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Chronic Obstructive Pulmonary Disease


Stable COPD and acute exacerbations COPD

See below for:

  • Stable COPD management
  • Acute exacerbations
  • Spirometry advice
  • Pulmonary rehabilitation
  • Oxygen prescribing
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Coventry Guidance  

Coventry Community COPD Service

Interim Spirometry Service Post Covid

Coventry Community COPD Service is NO LONGER providing an interim spirometry service (from 1 May 2022)

Referrals to COPD Service:

Update March 2024: Please note that the service has a temporarily reduced workforce and is currently oversubscribed. Therefore all appropriate accepted referrals may be held on a waiting list until caseload is reduced to manageable commissioned levels

Inclusion criteria:

Patients registered with a Coventry GP with a confirmed diagnosis of COPD.

Referrals may be appropriate at ALL stages of the disease when clinically indicated and / or where specialist advice is required.

Referrals are accepted for patients with COPD in both a stable phase and during acute exacerbation (see Acute Exacerbation of COPD Pathway for referral criteria).

We offer both clinic-based and domiciliary assessment as required.

The following information is required when referring a patient:

  • Spirometry (graph desirable)
  • Most recent Chest X-Ray
  • Past medical history
  • Current medication (including oxygen)

For queries, please contact the Community COPD Service directly.

Contact: 02476 964167

Lisa Cornell Service Manager for Community COPD Service and RNS team

Dr J. Bhat, Consultant in Respiratory Medicine

This service is available on the NHS eReferral Service. Specialty: Respiratory Medicine Clinic Type: COPD. The service is setup as a Referral Assessment Service, so all referrals will be reviewed before an appointment is allocated.

Acute Exacerbation COPD – Community Pathway

The Community COPD service is available to support primary care in the management of COPD patients during an acute exacerbation.

Rapid access to specialist opinion for patients at home suffering an acute exacerbation of COPD preventing avoidable hospital admissions.

It is expected that referrals to this service will be from the patient’s GP and that patients will have been reviewed by their GP during this exacerbation to confirm the diagnosis


Availability Monday-Friday 9-5pm

  • Contact 02476 964167
  • FOR Health Care Professionals Only: call 07553 586364 to discuss with the COPD team


The Community COPD service will assess patients (in clinic or at home) and will provide either;

  • Management plan and transfer patient care back to referring GP
  • Management plan and share care with the patient’s GP until the patient is stable
  • Admit patient to hospital for further assessment if required

Please note: restricted to individuals with an established diagnosis of COPD (i.e. not first presentation) with an acute exacerbation.

Exclusions: Chest pain, Pneumonia, Pulmonary Embolus, Cardiac Failure etc.

Spirometry Update

Coventry Patients Interim Spirometry Service

Coventry Community COPD Service is no longer providing an interim spirometry service whilst usual primary care spirometry services are interrupted 

Area Prescribing Committee COPD Guidance

Follow link for local prescribing guidance (Jan 2021)

Management Principles

Diagnosis of COPD

Consider in any patient who has dyspnoea, chronic cough or sputum production, a history of recurrent lower respiratory tract infections and/or a history of exposure to risk factors for the disease.

Requires the presence of irreversible airways obstruction; if unable to perform effective spirometry reconsider diagnosis & refer to secondary care

Airflow obstruction is defined as reduced FEV1/FVC ratio (<0.70). This must persist after administration of bronchodilators. No longer necessary to have an FEV1 <80% predicted for definition of airflow obstruction

If FEV1 is >80% predicted, a diagnosis of COPD should only be made in the presence of respiratory symptoms e.g. breathlessness or cough

If the FEV1 improves markedly over time, with treatment or spontaneously, the diagnosis of COPD must be reconsidered, provided all the FEV1 measurements are reliable and taken in the clinically stable state (ie not during a exacerbation)

