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Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care [CG101]

Measuring the use of this guidance

Recommendation: 1.1.1.3

One of the primary symptoms of COPD is breathlessness. The Medical Research Council (MRC) dyspnoea scale (see table 1) should be used to grade the breathlessness according to the level of exertion required to elicit it.

What was measured: The proportion of people on COPD registers in Wales that have a MRC breathlessness score recorded.
Data collection end: March 2015
88.9%
Area covered: Wales
Source: Royal College of Physicians. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: National primary care audit (Wales).


Recommendation: 1.1.2.2

Measure post-bronchodilator spirometry to confirm the diagnosis of COPD.

What was measured: Proportion of patients with COPD (diagnosed on or after 1 April 2011) in whom the diagnosis has been confirmed by post bronchodilator spirometry between 3 months before and 12 months after entering on to the register.
Data collection end: July 2015
81.09%
Area covered: England
Source: Health and Social Care Information Centre. Quality Outcomes Framework.

What was measured: The proportion of people on the COPD register in Wales that have an electronic record of the postbronchodilator FEV1/FVC ratio.
Data collection end: March 2015
19.7%
Area covered: Wales
Source: Royal College of Physicians. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: National primary care audit (Wales).


Recommendation: 1.1.3.1

At the time of their initial diagnostic evaluation in addition to spirometry all patients should have: a chest radiograph to exclude other pathologies a full blood count to identify anaemia or polycythaemia body mass index (BMI) calculated.

What was measured: The proportion of people on COPD registers in Wales that have a record of chest X-ray around the time of diagnosis.
Data collection end: March 2015
63.2%
Area covered: Wales
Source: Royal College of Physicians. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: National primary care audit (Wales).


Recommendation: 1.2.1.2

All COPD patents still smoking, regardless of age, should be encouraged to stop, and offered help to do so, at every opportunity

What was measured: Proportion of pharmacists who routinely asked about the smoking status of those they dispensed COPD medication to
Data collection end: April 2007
19.6%
Number that met the criteria: 203 / 1037
Area covered: Local
Source: Verma. A., Harrison, A., Torun, P., Vestbo, J., Edwards, R. and Thornton, J. (2012). Are pharmacists reducing COPD’S impact through smoking cessation and assessing inhaled steroid use? Respiratory Medicine, Vol 106, pp 230-234.

What was measured: Proportion of those pharmacists who ascertained smoking status, offered advice on the additional risk of continuing to smoke
Data collection end: April 2007
93.1%
Number that met the criteria: 189 / 203
Area covered: Local
Source: Verma. A., Harrison, A., Torun, P., Vestbo, J., Edwards, R. and Thornton, J. (2012). Are pharmacists reducing COPD’S impact through smoking cessation and assessing inhaled steroid use? Respiratory Medicine, Vol 106, pp 230-234.

What was measured: Proportion of pharmacists that did not ascertain smoking status who offered advice about continuing risk of smoking
Data collection end: April 2007
3.6%
Number that met the criteria: 30 / 834
Area covered: Local
Source: Verma. A., Harrison, A., Torun, P., Vestbo, J., Edwards, R. and Thornton, J. (2012). Are pharmacists reducing COPD’S impact through smoking cessation and assessing inhaled steroid use? Respiratory Medicine, Vol 106, pp 230-234.

What was measured: Proportion of pharmacists overall who offered some form of advice regarding either cessation or risks of continuing to smoke when dispensing COPD medications
Data collection end: April 2007
22.5%
Number that met the criteria: 233 / 1037
Area covered: Local
Source: Verma. A., Harrison, A., Torun, P., Vestbo, J., Edwards, R. and Thornton, J. (2012). Are pharmacists reducing COPD’S impact through smoking cessation and assessing inhaled steroid use? Respiratory Medicine, Vol 106, pp 230-234.

What was measured: The proportion of people who were current tobacco smokers who had been referred for smoking cessation in the last year.
Data collection end: March 2015
74.3%
Area covered: Wales
Source: Royal College of Physicians. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: National primary care audit (Wales).


Recommendation: 1.2.1.3

Unless contraindicated, offer NRT, varenicline or bupropion, as appropriate, to people who are planning to stop smoking combined with an appropriate support programme to optimise smoking quit rates for people with COPD.

What was measured: The proportion of people with COPD who were current tobacco smokers and received pharmacology for tobacco dependency in the last year.
Data collection end: March 2015
10.8%
Area covered: Wales
Source: Royal College of Physicians. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: National primary care audit (Wales).


