GPs’ COPD tool is first to track severity

[maryaz]

I think if they ever started doing this it might make it more complicated. I have to re-read it. Late and I am leaving it here as the last one I read. I have gotten way behind on my readings.
www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4114707&c=2

[Blossom/Jackie W.]

I think they're onto something here Mary but I do want to reread and comment further since the current method of calculating is lacking.....IMO

[Joyce7]

Hi--I think they are on to something too. How one is able to perform their daily activities is an individual thing with some people being more able than others. There are so many contributing factors to consider, and I'm pleased that they are looking into this area for evaluating and not just the PFT.. Joyce

[cocojax]

Last week when I went for the Doppler on my leg and chest x-ray, Judy Dr. Ross's receptionist knowing that Dr. Ross was off on Friday called my Gp's office and of course he was off also, she then requested a verbal report be given to the nurse at my GP's office, in case a blood clot was detected I could go to emergency and be taken care of. As I said in an earlier post no blood clot, however the technician who read the chest x-ray told the nurse that I had mild COPD with a touch of Bronchitis. I spoke with Dr. Ross about it today and he stated you cannot tell how bad COPD is by just a chest x-ray. The thing that ticked me off was, I don't think that such an inaccurate report should be even given. Repercussions could have been serious...so this is a good thing they are setting up...

[LindaNY]

This is a good thing. It's about time there were more tools to evaluate the severity of COPD, rather than relying only on the PF test.

[chrisw]

Their proposed rating system is probably close to what the average GP (doing his job well!) does in his mind for all his patients.

DOSE: four ways to assess COPD severity
DOSE score 0 1 2 3
MRC dyspnoea score 0-1 2 3 4
Obstruction, % predicted FEV1 >50 30-49 <30
Smoking status non-smoker smoker
Exacerbations in previous year 0-1 2-3 >3
So a patient with an MRC dyspnoea score of 2, an FEV1 of 34% expected, 4 exacerbations a year and a current smoker has a DOSE score of 5. Patients with a DOSE score of more than four were found to be much more likely to be admitted to hospital, to require out-of-hours visits, and to attend at A&E departments compared with those with lower scores.

However it does not include any sort of evaluation for oxygen, for DLCO, CO2 retention, for exercise conditioning or training/knowledge or for any of the frequent co-morbidities such as cardiovascular problems, diabetes, obesity or cachexia, or depression.

In other words I think it is too simplistic and that it is likely to result in people being pigeon-holed instead of being treated as a whole person.

I would hate for there to be a conversation sounding like "well he is only a two, so we don't need to schedule him for rehab or check his oxygen level, just give him a puffer and tell him to quit smoking" or "he is a four - too far gone for rehab, just put him on home oxygen"