Consider alternative diagnosis (a fifth of all people on COPD registers do not have a diagnosis of COPD). Exclude diagnosis of asthma (variable chest tightness, wheeze, cough and breathlessness; night-time waking; significant diurnal variation of symptoms and peak expiratory flow; symptoms related to work; normalisation of spirometry after inhaled beta2 agonist or inhaled/oral corticosteroid course)

Ensure other investigations including Chest X Ray, Full Blood Count (to identify anaemia & polycythaemia) are performed and reviewed

Treatments and plans should be revisited and assessed at every review

Practice Points:

Check for other co-existing conditions, for example, cardiac failure, bronchiectasis (consider HRCT chest), ischaemic heart disease, lung cancer, cor-pulmonale, anxiety and depression then manage appropriately

Offer treatment and support to stop smoking

Consider pharmacological treatment as per GOLD 2021 – Is the patient adherent to their treatments? Ask the patient and check prescription refill records – Can the patient use their inhalers correctly?

Optimise inhaled therapy as per GOLD 2021

Give general self management advice & co-develop a personalised self-management plan

Refer for dietetic advice if Body Mass Index (BMI) <20 or >25 kg/m2 or changing over time

Offer pneumococcal vaccine, annual Influenza vaccine and pulmonary rehabilitation (PR) if indicated

Smoking Cessation

Smoking cessation services are delivered in GP surgeries and also by other providers (Any Qualified Provider).

Pulmonary rehabilitation

Does your patient have a confirmed diagnosis of COPD? Would they benefit from pulmonary rehab?

Inclusion criteria: MRC score 3, 4 or 5

Sessions are held at Atrium Health, Unit 1 Watch Close (off Spon Street), Coventry, CV1 3LN.

Available for patients across Coventry & Rugby (but transport is not available from Rugby)

Helps the patients:

  • Feel less breathless and understand condition better
  • Improve confidence and coping strategies
  • Help recognise and cope with chest infections
  • Learn about drugs and inhalers and ensure they are working
  • Improve walking distance and stamina

The class runs on Monday and Thursday afternoons, 13:30-15:30. Most patients attend twice per week but there is some flexibility.

It is run in small groups and each session is split into 2 parts:

13:30—Informal discussions/talks on a variety of topics to help you learn more about your lungs, breathing, and treatment.

14:30—Exercise in a safe environment with health professionals on hand to help.

Atrium has started a Vascular and a Heart Failure Group offering a more functional, strength and balanced based class for more significantly disabled patients


The Pulmonary Rehab referral form is available to download – see link right.

Referrals cannot be accepted without a confirmed COPD diagnosis -full referral criteria are explained on the form

Email completed forms: covprreferrals@uhcw.nhs.uk

Please ensure practice nurses are aware of this service.


Please visit the GP Gateway Oxygen page for more information.

Management of Exacerbations


If an acute exacerbation is suspected, assess its severity

Features suggestive of an acute exacerbation include:

  • Worsening breathlessness
  • Increased sputum volume and purulence
  • Cough
  • Wheeze
  • Fever without an obvious source
  • Upper respiratory tract infection in the past 5 days
  • Increased respiratory rate or heart rate increase 20% over baseline

A severe exacerbation may be suggested by:

  • Marked breathlessness and tachypnoea
  • Pursed-lip breathing and/or use of accessory muscles at rest
  • New-onset cyanosis or peripheral oedema
  • Acute confusion or drowsiness
  • Marked reduction in activities of daily living.

Consider the need for hospital admission.

Consider other causes of symptoms (such as myocardial infarction, worsening heart failure, pulmonary embolus and pneumonia).


If admission is not indicated, advise the person to increase the doses or frequency of short-acting bronchodilators (not exceeding the maximum dose).

If there are no contraindications, consider oral corticosteroids for people with a significant increase in breathlessness that interferes with daily activities

Offer 30 mg (NICE) – 40mg (GOLD) oral prednisolone once daily for 5 days – discuss adverse effects of prolonged therapy.

