medication review.
Use prescribed antibiotic for a COPD flare up.
Take
Use prescribed prednisone for a COPD flare up. Take
Call to make a more urgent appointment if you have not been seen and if you feel worse or do not feel better after 48 hours of treatment.
Other:

If you are extremely breathless, anxious, fearful, drowsy or having chest pain, call 911 for an ambulance to take you to the Emergency Department

Physician Signature:

Patient Signature: (optional)

Goals of COPD management

1) Prevention of disease progression (smoking cessation key)
2) Decrease of frequency and severity of exacerbations
3) Decrease symptoms including breathlessness
4) Improve exercise tolerance and daily activities
5) Recognize and treat flareups early
6) Prevent hospitalizations and emergency visits
7) Decrease premature deaths

COPD Maintenance Medication Record

Take the following maintenance medications as prescribed to help maintain control of your COPD symptoms.

COPD Stage:
BY SYMPTOMS
NORMAL
MILD	Dyspnoea from COPD hurrying on the level or walking up a slight hill
MODERATE	Dyspnoea from COPD causing patient to stop after waking 100m on the level
SEVERE	Dyspnoea from COPD with patient too breathless to leave home, breathless with dressing or chronic resp failure or R sided CHF

BY SPIROMETRY
NORMAL	FEV1/FVC >= 0.7
MILD	FEV1 >= 80% predicted. FEV1/FVC < 0.7
MODERATE	50% <= FEV1 < 80% predicted. FEV1/FVC < 0.7
SEVERE	30% <= FEV1 < 50% predicted. FEV1/FVC < 0.7
VERY SEVERE	FEV1 < 30% predicted. FEV1/FVC < 0.7

	Long acting anticholinergic	AND	OR	Tiotropium (Spiriva 18mcg QD INH)
	Long acting beta 2 agonist		OR	Salmeterol (Serevent 50mcg BID INH) or Formoterol (Oxeze 6mcg-24mcg BID INH)

	Long acting B2 agonist/ Low dose inhaled corticosteroid	Fluticasone/salmeterol or Budesonide/formoterol
	Long acting B2 agonist/ High dose inhaled corticosteroid	Fluticasone/salmeterol (Advair 50/500) or Budesonide/formoterol (Symbicort 400mcg )
	Oral theophylline	Theophylline (Theodur BID PO)

	Other strategies:
	Consider smoking cessation
	Encourage annual influenza vaccination
	Check pneumococcal vaccination status
	Consider pulmonary rehabilitation
	Create a personalized COPD Action Plan (Patient self management education)
	Consider home O2 assessment (Walk test, ABG for FEV1 < 40% predicted, low O2 on oximetry, respiratory failure/cor pulmonale)

COPD Action Plan

Goals of COPD management

COPD Maintenance Medication Record

COPD Flare-up Medication Record

Resources

	Pharmacotherapy:
	Short acting bronchodilator (anticholinergic and/or B2 agonist)QID or PRN	Ipratroprium and/or Salbutamol or Terbutaline

MEDICATION PRESCRIBED	Type of medication

MEDICATION PRESCRIBED	Start/Finish Date	Start/Finish Date