Recommendation: 1.2.2.6

In people with stable COPD who remain breathless or have exacerbations despite using short-acting bronchodilators as required, offer the following as maintenance therapy: if FEV1 ≥ 50% predicted: either long-acting beta2 agonist (LABA) or LAMA if FEV1 < 50% predicted: either LABA with an inhaled corticosteroid (ICS) in a combination inhaler, or LAMA.

What was measured: The proportion of people with COPD who do not have an asthma diagnosis and who received inhaled corticosteroids (ICS) in the last 6 months of the audit also appropriately received an long-acting beta2 agonists (LABA).
Data collection end: March 2015
92.8%
Area covered: Wales
Source: Royal College of Physicians. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: National primary care audit (Wales).


Recommendation: 1.2.2.8

Offer LAMA in addition to LABA+ICS to people with COPD who remain breathless or have exacerbations despite taking LABA+ICS, irrespective of their FEV1.

What was measured: The proportion of people with COPD and an MRC breathlessness score of 4 who have received inhaled steroids, long-acting muscarinic antagonist (LAMA) and LABA (triple therapy) in the last 6 months.
Data collection end: March 2015
58%
Area covered: Wales
Source: Royal College of Physicians. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: National primary care audit (Wales).


Recommendation: 1.2.2.14

Patients should have their ability to use an inhaler device regularly assessed by a competent healthcare professional and, if necessary, should be re-taught the correct technique.

What was measured: The proportion of people who have COPD and are using inhaler therapy received an inhaler technique check.
Data collection end: March 2015
91.3%
Area covered: Wales
Source: Royal College of Physicians. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: National primary care audit (Wales).


Recommendation: 1.2.8.1

Pulmonary rehabilitation should be made available to all appropriate people with COPD (see 1.2.8.2) including those who have had a recent hospitalisation for an acute exacerbation. [new 2010]

What was measured: Proportion of pulmonary rehabilitation programmes that offer pulmonary rehabilitation following hospitalisation for exacerbation of COPD.
Data collection end: April 2015
68%
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme - Pulmonary Rehabilitation: Time to breathe better.


Recommendation: 1.2.8.2

Pulmonary rehabilitation should be offered to all patients who consider themselves functionally disabled by COPD (usually MRC grade 3 and above). Pulmonary rehabilitation is not suitable for patients who are unable to walk, have unstable angina or who have had a recent myocardial infarction. [2004]

What was measured: The proportion of pulmonary rehabilitation programmes that accept patients with COPD who report significant exercise limitation and report MRC grade 3.
Data collection end: April 2015
96%
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme - Pulmonary Rehabilitation: Time to breathe better.

What was measured: The proportion of pulmonary rehabilitation programmes that accept patients with COPD who report significant exercise limitation and report MRC grade 4.
Data collection end: April 2015
97%
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme - Pulmonary Rehabilitation: Time to breathe better.

What was measured: The proportion of pulmonary rehabilitation programmes that accept patients with COPD who report significant exercise limitation and report MRC grade 5.
Data collection end: April 2015
81%
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme - Pulmonary Rehabilitation: Time to breathe better.

What was measured: The proportion of people on COPD registers in Wales with a severity of breathlessness that would indicate suitability for referral for pulmonary rehabilitation have ever been referred to the service.
Data collection end: March 2015
34.5%
Area covered: Wales
Source: Royal College of Physicians. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: National primary care audit (Wales).


Recommendation: 1.2.8.4

Pulmonary rehabilitation programmes should include multicomponent, multidisciplinary interventions, which are tailored to the individual patient's needs. The rehabilitation process should incorporate a programme of physical training, disease education, nutritional, psychological and behavioural intervention. [2004]

What was measured: Proportion of pulmonary rehabilitation programmes that offer walking based aerobic training.
Data collection end: April 2015
94%
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme - Pulmonary Rehabilitation: Time to breathe better.

What was measured: Proportion of pulmonary rehabilitation programmes that offer cycling based aerobic training.
Data collection end: April 2015
82%
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme - Pulmonary Rehabilitation: Time to breathe better.

What was measured: Proportion of pulmonary rehabilitation programmes that offer resistance or strength training.
Data collection end: April 2015
99.6%
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme - Pulmonary Rehabilitation: Time to breathe better.

What was measured: Proportion of pulmonary rehabilitation programmes that provide disease education.
Data collection end: April 2015
100%
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme - Pulmonary Rehabilitation: Time to breathe better.

