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Patient Oriented Evidence that Matters

Introduction COPD POEM PDF
The COPDX Plan
Confirm diagnosis & assess severity
Optimise function
Prevent deterioration
Develop support network & self-management plan
eXacerbations manage appropriately
Review of drug use in COPD
Appendix One - Resources and contacts

P Prevent deterioration

Smoking status

Smoking cessation is the only intervention which will halt the accelerated decline in lung function seen in COPD (see diagram). It is effective at all stages of the disease.

No medication has been shown to prevent the long-term decline in lung function.

Adapted from Fletcher, C & Peto, R7
Time Course of COPD (NZGG, 2002)

The risks of developing chronic obstructive lung disease: the lines illustrate the natural decline and the effects that smoking and stopping smoking can have on FEV1. = death. This graph shows the rate of loss of FEV1 for a hypothetical, suseptable smoker, and the potential effect of stopping smoking early or late in the course of COPD. Other susceptible smokers will have different rates of loss, thus reaching ‘disability’ at different ages. The normal FEV1 ranges from below 80% to above 120% so this will affect the starting point for the individual’s data (not shown)

The task of the clinician is to determine the patient's position on the smoking cessation cycle and use this knowledge to move the patient at least one step around the cycle.

Suggested schema for review of people with COPD on ICS

Brief counselling is an effective way of progressing people around the cycle and should be provided at every visit. The 5-A strategy is currently accepted best practice:

  • Ask and identify smokers.
  • Advise smokers about the risks of smoking and benefits of quitting and discuss options.
  • Assess their readiness to quit, degree of nicotine dependence and explore what would motivate them to quit.
  • Assist cessation this may include specific advice about pharmacological interventions or referral to a formal cessation programme.
  • Arrange follow-up (by you or someone else) to reinforce the message.

Smoking cessation counselling is effective especially if combined with nicotine replacement therapy (NRT). This is covered in the guide for Primary Care Nurses which has been produced as a supplement to this POEM.

Recall list for influenza and pneumococcal vaccination

Annual influenza vaccination is recommended for all patients with COPD. The evidence for pneumococcal vaccination is less convincing but vaccination every five years will help prevent pneumonia in these patients with already reduced respiratory reserve.

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