What is the current level of risk of a lung attack (COPD exacerbation)?
To determine risk level of the patient, first confirm number of exacerbations in the
previous 12 months and then
secondary to this, do they have ≥ 2 further risk factors?
Treat based on risk and eosinophil levels:
-
In high risk or very high risk patients with EOS ≥100 cells/μL consider ICS
-
ICS is recommended where EOS ≥300 cells/µL
-
ICS is not recommended in patients with EOS <100 cells/μL
Document in clinical records the reason for continuing ICS treatment.
*In previous 12 months; + Includes exacerbations and number of acute OCS prescriptions/ rescue packs.
These treatments and plans should be revisited at every review, for each risk group:
- Check inhaler technique and medication adherence
- Offer treatment and support to stop smoking
- Offer pneumococcal, influenza, COVID-19, and RSV vaccinations
- Refer to pulmonary rehabilitation if appropriate
- Co-develop a personalised self-management plan
- Optimise treatment for comorbidities
- Signpost to mental health services if appropriate
- Consider occupational and environmental hazards
REMEMBER patients with an increased risk of exacerbations in the next 12 months include those who have:
- A past history of COPD exacerbations (identify cause and trigger of these exacerbations where possible)
- Raised EOS counts and are not on ICS therapy
- Both COPD and cardiovascular disease
Please note: This is an awareness piece and provides guidance only on a collection of risk factors, with the objective of supporting the direction of patient management. It DOES NOT replace local guidelines.
GB-61721 | DOP: November 2024
Abbreviations: COPD, Chronic Obstructive Pulmonsary Disease; EOS, eosinophils; ICS, inhaled corticosteroids; OCS ADR’s, Oral Corticosteroid Adverse Drug Reactions; CAT, COPD Assessment Test; FEV1, forced expiratory volume in 1 second; MRC,Medical Research Council Questionnaire; CVD, Cardiovascular Disease; SABA, short- acting β2-agonist; RSV, respiratory syncytial virus.
Version 1, 2024. For full list of references please refer to aide-memoire.
This material has been funded by AstraZeneca and co-designed by
