GPs’ COPD tool is first to track severity
By Mark Pownall
A four-item measure of COPD – devised by UK GPs – could replace simple spirometry as a way of tracking disease severity. It also offers GPs a quick guide to the best treatment for COPD.
The measure, DOSE, is under consideration by the respiratory disease specialists who are developing a national service framework for COPD and will also feed into quality and outcome framework negotiations.
The QOF currently uses FEV1, which is not a good measure of lung damage or disease severity but remains the key test for COPD diagnosis.
Devon GP Dr Rupert Jones, one of the GPs involved in DOSE, said it could be readily built in to GP clinical systems as much of the data it requires will already be in patient records.
The score is simple enough to be used in primary care where complex measures of COPD severity such as exercise tests and detailed quality-of-life questionnaires have proved impractical.
Unlike FEV1 alone, it accurately predicts quality of life, consumption of healthcare resources and mortality.
Dr Jones, who was speaking at the European Respiratory Society meeting in Stockholm, told Pulse: ‘We're excited about the potential for this score in primary care.
‘The four items in DOSE are important in their own right, are easily measured and are a useful minimum dataset for COPD patients. It correlates well with quality of life.'
He said the score gave a guide to management. Those with poor dyspnoea scores should be considered for pulmonary rehabilitation, those with poor FEV1 and two or more exacerbations should be considered for inhaled steroids, those with exacerbations alone should be considered for long-term bronchodilation.
Dr Mike Thomas, Gloucestershire GP and research fellow of the General Practice Airways Group, said of the scoring system: ‘This seems like a really good idea and could be easily incorporated into GP COPD assessment. Each individual and a composite score is a good way of checking clinical hunches about disease severity.
‘It has been assessed in primary care patients so is more applicable than many other tools.'Spirometry DOSE