Patients with COPD should be evaluated on a regular basis depending on the severity of disease. Mild stable COPD patients may be followed up at 6-month intervals, while patients with severe, frequent exacerbations and recently hospitalized patients need follow-up at 2-week to 1-month intervals. In follow-up sessions, patients should be evaluated to determine adherence to medical regimen, response to therapy, inhaler technique, adverse effects of therapy, and disease progression. The level of dyspnea at rest and with exercise should be determined, as well as number of exacerbations. Questionnaires such as the COPD Assessment Test (CAT) can be used to assess symptoms. These can be found in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.
Smoking status and smoke exposure should be determined at each appointment, followed by appropriate action.
The GOLD guidelines recommend measuring FEV1 by spirometry at least once a year to identify patients who are declining quickly. Functional capacity should be measured by a timed walking test. Oxygen saturation should be monitored and patients evaluated periodically for the need of supplemental oxygen. Imaging may be indicated if symptoms have worsened; patients with repeated exacerbation characterized by purulent sputum should be investigated for bronchiectasis.
Patients need to be monitored for short-term and long-term complications of COPD and for comorbidities. Patient weight, nutrition status, and physical activity should also be monitored. Cachexia and reduced physical performance are indicators of a poor prognosis.
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