Do not send sputum samples for culture routinely

Follow link right for full document

Rugby & South Warwickshire Guidance  

Breathe Arts Health Research are commissioned to deliver singing groups for adults with chronic respiratory conditions.

This will consist of 6-week courses led by an experienced singing specialist.


Current Activity: Breathe Arts Health Research have recently delivered a taster session for interested stakeholders.

A steering group has also been set up. Looking Ahead: Planned activity will be the start of the first Singing for Lung Health 10-week programme in June 2021.

North Warwickshire Guidance  

Cardio-Respiratory Unit Direct Access Spirometry Service (North Warwickshire Patients Only)


The Cardio-Respiratory Unit will provide an auxiliary spirometry service for community based spirometry.

This service will be provided with the aim of addressing the current backlog of patients waiting for community spirometry testing. \The backlog has been generated due to a temporary cessation of community spirometry services during the COVID-19 pandemic. This will be a short term diagnostic service, only, and will not be linked to medical review.

The use of quality assured spirometry will aid diagnosis of a range of respiratory conditions including obstructive lung disease (COPD/ Asthma) and restrictive lung disease.

It is also used to quantify the severity and or progression of disease. A diagnosis of lung disease cannot be made by spirometry alone and should be reviewed alongside patient history and / or further testing such as chest x-ray, blood etc.

Referral (North Warwickshire patients only)

Triage process

Patients identified for spirometry testing are to be considered on a case by case basis and should be reviewed to ensure spirometry is necessary and likely to either:-

Patients awaiting spirometry must be triaged and referred into the Cardio-Respiratory Unit in order of priority. This must be performed by an appropriate referrer.
Patients may be triaged by priority using the following criterion:

  • Criteria 1. Aid to diagnose
  • Criteria 2. Commenced onto new treatment
  • Criteria 3. Routine review

Referrals to be made using the Cardio-Respiratory Unit Spirometry Direct access referral form (see referral link right).

There are two types of investigation that can be requested, spirometry and bronchodilator response (see service provision for details).

Failure to correctly complete a referral form may result a delay in an appointment or cancellation of the referral.

If requesting a bronchodilator response study the form must be signed by a prescribing physician, if not then spirometry alone will be performed as physiologists are, currently not prescribers, and must work under a PGD policy.

Update: April 2023 The GEH spirometry service are receiving an increasing number of referral requests for spirometry with bronchodilator response that are not completed appropriately.

A medical or non-medical prescriber is required to sign the prescription on the request form in order for the physiology team to administer the bronchodilator drug.

Failure to complete this section fully will result in a delay of patient appointment or repeated tests being performed unnecessarily


Emailing form to: Respiratory.Physiologists@geh.nhs.uk

Service provision

Location:  Cardio- Respiratory Unit where there is fully equipped pulmonary function rooms fit for purpose.

Staffing: The service will be staffed by members of the GEH Cardio-Respiratory team who are fully qualified in the performance and interpretation of spirometry testing.

Testing and results: Patients will be contacted by letter and phone to inform them of their appointment for spirometry testing. Patients will be pre-screened at this time to ensure they have no current symptoms of COVID 19. They will be advised to contact the department, prior to their appointment, should their status change. Symptom questioning is to be repeated on arrival for testing. Patients who have been asked to isolate will be offered an alternative appointment.

Spirometry Testing: Spirometry will be performed to ARTP standards and provide the measurements of slow vital capacity (SVC), forced expiratory volume (FEV1), forced vital capacity (FVC) and peak flow (PEF) along with a graphical display of a flow volume loop.

If a bronchodilator response is required this will be performed to Salbutamol 400mcg via MDI and spacer device. Post bronchodilator spirometry results will include FEV1, FVC and PEF. Results will be provided in a digital format and including table of results, flow volume loop graph and an interpretation of results.

Results: will be returned to the referrer via the DOCMAN platform, paper copies will not be sent unless specifically requested individually via the electronic referral.

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