1. COPD Report
5 Coles Lane, Oakington, Cambridge, CB24 3BA

2. COPD Patient: COPD QOF diagnosis code
Practice Overview
COPD Patient: COPD QOF diagnosis code
Page 1

3. Contents Patient Demographics COPD Diagnosis COPD Health Status
Risk and Exacerbations
COPD Management & Reviews
Recommendations
Page 2

4. Age Distribution Co-morbidities Smoking Status Patient Demographics
Contents
Patient Demographics
Age Distribution
Co-morbidities
Smoking Status
COPD Diagnosis
COPD Health Status
Risk and Exacerbations
COPD Management & Reviews
Recommendations
Page 3

5. Patient Demographics
Age Distribution
Page 4

6. Co-morbidities Patient Demographics Page 5
Rhinitis: Read code entry in last 2 years or nasal steroid therapy in last year GERD, Depression/Anxiety: Read code entry in last 2 years
Page 5

7. Smoking Status Patient Demographics Page 6
Smoking status is obtained from patient questionnaires where available or from routine practice data
Page 6

8. Confirming Diagnosis COPD Severity Status Patient Demographics
Contents
Patient Demographics
COPD Diagnosis
Confirming Diagnosis
COPD Severity Status
COPD Health Status
Risk and Exacerbations
COPD Management & Reviews
Recommendations
Page 7

9. Confirming COPD Diagnosis*
COPD Diagnosis: COPD QOF diagnosis code
Page 8

10. COPD Severity Classification*
COPD Diagnosis
COPD Severity Classification*
Adapted from NICE and Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines
Page 9

11. COPD Severity in Patients with Confirmed Diagnosis*
COPD Diagnosis
COPD Severity in Patients with Confirmed Diagnosis*
Confirmed COPD diagnosis: where FEV1/FVC < 0.7
Page 10

12. MRC Breathlessness Score COPD Assessment Test (CAT) Score
Contents
Patient Demographics
COPD Diagnosis
COPD Health Status
MRC Breathlessness Score
COPD Assessment Test (CAT) Score
GOLD Combined Assessment of COPD
Risk and Exacerbations
COPD Management and Reviews
Recommendations
Page 11

13. Measuring COPD Health Status
Information from practice recorded data and patient questionnaire responses is used to assess the health status of patients with COPD in three ways:
The Medical Research Council (MRC) breathlessness score
COPD Assessment Test (CAT) score
Combined assessment of COPD using GOLD patient groups*
Global initiative for chronic Obstructive Lung Disease (GOLD) patient groups can be calculated from MRC or CAT scores, reliever use and lung function data
Page 12

14. MRC Breathlessness Scale
COPD Health Status
MRC Breathlessness Scale
Page 13

15. MRC Score* Distribution
COPD Health Status
MRC Score* Distribution
MRC data is obtained from patient questionnaires where available or from routine practice data
Page 14

16. MRC Score* and COPD Severity
COPD Health Status
MRC Score* and COPD Severity
OPC Service
MRC data is obtained from patient questionnaires where available or from routine practice data
Page 15

17. COPD Assessment Test (CAT)
COPD Health Status
COPD Assessment Test (CAT) 1 2 3 4 5
I never cough
I cough all the time
I have no phlegm (mucus) in my chest at all
My chest is full of phlegm (mucus)
My chest does not feel tight at all
My chest feels very tight
When I walk up a hill or one flight of stairs I am not breathless
When I walk up a hill or one flight of stairs I am very breathless
I am not limited doing any activities at home
I am very limited doing any activities at home
I am confident leaving my home despite my lung condition
I am not at all confident leaving my home despite my lung condition
I sleep soundly
I don’t sleep soundly because of my lung condition
I have lots of energy
I have no energy at all
Page 16

18. Application of CAT Score
COPD Health Status
Application of CAT Score
Page 17

19. CAT Score* Distribution
COPD Health Status
CAT Score* Distribution
CAT data is obtained from patient questionnaires where available or from routine practice data
Page 18

20. GOLD Combined Assessment of COPD*
COPD Health Status
GOLD Combined Assessment of COPD*
The combined assessment of COPD aims to determine severity of disease, its impact on patients’ health status, and risk of future adverse events (exacerbations, hospitalisations, etc.) It provides a rubric for combining the key assessments of COPD to improve management of patients by categorizing them into the GOLD patients groups A, B, C or D.
The key assessments include: severity of airflow limitation, symptoms and exacerbations. When assessing risk, choose the highest risk according to airflow limitation or exacerbation history (one or more hospitalisations for exacerbations is considered high risk).
Adapted from Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines 2014
Page 19

