COPD Report 5 Coles Lane Oakington Cambridge CB

COPD Report 5 Coles Lane, Oakington, Cambridge, CB 24 3 BA

Practice Overview COPD Patient: COPD QOF diagnosis code Page 1

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

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

Patient Demographics Age Distribution Page 4

Patient Demographics Co-morbidities 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

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

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

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

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

COPD Diagnosis COPD Severity in Patients with Confirmed Diagnosis* Confirmed COPD diagnosis: where FEV 1/FVC < 0. 7 Page

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

COPD Health Status 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

COPD Health Status MRC Breathlessness Scale Page

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

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

COPD Health Status COPD Assessment Test (CAT) I never cough 0 1 2 3 4 5 I cough all the time I have no phlegm (mucus) in my chest at all 0 1 2 3 4 5 My chest is full of phlegm (mucus) My chest does not feel tight at all 0 1 2 3 4 5 My chest feels very tight When I walk up a hill or one flight of stairs I am not breathless I am not limited doing any activities at home I am confident leaving my home despite my lung condition 0 1 2 3 4 5 When I walk up a hill or one flight of stairs I am very breathless 0 1 2 3 4 5 I am very limited doing any activities at home 0 1 2 3 4 5 I am not at all confident leaving my home despite my lung condition I sleep soundly 0 1 2 3 4 5 I don’t sleep soundly because of my lung condition I have lots of energy 0 1 2 3 4 5 I have no energy at all Page

COPD Health Status Application of CAT Score Page

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

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

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

COPD Health Status GOLD Combined Assessment of COPD Page

Contents � Patient Demographics � COPD Diagnosis � COPD Health Status � Risk and Exacerbations § Future Risk – DOSE Score � COPD Management and Reviews � Recommendations Page

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

Risk and Exacerbations and COPD Severity OPC Service Page

Risk and Exacerbations Future Risk: 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

Risk and Exacerbations Future Risk: DOSE Score Distribution Page

Risk and Exacerbations DOSE Score and COPD Severity OPC Service Page

Contents � Patient Demographics � COPD Diagnosis � COPD Health Status � Risk and Exacerbations � COPD Management & Reviews § Smoking § Pharmacotherapy Management § COPD Reviews � Recommendations Page

COPD Management & Reviews Smoking Status and COPD Severity OPC Service Page

COPD Management & Reviews Pharmacotherapy Management: NICE Guidelines 2010 Page

COPD Management & Reviews Pharmacotherapy Management Page

COPD Management Pharmacotherapy Management by COPD Severity: All patients Page

COPD Management & Reviews Pharmacotherapy Management by MRC Score: Mild & Moderate Patients (FEV 1% Predicted ≥ 50%) Page

COPD Management & Reviews Pharmacotherapy Management by MRC Score: Severe & Very Severe Patients (FEV 1% Predicted < 50%) Page

COPD Management & Reviews Pharmacotherapy Management by Exacerbations: Mild & Moderate Patients (FEV 1% Predicted ≥ 50%) Page

COPD Management & Reviews Pharmacotherapy Management by Exacerbations: Severe & Very Severe Patients (FEV 1% Predicted < 50%) Page

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

Contents � Patient Demographics � COPD Diagnosis � COPD Health Status � Risk and Exacerbations � COPD Management & Reviews � Recommendations § Therapy Recommendation § Management Recommendation Page

Recommendations PLEASE NOTE 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, CB 24 3 BA Tel: 01223 967 855 E-mail: services@optimumpatientcare. org Page