COPD Review

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Key Points

- This secure form will allow you to provide the information your GP team needs to review your COPD.
- This includes some questions about key COPD symptoms.
- Coughing up blood or unintended weight loss may indicate a serious problem. In this case please abandon this online review and contact the practice directly.
- Your answers may not be seen immediately meaning this service is not suitable for seeking urgent or emergency care.
- This form should only be used by someone over the age of 13.
- When you are ready to complete your review, click the "Review my COPD" tab above.

Vaccines

- Exacerbations or flare-ups of COPD are mainly caused by respiratory viruses and bacteria.
- These respiratory bugs lead to increased inflammation and chest infections.
- Vaccination can reduce the number of exacerbations of the disease and reduce hospital admissions.
- The first reccomendation is the Influenza (flu) vaccine (normally administered once a year in October or November).
- The second reccomendation is the Pneumococcal vaccine (for most people this is a one-off vaccine).

Helpful Tips

- If your inhaler contains a steroid, brush your teeth or rinse your mouth with water and spit it out after every use to prevent mouth infections.
- All used inhalers should be returned to a pharmacy to be disposed of safely.
- If you have your own oxygen saturation machine at home and it falls below 90%, then this may indicate a serious problem.
- If your oxygen level falls below 90%, you should contact the urgent care services (111).


Your Details:
DOB:
These questions relate to your general health.
How many Standard Drinks of alcohol do you have on average each week?
How much / what do you smoke each day (if anything)?
How would you like to enter your height and weight?
Your BMI is one indicator of a healthy weight.

Your BMI: Please provide your height and weight

Breathing Review

These questions help us quantify the impact of COPD symptoms on your overall health and form the COPD Assessment Test (CAT), which is a trademark of the GSK group.

I never cough
I cough all the time
0
Set at: 0
5
I have no phlegm (mucus) on my chest at all
My chest is full of phlegm (mucus)
0
Set at: 0
5
My chest does not feel tight at all
My chest feels very tight
0
Set at: 0
5
When I walk up a hill or a flight of stairs I am not out of breath
When I walk up a hill or a flight of stairs I am completely out of breath
0
Set at: 0
5
I am not limited to doing any activities at home
I am completely limited to doing all activities at home
0
Set at: 0
5
I am confident leaving my home despite my lung condition
I am not confident leaving my home at all because of my lung condition
0
Set at: 0
5
I sleep soundly
I do not sleep soundly because of my lung condition
0
Set at: 0
5
I have lots of energy
I have no energy at all
0
Set at: 0
5
Breathing Control.
The following questions are about your breathing control.
How breathless do you currently get (MRC Question)?
You can provide your oxygen reading here (if known). Don't add the % sign.
Are you receiving longterm oxygen therapy at home?
Daily Management

The following questions are about your everyday COPD management.

A preventer inhaler is a regular inhaler taken to prevent lung symptoms. Do you have a preventer inhaler?
These questions are about what you do when your COPD worsens
How do you manage if your COPD is much worse than normal (tick all that apply or leave blank if none apply)?
Separate reliever inhaler
Reliever Inhaler
Start treatment course
Rescue Tablets
Monitor Oxygen Levels
Oxygen Reading
These questions are about sudden COPD exacerbations
Exacerbations are sudden worsening of your symptoms such as coughing up phlegm, tight chest and breathlessness. Exacerbations often require additional treatment, such as steroids and antibiotics, and are especially common in the winter.
Have you had an exacerbation in the last year?
Do you feel your breathing is well controlled?
Are you happy for a clinician to see your responses and complete your review without further discussion (if appropriate)?

Questions, concerns or additional comments: