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CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): ROUTINE CARE• Ensure that a doctor confirms the diagnosis of COPD within 1 month of diagnosis.Assess the patient with COPDAssess When to assess NoteCOPD symptoms: persistentcough and difficult breathingEvery visit• Assess disease severity: difficulty breathing occurs with strenuous activity like climbing stairs (mild COPD), at normal pace like walking (moderate COPD)or with activities of daily living like dressing (severe COPD).• In patient with cough:--Treat for chest infection as below if sputum increases or changes in colour to yellow/green.--Investigate for TB only if patient has other TB symptoms like weight loss, sweats 55.Other symptoms Every visit • Manage symptoms as on symptom pages.• Ask the patient using inhaled corticosteroids about a sore mouth 14. See advice below.• If patient has leg swelling, refer to doctor for assessment.Medication use Every visit • Ensure patient is adherent to treatment before adjusting or adding treatment.• Check that patient can use inhaler and spacer correctly 65.CVD risk assessment At diagnosis • The patient with COPD is at increased risk of cardiovascular disease.• Assess the patient’s CVD risk 68.Advise the patient with COPD• Ask about smoking. If yes, urge patient to stop. This is the mainstay of COPD care.• Exercise: encourage the patient to take a walk daily and to increase activities of daily living like gardening, housework and using stairs instead of lifts.• Help the patient to manage his/her CVD risk 69.• Check that patient can use inhaler and spacer correctly 65.• Inhaled corticosteroids can cause oral thrush: advise patient to rinse and gargle after each dose of inhaled corticosteroid.Treat the patient with COPD• Ensure patient can use inhaler and spacer correctly before adjusting treatment 65.• Give bronchodilator inhaled salbutamol 2 puffs when needed (up to 4 times a day).• Give influenza vaccination yearly and pneumococcal vaccination every 5 years.• Add bronchodilator inhaled ipratropium bromide 2 puffs when needed (up to 4 times a day) if moderate or severe COPD.• Add slow release theophylline 200–300mg twice a day long-term if severe COPD.• Treat for chest infection if sputum increases or changes in colour to yellow/green:--Give amoxicillin 500mg 8 hourly for 10 days or doxycycline 100mg 12 hourly for 10 days.--If increased breathlessness, give oral prednisone 40mg daily for 7 days if severe COPD.--Doctor to give inhaled corticosteroid budesonide 400µg 12 hourly if severe COPD and > 2 chest infections per year.Review every 3–6 months if stable.67