What was measured: Proportion of COPD patients attending a pulmonary rehabilitation programme that included walking aerobic training.
Data collection end: April 2015
95%
Number that met the criteria: 6004 / 6319
Area covered: England and Wales
Source: Royal College of Physicians. Pulmonary Rehabilitation: Steps to breathe better National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Clinical audit of Pulmonary Rehabilitation services in England and Wales 2015

What was measured: Proportion of COPD patients attending a pulmonary rehabilitation programme that included upper limb (aerobic or resistance) exercise.
Data collection end: April 2015
92%
Number that met the criteria: 5839 / 6319
Area covered: England and Wales
Source: Royal College of Physicians. Pulmonary Rehabilitation: Steps to breathe better National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Clinical audit of Pulmonary Rehabilitation services in England and Wales 2015

What was measured: Proportion of COPD patients attending a pulmonary rehabilitation programme that included resistance training.
Data collection end: April 2015
89%
Number that met the criteria: 5602 / 6319
Area covered: England and Wales
Source: Royal College of Physicians. Pulmonary Rehabilitation: Steps to breathe better National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Clinical audit of Pulmonary Rehabilitation services in England and Wales 2015

What was measured: Proportion of COPD patients attending a pulmonary rehabilitation programme that included cycle aerobic training.
Data collection end: April 2015
70%
Number that met the criteria: 4429 / 6319
Area covered: England and Wales
Source: Royal College of Physicians. Pulmonary Rehabilitation: Steps to breathe better National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Clinical audit of Pulmonary Rehabilitation services in England and Wales 2015

What was measured: Proportion of COPD patients attending a pulmonary rehabilitation programme that included interval training.
Data collection end: April 2015
44%
Number that met the criteria: 2758 / 6319
Area covered: England and Wales
Source: Royal College of Physicians. Pulmonary Rehabilitation: Steps to breathe better National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Clinical audit of Pulmonary Rehabilitation services in England and Wales 2015

What was measured: Proportion of COPD patients attending a pulmonary rehabilitation programme that recorded psychological status.
Data collection end: April 2015
74%
Number that met the criteria: 5466 / 7413
Area covered: England and Wales
Source: Royal College of Physicians. Pulmonary Rehabilitation: Steps to breathe better National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Clinical audit of Pulmonary Rehabilitation services in England and Wales 2015

What was measured: Proportion of COPD patients attending a pulmonary rehabilitation programme that recorded patient knowledge.
Data collection end: April 2015
28%
Number that met the criteria: 2100 / 7413
Area covered: England and Wales
Source: Royal College of Physicians. Pulmonary Rehabilitation: Steps to breathe better National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Clinical audit of Pulmonary Rehabilitation services in England and Wales 2015


Recommendation: 1.2.9.1

Pneumococcal vaccination and an annual influenza vaccination should be offered to all patients with COPD as recommended by the Chief Medical Officer.

What was measured: Proportion of patients with COPD who have had influenza immunisation in the preceding 1 August to 31 March.
Data collection end: July 2015
81.5%
Area covered: England
Source: Health and Social Care Information Centre. Quality Outcomes Framework.


Recommendation: 1.2.14.2

Patients with COPD should be reviewed at least once per year, or more frequently if indicated, and the review should cover the issues listed in table 6.

What was measured: Proportion of patients with COPD who have had a review, undertaken by a healthcare professional, including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months.
Data collection end: July 2015
79.9%
Area covered: National
Source: Hawthorne G et al (2012). Diabetes care provision in UK primary care practices. Plos one, 7(7), e41562

What was measured: Proportion of patients with COPD with a record of FEV1 in the preceding 12 months.
Data collection end: July 2015
73.2%
Area covered: England
Source: Health and Social Care Information Centre. Quality Outcomes Framework.

What was measured: Proportion of patients with COPD and Medical Research Council dyspnoea grade ≥3 at any time in the preceding 12 months, with a record of oxygen saturation value within the preceding 12 months
Data collection end: July 2015
94.5%
Area covered: England
Source: Health and Social Care Information Centre. Quality Outcomes Framework.


Recommendation: 1.2.14.4

When patients with very severe COPD are reviewed in primary care, they should be seen at least twice a year, and specific attention should be paid to the issues listed in table 6. [2004] [Table 6 includes 'smoking status and desire to quit'.]

What was measured: The proportion of people with COPD with a smoking status recorded within the last year.
Data collection end: March 2015
71.7%
Area covered: Wales
Source: Royal College of Physicians. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: National primary care audit (Wales).


Recommendation: 1.3.5.21

Theophylline levels should be monitored within 24 hours of starting treatment and subsequently as frequently as indicated by the clinical circumstances.

What was measured: Proportion of patients prescribed theophylline for acute exacerbations for COPD who had theophylline levels checked during their admission.
Data collection end: December 2013
43%
Number that met the criteria: 23 / 54
Area covered: Local
Source: Ullah MA (2014) Compliance with guidelines for the management of theophylline in patients with acute exacerbations of COPD. Thorax December Conference: var.pagings



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