21. GOLD Combined Assessment of COPD*
COPD Health Status
GOLD Combined Assessment of COPD*
GOLD Patient Groups
RISK
Airflow Limitation
RISK
FEV1% Predicted
< 50% C D
Exacerbation History
≥ 2
or ≥ 1
with hospitalisation
FEV1% Predicted
≥ 50% A B 1
without hospitalisation
CAT <10 or
mMRC 0 – 1
CAT ≥10 or
mMRC ≥ 2
SYMPTOMS or BREATHLESSNESS
Adapted from Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines 2014
Page 20

22. GOLD Combined Assessment of COPD
COPD Health Status
GOLD Combined Assessment of COPD
Page 21

23. Future Risk – DOSE Score
Contents
Patient Demographics
COPD Diagnosis
COPD Health Status
Risk and Exacerbations
Exacerbations
Future Risk – DOSE Score
COPD Management and Reviews
Recommendations
Page 22

24. Exacerbations* Risk and Exacerbations Page 23
Exacerbations: exacerbation Read code entry or patient reported exacerbation & hospitalisations & number of courses of oral steroids in last 12 months
Page 23

25. Exacerbations and COPD Severity
Risk and Exacerbations
Exacerbations and COPD Severity
OPC Service
Page 24

26. Future Risk: DOSE Score
Risk and Exacerbations
Future Risk: DOSE Score
DOSE Score = Sum of Points scored for each DOSE item
Validated research demonstrates that DOSE Score ≥ 4 is indicative of increased future risk of exacerbation, hospitalisation and mortality
Page 25

27. Future Risk: DOSE Score Distribution
Risk and Exacerbations
Future Risk: DOSE Score Distribution
Page 26

28. DOSE Score and COPD Severity
Risk and Exacerbations
DOSE Score and COPD Severity
OPC Service
Page 27

29. Pharmacotherapy Management COPD Reviews
Contents
Patient Demographics
COPD Diagnosis
COPD Health Status
Risk and Exacerbations
COPD Management & Reviews
Smoking
Pharmacotherapy Management
COPD Reviews
Recommendations
Page 28

30. Smoking Status and COPD Severity
COPD Management & Reviews
Smoking Status and COPD Severity
OPC Service
Page 29

31. Pharmacotherapy Management: NICE Guidelines 2010
COPD Management & Reviews
Pharmacotherapy Management: NICE Guidelines 2010
Page 30

32. Pharmacotherapy Management
COPD Management & Reviews
Pharmacotherapy Management
Page 31

33. Pharmacotherapy Management by COPD Severity:
COPD Management
Pharmacotherapy Management by COPD Severity:
All patients
Page 32

34. Pharmacotherapy Management by MRC Score:
COPD Management & Reviews
Pharmacotherapy Management by MRC Score:
Mild & Moderate Patients (FEV1% Predicted ≥ 50%)
Page 33

35. Pharmacotherapy Management by MRC Score:
COPD Management & Reviews
Pharmacotherapy Management by MRC Score:
Severe & Very Severe Patients (FEV1% Predicted < 50%)
Page 34

36. Pharmacotherapy Management by Exacerbations:
COPD Management & Reviews
Pharmacotherapy Management by Exacerbations:
Mild & Moderate Patients (FEV1% Predicted ≥ 50%)
Page 35

37. Pharmacotherapy Management by Exacerbations:
COPD Management & Reviews
Pharmacotherapy Management by Exacerbations:
Severe & Very Severe Patients (FEV1% Predicted < 50%)
Page 36

38. COPD Reviews & Self-Management Plans*
COPD Management & Reviews
COPD Reviews & Self-Management Plans*
COPD Reviews and Self-management plans provided in the 12 months prior to the date of extraction and recorded by Read code entry
Page 37

39. Therapy Recommendation Management Recommendation
Contents
Patient Demographics
COPD Diagnosis
COPD Health Status
Risk and Exacerbations
COPD Management & Reviews
Recommendations
Therapy Recommendation
Management Recommendation
Page 38

40. PLEASE NOTE Recommendations
The practice report recommendations have been grouped into ‘Therapy Recommendations’ and ‘Management Recommendations’. Please consider both groups of recommendations together, as a holistic approach is vital for effective patient care and optimising patient outcomes.
Patients covered within each recommendation and the patient questionnaire responses can be viewed on your COPD patient level reports, through the OPC Tools application on your practice computer. Please refer to the ‘Viewing Patient Reports’ user-guide to assist you in this regard. Alternatively, please contact the OPC service delivery team for assistance.
Optimum Patient Care
5 Coles Lane, Oakington, Cambridge, CB24 3BA
Tel:
Page 39

41. Therapy Recommendations
Adapted from NICE and Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines
Page 40

42. Your Practice Therapy Recommendations
Page 41

43. Management Recommendations
Adapted from NICE and Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines
Page 42

44. Management Recommendations
Page 43

45. Your Practice Management Recommendations
Page 44