Monitor Disease Progression and Dev

Monitor Disease Progression and Development of Complications Measurements. Decline in lung function is best tracked by spirometry performed at least once a year to identify patients whose lung function is declining quickly. Questionnaires such as the COPD Assessment Test (CAT)124 can be performed every two to three months; trends and changes are more valuable than single measurements.
Symptoms. At each visit, inquire about changes in symptoms since the last visit, including cough and sputum,
breathlessness, fatigue, activity limitation, and sleep disturbances. Smoking Status. At each visit, determine current smoking status and smoke exposure; strongly encourage participation in programs to reduce and eliminate wherever possible exposure to COPD risk factors.
Monitor Pharmacotherapy and Other Medical Treatment In order to adjust therapy appropriately as the disease progresses, each follow-up visit should include a discussion of the current therapeutic regimen. Dosages of various medications, adherence to the regimen, inhaler technique, effectiveness of the current regime at controlling symptoms, and side effects of treatment should be monitored. Treatment modifications should be recommended as appropriate with a focus on avoiding unnecessary polypharmacy. At the individual patient level, measurements such as FEV1 and questionnaires such as the CAT are useful but are not completely reliable, because the size of a clinically important response is smaller than between-assessment variability. For this reason, the following questions might be useful when deciding whether a patient has had a symptomatic response to treatment:
• Have you noticed a difference since starting this treatment? • If you are better: Are you less breathless? Can you do more? Can you sleep better? Describe what difference it has made to you. • Is that change worthwhile to you?
Monitor Exacerbation History Evaluate the frequency, severity, and likely causes of any exacerbations391. Increased sputum volume, acutely worsening dyspnea, and the presence of purulent sputum should be noted. Specific inquiry into unscheduled visits to providers, telephone calls for assistance, and use of urgent or emergency care facilities is important. Severity of exacerbations can be estimated by the increased need for bronchodilator medication or corticosteroids and by the need for antibiotic treatment. Hospitalizations should be documented, including the facility, duration of stay, and any use of critical care or mechanical ventilatory support.
Monitor Comorbidities
Comorbidities are common in COPD, amplify the disability associated with COPD, and can potentially complicate its management. Until more integrated guidance about disease management for specific comorbid problems becomes available, the focus should be on identification and management of these individual problems in line with local treatment guidance (See also Chapter 6).