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Opinion

Updated action plan for essential COPD management


Kerry Hancock


30/11/2022 3:05:38 PM

Dr Kerry Hancock gives an overview of the Lung Foundation’s updated COPD Action Plan to ensure best practice when self-managing exacerbations.

Man with nasal oxygen cannula
People with COPD who use action plans have been shown to have reduced hospital attendances.

Chronic obstructive pulmonary disease (COPD) is the number one cause of potentially preventable hospital admissions in Australia, responsible for more than 77,000 hospitalisations of people aged over 45 each year, and the fifth leading cause of death.
 
To ensure that ongoing, best practice care is implemented for patients with COPD, the Lung Foundation Australia (LFA) COPD Guidelines Committee, in consultation with other LFA advisory groups such as the National Consumer Committee Advisory Council and the Primary Care Clinical Advisory Committee, have recently revised the (COPD) Action Plan.
 
Practical and easy to implement when patients are experiencing worsening symptoms, the revised action plan is a template that is completed by a GP or other specialist, in conjunction with the patient with COPD, to outline the best course of treatment in a flare-up or when symptoms are worsening.
 
An evidence-based recommendation in the updated 2022 COPD-X Guidelines – published in the Medical Journal of Australia – is a crucial management tool that can optimise quality of life for our patients with COPD and ensure best practice when patients are self-managing exacerbations.
 
People with COPD who use action plans have been shown to have reduced emergency department attendances and hospital admissions, with action plans also able to assist in preventing disease progression.
 
The new version of the LFA COPD Action Plan was launched for World COPD Day in mid-November and has been completely revamped as a result of feedback from consumers.
 
The reverse side of the action plan has more detailed information for patients, with strategies to manage breathlessness and links via QR codes to other self-management strategies such as the use of hand-held fans, relaxed breathing and control strategies, and how to use inhaler devices correctly.
 
The COPD Action Plan for health professionals has four sections – the action plan, the reverse side and two additional resources: How to write a COPD Action Plan and the Managing Exacerbations Algorithm.
 
Since completing a COPD Action Plan for a patient is not a task that we are necessarily doing every day, a bit of help can go a long way to streamline the consultation with the patient, so some GPs may find it helpful to refer to these additional documents.
 
Or, if preferred, the COPD Action Plan can be downloaded as a standalone template.
 
Furthermore, the new action plan has a space for the patient to document the date of their flare-ups and what action the patient took, ie prednisolone + / - antibiotics. Hopefully that will assist GPs when their patients attend their review consultations.
 
Administration: Have the latest action plan on hand
I recommend for GPs to put the link to the COPD Action Plan on their desktop, into a favourites folder, or even download the PDF template (either as the standalone version, or with the additional documents) and place it into an appropriate section in the electronic medical record software.
 
I usually import the (blank) action plan into the ‘Patient Education’ section of Best Practice and try to remember to update it when there is a new version – like now. GPs might have their own way of being able to access the template easily when seeing a patient and developing an action plan.
 
Then I import the completed version into ‘Correspondence in’ and make a note either in the comments field that a COPD Action Plan is done, with the date, and/or in the comments where I have coded COPD in the current history. I also place a reminder to review and update the COPD Action Plan in the patient’s file, eg in six or 12 months, depending on the severity of their illness or the presence of other comorbidities that might put them at higher risk.
 
There is a statement on the COPD Action Plan to emphasise to patients that they should make an appointment to see their doctor, sooner than their routine review, if they have already had to use their plan twice.
 
The COPD Action Plan is an editable PDF format, and GPs can also print and complete by hand for their patients, or perhaps arrange to have some pre-printed in colour, since a colour version is more appealing for the patient and easier for them to follow the ‘traffic light’ system. 
 
Further updates to resources
We all know how challenging the tsunami of inhaler medicines and devices for COPD and asthma has become over the past few years, and LFA is also currently updating their wonderful COPD Medicines Chart, which should be available in the new year.
 
This will assist in determining which inhaler medicines are PBS-approved for COPD and which ones are also suitable for patients who also have co-existing asthma. I’m sure all GPs will agree that we very much look forward to that.  
 
The LFA website has numerous other resources for GPs, practice nurses, pharmacists and patients.  
 
As Chair of the LFA Primary Care Clinical Council and RACGP Specific Interests Respiratory Medicine, I am keen to receive GP feedback about the updated COPD Action Plan and other LFA resources or activities to help inform how we can best support our patients with COPD.
 
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