The acute exacerbation COPD service offers urgent support for managing COPD exacerbations at home, aiming to visit within 24-72 hours of referral. It provides up to six home visits focusing on safe admission avoidance, enhancing self-management, reviewing inhaler techniques, supporting smoking cessation, and encouraging completion of pulmonary rehabilitation

Patients will be discussed in a virtual MDT with the integrated respiratory consultant

A face-to-face assessment by the GP is a prerequisite for referring to the service, unless the patient has previously been case-managed and is already known to the community respiratory team.

Eligibility Criteria

Inclusions

• confirmed diagnosis of COPD
  • post bronchodilator airflow obstruction on spirometry: FEV1/FVC < 0.7 
  • symptoms of cough, sputum, breathlessness and a history of smoking in a patient aged 35+
• symptoms typical of an acute exacerbation
  • increase in breathlessness/sputum purulence from usual baseline over a 24-hour period
• when other causes of increased breathlessness considered by the referring clinician and thought unlikely (such as pulmonary oedema, consolidation, pulmonary embolism, pneumothorax)
• self-referral is possible, if already on the caseload of the Islington Community Intermediate Chronic Obstructive Pulmonary Disease (COPD) Service

Exclusions

• patients with concurrent asthma should not be managed on this pathway but should be clinically assessed by their GP as to whether they need acute admission to hospital as per asthma guidance
• when other causes of increased breathlessness are considered and suspected by the referring clinician, such as pulmonary oedema, consolidation, pulmonary embolism, pneumothorax
• patients with new respiratory failure (oxygen saturations </= 92%) are not suitable for this pathway and should be admitted to hospital for safe assessment.

How to Refer