Respiratory[autotexts]

COPD / Consultation template

New COPD patient

First assessment, with the spirometry that confirms it, the exacerbation history that grades it, and the interventions that actually change outcomes.

Fills in order
  1. 1Referred with
  2. 2Breathlessness, MRC dyspnoea scale
  3. 3Cough and sputum
  4. 4Blood in the sputum
  5. 5Wheeze and chest tightness
  6. 6Exercise tolerance
  7. 7What they can no longer do that they use…
  8. 8Weight change
  9. 9Courses of antibiotics or steroids
  10. 10Hospital admissions
  11. 11Any ventilatory support
  12. 12Smoking
  13. 13Vaping
  14. 14Occupational dust, fume and vapour expos…
  15. 15Biomass or indoor cooking fuel exposure
  16. 16Childhood chest illness, prematurity, as…

and 40 more, in the block below.

Paste block 56 fields 
Referred with: []

History:
Breathlessness, MRC dyspnoea scale [1 to 5]
Cough and sputum: [daily, colour, volume]
Blood in the sputum: [yes or no]
Wheeze and chest tightness: []
Exercise tolerance: [metres on the flat, and stairs]
What they can no longer do that they used to: []
Weight change: []

Exacerbation history in the last 12 months:
Courses of antibiotics or steroids: []
Hospital admissions: []
Any ventilatory support: []

Risk factors:
Smoking: [current or ex, pack-years, quit date]
Vaping: []
Occupational dust, fume and vapour exposure: []
Biomass or indoor cooking fuel exposure: []
Childhood chest illness, prematurity, asthma: []
Family history of emphysema or liver disease, and age of onset: []

Comorbidity:
Cardiovascular disease: []
Osteoporosis and fracture history: []
Anxiety and depression: []
Nutrition, weight [] kg, BMI []
Bronchiectasis symptoms: []

Current treatment and how it is taken:
Inhalers: [drug, device, dose, doses per day]
Inhaler technique observed today: [adequate, or the specific error seen]
Adherence by prescription collection: []
Home oxygen or nebuliser already in place: []

Examination:
SpO2 []% on air   BP [] mmHg   Pulse [] bpm
Height [] cm   Weight [] kg   BMI []
[barrel chest, accessory muscle use, pursed lip breathing, chest signs, ankle oedema]

Investigations:
Post-bronchodilator spirometry: FEV1 [] L ([]% predicted), FVC [] L, ratio []%
Full lung function including gas transfer: []
Blood eosinophils [] x10^9/L
Alpha-1 antitrypsin level: []
Chest x-ray: []
CT chest: []
ECG and echocardiogram if indicated: []
Full blood count for anaemia or polycythaemia: []

Impression:
COPD confirmed on post-bronchodilator ratio below 0.7, FEV1 []% predicted,
MRC [], [] exacerbations in the last year, [with or without] a history of
hospitalisation.

Plan:
1. Smoking: [very brief advice given, referred to stop smoking service,
pharmacotherapy offered]
2. Pulmonary rehabilitation: [referred, or reason not]
3. Vaccination: [influenza, pneumococcal, COVID-19, RSV as eligible]
4. Inhaled treatment: [drug and device, chosen with the patient]
5. Inhaler technique taught and checked: []
6. Self-management plan and rescue pack: [issued or not, with reason]
7. Assessment for long-term oxygen: [not indicated, or arranged]
8. Treat comorbidity: []
9. Review in [] months

How to use it

The diagnosis needs post-bronchodilator spirometry with a ratio below 0.7 and a history that fits; a ratio alone in a lifelong non-smoker with no exposure history should make you look harder rather than write COPD. Grade the disease on three axes and record all three, because they drive different decisions: how bad the airflow obstruction is, how breathless the person is, and how often they exacerbate. Check alpha-1 antitrypsin at least once — the guidance is to test early-onset disease, a minimal smoking history or a family history, and it is a single tube that occasionally changes a family's future as well as a patient's. The plan is ordered deliberately: stopping smoking and pulmonary rehabilitation do more for symptoms, admissions and survival than any inhaler, and they should not be the ninth thing you get to. NETT and the long-term oxygen trials are in the evidence panel because both are still routinely misapplied — oxygen for breathlessness without hypoxaemia does not help.

Why it says that

None of this is in the copied text. It is here so you can check the block against its source, and change it when the source changes.

Trials behind it

  • ETHOS 2020 Triple therapy beat both dual therapies, and the lower steroid dose worked as well as the higher
  • IMPACT 2018 Triple therapy reduced exacerbations versus either dual therapy, at the cost of more pneumonia
  • TORCH 2007 Salmeterol/fluticasone narrowly missed a mortality benefit but reduced exacerbations, at the cost of more pneumonia
  • NETT 2003 No overall survival benefit, but a real one for upper-lobe emphysema with low exercise capacity
  • MRC oxygen 1981 Domiciliary oxygen for at least 15 hours a day improved survival in hypoxaemic cor pulmonale
  • NOTT 1980 Continuous oxygen halved mortality compared with nocturnal-only oxygen in hypoxaemic COPD

Records on respiratorytrials.org.

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