The following steps are recommended for a COPD consultation:

Confirm Diagnosis

• evidence of post-bronchodilator spirometry FEV1/FVC ratio less than LLN
• blood eosinophil level and CXR is also recommended

Record the relevant information

• smoking status
• MRC score
• CAT score
• SpO2
• Number of exacerbations in past 12 months
• BMI

Optimise therapy

Non-pharmacological:

• Smoking cessation referral
• Pneumonia/flu/covid vaccinations
• Pulmonary rehabilitation referral (MRC3 and above)
• Inhaler technique check

Pharmacological:

Phenotype patient according to All Wales COPD Guidelines, and prescribe inhalers accordingly:

• Phenotype 1 – COPD with mainly breathlessness
• Phenotype 2 – COPD with exacerbations (+/- breathlessness)
• Phenotype 3 – COPD with asthma overlap

Optimal pharmacological treatment will depend on the patient’s phenotype.